What is the treatment for laryngitis?

Treatment of Laryngitis

The primary treatment for laryngitis should focus on conservative measures including voice rest, hydration, humidification, and avoiding irritants, as antibiotics have no proven benefit for acute laryngitis and routine use of corticosteroids for hoarseness without stridor should be avoided. 1

Types of Laryngitis and Initial Management

Acute Laryngitis

• Conservative management:

  • Voice rest (minimize speaking)
  • Adequate hydration
  • Humidification of inspired air
  • Avoidance of irritants (smoking, alcohol)
  • Throat lozenges or warm liquids for symptomatic relief 1

• Medication considerations:

  • Antibiotics: Not recommended for routine use in acute laryngitis
    • Cochrane reviews show antibiotics have no objective benefit in treating acute laryngitis 2, 3
    • Erythromycin showed minimal subjective improvement in voice disturbance at one week and cough at two weeks, but these outcomes are not clinically relevant 2

Chronic Laryngitis

When laryngitis persists beyond 3 weeks, consider the following approaches:

Reflux-Associated Laryngitis

• For patients with concurrent esophageal GERD symptoms:

  • Once or twice-daily PPIs are recommended (Grade B evidence) 4
  • Treatment duration typically 3-4 months 4

• For suspected extraesophageal GERD without esophageal symptoms:

  • Evidence for PPI treatment is insufficient 4
  • Empiric trials often use twice-daily PPI dosing for 3-4 months, though this is an off-label use 4
  • Consider laryngoscopy to identify signs predictive of response (erythema, edema of vocal folds, posterior commissure hypertrophy) 4

Infectious Laryngitis

• Bacterial laryngitis:

  • Culture-directed antibiotics may be necessary in persistent cases 5
  • MSSA and MRSA infections may require extended antibiotic courses 5
  • Consider biopsy for culture in refractory cases 5

• Fungal laryngitis:

  • Antifungal therapy with fluconazole or amphotericin B for candidal laryngitis 1

Special Considerations

Post-Extubation Stridor/Laryngitis

For patients with stridor after extubation:

1. Nebulized epinephrine as first-line treatment
2. Systemic corticosteroids if symptoms persist
3. CPAP with 100% oxygen if needed 1

Voice Professionals

• More aggressive management may be warranted
• Earlier referral to otolaryngology
• Voice therapy is often beneficial (used in 17% of cases) 6

Common Pitfalls and Caveats

1. Overuse of antibiotics: Antibiotics do not improve objective outcomes in acute laryngitis and contribute to antibiotic resistance 2, 3

2. Overdiagnosis of reflux-related laryngitis: Clinical predictors implicating GERD in extraesophageal syndromes are elusive, leading to overdiagnosis 4

3. Inadequate duration of PPI therapy: When treating suspected reflux-related laryngitis, insufficient duration of therapy (less than 3-4 months) may lead to treatment failure 4

4. Missing serious underlying conditions: Persistent laryngitis requires evaluation for underlying causes including:

   • Malignancy
   • Structural abnormalities
   • Neurologic disorders

5. PPI side effects: Long-term PPI use may interfere with calcium absorption, increase risk of hip fractures in older adults, decrease vitamin B12 and iron absorption, and potentially increase risk of pancreatitis 4

When to Refer to Otolaryngology

• Symptoms persisting beyond 2-3 weeks
• Voice changes not improving with conservative management
• Presence of concerning symptoms (dysphagia, odynophagia, hemoptysis)
• Professional voice users with any degree of voice impairment

The incidence of chronic laryngitis is approximately 3.47 cases per 1,000 people annually, with up to 21% of the population potentially developing chronic laryngitis in their lifetime 6. Proper diagnosis and management are essential to prevent long-term voice impairment.