What medications are used to treat laryngitis?

Medications for Treating Laryngitis

Routine prescription of antibiotics or corticosteroids is not recommended for most cases of laryngitis as they provide no proven benefit and may cause harm. 1

Understanding Laryngitis

Laryngitis is inflammation of the larynx (voice box) that causes hoarseness or loss of voice. It can be:

• Acute laryngitis: Symptoms lasting less than 3 weeks
• Chronic laryngitis: Symptoms persisting for more than 3 weeks

First-Line Management

Non-Pharmacological Approaches

• Voice rest is the cornerstone of treatment for both acute and chronic laryngitis 1, 2
• Adequate hydration to maintain vocal cord moisture
• Humidification of ambient air
• Avoidance of irritants (smoking, alcohol, excessive talking)

Symptomatic Relief

• Warm salt water gargles may provide symptomatic relief, though not extensively studied 1
• Topical lozenges or sprays containing local anesthetics (lidocaine, benzocaine) may provide temporary symptomatic relief 1
  • Caution: Lozenges may pose a choking hazard for young children

When Medications Are NOT Indicated

Antibiotics

• Antibiotics should not be routinely prescribed for laryngitis 1, 3
  • Most cases are viral in origin
  • A Cochrane review found no objective benefit of antibiotics for acute laryngitis 3
  • Misuse contributes to antibiotic resistance and unnecessary side effects
  • Antibiotics may increase the risk of laryngeal candidiasis 1

Corticosteroids

• Systemic corticosteroids should not be routinely prescribed for empiric treatment of laryngitis 1
  • No strong evidence supporting their use
  • Potential for significant adverse effects including:
    • Sleep disturbances
    • Gastrointestinal issues
    • Metabolic effects
    • Increased risk of infections
    • Adrenal suppression with longer use

Special Circumstances Where Medications May Be Considered

1. Reflux-Related Laryngitis

• Anti-reflux medications may be considered when laryngoscopy shows signs of chronic laryngitis with findings consistent with reflux 1
  • Proton pump inhibitors (PPIs) may be beneficial in selected cases
  • Not recommended without evidence of reflux or laryngitis on examination

2. Fungal Laryngitis

• Antifungal therapy may be indicated for confirmed fungal laryngitis 1, 4
  • Fluconazole for milder cases
  • Amphotericin B for severe cases in immunocompromised patients
  • Diagnosis should be confirmed by microbiological examination

3. Specific Bacterial Infections

• Antibiotics may be warranted only in confirmed bacterial laryngitis 1
  • Examples include tuberculosis laryngitis or bacterial laryngotracheitis
  • Diagnosis should be established prior to initiating therapy

4. Ulcerative Laryngitis

• Comprehensive approach may be needed for ulcerative laryngitis 4
  • Anti-reflux medications (used in 85% of cases)
  • Antifungals (39% of cases)
  • Antivirals (52% of cases)
  • Steroids (52% of cases)
  • Earlier treatment initiation associated with better outcomes

Clinical Pearls and Pitfalls

• Visualization of the larynx is essential before prescribing specific treatments, especially for chronic cases 1
• Misdiagnosis risk: Hoarseness can be a symptom of more serious conditions including malignancy
• Treatment duration: Acute viral laryngitis is self-limited with improvement typically within 7-10 days regardless of treatment 1
• Occupational factors: Teachers, singers, and those with high vocal demands may require more aggressive voice rest and therapy 2
• Chronic cough following viral laryngitis may represent postviral vagal neuropathy, which may respond to neuromodulators rather than traditional laryngitis treatments 5

Conclusion

For most cases of laryngitis, medications offer little benefit beyond symptomatic relief. Voice rest remains the cornerstone of treatment, with specific medications reserved for confirmed cases of non-viral etiology or complications.