Treatment for Laryngitis
Laryngitis should be treated with supportive care only—voice rest, hydration, and analgesics—while avoiding antibiotics and systemic corticosteroids, which provide no benefit and cause harm. 1
First-Line Management: Supportive Care Only
The cornerstone of laryngitis treatment is symptomatic relief without pharmacologic intervention:
- Voice rest is essential to reduce vocal fold irritation and promote healing 1
- Adequate hydration maintains mucosal moisture and reduces irritation 1
- Analgesics or antipyretics (acetaminophen or NSAIDs) can be used for pain or fever relief 1
- 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
What NOT to Use: Critical Pitfalls to Avoid
Antibiotics Have No Role in Typical Laryngitis
- Antibiotics should not be routinely prescribed for viral laryngitis, as they show no effectiveness in treating acute laryngitis 1
- A Cochrane review found no significant differences in objective voice scores between antibiotic and placebo groups 2
- Antibiotic misuse contributes to bacterial resistance, increases healthcare costs unnecessarily, and may cause side effects including laryngeal candidiasis 1
Systemic Corticosteroids Should Be Avoided
- Systemic corticosteroids should not be routinely prescribed due to lack of supporting evidence for efficacy 1
- Potential adverse effects include cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, and mood disorders 1
Special Clinical Scenarios
Reflux-Associated Laryngitis
- Consider anti-reflux treatment if laryngoscopy shows signs of reflux laryngitis 1
- Be aware of PPI side effects: decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, and iron deficiency anemia 1
Pediatric Laryngitis with Croup Features
- Systemic steroids have shown better outcomes in pediatric patients with croup and associated hoarseness 1
- Epinephrine nebulization may be used for post-extubation stridor caused by laryngeal edema, with effects occurring within 30 minutes but lasting only about 2 hours 1
- Corticosteroids and nebulized epinephrine should be reserved for moderate to severe cases with respiratory distress 3
When to Escalate Care
Additional evaluation is required for:
- Symptoms persisting beyond 2-3 weeks 1
- Progressive worsening of symptoms 1
- Signs of airway compromise 1
- Suspicion of bacterial superinfection 1