Treatment for Laryngitis
Laryngitis should be managed with symptomatic care including voice rest, hydration, and analgesics—antibiotics and systemic corticosteroids should NOT be routinely prescribed due to lack of proven benefit and potential for significant harm. 1, 2
First-Line Management: Symptomatic Care Only
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 reduce irritation 1, 2
- Analgesics or antipyretics (acetaminophen or NSAIDs) 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 1, 3. The most common viral pathogens are parainfluenza viruses, rhinovirus, influenza, and adenovirus 1, 2.
What NOT to Prescribe
Antibiotics: Do Not Use
Antibiotics should not be routinely prescribed for viral laryngitis as they show no objective benefit in treating acute laryngitis 2, 4. A Cochrane review of randomized controlled trials found no significant differences in objective voice scores between antibiotic and placebo groups 4.
The harms of inappropriate antibiotic use include:
- Contribution to bacterial antibiotic resistance 1, 2
- Unnecessary healthcare costs 1, 2
- Potential side effects including laryngeal candidiasis 1, 2
Systemic Corticosteroids: Do Not Use Routinely
Systemic corticosteroids should not be routinely prescribed for laryngitis due to lack of supporting evidence for efficacy and potential for significant adverse effects 1, 3. The American Academy of Otolaryngology-Head and Neck Surgery specifically recommends against empiric steroid use before laryngoscopy 3.
Well-documented risks of corticosteroid therapy include:
- Cardiovascular disease, hypertension, and cerebrovascular disease 3
- Osteoporosis and avascular necrosis 3
- Cataracts 3
- Impaired wound healing and increased infection risk 3
- Mood disorders 3
- Diabetogenesis and weight gain 3
When to Consider Additional Evaluation
Refer for laryngoscopy if hoarseness persists beyond 4 weeks or if there is serious underlying concern 5. Viral laryngitis symptoms typically last 1-3 weeks and resolve spontaneously 5.
Additional evaluation is warranted 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
Special Circumstances
Reflux-Associated Laryngitis
Do NOT use anti-reflux medications empirically for hoarseness without laryngoscopy 5. However, if laryngoscopy demonstrates signs of reflux laryngitis (erythema, edema, surface irregularities of the interarytenoid mucosa, arytenoid mucosa, posterior laryngeal mucosa, and/or vocal folds), anti-reflux treatment may be considered as an option 5.
For patients with concomitant esophageal GERD symptoms (heartburn, regurgitation) AND laryngitis, PPIs are recommended 5. For suspected extraesophageal reflux without esophageal symptoms, evidence is insufficient to recommend routine PPI use 5.
Be aware of PPI side effects:
- Decreased calcium absorption and increased hip fracture risk 5, 1
- Vitamin B12 deficiency 5, 1
- Iron deficiency anemia 5, 1
Professional Voice Users
Prednisone may be appropriate only in professional voice users with confirmed allergic laryngitis who are acutely dependent on their voice, but only after laryngoscopy 3. The lowest effective dose should be used for the shortest duration necessary 3.
Pediatric Croup
In pediatric patients with croup (which may include hoarseness), systemic steroids have shown better outcomes 1. Oral glucocorticoids and inhaled racemic epinephrine are effective in emergency settings 6.
Patient Education Algorithm
Explain to patients: