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 chronic laryngitis:

• Perform laryngoscopy first to identify signs of laryngitis (erythema, edema, redundant tissue, surface irregularities of the vocal folds or arytenoid mucosa) 4
• Anti-reflux therapy is an option only when laryngoscopic findings confirm laryngitis, not for empiric treatment of hoarseness alone 4
• If prescribed, be aware of PPI side effects: decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, and iron deficiency anemia 4, 1
• Evidence shows that while laryngoscopic findings may improve with PPIs, symptom improvement is inconsistent 4

Corticosteroids may be considered only in these specific situations:

• Professional voice users with confirmed allergic laryngitis who are acutely voice-dependent 3
• Severe airway obstruction after appropriate evaluation 3
• Autoimmune disorders involving the larynx (lupus, sarcoidosis, granulomatosis with polyangiitis) 3
• Pediatric croup with associated hoarseness 1, 3

For bacterial superinfection (rare):

• Consider antibiotics only for immunocompromised patients, confirmed bacterial infection, or 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

Key Clinical Pitfalls

Do not prescribe corticosteroids or anti-reflux medications empirically before laryngoscopy, as this may delay appropriate diagnosis and treatment while exposing patients to unnecessary risks. 4, 3 The American Academy of Otolaryngology-Head and Neck Surgery explicitly recommends against empiric therapy for hoarseness without laryngoscopic confirmation of laryngitis. 4

Avoid the common error of treating all hoarseness as reflux disease—the benefit of anti-reflux treatment for hoarseness in patients without GERD symptoms or laryngoscopic evidence of laryngitis is unclear, and one large randomized trial showed no benefit of esomeprazole over placebo for chronic laryngeal symptoms. 4