From the Guidelines
Laryngitis is typically a self-limiting condition that can be managed with self-care measures, and antibiotics are not recommended unless a bacterial infection is suspected. The majority of cases are caused by viral infections and resolve within 1-2 weeks with rest, hydration, and avoidance of irritants 1. To manage laryngitis, it is essential to:
- Rest your voice as much as possible and avoid whispering, which strains the vocal cords more than soft speech
- Stay hydrated by drinking plenty of water (at least 8-10 glasses daily) and use a humidifier to moisten the air
- Use over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to help with throat discomfort
- Gargle with warm salt water (1/4 to 1/2 teaspoon of salt in 8 ounces of water) several times daily to soothe irritation
- Avoid irritants like smoking, secondhand smoke, alcohol, and spicy foods
Seek medical attention if symptoms persist beyond two weeks, if you have difficulty breathing or swallowing, if you cough up blood, or if you develop a fever above 103°F (39.4°C) 1. Antibiotics may be prescribed if a bacterial infection is suspected, but their misuse can lead to unnecessary costs, side effects, and antibiotic resistance 1. In some cases, anti-reflux medication may be prescribed for patients with hoarseness and signs of chronic laryngitis, but the evidence for this is limited 1. Steroids should not be used empirically for dysphonia prior to examination of the larynx, as they can have significant and serious side effects 1.
It is crucial to note that most patients with dysphonia initially present to their primary care physicians, and only a small percentage are referred to otolaryngologists 1. Therefore, primary care physicians play a vital role in managing laryngitis and referring patients to specialists when necessary.
In terms of referral, patients with persistent laryngitis or those with symptoms suggestive of a serious underlying condition should be referred to an ear, nose, and throat specialist for further evaluation 1. This is essential to rule out more serious conditions, such as malignancy, and to provide appropriate treatment.
Overall, the management of laryngitis should prioritize self-care measures, and antibiotics and steroids should only be used when necessary and under the guidance of a healthcare professional.
From the Research
Definition and Causes of Laryngitis
- Laryngitis is an inflammatory process that affects the larynx and can be caused by infectious, inflammatory, and autoimmune factors 2
- It can be acute or chronic, with chronic laryngitis lasting at least 3 weeks and affecting phonation, breathing, and swallowing 2
- Laryngeal inflammation can be present secondary to direct effects of irritants, toxins, and antigens, as well as mechanical and infectious effects 3
Symptoms of Laryngitis
- Symptoms of laryngitis are nonspecific and may range from mild to airway compromise requiring emergent tracheostomy 2
- Symptoms can include sore throat, hoarseness, and cough, and can be similar to those of pharyngitis 4
Treatment of Laryngitis
- Antibiotics do not appear to be effective in treating acute laryngitis when assessing objective outcomes, but may be beneficial for some subjective outcomes 5, 6
- Erythromycin could reduce voice disturbance at one week and cough at two weeks when measured subjectively 5, 6
- Fusafungine could increase the cure rate at day five 6
- Treatment of chronic laryngitis depends on the underlying cause and may involve addressing underlying inflammatory or autoimmune conditions 2
Diagnosis of Laryngitis
- Diagnosis of laryngitis is often made by case history alone and treatment is often directed toward controlling symptoms 5, 6
- A thorough history is key to diagnosing laryngitis, and rapid antigen detection tests and throat cultures can be used to identify the inciting organism in cases of pharyngitis 4