What is the best way to speed up voice return in laryngitis?

Speeding Up Voice Return in Laryngitis

Most laryngitis is viral and self-limited, resolving in 7-10 days regardless of treatment, so the focus should be on symptomatic relief with voice rest, hydration, and analgesics—while avoiding antibiotics and corticosteroids which provide no benefit and carry potential harm. 1, 2, 3

What NOT to Do (Critical to Avoid Harm)

• Do not prescribe antibiotics for viral laryngitis — they show zero effectiveness in treating acute laryngitis, contribute to antibiotic resistance, increase costs, and may cause laryngeal candidiasis 1, 2, 3, 4
• Do not routinely prescribe systemic corticosteroids — there is no supporting evidence for efficacy in viral laryngitis, and they carry significant risks including cardiovascular disease, hypertension, osteoporosis, impaired wound healing, infection risk, and mood disorders 1, 2, 3
• Do not prescribe proton pump inhibitors (PPIs) empirically without laryngoscopy — there is no evidence supporting empirical PPI use for dysphonia alone, and prolonged use carries risks including impaired cognition, pneumonia, hip fractures, vitamin B12 deficiency, and chronic kidney disease 1

First-Line Symptomatic Management

• Voice rest is essential to reduce vocal fold irritation and promote healing 2, 3
• Adequate hydration maintains mucosal moisture and reduces irritation 2, 3
• Analgesics or antipyretics (acetaminophen or NSAIDs) for pain or fever relief 2, 3
• Avoid both loud speaking AND whispering — both strain the vocal cords 3

When to Escalate Care

Laryngoscopy is indicated if dysphonia persists beyond 2-3 weeks, symptoms progressively worsen, or there are signs of airway compromise 2, 3. This is critical because:

• Most viral laryngitis resolves within 7-10 days 1
• Persistent symptoms may indicate other pathology requiring different management 1
• Professional voice users warrant earlier evaluation due to occupational impact 1

Voice Therapy for Persistent Dysphonia

If dysphonia persists and reduces quality of life after laryngoscopy confirms the diagnosis, voice therapy should be advocated — there is moderate-to-good evidence supporting direct symptomatic and behavioral voice therapies 1, 5. Key techniques include:

• Natural reflexive behaviors and playful sounds (sighing "ah," quiet sirens using nasal sounds, low-pitched glottal fry, giggling) 1
• Automatic phrases with minimal communicative responsibility (counting, days of the week, singing familiar songs) 1
• Physical maneuvers including circumlaryngeal massage with concurrent vocalization and laryngeal repositioning during phonation 1, 5
• Attentional redirection such as bubble blowing into water with vocalization and large body movements while making sounds 1, 5

Special Considerations

For reflux-associated laryngitis confirmed by laryngoscopy, consider anti-reflux treatment only if there are visible signs of reflux laryngitis or concomitant GERD symptoms (heartburn, regurgitation) 1, 3. Be aware that PPI benefits for dysphonia without esophageal symptoms are inconclusive 1.

For professional voice users, early evaluation is warranted as delay in diagnosis can have significant psychological and economic ramifications 1.

Common Pitfalls

• Prescribing antibiotics because mucus is colored — colored mucus does NOT differentiate viral from bacterial infection 2
• Using corticosteroids before laryngoscopy — this can mask serious pathology and provides no proven benefit 1, 2
• Assuming all persistent hoarseness is "just laryngitis" — smokers with dysphonia require particular concern due to increased risk of polypoid lesions and laryngeal cancer 1