What is the treatment for laryngitis?

Treatment of Laryngitis

Laryngitis should be treated conservatively with voice rest and supportive care, avoiding antibiotics and steroids unless specifically indicated for certain conditions, as most cases are self-limiting and resolve within 7-10 days. 1

Etiology and Classification

Laryngitis is inflammation of the larynx that can be classified as:

• Acute laryngitis: Usually viral in origin (parainfluenza, rhinovirus, influenza, adenovirus)
• Chronic laryngitis: Persisting for more than 3 weeks
• Special forms: Fungal (candidal) laryngitis, bacterial laryngitis

First-Line Treatment Approach

Conservative Management

• Voice rest: Reduce voice use to allow healing
• Hydration: Adequate fluid intake to keep vocal folds moist
• Humidification: Use of humidifiers, especially in dry environments
• Avoid irritants: Smoking cessation, alcohol reduction
• Throat lozenges/warm liquids: For symptomatic relief

What NOT to Use Routinely

1. Antibiotics

   • Strong recommendation AGAINST routine use 1
   • Acute laryngitis is predominantly viral in origin
   • Cochrane reviews show no objective benefit for voice outcomes 2, 3
   • Risks include antibiotic resistance, side effects (rash, GI disturbances), and increased cost
   • May increase risk of laryngeal candidiasis 1

2. Corticosteroids

   • Strong recommendation AGAINST routine use 1
   • Limited evidence for efficacy in general laryngitis cases
   • Significant potential side effects even with short-term use 1
   • Side effects include immunosuppression, hyperglycemia, mood disorders, and increased infection risk

Special Situations

Specific Indications for Medication

1. Professional voice users with allergic laryngitis

   • Limited role for short-course systemic steroids 1
   • Must be a shared decision after discussing risks and limited evidence

2. Pediatric patients with croup

   • Systemic steroids may be beneficial 1
   • Epinephrine nebulization for post-extubation stridor 1

3. Fungal (Candidal) Laryngitis

   • Antifungal therapy with fluconazole (oral) or amphotericin B (IV) 1
   • Early detection with laryngoscopy is crucial
   • Monitor for airway patency

4. Reflux-Associated Chronic Laryngitis

   • Anti-reflux medication may be considered when laryngoscopy confirms laryngitis with signs of inflammation 1
   • Not recommended empirically without evidence of GERD or laryngitis

Monitoring and Follow-up

• Most cases resolve within 7-10 days 1
• Persistent symptoms beyond 2-3 weeks warrant laryngoscopy
• Red flags requiring immediate evaluation:
  • Progressive difficulty breathing
  • Stridor
  • Complete voice loss
  • Hemoptysis
  • Dysphagia

Common Pitfalls to Avoid

1. Overuse of antibiotics

   • No benefit in objective voice outcomes 2, 3
   • Contributes to antibiotic resistance
   • Increases healthcare costs

2. Empiric steroid use

   • Significant side effect profile 1
   • Limited evidence of benefit in general cases

3. Failure to identify underlying causes in chronic cases

   • Reflux, smoking, vocal abuse, allergies
   • Incidence of chronic laryngitis is approximately 3.47 cases per 1,000 people annually 4

4. Delayed evaluation of concerning symptoms

   • Persistent hoarseness >2-3 weeks requires laryngoscopy
   • May mask underlying malignancy

By following these evidence-based guidelines, most cases of laryngitis can be effectively managed with conservative measures while avoiding unnecessary medications and their associated risks.