What is the treatment for laryngitis?

Treatment of Laryngitis

Most cases of laryngitis are self-limited and should be managed with conservative measures including voice rest, hydration, humidification, and avoidance of irritants, as these approaches provide symptomatic relief without medication risks. 1

Causes and Diagnosis

Laryngitis is typically caused by:

• Viral inflammation of the larynx (most common)
• Increased sensitivity of afferent sensory nerves in the upper airway
• Postnasal drip irritating the larynx
• Less commonly: bacterial infection, fungal infection, or reflux

When to Refer for Laryngoscopy

• Hoarseness persisting beyond 3-4 weeks 2, 1
• Red flags requiring immediate evaluation:
  • Progressive difficulty breathing
  • Stridor
  • Complete voice loss
  • Hemoptysis
  • Dysphagia
  • Unexplained weight loss

Treatment Algorithm

1. Acute Laryngitis (Duration < 3 weeks)

• First-line treatment:

  • Voice rest (reduce talking, no whispering or shouting)
  • Adequate hydration (at least 8 glasses of water daily)
  • Humidification (humidifier or steam inhalation)
  • Avoidance of irritants (smoking, alcohol, caffeine)
  • Throat lozenges or warm liquids for symptomatic relief 1

• Adjunctive measures:

  • NSAIDs may help reduce inflammation and associated symptoms
  • First-generation antihistamine/decongestant combinations may reduce cough and associated hoarseness 1

• NOT recommended:

  • Antibiotics (no benefit in treating acute laryngitis) 3
  • Routine use of corticosteroids (risk outweighs benefit) 1
  • Empiric anti-reflux medications without signs/symptoms of GERD 2, 1

2. Chronic Laryngitis (Duration > 3 weeks)

Initial approach:

• Refer for laryngoscopy to visualize the larynx 2
• Identify underlying cause through comprehensive evaluation

Treatment based on etiology:

1. Reflux-related laryngitis:

   • Anti-reflux medication may be prescribed if laryngoscopy confirms signs of chronic laryngitis (erythema, edema, redundant tissue, surface irregularities) 2, 4
   • PPI therapy (twice daily) has shown benefit in patients with confirmed GERD-related laryngitis 4

2. Fungal (candidal) laryngitis:

   • Antifungal therapy with fluconazole or amphotericin B 1

3. Bacterial laryngitis:

   • Culture-directed antibiotics based on biopsy results
   • For MSSA or MRSA, extended antibiotic courses may be necessary 5
   • For other bacterial pathogens, a single course of appropriate antibiotics 5

4. Professional voice users with allergic laryngitis:

   • Short course of systemic steroids may be considered as a shared decision after discussing risks 1

Special Considerations

Pediatric Patients

• Systemic steroids may be beneficial for children with croup 1
• Epinephrine nebulization may be used for post-extubation stridor 1

Common Pitfalls to Avoid

• Inappropriate antibiotic use (increases risk of laryngeal candidiasis) 1
• Prolonged use of decongestants (can lead to rhinitis medicamentosa) 1
• Assuming all hoarseness is benign (can delay diagnosis of serious conditions) 1
• Empiric PPI therapy without GERD symptoms or laryngoscopic evidence (potential side effects include immunosuppression, hyperglycemia, mood disorders, decreased calcium absorption) 2, 1

The yearly incidence of chronic laryngitis is approximately 3.47 cases per 1,000 people, with dysphonia, globus sensation, and pain being the most common symptoms 6. Proper evaluation and targeted treatment based on the underlying cause are essential for effective management.