What is the treatment for laryngitis?

Treatment for Laryngitis

The primary treatment for laryngitis is symptomatic relief with voice rest, adequate hydration, and analgesics—while avoiding antibiotics and systemic corticosteroids, which lack proven benefit and carry potential harm. 1, 2

First-Line Management

The cornerstone of laryngitis treatment focuses on conservative measures that promote healing without pharmacologic intervention:

• Voice rest is essential to reduce vocal fold irritation and allow tissue recovery 1, 2
• Avoid both loud speaking and whispering, as both strain the vocal cords 1
• Maintain adequate hydration to preserve mucosal moisture and minimize irritation 1, 2
• Use analgesics or antipyretics (acetaminophen or NSAIDs) for pain or fever relief 1, 2

Most cases of acute laryngitis are viral in origin (caused by parainfluenza viruses, rhinovirus, influenza, or adenovirus) and are self-limited, with improvement occurring within 7-10 days even without specific treatment 1, 3.

Medications to Explicitly Avoid

Antibiotics

Do not prescribe antibiotics for routine viral laryngitis. 1, 2 The evidence is clear:

• Antibiotics show no objective benefit in treating acute laryngitis 2
• They contribute to bacterial antibiotic resistance 1, 2
• They increase unnecessary healthcare costs 2
• They may cause side effects, including laryngeal candidiasis 1, 2

Exception: Antibiotics may be appropriate only for immunocompromised patients, confirmed bacterial infection, or bacterial laryngotracheitis with mucosal crusting and increased work of breathing 2

Systemic Corticosteroids

Do not routinely prescribe systemic corticosteroids for adult viral laryngitis. 1, 2 The rationale:

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

Exception: In pediatric patients with croup and associated hoarseness, systemic steroids have shown better outcomes 1. For pediatric laryngitis (croup), oral glucocorticoids and inhaled racemic adrenaline are effective in emergency settings 3.

Special Considerations

Reflux-Associated Laryngitis

If laryngoscopy demonstrates signs of reflux laryngitis (erythema, edema of interarytenoid mucosa, arytenoid mucosa, or vocal folds), consider anti-reflux treatment 4, 1:

• PPI therapy may improve laryngeal lesions over weeks to months (not days) 4
• Response to treatment typically occurs over weeks rather than days 4
• ENT symptoms may take 2-6 months to respond to PPI therapy 4
• Be aware of PPI side effects: decreased calcium absorption, increased hip fracture risk in older adults, vitamin B12 deficiency, iron deficiency anemia, and increased pancreatitis risk 4, 1

However, the evidence for PPI efficacy in laryngitis is mixed—one randomized trial showed no benefit of esomeprazole 40 mg twice daily versus placebo for symptom scores after 16 weeks 4.

When to Seek Additional Evaluation

Refer or evaluate further if 1, 2:

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

Patient Education

Explain to patients 1, 2:

• The viral nature of most laryngitis cases
• Expected time course of 7-10 days for improvement
• Voice conservation techniques and adequate hydration
• Why antibiotics and steroids are not indicated for typical viral laryngitis