Laryngitis and Pharyngitis

Acute laryngitis is a typically mild and self-limiting condition usually due to infection by adenoviruses and parainfluenza viruses, sometimes followed by secondary infection by organisms such as Streptococcus pneumoniae, Streptococcus pyogenes, and Neisseria catarrhalis. It is characterized by fever, local lymphadenitis, and swelling of the larynx, sometimes accompanied by mild epiglottitis. The characteristic symptom found in laryngitis is a loss of voice, due to the temporary swelling of the vocal cords. In chronic laryngitis the mucus glands may become hyperplastic leading to enhanced mucus secretion. Another possibility with chronic laryngitis is squamous metaplasia, which results in a loss of ciliary function and a tendency to recurrent infection. The most common cause of chronic laryngitis is smoking, but other factors such as excessive talking or singing, chronic allergic reactions or chronic exposure to noxious inhalants. (Berkow 1992; Govan 1991, 292-93)

Pharyngitis, or sore throat,refers to the inflammation of the pharynx or throat, and can have a variety of causes including the rhinoviruses, influenza viruses, adenoviruses and EBV, as well as bacteria such as Group A Streptococcus, Corynebacterium, Arcanobacterium, Neisseria gonorrhoeae and Chlamydia pneumoniae. In up to 30% of cases, no infectious agent can be identified, indicating that other factors such as excessive talking or singing and allergic reactions could play a role. The condition may be accompanied by fever, headache, and local lymphadenitis. In severe cases a throat swab is usually performed to rule out Group A Streptococcus, which causes strep throat. Complications of strep throat include rheumatic fever, and glomerulonephritis (kidney inflammation). In particularly severe forms of pharyngitis airway obstruction may occur. (Berkow 1992;Rubin 2001)

Medical treatment

The recognized causes of laryngitis and pharyngitis in modern medicine extend to the pathogenic activity of viruses, bacteria and in some cases, fungi, and thus the focus of the treatment is upon inhibiting microbial activity. For viral conditions little treatment is recommended other than bed rest and hydration although in immunocompromised patients antiviral agents may be prescribed (e.g. acyclovir, famciclovir, and valacyclovir). Antibiotics (e.g. amoxicillin, penicillin, erythromycin) are reserved for prophylactic use in severe viral conditions or where a bacteria pathogen has been isolated from the swab of the pharyngeal mucosa. Oral and inhaled corticosteroids (e.g. prednisone, dexamethasone) may be prescribed short term to provide symptomatic relief, but comprise immune function. Antifungals (e.g. nystatin, fluconazole) are used in fungal infections (e.g. candidiasis). (Berkow 1992)

Holistic treatment

The focus of treatment in holistic medicine is to recognize the underlying mechanism of the condition, particularly in chronic or recalcitrant cases, and to re-establish the normal ecology of the oropharynx by the use of topical and internal treatments. In Ayurvedic medicine the underlying mechanism of laryngitis and pharyngitis is usually the accumulation of Kapha (identified by an increase in mucus and swelling of the throat), but given specific symptoms may be classified as Vata (e.g. airway obstruction, pharyngeal dryness, physical exhaustion) or Pitta (e.g. acute inflammation, mucopurulence). Chronic pharyngitis is typically caused by ama, and the subsequent vitiation of the doshas. In Chinese medicine the causes of acute pharyngitis is typically Wind-Heat or Heat Toxin, whereas chronic forms may be related to a Lung Yin Deficiency or Qi Stasis and Stagnation of Phlegm. Any protocol for laryngitis and pharyngitis must distinguish between acute and chronic forms, and ideally, the specific pathogen involved (i.e. viral, bacterial or fungal):

1. Reduce throat inflammation and swelling.

  • Demulcents and vulneraries, best used in acute inflammation and not in profound catarrh, used as a gargle in combination with antimicrobial botanicals (see below), e.g. Licorice (Glycyrrhiza glabra), St John’s Wort (Hypericum perforatum), Comfrey (Symphytum officinale), Plantain (Plantago spp.), Marshmallow (Althaea officinalis), Chickweed (Stellaria media), Mai Men Dong (Ophiopogon japonicus), Shi Di Huang (Rehmannia glutinosa), Shi Hu (Dendrobium nobile)
  • Antiinflammatories, to reduce heat and inflammation, e.g. see demulcents and vulneraries, as well as heat-reducing botanicals including Sage(Salvia officinalis), Purple Coneflower (Echinacea angustifolia), Goldenseal (Hydrastis canadensis), Barberry (Berberis vulgaris), Neem (Azadirachta indica), Bhunimba (Andrographis paniculata), Guduchi (Tinospora cordifolia),(Chrysanthemum moriflora), Amla (Emblica officinalis), Haridra (Curcuma longa), Sheng Di Huang (Rehmannia glutinosa), Shi Hu (Dendrobium nobile), Mai Men Dong (Ophiopogon japonicus), Yin Chai Hu (Stellaria dichotoma), Shi Hu (Dendrobium nobile), Lian Qiao(Forsythia suspens), Jin Yin Hua (Lonicera japonica),Ban Lan Gen (Isatis tinctoria), Huang Qin (Scutellaria baicalensis)
  • Analgesics: Yellow Jessamine (Gelsemium sempervirens), Ativisha (Aconitum heterophyllum)

