What is the treatment for laryngitis?

Treatment of Laryngitis

For acute viral laryngitis, focus on symptomatic relief with voice rest, hydration, and analgesics—avoid antibiotics and systemic corticosteroids as they provide no benefit and carry significant risks. 1, 2

First-Line Management

Voice rest is the cornerstone of treatment, reducing vocal fold irritation and promoting healing. 1 This means:

• Avoid speaking loudly or whispering, as both strain the vocal cords 1
• Minimize talking altogether during the acute phase 1

Supportive measures include:

• Adequate hydration to maintain mucosal moisture and reduce irritation 1, 2
• Analgesics (acetaminophen or NSAIDs) for pain or fever relief 1, 2

What NOT to Prescribe

Antibiotics should never be routinely prescribed for viral laryngitis because:

• They show no objective benefit in treating acute laryngitis 1, 2
• Most cases are viral (parainfluenza, rhinovirus, influenza, adenovirus) 1, 2
• They contribute to antibiotic resistance, increase costs, and may cause laryngeal candidiasis 1, 2

Systemic corticosteroids should not be routinely used due to:

• Lack of supporting evidence for efficacy 1, 2, 3
• Significant adverse effects including cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, and mood disorders 1, 3
• The condition is self-limited, with improvement within 7-10 days even with placebo 1, 3

Special Clinical Scenarios

For reflux-associated laryngitis:

• Laryngoscopy must be performed first to visualize signs of reflux laryngitis (erythema, edema, surface irregularities of the interarytenoid mucosa, arytenoid mucosa, posterior laryngeal mucosa, or vocal folds) 4
• Anti-reflux medications should NOT be used empirically for hoarseness without laryngoscopic evidence of laryngitis 4
• If laryngitis is confirmed on laryngoscopy, anti-reflux therapy may be considered as an option 4
• Be aware that PPIs carry risks including decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, and iron deficiency anemia 4, 1

Corticosteroids may be appropriate only in these specific circumstances:

• Professional voice users with confirmed allergic laryngitis who are acutely dependent on their voice 3
• Pediatric patients with croup and associated symptoms like hoarseness 1, 3
• Severe airway obstruction after appropriate evaluation 3
• Certain autoimmune disorders involving the larynx 3
• Always perform laryngoscopy before considering steroid therapy 3

Antibiotics may be appropriate for:

• Immunocompromised patients 2
• Confirmed bacterial infection 2
• Bacterial laryngotracheitis with mucosal crusting and increased work of breathing 2

When to Escalate Care

Additional evaluation is required for:

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

Patient Education Points

Explain to patients:

• The viral nature of most laryngitis cases and expected 7-10 day time course 1, 2
• Voice conservation techniques and the importance of adequate hydration 1, 2
• Why antibiotics and steroids are not appropriate for typical viral laryngitis 1, 2