What is the treatment for viral laryngitis?

Treatment for Viral Laryngitis

Viral laryngitis is a self-limited condition that does not require antibiotics and typically resolves within 7-10 days with supportive care only.

Diagnosis and Etiology

• Viral laryngitis is commonly caused by parainfluenza viruses, rhinovirus, influenza, and adenovirus 1, 2
• Typical symptoms include hoarseness (dysphonia), dry cough (often barking in children), and possible inspiratory difficulty 2
• Diagnosis is primarily clinical, based on symptoms and history of upper respiratory infection 2

Treatment Recommendations

First-Line Management: Supportive Care

• Viral laryngitis is self-limited, with most patients experiencing symptomatic improvement within 7-10 days regardless of treatment 1, 3
• Symptomatic relief should be the focus of management 1:
  • Analgesics or antipyretics (acetaminophen, ibuprofen) for pain or fever 1
  • Adequate hydration to maintain vocal fold lubrication 1
  • Voice rest to reduce vocal fold irritation 1

Medications to AVOID

Antibiotics

• Antibiotics should not be routinely prescribed for viral laryngitis 1
• Cochrane reviews have found no objective benefit of antibiotics in treating acute laryngitis 1, 3
• Misuse of antibiotics contributes to:
  • Bacterial antibiotic resistance 1
  • Unnecessary healthcare costs 1
  • Potential side effects (rash, abdominal pain, diarrhea, vomiting) 1
  • Risk of laryngeal candidiasis 1

Corticosteroids

• Routine use of systemic corticosteroids for viral laryngitis in adults is not recommended due to:
  • Lack of supporting evidence for efficacy 1
  • Potential for significant adverse effects 1
• Corticosteroids may be considered in specific circumstances:
  • Professional voice users with known diagnosis requiring rapid symptom relief 1
  • Children with significant airway symptoms (croup) 4

Special Considerations

When to Consider Additional Evaluation

• Symptoms persisting beyond 2-3 weeks 1
• Progressive worsening of symptoms 1
• Signs of airway compromise 1
• Suspicion of bacterial superinfection 1

When Antibiotics May Be Appropriate

• Immunocompromised patients (e.g., those with HIV, transplant recipients) 1
• Confirmed bacterial infection (rare) 1
• Bacterial laryngotracheitis with mucosal crusting, increased work of breathing 1

Common Pitfalls to Avoid

• Prescribing antibiotics empirically for viral laryngitis 1, 3
• Failing to distinguish between viral laryngitis and other causes of hoarseness requiring different management 1
• Not considering laryngoscopy for persistent symptoms (>3 weeks) 1
• Overlooking potential structural or functional anomalies in children under one year of age with laryngitis-like symptoms 2

Patient Education

• Explain the viral nature of the condition and expected time course (7-10 days) 1
• Emphasize that antibiotics are ineffective for viral infections 3
• Recommend voice conservation techniques and adequate hydration 1
• Advise when to return for follow-up (persistent or worsening symptoms) 1