What is the treatment for laryngitis?

Treatment of Laryngitis

Laryngitis should be managed with symptomatic care including voice rest, hydration, and analgesics—antibiotics and systemic corticosteroids should NOT be routinely prescribed as they provide no benefit and may cause harm. 1, 2

First-Line Management

The cornerstone of laryngitis treatment is conservative, supportive care:

• Voice rest is essential to reduce vocal fold irritation and promote healing 1, 2
• Adequate hydration helps maintain mucosal moisture and reduces irritation 1, 2
• Analgesics or antipyretics (acetaminophen or NSAIDs) can be used for pain or fever relief 1, 2
• Avoid both loud speaking AND whispering, as both strain the vocal cords 1

Most viral laryngitis is self-limited, with improvement occurring within 7-10 days even with placebo treatment, and symptoms typically resolve within 1-3 weeks 3, 1.

Medications to AVOID

Antibiotics - Do NOT Use Routinely

Antibiotics show no objective benefit in treating acute viral laryngitis and should not be prescribed 2, 4:

• A Cochrane review found no significant differences in objective voice scores between antibiotic and placebo groups 4
• Erythromycin showed only subjective improvement at one week (not clinically relevant) but no objective voice improvement 4
• Routine antibiotic use contributes to bacterial resistance, increases healthcare costs unnecessarily, and may cause side effects including laryngeal candidiasis 1, 2

Exceptions where antibiotics may be appropriate: immunocompromised patients, confirmed bacterial infection, or bacterial laryngotracheitis with mucosal crusting and increased work of breathing 2

Systemic Corticosteroids - Do NOT Use Routinely

Systemic corticosteroids should not be routinely prescribed for laryngitis in adults due to lack of efficacy evidence and significant potential adverse effects 1, 2:

• Potential harms include cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, and mood disorders 1
• The evidence does not support routine use despite widespread practice 3, 2

Exception: In pediatric patients with croup and associated hoarseness, systemic steroids have shown better outcomes 1

Special Considerations

Reflux-Associated Laryngitis

• Consider anti-reflux treatment ONLY if laryngoscopy shows signs of chronic laryngitis (erythema, edema, redundant tissue, or surface irregularities of the interarytenoid mucosa, arytenoid mucosa, posterior laryngeal mucosa, and/or vocal folds) 3, 1
• Do NOT prescribe anti-reflux medications empirically for hoarseness without signs of GERD or laryngeal inflammation 3
• Be aware of PPI side effects: decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, and iron deficiency anemia 1

When to Escalate Care

Refer for laryngoscopy if: 3, 2

• Hoarseness persists beyond 4 weeks 3
• Progressive worsening of symptoms 2
• Signs of airway compromise 2
• Suspicion of bacterial superinfection 2
• Serious underlying concern exists (potential malignancy or significant impact on professional voice users) 3

Visualization of the larynx is the principal method to refine the differential diagnosis and allows for appropriately directed treatment, preventing delay in diagnosis of malignancy or other morbid conditions 3.

Patient Education

Counsel patients on: 1, 2

• The viral nature of most laryngitis cases and expected time course (7-10 days to 2-3 weeks)
• Voice conservation techniques and adequate hydration
• Why antibiotics and steroids are not indicated for typical viral laryngitis
• When to return for further evaluation (symptoms beyond 2-3 weeks)