What is the treatment for laryngitis?

Treatment for Laryngitis

The treatment for laryngitis should primarily consist of conservative measures including voice rest, hydration, humidification, avoidance of irritants, and symptomatic relief with throat lozenges or warm liquids, as antibiotics and corticosteroids are not routinely recommended. 1

Conservative Management (First-Line Treatment)

Conservative management is the cornerstone of laryngitis treatment and includes:

• Voice rest: Minimize talking and avoid whispering or shouting
• Adequate hydration: Drink plenty of fluids (6-8 glasses of water daily)
• Humidification: Use a humidifier, especially at night
• Avoid irritants: Stay away from smoke, alcohol, and spicy foods
• Symptomatic relief: Use throat lozenges, warm saltwater gargles, or warm liquids with honey

These measures are strongly recommended by the American Academy of Otolaryngology-Head and Neck Surgery and should be the first approach for most cases of laryngitis, which is typically self-limiting and resolves within 7-10 days 1.

Medications to Avoid

Antibiotics

• Antibiotics are NOT recommended for routine treatment of laryngitis 1
• Laryngitis is predominantly viral in origin
• Evidence from Cochrane reviews shows antibiotics do not improve objective voice outcomes 2, 3
• Unnecessary antibiotic use may increase the risk of laryngeal candidiasis 1

Corticosteroids

• Corticosteroids are NOT recommended for routine treatment of laryngitis 1
• Limited evidence of efficacy
• Significant potential side effects including immunosuppression, hyperglycemia, and mood disorders 1

Special Circumstances

Professional Voice Users

• For professional voice users with allergic laryngitis, a short course of systemic steroids may be considered
• This must be a shared decision after discussing risks and limited evidence 1

Reflux-Associated Laryngitis

• For chronic laryngitis associated with reflux, anti-reflux medication (typically proton pump inhibitors) may be considered 1, 4
• This should only be used when laryngoscopy confirms signs of inflammation related to reflux 1

Fungal Laryngitis

• For fungal (candidal) laryngitis, antifungal therapy with fluconazole or amphotericin B is recommended
• Early detection with laryngoscopy is crucial 1

Pediatric Considerations

• For pediatric patients with croup (a form of laryngitis), systemic steroids may be beneficial
• Epinephrine nebulization may be used for post-extubation stridor 1

Red Flags Requiring Immediate Evaluation

• Persistent symptoms beyond 2-3 weeks
• Progressive difficulty breathing
• Stridor (high-pitched breathing sound)
• Complete voice loss
• Hemoptysis (coughing up blood)
• Dysphagia (difficulty swallowing) 1

Common Pitfalls to Avoid

1. Overuse of antibiotics: Despite being commonly prescribed, antibiotics show no objective benefit in treating acute laryngitis 2, 3
2. Inadequate voice rest: Many patients continue normal voice use, which prolongs recovery
3. Failure to identify underlying causes: Chronic laryngitis may be due to reflux, allergies, or other conditions requiring specific treatment 5
4. Missing red flags: Delayed referral for persistent symptoms may miss more serious conditions
5. Inappropriate steroid use: Using steroids without clear indication exposes patients to unnecessary risks 1

When symptoms persist beyond 2-3 weeks, laryngoscopy is warranted to evaluate for underlying causes and complications 1.