2. Restore the ecology of the oropharynx.

  • Antivirals: St John’s Wort (Hypericum perforatum), Osha (Ligusticum porteri), Biscuit root (Lomatium dissectum), Bhunimba (Andrographis paniculata), Guduchi(Tinospora cordifolia),Isatis tinctoria)
  • Antibacterials: Purple Coneflower (Echinacea angustifolia), Wild Indigo(Baptisia tinctoria), Goldenseal (Hydrastis canadensis),Garlic (Allium sativum), Guggulu (Commiphora mukul),Nimba (Azadirachta indica), Bhunimba (Andrographis paniculata), Katuka (Picrorrhiza kurroa), Guduchi (Tinospora cordifolia), Haridra (Curcuma longa), Huang Lian (Coptis chinense),Lian Qiao (Forsythia suspens), Jin Yin Hua (Lonicera japonica), Ban Lan Gen (Isatis tinctoria), Huang Qin (Scutellaria baicalensis)
  • Antifungals: Garlic (Allium sativum), Sweet Annie (Artemisia annua), Pau D’Arco (Tabebiua spp.), Barberry (Berberis vulgaris), Purple Coneflower (Echinacea angustifolia), Tooth Ache plant (Spilanthes acmella), Neem (Azadirachta indica),Huang Lian (Coptis chinense), Tulasi (Ocimum sanctum),Bhringaraj (Eclipta alba), Haritaki (Terminalia chebula), Hingu (Ferula foetida) and Bibhitaki(Terminalia bellerica)
  • Probiotics: e.g.lactobacilli, bifidobacterium
  • Prebiotics: e.g. fructo-oligosaccharides, inulin (e.g. found in Inula and Taraxacum root)

3. Mucolytics and anticatarrhals

  • Antiinflammatory mucolytics, e.g. Goldenseal (Hydrastis canadensis), Witch Hazel (Hamamelis virginiana), Mullein (Verbascum thapsus), Goldenrod (Solidago virgaurea), Eyebright (Euphrasia officinalis)
  • Stimulating mucolytics, used with caution in symptoms of heat, e.g.
  • Bayberry (Myrica cerifera), Cayenne (Capsicum minimum), Horseradish (Armoracea rusticana), Ginger (Zingiber officinalis), Pippali (Piper longum), Cardamom (Elettaria cardamomum),Cang Er Zhi (Xanthium sibiricum)

4. Support immune function.

  • Lymphagogues as supportive, and specifically with lymphadenopathy, e.g. Purple Coneflower (Echinacea angustifolia), Red Root (Ceanothus americanus), Poke Root (Phytolacca americana), Western Red Cedar (Thuja plicata), Cleavers (Galium aparine), Red Clover (Trifolium pratense)
  • Immunomodulants in chronic or recurring conditions, e.g. Purple Coneflower (Echinacea angustifolia), Pau D’Arco (Tabebiua spp.), Reishi (Ganoderma lucidum), Huang qi (Astragalus membranaceus),Amalaki (Emblica officinalis), Wu Wei Zi (Schizandra chinense)
  • Immunosupportive nutrients, including vitamins A (25,000 IU daily), B complex (50 mg daily), C (to bowel tolerance) and E (800 IU daily), as well as zinc (50 mg daily)

5. Dietary changes.

  • Mucus-producing foods must be eliminated, including dairy, flour, and sugar.
  • Animal proteins and fats should be reduced in favor of lightly cooked vegetables and boiled whole grains for the duration of the illness.
  • Emphasize moistening and nourishing articles including meat and vegetable broths

6. Specific formulae.

  • Composition powder, 3-5 g tid-qid:
    • Bayberry bark (Myrica cerifera) 2 parts
    • Ginger root (Zingiber officinalis) 1 part
    • Cayenne fruit (Capsicum spp.) 1/8 part
    • Cinnamon bark (Cinnamomum cassia) 1/8 part
  • Prickly ash bark (Zanthoxylum americanum) 1/8 part
  • Katukadi kvatha,30-60 mL bid-tid
  • Pippalyadi churna, 2-3 g bid-tid
  • Chuan Xin Lian, 3-5 pills tid-qid
  • Huang Lien Shang Ching Pien, 4 pills bid-tid
  • Liu Shen Wan, 10 pills bid-tid
  • Lian Qiao Bai Du Pian, 2-4 pills bid-tid
  • Niu Huang Water-melon frost, applied topically, ad lib.