What is the treatment for laryngitis?

Treatment of Laryngitis

Laryngitis should be managed with supportive care alone—voice rest, hydration, and analgesics—while avoiding antibiotics and systemic corticosteroids, which provide no benefit and carry significant risks. 1

First-Line Management: Supportive Care Only

The cornerstone of laryngitis treatment is conservative management, as acute laryngitis is self-limited with improvement within 7-10 days regardless of intervention 1, 2:

• Voice rest is essential to reduce vocal fold irritation and promote healing 1
• Adequate hydration maintains mucosal moisture and reduces irritation 1
• Analgesics (acetaminophen or NSAIDs) provide symptomatic relief for pain or fever 1
• Avoid both loud speaking and whispering, as both strain the vocal cords 1

What NOT to Prescribe

Antibiotics: No Role in Treatment

Antibiotics should never be prescribed for laryngitis, as the condition is viral in origin and antibiotics demonstrate no effectiveness 1, 3:

• A Cochrane systematic review found no objective improvement in voice scores with antibiotic therapy 3
• While one trial showed subjective improvement with erythromycin at one week, this is not clinically relevant 3
• Antibiotic use contributes to bacterial resistance, increases healthcare costs, and may cause side effects including laryngeal candidiasis 1, 2

Systemic Corticosteroids: Avoid Routine Use

The American Academy of Otolaryngology-Head and Neck Surgery recommends against routine corticosteroid use for laryngitis, citing a "preponderance of harm over benefit" 2:

• No clinical trials demonstrate efficacy for corticosteroids in treating adult laryngitis 2
• Documented risks include cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, and mood disorders 1, 2
• Even single-dose steroid therapy can cause sleep disturbances, mood disorders, gastrointestinal disturbances, and metabolic effects 2

Special Circumstances Requiring Modified Approach

Reflux-Associated Laryngitis

Anti-reflux therapy should only be considered when laryngoscopy demonstrates signs of reflux laryngitis (erythema, edema, redundant tissue, or surface irregularities of the interarytenoid mucosa, arytenoid mucosa, posterior laryngeal mucosa, and/or vocal folds) 4:

• Do not prescribe PPIs empirically for hoarseness without GERD symptoms or laryngoscopic findings 4
• When laryngitis is confirmed on laryngoscopy, anti-reflux medications may be considered as an option 4
• Be aware that PPI use carries risks including decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, and iron deficiency anemia 4, 1

Professional Voice Users

In professional voice users with confirmed allergic laryngitis who are acutely dependent on their voice, corticosteroids may be considered only after 2:

• Laryngoscopy confirms the diagnosis 2
• Shared decision-making discusses limited evidence and documented risks 2
• Using the lowest effective dose for the shortest duration 2

This exception is based on limited case reports, not high-quality evidence 2.

Pediatric Croup with Laryngitis

In children with croup and associated laryngitis symptoms, management differs 1, 5:

• Systemic corticosteroids (such as dexamethasone) are effective for moderate to severe cases with respiratory distress 5
• Nebulized epinephrine provides rapid but transient relief (effects within 30 minutes, lasting approximately 2 hours) 1, 5
• Mild cases still require only supportive care 5

When to Pursue Further Evaluation

Laryngoscopy should be performed if 1, 2:

• Symptoms persist beyond 2-3 weeks 1
• Progressive worsening of symptoms occurs 1
• Signs of airway compromise develop 1
• Suspicion of bacterial superinfection arises 1
• No patient should wait longer than 3 months for laryngeal examination 2

Common Pitfalls to Avoid

• Do not prescribe corticosteroids before laryngeal visualization, as this may delay appropriate diagnosis and treatment 2
• Do not use antibiotics based on patient expectation alone—patient education about the viral, self-limited nature is crucial 1, 2
• Do not prescribe PPIs empirically without laryngoscopic evidence of laryngitis or GERD symptoms 4
• Avoid aspirin in children due to Reye syndrome risk 5