What is the treatment for laryngitis?

Treatment of Laryngitis

Laryngitis should be managed with symptomatic care including voice rest, hydration, and analgesics—antibiotics and systemic corticosteroids should NOT be routinely used for typical viral laryngitis in adults. 1, 2

First-Line Management: Supportive Care Only

The cornerstone of laryngitis treatment is conservative, symptomatic management:

• 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 viral (parainfluenza, rhinovirus, influenza, adenovirus) and self-limited, improving within 7-10 days even with placebo 1, 2.

What NOT to Use: Critical Pitfalls

Antibiotics: No Benefit, Only Harm

Antibiotics should NOT be prescribed for typical viral laryngitis. The evidence is definitive:

• A Cochrane review found no objective benefit from antibiotics in acute laryngitis 3
• A randomized trial of 100 adults showed penicillin V had identical outcomes to placebo for voice recovery 4
• Antibiotic use contributes to resistance, increases costs, causes side effects, and risks laryngeal candidiasis 1, 2

Systemic Corticosteroids: Avoid in Adults

Routine systemic corticosteroids should NOT be used for viral laryngitis in adults due to lack of efficacy evidence and significant potential harms including cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, and mood disorders 1, 2.

Special Populations and Exceptions

Reflux-Associated Laryngitis

Anti-reflux therapy is NOT recommended as empiric treatment for hoarseness alone without GERD symptoms or laryngoscopic evidence of laryngitis 5:

• The American Academy of Otolaryngology-Head and Neck Surgery recommends AGAINST empiric PPI therapy for hoarseness without esophageal GERD symptoms 5
• A randomized trial of 145 patients with chronic laryngeal symptoms showed NO benefit from esomeprazole 40 mg twice daily versus placebo 5

However, if laryngoscopy demonstrates inflammatory findings (erythema, edema, redundant tissue, surface irregularities of interarytenoid mucosa, arytenoid mucosa, posterior laryngeal mucosa, or vocal folds), anti-reflux treatment may be considered as an option 5:

• Once- or twice-daily PPIs can be used when concomitant esophageal GERD syndrome is present 5
• Be aware of PPI risks: decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, iron deficiency anemia, and pancreatitis 5

Pediatric Laryngitis (Croup)

Children with moderate to severe respiratory distress require different management 6:

• Corticosteroids (oral or parenteral dexamethasone) are effective for reducing subglottic edema 6
• Nebulized epinephrine for emergency treatment of significant respiratory distress—effects occur within 30 minutes but last only ~2 hours, requiring monitoring 1, 6
• Supportive care remains primary for mild cases 6
• Antibiotics still NOT indicated for typical viral cases 6

Chronic Bacterial Laryngitis: Rare Exception

In the uncommon scenario of chronic bacterial laryngitis (long-standing hoarseness with exudative laryngitis confirmed by culture):

• MRSA may be responsible in up to 30% of chronic bacterial cases 7
• Prolonged antibiotic therapy (minimum 21 days) is required 7
• Consider sulfamethoxazole-trimethoprim if MRSA suspected or amoxicillin-clavulanate fails 7
• This represents a distinct entity from typical acute viral laryngitis 8

When to Reassess

Additional evaluation is warranted for 1, 2:

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

Patient Education Points

Explain to patients 1, 2:

• Laryngitis is typically viral and self-limited (7-10 days)
• Antibiotics provide no benefit and cause harm
• Voice conservation and hydration are the most effective interventions
• Expected time course for symptom resolution