From the Guidelines
The appropriate workup and treatment for a patient presenting with symptoms of laryngitis should prioritize supportive care, including voice rest, hydration, and humidification, with antibiotics reserved for clear cases of bacterial infection, as indicated by the most recent guidelines 1.
Symptoms and Initial Assessment
The symptoms of laryngitis can include hoarseness, sore throat, fever, and a globus sensation, often resulting from acute upper respiratory infections caused by viruses such as parainfluenza, rhinovirus, influenza, and adenovirus. A thorough history and physical examination are crucial, focusing on symptom duration, severity, and associated factors.
Treatment Approach
For acute laryngitis (lasting less than 3 weeks), which is typically viral, treatment is primarily supportive:
- Voice rest
- Adequate hydration
- Humidification
- Avoiding irritants like smoking Over-the-counter analgesics such as acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) can help with pain and inflammation.
Consideration for Antibiotics and Corticosteroids
Antibiotics are generally not indicated unless there's clear evidence of bacterial infection, as their misuse can lead to unnecessary costs, side effects, and contribute to antibiotic resistance 1. For severe cases with significant airway concerns, a short course of oral corticosteroids like prednisone (40-60mg daily for 5-7 days) may be considered.
Chronic Laryngitis
For chronic laryngitis (lasting more than 3 weeks), addressing underlying causes is essential, which may include:
- Treating GERD with proton pump inhibitors (such as omeprazole 20mg daily)
- Managing allergies
- Addressing vocal misuse Referral to an otolaryngologist is warranted for persistent symptoms beyond 2-3 weeks, suspicion of underlying pathology, or in high-risk patients (smokers, those with voice-dependent occupations). Laryngoscopy may be necessary to visualize the vocal cords and rule out more serious conditions like vocal cord nodules or malignancy.
Psychological and Symptomatic Interventions
For functional voice disorders, interventions may include education, symptomatic treatments such as vocal exercises, and psychological support to address underlying issues that may be contributing to the voice problem, as outlined in recent consensus recommendations 1. These approaches aim to improve voice quality, reduce symptoms, and enhance the patient's quality of life.
Importance of Visualization and Referral
Visualization of the larynx is the principal method to refine the differential diagnosis for a patient with dysphonia and allows for appropriately directed treatment, emphasizing the need for timely referral to an otolaryngologist when symptoms persist or worsen 1. This approach is crucial for preventing delay in the diagnosis of serious conditions and for improving patient outcomes.
From the Research
Symptoms of Laryngitis
- Hoarseness or loss of voice
- Sore throat
- Cough
- Difficulty swallowing
- Fever
- Fatigue
Workup for Laryngitis
- Diagnosis is often made by case history alone 2, 3, 4
- Physical examination to assess the larynx and surrounding mucosal surfaces 5
- Laboratory tests, such as throat culture or laryngoscopy, may be ordered to rule out other conditions 6
Treatment for Laryngitis
- Antibiotics may not be effective in treating acute laryngitis, as they do not appear to improve objective outcomes 2, 3, 4
- Erythromycin may reduce voice disturbance at one week and cough at two weeks when measured subjectively 2, 3, 4
- Fusafungine may increase the cure rate at day five 2
- Treatment is often directed towards controlling symptoms, such as pain and inflammation 2, 3, 4
- Chronic laryngitis may require additional treatment, such as voice therapy or medication to manage underlying conditions 6
Types and Causes of Laryngitis
- Acute laryngitis: often caused by viral or bacterial infections 2, 3, 4
- Chronic laryngitis: can be caused by infectious, inflammatory, or autoimmune factors 6
- Laryngeal inflammation can be present secondary to direct effects of irritants, toxins, and antigens, as well as mechanical and infectious effects 5