What are the treatments for vocal loss and sore throat?

Treatment of Vocal Loss and Sore Throat

For vocal loss (dysphonia), avoid antibiotics, steroids, and antireflux medications without laryngoscopy; instead, prioritize vocal hygiene measures, voice rest, and analgesics, with laryngoscopy required if symptoms persist beyond 4 weeks. 1 For sore throat, use ibuprofen or paracetamol for symptom relief and avoid routine antibiotics unless severe streptococcal infection is confirmed. 1

Immediate Management of Vocal Loss (Dysphonia)

What NOT to Do First

• Do not prescribe antibiotics routinely for dysphonia - most cases are viral laryngitis that resolve within 7-10 days without treatment, and antibiotics are ineffective while contributing to resistance and side effects 1
• Do not prescribe corticosteroids before laryngoscopy - significant risk profile with limited evidence of benefit, and should only be considered after visualization of the larynx 1
• Do not prescribe antireflux medications based on symptoms alone without visualizing the larynx first 1
• Do not order CT or MRI imaging before direct visualization of the larynx 1

Initial Conservative Management

Implement vocal hygiene measures immediately 1:

• Adequate hydration - drink water daily (absence of water intake associated with 60% higher dysphonia risk) 1
• Voice rest - brief periods to prevent fatigue, straining, and overuse 1
• Humidification - provide indoor air humidification in dry environments 1
• Amplification - use in large noisy spaces to reduce vocal strain 1

Avoid these vocal irritants 1:

• Smoking and secondhand smoke 1
• Yelling, shouting, speaking over loud noise, and whispering 1
• Excessive throat clearing and coughing 1
• Alcohol and caffeine (causes throat drying and mucous thickening) 1
• Drying medications 1

When to Escalate Care

Perform laryngoscopy or refer for laryngoscopy if 1:

• Dysphonia persists beyond 4 weeks without improvement 1
• Recent head, neck, or chest surgery 1
• Recent endotracheal intubation 1
• Concomitant neck mass present 1
• Respiratory distress or stridor 1
• History of tobacco abuse 1
• Professional voice user (singers, teachers, call center operators) 1

Treatment After Laryngoscopy

Voice therapy is strongly recommended for dysphonia from causes amenable to behavioral intervention, including functional voice disorders, muscle tension dysphonia, and vocal fold lesions 1

Specific techniques for functional dysphonia include 1:

• Natural reflexive behaviors: coughing, yawning with sighs, grunting, gargling with firm sound 1
• Semi-occluded vocal tract exercises and resonant voice exercises 1
• Circumlaryngeal massage with concurrent vocalization (explain and obtain permission before touching neck) 1
• Vocal function exercises for voice consolidation 1

Surgery is indicated for suspected malignancy, symptomatic benign vocal fold lesions not responding to conservative management, or glottic insufficiency 1

Botulinum toxin injections should be offered for spasmodic dysphonia and laryngeal dystonia 1

Management of Sore Throat

Symptomatic Relief

Use ibuprofen or paracetamol as first-line analgesics for acute sore throat pain relief 1, 2

• Ibuprofen shows slightly better efficacy than paracetamol, particularly after 2 hours 2
• Both are safe for short-term use with low adverse effect risk 2
• Both equally effective in children with no significant safety differences 2

Antibiotic Decision-Making

Do not use antibiotics for patients with 0-2 Centor criteria (low likelihood of streptococcal infection) 1

Consider discussing antibiotics with patients scoring 3-4 Centor criteria (fever, tonsillar exudates, tender anterior cervical lymphadenopathy, absence of cough), weighing modest symptom benefits against side effects, resistance, and costs 1

If antibiotics are indicated, prescribe penicillin V twice or three times daily for 10 days 1

Antibiotics are NOT indicated to prevent 1:

• Rheumatic fever or acute glomerulonephritis in low-risk patients 1
• Suppurative complications (quinsy, acute otitis media, cervical lymphadenitis, mastoiditis, sinusitis) 1

Corticosteroids for Severe Sore Throat

Consider single-dose corticosteroids in conjunction with antibiotics only for adult patients with severe presentations (3-4 Centor criteria), though this is not routinely recommended 1

• No evidence of benefit in children 1
• Effect is smaller when administered orally 1
• Studies not powered to detect adverse effects of short courses 1

What Does NOT Work

Do not recommend zinc gluconate - conflicting results and more adverse effects in treatment groups 1

Do not recommend herbal treatments or acupuncture - inconsistent evidence from methodologically poor quality studies 1, 2

Common Pitfalls to Avoid

For dysphonia: The most common error is empiric treatment with antibiotics, steroids, or antireflux medications without laryngoscopy, which delays proper diagnosis and exposes patients to unnecessary risks 1

For sore throat: Overuse of antibiotics in low-risk patients (0-2 Centor criteria) contributes to resistance without meaningful symptom benefit 1

Medication side effects: Be aware that many medications have direct or indirect adverse voice effects, including drying medications, which should be avoided during dysphonia 1, 3

Voice rest misconceptions: While brief voice rest helps acute noncompounded phonotrauma, it is not a long-term solution for compounded phonotrauma without addressing underlying vocal behaviors 4