What is the treatment for laryngitis?

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 as they provide no objective benefit and carry significant risks. 1, 2

Initial Management Approach

First-Line Symptomatic Treatment

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

Expected Clinical Course

• Viral laryngitis typically resolves spontaneously within 1-3 weeks 3
• Most patients improve within 7-10 days even with placebo treatment 1
• Common viral pathogens include parainfluenza viruses, rhinovirus, influenza, and adenovirus 1, 2

What NOT to Prescribe

Antibiotics: Contraindicated

Antibiotics should NOT be routinely prescribed for laryngitis because: 1, 2, 4

• No objective benefit in treating acute laryngitis 2, 4
• Contributes to bacterial antibiotic resistance 1
• Increases healthcare costs unnecessarily 1
• May cause side effects including laryngeal candidiasis 1
• A Cochrane review of 206 adults found no significant differences in objective voice scores between antibiotic and placebo groups 4

Systemic Corticosteroids: Generally Contraindicated

Corticosteroids should NOT be empirically prescribed for hoarseness or laryngitis before laryngoscopy because: 5

• No clinical trials demonstrate efficacy for dysphonia or laryngitis in adults 5
• Significant adverse effects even with short-term use, including: 1, 5
  • Cardiovascular disease and hypertension
  • Osteoporosis and fractures
  • Cataracts
  • Impaired wound healing
  • Increased infection risk
  • Mood disorders and sleep disturbances
  • Vitamin B12 and iron deficiency

When to Consider Additional Evaluation

Indications for Laryngoscopy

Visualize the larynx if hoarseness persists beyond 4 weeks or if serious underlying concern exists: 3

• Symptoms persisting beyond 2-3 weeks 1, 2
• Progressive worsening of symptoms 1, 2
• Signs of airway compromise 1, 2
• Suspicion of bacterial superinfection 2
• Professional voice users with acute voice-dependent needs 5

Reflux-Associated Laryngitis

Anti-reflux treatment may be considered ONLY if laryngoscopy demonstrates signs of reflux laryngitis (erythema, edema, surface irregularities of interarytenoid/arytenoid mucosa, posterior laryngeal mucosa, or vocal folds): 3, 1

• Use twice-daily PPI therapy for patients with laryngitis AND concomitant esophageal GERD symptoms 3
• Do NOT use empiric PPI therapy for hoarseness without GERD symptoms or laryngoscopic findings 3
• Be aware of PPI risks: decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, iron deficiency anemia 3, 1

Special Circumstances Where Steroids MAY Be Appropriate

Limited Exceptions (Requires Laryngoscopy First)

• Professional voice users with confirmed allergic laryngitis who are acutely voice-dependent (requires shared decision-making about risks) 5
• Pediatric croup with associated hoarseness (systemic steroids have shown benefit) 1, 5
• Severe airway obstruction after appropriate evaluation 5
• Autoimmune disorders involving the larynx (SLE, sarcoidosis, granulomatosis with polyangiitis) 5

Pediatric Considerations

• Epinephrine nebulization may be used for post-extubation stridor from laryngeal edema (effects within 30 minutes but last only ~2 hours) 1
• Epiglottitis (bacterial supraglottic laryngitis) requires antibiotics plus corticosteroids 6

Patient Education Points

• Explain the viral nature of most laryngitis cases and expected 1-3 week time course 1, 2
• Emphasize voice conservation techniques and adequate hydration 1, 2
• Clearly advise against antibiotics and steroids for typical viral laryngitis 1, 2
• Counsel on when to return: symptoms beyond 2-3 weeks, worsening symptoms, or breathing difficulty 1, 2

Common Pitfalls to Avoid

• Do not prescribe antibiotics empirically—they provide no benefit and contribute to resistance 1, 2, 4
• Do not prescribe steroids without laryngoscopy—may delay appropriate diagnosis and expose patients to unnecessary harm 5
• Do not prescribe PPIs empirically for hoarseness without reflux symptoms or laryngoscopic evidence of laryngitis 3
• Do not assume chronic laryngitis is simply recurrent acute laryngitis—it is a distinct entity requiring different evaluation 6