What is the treatment for viral laryngitis?

Treatment for Viral Laryngitis

The treatment for viral laryngitis should focus on symptomatic relief, including voice rest, adequate hydration, and analgesics, while avoiding antibiotics and systemic corticosteroids due to lack of proven benefit and potential harm. 1, 2

First-Line Treatment Approach

• Voice rest is essential to reduce vocal fold irritation and promote healing of the larynx 1, 2
• Maintain adequate hydration to help preserve mucosal moisture and reduce irritation of the vocal folds 1, 2
• Use analgesics or antipyretics (such as acetaminophen or NSAIDs) for pain or fever relief as needed 1, 2
• Avoid speaking loudly or whispering, as both can strain the vocal cords and delay recovery 2

Medications to Avoid

• Antibiotics should not be routinely prescribed for viral laryngitis as they:

  • Show no objective benefit in treating acute laryngitis 1, 2
  • Contribute to bacterial antibiotic resistance 1, 2
  • Increase healthcare costs unnecessarily 2
  • May cause side effects, including laryngeal candidiasis 1, 2
  • Research confirms the inefficacy of antibiotics like penicillin V in adults with acute laryngitis 3, 4

• Systemic corticosteroids should not be routinely used for viral laryngitis in adults due to:

  • Lack of supporting evidence for efficacy 1, 2
  • Potential for significant adverse effects, including cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, increased infection risk, and mood disorders 2

Special Considerations

• Consider additional evaluation if symptoms persist beyond 2-3 weeks, progressively worsen, show signs of airway compromise, or suggest bacterial superinfection 1, 2

• Antibiotics may be appropriate in specific circumstances:

  • Immunocompromised patients 1
  • Confirmed bacterial infection 1
  • Bacterial laryngotracheitis with mucosal crusting and increased work of breathing 1

• In pediatric patients with croup and associated symptoms like hoarseness, the approach differs:

  • Systemic steroids have shown better outcomes 2, 5
  • Inhaled racemic adrenalin may be effective in emergency settings for children 5

Patient Education

• Explain the viral nature of the condition (commonly caused by parainfluenza viruses, rhinovirus, influenza, and adenovirus) 1, 2
• Inform patients that acute viral laryngitis is typically self-limited, with improvement occurring within 7-10 days even with placebo treatment 2
• Recommend voice conservation techniques and adequate hydration 1, 2
• Advise against the use of antibiotics and steroids for typical viral laryngitis 1, 2

Clinical Pitfalls to Avoid

• Misdiagnosing reflux-associated laryngitis as viral laryngitis. Consider anti-reflux treatment if laryngoscopy shows signs of reflux laryngitis 2
• Overlooking potential structural or functional anomalies in children under one year of age that may cause symptoms resembling laryngitis 5
• Failing to distinguish between viral subglottic laryngitis and bacterial epiglottitis (supraglottic laryngitis), which requires different management approaches 6
• Unnecessarily prescribing antibiotics for viral laryngitis despite evidence showing they do not improve objective voice outcomes 4