From the Guidelines
Viral laryngitis is a self-limiting condition that typically resolves within 1-2 weeks without specific antiviral treatment, and the primary approach to management should focus on supportive care and symptom relief. The diagnosis of viral laryngitis is often based on the presence of symptoms such as hoarseness, sore throat, and cough, which are typically caused by viral upper respiratory tract infections 1.
Key Principles of Management
- Rest your voice as much as possible and avoid whispering, which can strain vocal cords more than soft speaking.
- Stay hydrated by drinking plenty of fluids (at least 8-10 glasses of water daily) and use a humidifier to moisten the air, which helps soothe irritated vocal cords.
- For symptom relief, take over-the-counter pain medications like acetaminophen (Tylenol) 500-1000mg every 6 hours or ibuprofen (Advil, Motrin) 400-600mg every 6-8 hours as needed for pain and inflammation.
- Throat lozenges containing benzocaine or menthol can provide temporary relief, and warm salt water gargles (1/4 to 1/2 teaspoon of salt in 8 ounces of warm water) several times daily can help reduce inflammation.
- Avoid irritants like smoking, alcohol, and caffeine.
Importance of Avoiding Antibiotics
The misuse of antibiotics in treating viral laryngitis is a significant concern, as it can lead to unnecessary costs, side effects, and the development of antibiotic resistance 1. Antibiotics are only effective against bacterial infections and should not be used as a routine treatment for viral laryngitis.
When to Seek Medical Attention
If symptoms persist beyond two weeks, worsen significantly, or if you develop difficulty breathing or swallowing, seek medical attention as these may indicate a more serious condition requiring different treatment 1. Visualization of the larynx is the principal method to refine the differential diagnosis for a patient with dysphonia and allows for appropriately directed treatment.
Additional Considerations
The management of viral laryngitis is primarily directed toward relief of symptoms, and palliative medications—such as analgesics, anti-inflammatory agents, nasal saline, decongestants, antihistamines, mucolytics, cough suppressants, and topical or oral corticosteroids—may be used alone or in varying combinations for symptom relief 1. However, the use of these medications should be based on patient preference and medical contraindications.
From the Research
Diagnosis of Viral Laryngitis
- The diagnosis of viral laryngitis is often made based on clinical symptoms, including dry cough, inspiratory difficulty, and wheezing 2.
- In children, the diagnosis is typically made based on a clinical examination, with typical symptoms including a barking cough and inspiratory difficulty 2.
- In adults, the diagnosis may be made based on a thorough history and physical exam, and may require referral to other subspecialties such as gastroenterology and pulmonology 3.
Treatment of Viral Laryngitis
- The best treatment for acute and chronic overuse symptoms of viral laryngitis is vocal rest 4.
- The use of antibiotics or decongestants is not recommended for the treatment of viral laryngitis, as they are not effective in treating the underlying viral infection 4, 5.
- In some cases, orally administered glucocorticoids and inhaled racemic adrenalin may be effective in emergency situations 2.
- For chronic cough due to postviral vagal neuropathy, treatment has focused on the use of neuromodulators 3.
- There is limited evidence on the effectiveness of antibiotics in treating acute laryngitis, and their use may not outweigh the potential risks and negative consequences for antibiotic resistance patterns 5.
Specific Treatment Options
- Erythromycin may be beneficial in reducing voice disturbance at one week and cough at two weeks in adults with acute laryngitis 5.
- Fusafungine may increase the cure rate at day five in adults with acute laryngitis 5.
- Systemic and inhaled glucocorticoids may be effective in the treatment of glotto-subglottic laryngitis, with high dosages (more than 0.3 mg/kg dexamethasone for 48 hours) followed by oral corticosteroids 6.