Treatment for 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 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 maintains mucosal moisture and reduces 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 cases are self-limited, with improvement occurring within 7-10 days even without specific treatment 1. The viral etiology (parainfluenza, rhinovirus, influenza, adenovirus) means that targeted antimicrobial therapy is ineffective 1, 2.
What NOT to Prescribe
Antibiotics Should Be Avoided
- Antibiotics show no objective benefit in treating acute viral laryngitis 2, 3
- They contribute to bacterial resistance, increase healthcare costs unnecessarily, and may cause side effects including laryngeal candidiasis 1, 2
- A Cochrane review of 206 adults found no significant differences in objective voice scores between antibiotic and placebo groups 3
- Exceptions: Consider antibiotics only for immunocompromised patients, confirmed bacterial infection, or bacterial laryngotracheitis with mucosal crusting and increased work of breathing 2
Systemic Corticosteroids Should Be Avoided
- Routine use is not recommended due to lack of efficacy evidence and potential for significant adverse effects 1, 2
- Potential harms include cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, and mood disorders 1
- Exception: For pediatric croup with associated hoarseness, systemic steroids have shown better outcomes 1
Special Clinical Scenarios
Reflux-Associated Laryngitis
- Consider anti-reflux treatment if laryngoscopy shows signs of reflux laryngitis 1
- Be aware of PPI side effects: decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, and iron deficiency anemia 1
Post-Extubation Laryngeal Edema (Pediatric)
- Epinephrine nebulization may be used for post-extubation stridor caused by laryngeal edema 1
- Effects occur within 30 minutes but last only about 2 hours 1
When to Pursue Additional Evaluation
Refer or investigate further if:
- Symptoms persist beyond 2-3 weeks 1, 2
- Progressive worsening of symptoms 1, 2
- Signs of airway compromise 1, 2
- Suspicion of bacterial superinfection 1, 2