Treatment for Laryngitis
The treatment for laryngitis should focus on conservative management with voice rest, hydration, humidification, avoidance of irritants, and throat lozenges or warm liquids for symptomatic relief, as most cases are self-limiting and resolve within 7-10 days. 1
First-Line Conservative Management
- Voice rest: Minimize talking and avoid whispering (which strains vocal cords)
- Hydration: Drink plenty of fluids to keep vocal cords moist
- Humidification: Use a humidifier, especially at night
- Avoid irritants: Stop smoking, limit alcohol consumption, and avoid dusty or smoky environments
- Symptomatic relief: Use throat lozenges, warm salt water gargles, or warm liquids like tea with honey
Medications to Avoid
Antibiotics
- Strong recommendation against routine antibiotic use for laryngitis 1
- Laryngitis is predominantly viral in origin
- Antibiotics show no objective benefit in treating acute laryngitis 2
- Unnecessary antibiotics may increase risk of laryngeal candidiasis 1
Corticosteroids
- Not recommended for routine use due to limited efficacy evidence and potential side effects 1
- Side effects include immunosuppression, hyperglycemia, and mood disorders
Anti-Reflux Medications
- Not recommended as empiric therapy for hoarseness without symptoms of GERD or laryngoscopic evidence of laryngitis 3
- Should only be considered when laryngoscopy confirms laryngitis with signs of inflammation 1
- PPIs may interfere with calcium absorption, increase risk of hip fractures, decrease vitamin B12 and iron absorption 3
Special Considerations
Professional Voice Users
- For allergic laryngitis in professional voice users, a short course of systemic steroids may be considered after discussing risks and limited evidence 1
- Voice therapy may be beneficial (used in 17% of cases) 4
Reflux-Associated Laryngitis
- Anti-reflux medication should only be considered when laryngoscopy confirms laryngitis with signs of inflammation 1
- Signs of reflux laryngitis include erythema, edema, redundant tissue, and/or surface irregularities of the inter-arytenoid mucosa, arytenoid mucosa, posterior laryngeal mucosa, and/or vocal folds 3
Infectious Laryngitis
- For confirmed bacterial laryngitis (uncommon), targeted antibiotics based on culture results may be necessary 5
- For fungal (candidal) laryngitis, antifungal therapy with fluconazole or amphotericin B is recommended 1
Red Flags Requiring Further Evaluation
- Persistent symptoms beyond 2-3 weeks warrant laryngoscopy 1
- Immediate evaluation needed for:
- Progressive difficulty breathing
- Stridor
- Complete voice loss
- Hemoptysis
- Dysphagia 1
Common Pitfalls to Avoid
Overuse of antibiotics: Despite being the most common treatment approach, antibiotics have not shown objective benefit for typical viral laryngitis 2
Empiric PPI use without confirmation: Prescribing proton pump inhibitors without confirming reflux-related laryngitis via laryngoscopy is not recommended due to potential side effects 3
Inadequate voice rest: Continuing to use the voice extensively during recovery can prolong symptoms and healing time
Missing red flags: Failing to recognize when symptoms require further evaluation can delay diagnosis of more serious conditions