Treatment of Laryngitis
Laryngitis should be managed with supportive care only—voice rest, hydration, and analgesics—while avoiding antibiotics and systemic corticosteroids, as these medications provide no proven benefit and expose patients to unnecessary harm. 1, 2
Primary Treatment Approach
The cornerstone of laryngitis management is conservative, symptomatic therapy:
- Voice rest is essential to reduce vocal fold irritation and promote healing 2
- Adequate hydration helps maintain mucosal moisture and reduces irritation 2
- Analgesics or antipyretics (acetaminophen or NSAIDs) can be used for pain or fever relief 2
- Avoid both loud speaking and whispering, as both strain the vocal cords 2
The rationale for this conservative approach is straightforward: acute laryngitis is predominantly viral (caused by parainfluenza, rhinovirus, influenza, and adenovirus) and self-limited, with symptomatic improvement occurring within 7-10 days regardless of treatment 1, 2.
What NOT to Prescribe
Antibiotics Should Be Avoided
Clinicians should not routinely prescribe antibiotics for laryngitis. 1 This is a strong recommendation based on:
- Lack of efficacy: A Cochrane review found antibiotics do not improve objective voice outcomes in acute laryngitis 3
- Penicillin V specifically showed no benefit in a double-blind study of 100 adults with acute laryngitis—voice resolution rates were identical to placebo 4
- Harm outweighs benefit: Antibiotics cause side effects (rash, diarrhea, vomiting), contribute to antibiotic resistance, increase healthcare costs unnecessarily, and may cause laryngeal candidiasis 1, 2
The only exception is in immunosuppressed patients or when bacterial superinfection is documented (e.g., laryngeal tuberculosis, atypical mycobacterial infection, bacterial laryngotracheitis with S. aureus), where the diagnosis should be established before initiating therapy 1.
Systemic Corticosteroids Should Be Avoided
Systemic corticosteroids should not be routinely prescribed for laryngitis due to lack of supporting evidence for efficacy and significant potential adverse effects 1, 2. The extensive risk profile includes:
- Cardiovascular disease, hypertension, osteoporosis 1, 2
- Cataracts, impaired wound healing, infection risk 1, 2
- Mood disorders, peptic ulcers, diabetogenesis 1
- Dose-dependent increased risk of candidiasis and pharyngitis 1
If steroids are considered in professional voice users with a known diagnosis requiring targeted treatment, this decision requires shared decision-making after discussing risks and limited evidence for benefit 1.
Special Clinical Scenarios
Reflux-Associated Laryngitis
- Consider anti-reflux treatment if laryngoscopy shows signs of reflux laryngitis 2
- Be aware of PPI side effects: decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, and iron deficiency anemia 2
Pediatric Croup with Hoarseness
- Systemic steroids have shown better outcomes in pediatric patients with croup and associated hoarseness 2
- 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
When to Escalate Care
Additional evaluation is required when:
- Symptoms persist beyond 2-3 weeks 2
- Progressive worsening of symptoms 2
- Signs of airway compromise 2
- Suspicion of bacterial superinfection 2
Patient Education
Explain to patients:
- The viral nature of most laryngitis cases and expected 7-10 day time course 2
- Voice conservation techniques and the importance of adequate hydration 2
- Why antibiotics and steroids are not recommended for typical viral laryngitis 2
Common pitfall: Prescribing antibiotics due to patient expectations or pressure. The evidence clearly shows this practice is ineffective and harmful, contributing to antibiotic resistance without improving outcomes 1, 3.