What is the treatment for laryngitis?

Treatment of Laryngitis

The first-line treatment for acute laryngitis should be conservative management with voice rest, hydration, humidification, avoidance of irritants, and symptomatic relief measures such as warm salt water gargles and throat lozenges, as antibiotics have no proven benefit in treating this condition. 1

Conservative Management (First-Line Treatment)

The American Academy of Otolaryngology-Head and Neck Surgery recommends the following conservative measures for acute laryngitis:

• Voice rest: Minimize talking and avoid whispering (which can strain vocal cords more)
• Adequate hydration: Drink plenty of fluids
• Humidification: Use a humidifier or steam inhalation
• Avoid irritants: Stop smoking, avoid alcohol and caffeine
• Symptomatic relief:
  • Warm salt water gargles
  • Throat lozenges
  • NSAIDs to reduce inflammation and pain

Antibiotic Therapy (Generally Not Recommended)

Cochrane systematic reviews have consistently shown that antibiotics provide no objective benefit in treating acute laryngitis 2, 3:

• A review of randomized controlled trials found that antibiotics did not improve objective voice scores compared to placebo
• While erythromycin showed some subjective improvement in voice disturbance at one week and cough at two weeks, these benefits were considered clinically insignificant
• The potential harms of antibiotics (side effects, cost, contribution to antibiotic resistance) outweigh their minimal benefits

Management of Specific Types of Laryngitis

Reflux Laryngitis

If laryngitis is suspected to be caused by gastroesophageal reflux disease (GERD):

• Antireflux precautions:
  • Elevate head of bed
  • Avoid eating 3 hours before bedtime
  • Avoid trigger foods (spicy, acidic, fatty)
• Medication therapy:
  • Proton pump inhibitors (PPIs) have shown effectiveness in treating chronic laryngitis with reflux etiology 4
  • H2 receptor antagonists (e.g., famotidine) may be used as an alternative

Post-Extubation Laryngitis/Stridor

For post-extubation stridor, which represents a specific form of acute laryngitis:

• Systemic corticosteroids: Dexamethasone IV (>0.3 mg/kg) for at least 48 hours 1
• Nebulized epinephrine: For persistent symptoms, with effects lasting 30 minutes to 2 hours 1
• Close monitoring for at least 24 hours after treatment

Special Considerations

• Chronic laryngitis: With an annual incidence of 3.47 cases per 1,000 people 5, chronic laryngitis often requires more targeted therapy based on underlying causes
• Viral laryngitis variants: Conditions like postviral vagal neuropathy and varicella zoster infection of the larynx may require specialized treatment approaches 6
• Corticosteroids: The routine use of corticosteroids for hoarseness and laryngitis without stridor should be avoided due to lack of efficacy data and potential side effects 1

Common Pitfalls to Avoid

1. Unnecessary antibiotic prescription: Despite patient expectations, antibiotics do not improve objective outcomes in acute laryngitis and contribute to antibiotic resistance
2. Overlooking underlying causes: Chronic laryngitis may be a symptom of reflux, allergies, or other conditions that require specific treatment
3. Inadequate voice rest: Continuing to use the voice extensively can prolong recovery time
4. Insufficient hydration: Adequate fluid intake is essential for healing inflamed vocal cords

When to Refer to a Specialist

Consider otolaryngology referral for:

• Symptoms persisting beyond 2-3 weeks
• Severe symptoms affecting breathing
• Recurrent episodes of laryngitis
• Suspicion of underlying structural abnormalities

By following these evidence-based recommendations, most cases of acute laryngitis will resolve within 1-2 weeks with conservative management alone.