What are the best outpatient treatment options for a patient with a lost voice due to an upper respiratory infection (URI) with negative tests for cold and flu?

From the Guidelines

For a patient with voice loss due to an upper respiratory infection with negative cold and flu tests, the best outpatient treatment options focus on symptomatic relief and vocal rest, with a strong emphasis on avoiding unnecessary antibiotic use as recommended by 1 and 1. The primary approach should include voice rest, limiting talking for 2-3 days to allow vocal cord inflammation to subside, as general medical knowledge suggests that reducing strain on the vocal cords is essential for recovery. Hydration is crucial, with recommendations to drink 8-10 glasses of water daily to help thin mucus and reduce irritation, as suggested by 1. A humidifier at night can prevent dryness, while warm salt water gargles (1/4 teaspoon salt in 8 ounces warm water) several times daily can soothe the throat. Over-the-counter medications like acetaminophen (Tylenol, 650mg every 6 hours) or ibuprofen (Advil, 400mg every 6-8 hours) can reduce pain and inflammation. Throat lozenges containing benzocaine or menthol provide temporary relief. It is essential to avoid irritants such as smoking, alcohol, caffeine, and spicy foods. If symptoms persist beyond 2 weeks, worsen significantly, or if breathing difficulties occur, medical evaluation is necessary as this could indicate laryngitis or another condition requiring different treatment, as outlined in 1. These approaches work by reducing inflammation and irritation of the vocal cords, allowing natural healing of the mucous membranes affected by the viral infection. Key points to consider in management include:

• Avoiding the misuse of antibiotics, which are not effective in treating acute viral laryngitis, as stated in 1.
• Focusing on symptomatic relief and vocal rest.
• Ensuring proper hydration and humidification.
• Using over-the-counter medications for pain and inflammation as needed.
• Avoiding irritants that can exacerbate symptoms. Given the potential for antibiotic resistance and the lack of efficacy in viral infections, it is crucial to follow the recommendation against routine antibiotic use for dysphonia, as strongly recommended by 1.

From the Research

Outpatient Treatment Options for Lost Voice with URI

The best outpatient treatment options for a patient with a lost voice due to an upper respiratory infection (URI) with negative tests for cold and flu are primarily focused on alleviating symptoms, as most URIs are caused by viruses and do not respond to antibiotics 2.

Symptomatic Relief

• Over-the-counter analgesics can help manage pain and fever associated with URIs 3.
• Nasal decongestants with or without antihistamines can provide relief from congestion and runny nose 3.
• Ipratropium can be used to treat cough 3.
• For children, options like acetylcysteine, honey (for those over one year old), nasal saline irrigation, and intranasal ipratropium are considered safe and effective 3.

Management Considerations

• It's essential to inform patients about the self-limited nature of URIs to manage expectations and limit unnecessary antibiotic use or over-the-counter purchases 3.
• Counseling on good hand hygiene is crucial for preventing the transmission of URI-causing viruses 3.
• In cases where upper respiratory tract symptoms mimic those of COVID-19, a strategic approach to identify patients who need immediate COVID-19 testing is necessary, considering factors that differentiate between high and low suspicion groups 4.

Specific Treatments for Lost Voice

There is limited direct evidence on the best outpatient treatment options specifically for a lost voice due to URI. However, treatments that alleviate URI symptoms can indirectly help in recovering vocal function by reducing inflammation and infection in the upper respiratory tract.

Avoiding Unnecessary Treatments

• Antibiotics are not effective against viral URIs and should not be prescribed unless there is a confirmed bacterial infection 2, 5.
• Intranasal sodium cromoglicate has been found not to be a useful additional treatment for acute viral upper respiratory tract infections in children 5.
• Over-the-counter cold medications should not be used in children under four years old 3.