From the Guidelines
The workup for acute viral laryngitis is primarily clinical, focusing on history and physical examination, and the natural disease progression is generally self-limiting, with symptoms resolving within 7-10 days without specific treatment. Diagnosis typically involves identifying symptoms like hoarseness, sore throat, and dry cough, along with recent upper respiratory infection symptoms 1. Laryngoscopy may be performed in cases of prolonged symptoms (beyond 2-3 weeks) or when concerning features like hemoptysis or severe pain are present. Laboratory tests are rarely needed unless bacterial infection is suspected.
Key Considerations
- The condition is viral in nature, and antibiotics are not indicated, as they do not appear to be effective in treating acute laryngitis in terms of objective outcomes 1.
- Management is supportive, including voice rest, adequate hydration (at least 2 liters of water daily), humidification, avoiding irritants like smoking and alcohol, and using over-the-counter analgesics such as acetaminophen (500-1000mg every 6 hours as needed) or ibuprofen (400-600mg every 6-8 hours with food) for pain relief.
- Throat lozenges containing benzocaine or menthol may provide temporary symptom relief.
- If symptoms persist beyond two weeks, worsen significantly, or are accompanied by difficulty breathing, stridor, or inability to swallow, further evaluation is necessary to rule out other conditions like bacterial superinfection or laryngeal malignancy.
Disease Progression and Referral
The natural disease progression of acute viral laryngitis is generally self-limiting, with symptoms developing over 1-2 days, peaking within 3-5 days, and resolving within 7-10 days without specific treatment 1. Referral for laryngeal visualization is warranted if dysphonia persists beyond this time or if there are concerns for serious underlying conditions, as delay in diagnosis could lead to worsened outcomes 1. Primary care physicians play a crucial role in identifying patients who need further evaluation, and otolaryngologists should be involved in cases where there are concerns for serious conditions or significant impact on the patient's quality of life.
From the Research
Acute Viral Laryngitis Workup
- The diagnostic approach to acute viral laryngitis typically involves a thorough case history and physical examination, as the condition is often caused by viral illnesses that lead to direct inflammation of the vocal cords or irritation due to postnasal drainage 2.
- Visualization of the vocal cords may be necessary to rule out potential malignant lesions, especially in cases of chronic laryngitis 2.
- There is no direct link between acute and chronic inflammation of the larynx, and chronic laryngitis is considered a distinct nosological entity 3.
Natural Disease Progression
- Acute laryngitis is characterized by symptoms such as dysphonia, which is the leading sign of the condition, and dyspnea, which is more frequent in children and related to disease severity 3.
- The natural disease progression of acute viral laryngitis typically involves resolution of symptoms within a short period, usually without the need for antibiotic treatment 4, 5.
- In some cases, acute laryngitis can lead to complications such as chronic cough or postviral vagal neuropathy, which can be a diagnosis of exclusion and may require referral to other subspecialties for management 6.
Treatment
- The use of antibiotics, such as penicillin V, has been shown to be ineffective in treating acute laryngitis in adults, and their use is not recommended as a first-line treatment 4, 5.
- Vocal rest is considered the best treatment for acute and chronic overuse symptoms of laryngitis, and the use of decongestants should be discouraged 2.
- In some cases, treatment with neuromodulators may be necessary for conditions such as postviral vagal neuropathy, while treatment of laryngeal shingles and idiopathic ulcerative laryngitis has not been well defined due to the rarity of these conditions 6.