What is the treatment for laryngitis?

Treatment for Laryngitis

The primary treatment for laryngitis is symptomatic relief including voice rest, adequate hydration, and analgesics, while avoiding antibiotics and systemic corticosteroids which have no proven benefit and potential harm. 1

Diagnosis and Etiology

• Laryngitis is commonly caused by viral pathogens including parainfluenza viruses, rhinovirus, influenza, and adenovirus 1
• Acute laryngitis is typically self-limited, with improvement occurring within 7-10 days even with placebo treatment 2
• Chronic laryngitis has a yearly incidence of 3.47 cases per 1,000 people, with dysphonia, pain/soreness, and globus sensation being the most common symptoms 3

First-Line Treatment Recommendations

• Voice rest is essential to reduce vocal fold irritation and promote healing 1
• Adequate hydration helps maintain mucosal moisture and reduce irritation 1
• Analgesics or antipyretics (such as acetaminophen or NSAIDs) for pain or fever relief 1
• Avoid speaking loudly or whispering, as both can strain the vocal cords 1

Medications to AVOID

• Systemic corticosteroids should not be routinely prescribed for laryngitis due to lack of supporting evidence for efficacy and potential for significant adverse effects including:
  • Cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, and mood disorders 2
• Antibiotics should not be routinely prescribed for viral laryngitis as they:
  • Show no effectiveness in treating acute laryngitis 2
  • Contribute to bacterial antibiotic resistance 1
  • Increase healthcare costs unnecessarily 1
  • May cause side effects including laryngeal candidiasis 1

Special Considerations

Reflux-Associated Laryngitis

• Consider anti-reflux treatment if laryngoscopy shows signs of reflux laryngitis (erythema, edema, posterior commissure hypertrophy) 2
• While some studies show improvement in laryngeal lesions with PPI treatment, others show no significant benefit for hoarseness symptoms 2
• Be aware of potential PPI side effects including decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, and iron deficiency anemia 2

Bacterial Laryngitis

• Antibiotics may be appropriate in specific cases:
  • Immunocompromised patients 1
  • Confirmed bacterial infection 1
  • Bacterial laryngotracheitis with mucosal crusting 1
  • For chronic bacterial laryngitis, extended antibiotic courses (minimum 21 days) may be necessary 4
  • MRSA should be considered in non-responsive cases (found in 30% of chronic bacterial laryngitis patients) 4

Pediatric Considerations

• Epinephrine nebulization may be used for post-extubation stridor caused by laryngeal edema, with effects occurring within 30 minutes but lasting only about 2 hours 2
• In pediatric patients with croup and associated symptoms like hoarseness, systemic steroids have shown better outcomes 2

When to Seek Additional Evaluation

• Symptoms persisting beyond 2-3 weeks 1
• Progressive worsening of symptoms 1
• Signs of airway compromise 1
• Suspicion of bacterial superinfection 1
• Need for instrumental assessment of voice and swallowing in cases of persistent symptoms 2

Patient Education

• Explain the viral nature of most laryngitis cases and expected time course (7-10 days) 2, 1
• Recommend voice conservation techniques and adequate hydration 1
• Advise against smoking, which can worsen laryngeal inflammation 4
• Explain that antibiotics and steroids are not helpful for typical viral laryngitis and may cause harm 2, 1