What is the treatment for laryngitis?

Treatment for Laryngitis

The primary treatment for laryngitis should focus on conservative measures including voice rest, hydration, humidification, avoidance of irritants, and symptomatic relief with throat lozenges or warm liquids, as antibiotics have no proven benefit for acute laryngitis. 1, 2

Conservative Management (First-Line)

• Voice rest: Minimize talking and avoid whispering (which strains vocal cords)
• Adequate hydration: Drink plenty of fluids to keep the larynx moist
• Humidification: Use a humidifier, especially during sleep
• Avoid irritants: Stop smoking, limit alcohol consumption, and avoid dusty or smoky environments
• Symptomatic relief:
  • Warm salt water gargles
  • Throat lozenges
  • Warm liquids (tea with honey)
  • NSAIDs for inflammation and pain relief

Reflux-Related Laryngitis

For laryngitis associated with reflux symptoms:

1. Nocturnal anti-reflux precautions:

   • Elevate head of bed
   • Avoid eating 3 hours before bedtime
   • Avoid trigger foods (caffeine, alcohol, spicy/acidic foods)

2. Medication therapy (if precautions alone don't help):

   • Start with H2-receptor antagonists (e.g., famotidine 20 mg at bedtime) 3
   • If no response, escalate to proton pump inhibitors (PPIs) (e.g., omeprazole 20 mg at bedtime) 3

Studies show that up to 96% of patients with reflux-related laryngitis respond to this stepped approach 3. However, it's important to note that the response to treatment of reflux-related laryngeal symptoms typically occurs over weeks rather than days 4.

Antibiotic Therapy

Antibiotics should NOT be routinely prescribed for acute laryngitis. A Cochrane review found that antibiotics have no benefit in treating acute laryngitis 2. The review examined penicillin V and erythromycin and found no significant differences in objective voice scores compared to placebo.

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. However, in cases of severe laryngitis with significant airway inflammation or post-extubation stridor, systemic corticosteroids may be considered.

Special Considerations for Vocal Professionals

Vocal professionals with chronic laryngitis may require:

• More aggressive voice rest
• Professional voice therapy (recommended for 17% of patients) 5
• Earlier specialist referral to otolaryngology

When to Refer to a Specialist

Consider referral to an otolaryngologist for:

• Symptoms persisting beyond 2-3 weeks
• Suspected structural laryngeal abnormalities
• Professional voice users
• Presence of stridor or respiratory distress
• Dysphagia or odynophagia not responding to initial treatment

Monitoring and Follow-up

• Most cases of acute laryngitis resolve within 1-2 weeks with conservative management
• If symptoms persist beyond 3 weeks, reassessment and possible laryngoscopy are warranted
• For reflux-related laryngitis, treatment may need to continue for several months, with gradual tapering of medications

The yearly incidence of chronic laryngitis is approximately 3.47 cases per 1,000 people 5, with the most common symptoms being dysphonia (53%), pain/soreness (45%), and globus sensation (40%).