Management of Acute Laryngitis with Hoarseness
Do not prescribe antibiotics or corticosteroids routinely for acute laryngitis, as this condition is self-limited and resolves within 7-10 days without treatment. 1
Core Management Principles
What NOT to Do
Avoid routine antibiotic therapy - The American Academy of Otolaryngology-Head and Neck Surgery makes a strong recommendation against routine antibiotic use for hoarseness, as systematic reviews demonstrate no benefit for acute laryngitis or upper respiratory tract infections. 1, 2
Avoid empiric corticosteroid use - Steroids should not be prescribed before laryngeal visualization, as acute laryngitis is self-limited with improvement in 7-10 days regardless of treatment. 1, 3 The risk-benefit ratio shows a preponderance of harm over benefit when steroids are used empirically. 3
Avoid anti-reflux medications empirically - These should only be considered if there are concurrent signs or symptoms of gastroesophageal reflux disease. 1
What TO Do
Conservative management is the cornerstone of treatment for acute laryngitis:
Voice rest and vocal hygiene - This is the primary intervention for acute laryngitis. 4, 5
Symptomatic treatment - Address symptoms such as cough and throat discomfort with supportive care. 6
Patient education - Counsel patients about the self-limited nature of the condition (7-10 day resolution) and preventive measures. 1
When to Perform Laryngoscopy
Consider laryngoscopy if:
Hoarseness persists beyond 2-4 weeks without a known benign cause. 7, 4
There is concern for an underlying serious condition (e.g., smoking history, concurrent alcohol use). 6, 4
The patient is a professional voice user requiring definitive diagnosis. 3
You are considering voice therapy, as laryngoscopy must be performed before prescribing voice therapy to establish a diagnosis. 1
Important caveat: The guideline allows laryngoscopy at any time as an option, or referral to a clinician who can visualize the larynx. 1 No patient should wait longer than 3 months for laryngeal examination. 1
Voice Therapy Considerations
If hoarseness reduces voice-related quality of life and persists beyond the acute phase:
Visualize the larynx first via laryngoscopy to establish diagnosis. 1
Advocate for voice therapy, which has Level 1a evidence for effectiveness in functional and organic vocal disturbances. 1, 6
Document and communicate laryngoscopy findings to the speech-language pathologist. 1
Rare Exceptions for Steroid Use
Corticosteroids may be considered only in specific circumstances:
Professional voice users with confirmed allergic laryngitis who are acutely dependent on their voice (requires laryngoscopy confirmation and shared decision-making). 3
Pediatric patients with croup and associated hoarseness. 1, 3
Severe airway obstruction after appropriate evaluation. 3
Specific autoimmune disorders involving the larynx (systemic lupus erythematosus, sarcoidosis, granulomatosis with polyangiitis). 3
Common Pitfalls to Avoid
Empiric treatment without visualization delays appropriate diagnosis and may mask serious pathology such as laryngeal malignancy (2.2-3% of hoarseness cases). 6, 4
Antibiotic overuse contributes to resistance patterns without providing benefit, as acute laryngitis is typically viral in origin. 1, 2
Short-term steroid use carries documented risks including sleep disturbances, mood disorders, gastrointestinal disturbances, metabolic effects, infection risk, and cardiovascular complications. 3