Treatment for Laryngitis
The primary treatment for laryngitis is symptomatic relief with voice rest, adequate hydration, and analgesics—antibiotics and systemic corticosteroids should NOT be routinely used for typical viral laryngitis. 1, 2
First-Line Symptomatic Management
The cornerstone of laryngitis treatment focuses on conservative measures that promote healing and reduce vocal fold irritation:
- Voice rest is essential to minimize vocal fold trauma and allow mucosal recovery 1, 2
- Adequate hydration maintains mucosal moisture and reduces laryngeal irritation 1, 2
- Analgesics or antipyretics (acetaminophen or NSAIDs) provide relief from pain and fever 1, 2
- Avoid both loud speaking and whispering, as both strain the vocal cords 1
Most cases of acute laryngitis are viral (caused by parainfluenza viruses, rhinovirus, influenza, or adenovirus) and self-limited, improving within 7-10 days even without specific treatment 1, 2.
What NOT to Prescribe
Antibiotics Should Be Avoided
Antibiotics have no objective benefit in treating acute viral laryngitis and should not be routinely prescribed. 1, 2 A double-blind study of 100 adults with acute laryngitis found that penicillin V provided no improvement in vocal symptoms, rhinorrhea, nasal congestion, or cough compared to placebo 3.
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
Exception: Antibiotics may be appropriate for immunocompromised patients, confirmed bacterial infection, or bacterial laryngotracheitis with mucosal crusting and increased work of breathing 2.
Systemic Corticosteroids Should Be Avoided
Systemic corticosteroids should not be routinely prescribed for laryngitis in adults due to lack of supporting evidence for efficacy and potential for significant adverse effects. 1, 2
The risks of systemic corticosteroids include:
- Cardiovascular disease 1
- Hypertension 1
- Osteoporosis 1
- Cataracts 1
- Impaired wound healing 1
- Increased infection risk 1
- Mood disorders 1
Exception: In pediatric patients with croup (glotto-subglottic laryngitis) and associated symptoms like hoarseness, systemic steroids have shown better outcomes and are the basic treatment, with dosing of more than 0.3 mg/kg dexamethasone for 48 hours 1, 4, 5.
Reflux-Associated Laryngitis
When laryngoscopy demonstrates signs of reflux laryngitis (erythema, edema, redundant tissue, and/or surface irregularities of the interarytenoid mucosa, arytenoid mucosa, posterior laryngeal mucosa, and/or vocal folds), anti-reflux treatment may be considered as an option 6.
However, empiric PPI treatment for dysphonia without laryngoscopy is not recommended. 6 The American Academy of Otolaryngology-Head and Neck Surgery recommends against widespread use of anti-reflux medications as empiric therapy for hoarseness without GERD symptoms or laryngeal findings consistent with laryngitis 6.
Evidence for Anti-Reflux Treatment
- A randomized trial of 145 subjects with chronic laryngeal symptoms and laryngoscopic evidence of laryngitis found no benefit in symptom scores with esomeprazole 40 mg twice daily versus placebo for 16 weeks 6
- Among 11 randomized trials evaluating PPI treatment for suspected reflux-related dysphonia, only 3 of 9 placebo-controlled trials reported increased odds of voice improvement with PPI treatment 6
- Some studies showed improvement in laryngoscopic findings (erythema, edema, posterior commissure hypertrophy) even when hoarseness symptoms did not improve 6
Risks of PPI Use
Be aware of potential PPI side effects when considering anti-reflux treatment 1:
- Decreased calcium absorption and increased hip fracture risk 6, 1
- Vitamin B12 deficiency 6, 1
- Iron deficiency anemia 6, 1
- Impaired cognition 6
- Community-acquired pneumonia 6
- Chronic kidney disease 6
When to Seek Additional Evaluation
Refer for further evaluation if: 1, 2
- 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