What is the treatment for laryngitis?

Treatment for Laryngitis

Laryngitis should be managed with supportive care alone—voice rest, hydration, and analgesics—while avoiding antibiotics and corticosteroids, which provide no benefit and cause harm. 1, 2

First-Line Treatment: Supportive Care Only

The cornerstone of laryngitis management is conservative, symptomatic treatment:

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

Acute laryngitis is self-limited, with most patients improving within 7-10 days regardless of treatment 1, 2. This is because laryngitis is typically caused by viral pathogens including parainfluenza, rhinovirus, influenza, and adenovirus 2.

What NOT to Prescribe

Antibiotics: Strong Recommendation Against

Do not prescribe antibiotics for laryngitis. 1

The evidence is unequivocal:

• A Cochrane review found antibiotics provide no objective improvement in voice scores compared to placebo 3
• While one trial showed erythromycin reduced subjective voice disturbance at one week, this outcome is not clinically relevant 3
• Antibiotics expose patients to unnecessary side effects including rash, abdominal pain, diarrhea, and laryngeal candidiasis 1
• Antibiotic misuse contributes to bacterial resistance, with regions of higher resistance experiencing 33% higher treatment costs for infectious diseases 1

Corticosteroids: Strong Recommendation Against Routine Use

Do not routinely prescribe systemic corticosteroids for laryngitis. 1, 2

The guideline evidence is clear:

• No clinical trials demonstrate efficacy for corticosteroids in treating dysphonia or laryngitis in adults 4
• Corticosteroids carry significant risks even with short-term use, including cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, mood disorders, diabetogenesis, and pancreatitis 1, 4
• The risk-benefit analysis shows a "preponderance of harm over benefit" 1, 4

Exception for professional voice users: Corticosteroids may be considered only in professional voice users with confirmed allergic laryngitis who are acutely dependent on their voice, but only after laryngoscopy confirms the diagnosis and shared decision-making discusses the limited evidence and documented risks 4

Special Circumstance: Reflux-Associated Laryngitis

When to Consider Anti-Reflux Therapy

Do not prescribe anti-reflux medications empirically for hoarseness without laryngoscopic findings. 1

However, anti-reflux therapy may be considered if:

• Laryngoscopy demonstrates signs of chronic laryngitis (erythema, edema, redundant tissue, or surface irregularities of the inter-arytenoid mucosa, arytenoid mucosa, posterior laryngeal mucosa, and/or vocal folds) 1
• Even in these cases, evidence is limited—a randomized trial of esomeprazole 40 mg twice daily for 16 weeks showed no benefit in symptom scores or quality of life 1

Be aware of PPI side effects:

• Decreased calcium absorption with increased hip fracture risk in older adults 1, 2
• Vitamin B12 deficiency in a dose-dependent manner 1, 2
• Iron deficiency anemia 1, 2
• Increased risk of pancreatitis 1

Pediatric Considerations

For children with croup and associated laryngitis symptoms:

• Systemic corticosteroids (such as dexamethasone) have shown benefit for reducing subglottic edema in moderate to severe cases with respiratory distress 5
• Nebulized epinephrine may be used for post-extubation stridor or acute respiratory distress, with effects occurring within 30 minutes but lasting only about 2 hours 2, 5
• Maintain supportive care with hydration, supported sitting position, and antipyretics (avoid aspirin due to Reye syndrome risk) 5

When to Reassess

Refer for further evaluation if:

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

Patient Education

Explain to patients:

• The viral nature of most laryngitis cases and expected 7-10 day recovery 2
• Voice conservation techniques and adequate hydration 2
• Why antibiotics and steroids are not appropriate for typical viral laryngitis 2