What is the treatment for laryngitis?

Treatment for Laryngitis

For viral laryngitis, focus on symptomatic relief with voice rest, hydration, and analgesics—avoid antibiotics and systemic corticosteroids as they provide no benefit and may cause harm. 1, 2

Acute Viral Laryngitis (Most Common)

First-Line Management

• Voice rest is essential to reduce vocal fold irritation and promote healing 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 2
• Most cases are self-limited, improving within 7-10 days even without treatment 2

What NOT to Use

Antibiotics:

• Do not routinely prescribe antibiotics for viral laryngitis—they show no objective benefit in treating acute laryngitis 1, 3
• A Cochrane review of 206 adults found no significant differences in objective voice scores between antibiotic and placebo groups 3
• Antibiotic misuse contributes to bacterial resistance, unnecessary costs, potential side effects, and risk of laryngeal candidiasis 1, 2

Systemic Corticosteroids:

• Avoid routine use of systemic corticosteroids in adults with viral laryngitis due to lack of efficacy evidence and potential for significant adverse effects including cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, and mood disorders 1, 2

When Antibiotics ARE Appropriate

• Immunocompromised patients 1
• Confirmed bacterial infection (not just colored mucus—this does NOT differentiate viral from bacterial) 1
• Bacterial laryngotracheitis with mucosal crusting and increased work of breathing 1
• True bacterial infections presenting with high fever (≥39°C/102.2°F) for at least 3 consecutive days PLUS thick colored mucus 1
• Chronic bacterial laryngitis (especially MRSA): requires prolonged antibiotic therapy; consider sulfamethoxazole-trimethoprim if MRSA suspected, as 30% of chronic bacterial laryngitis cases may be MRSA 4

Reflux-Associated Laryngitis

• Consider anti-reflux treatment if laryngoscopy shows signs of reflux laryngitis 2
• Use once- or twice-daily PPIs for patients with suspected extraesophageal GERD syndrome (laryngitis) WITH concomitant esophageal GERD symptoms 5
• Insufficient evidence to recommend PPIs for laryngitis in the absence of concomitant esophageal GERD symptoms 5
• Be aware of PPI side effects: decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, and iron deficiency anemia 2

Pediatric Considerations

• Supportive care is primary management for acute laryngitis in children 6
• Corticosteroids and nebulized epinephrine reserved for moderate to severe cases with respiratory distress 6
• Nebulized epinephrine is effective for emergency treatment but effects are transient (lasting only about 2 hours), requiring monitoring 2, 6
• Oral or parenteral corticosteroids (such as dexamethasone) reduce subglottic edema in moderate to severe cases 6
• Avoid aspirin in children due to Reye syndrome risk 6

Red Flags Requiring Additional Evaluation

• Symptoms persisting beyond 2-3 weeks 1, 2
• Progressive worsening of symptoms 1, 2
• Signs of airway compromise 1, 2
• Suspicion of bacterial superinfection 1, 2

Common Pitfalls to Avoid

• Do not prescribe antibiotics based on colored mucus alone—this does NOT indicate bacterial infection 1
• Do not use systemic corticosteroids routinely in adults with typical viral laryngitis 1, 2
• Do not assume all chronic laryngitis is reflux-related—chronic bacterial laryngitis (including MRSA) is an increasingly recognized entity requiring culture-directed antibiotic therapy 4