What is the treatment for laryngitis?

Treatment of Laryngitis

For typical viral laryngitis, focus on symptomatic relief with voice rest, hydration, and analgesics—antibiotics and systemic corticosteroids should NOT be used routinely. 1, 2

First-Line Management for Viral Laryngitis

The vast majority of laryngitis cases are viral (caused by parainfluenza, rhinovirus, influenza, or adenovirus) and self-limited, improving within 7-10 days even without treatment. 1, 2

Core symptomatic measures include:

• Voice rest to reduce vocal fold irritation—avoid both loud speaking AND whispering, as both strain the vocal cords 2
• Adequate hydration to maintain mucosal moisture 1, 2
• Analgesics or antipyretics (acetaminophen or NSAIDs) for pain or fever relief 1, 2

What NOT to Prescribe

Antibiotics Should Be Avoided

• Antibiotics show no objective benefit in treating acute viral laryngitis and should not be routinely prescribed 1, 2, 3
• The evidence is clear: while one Cochrane review found erythromycin provided modest subjective improvement in voice disturbance at one week, these minimal benefits do not outweigh the harms 3
• Antibiotic misuse leads to: bacterial resistance, unnecessary costs, potential side effects, and risk of laryngeal candidiasis 1, 2
• Even colored mucus does NOT differentiate viral from bacterial infection—this is a critical clinical pitfall 1

Systemic Corticosteroids Should Be Avoided

• Routine systemic corticosteroids are not recommended for viral laryngitis in adults due to lack of efficacy evidence and significant potential adverse effects 1, 2
• Potential harms include: cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, and mood disorders 2

When to Consider Alternative Diagnoses or Treatments

Bacterial Laryngitis (Rare)

• True bacterial infection presents with high fever (≥39°C/102.2°F) for at least 3 consecutive days PLUS thick colored mucus 1
• If bacterial laryngitis is suspected (particularly MSSA or MRSA), culture by biopsy is recommended, and extended courses of antibiotics may be necessary 4
• Bacterial epiglottitis (supraglottic laryngitis) requires antibiotics combined with corticosteroids 5

Fungal Laryngitis (Immunocompromised Patients)

• Candidal laryngitis requires early detection via fiberoptic or indirect laryngoscopy 6
• Treatment options include intravenous amphotericin B or oral/intravenous fluconazole 6
• Impending airway obstruction requires endotracheal intubation 6
• Aspergillus laryngeal infection in immunocompromised hosts requires systemic antifungal therapy plus surgical debridement or excision for successful outcomes 6

Red Flags Requiring Additional Evaluation

Consider further workup if: 1, 2

• Symptoms persist beyond 2-3 weeks
• Progressive worsening of symptoms
• Signs of airway compromise
• Suspicion of bacterial superinfection
• Immunocompromised status

Reflux-Associated Laryngitis

• If laryngoscopy shows signs of reflux laryngitis, consider anti-reflux treatment 2
• Be aware of PPI side effects: decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, and iron deficiency anemia 2

Special Populations

Pediatric Croup with Laryngitis

• Systemic steroids (high-dose dexamethasone >0.3 mg/kg for 48 hours) have shown better outcomes in children with croup-associated hoarseness 2, 5
• Epinephrine nebulization may be used for post-extubation stridor from laryngeal edema—effects occur within 30 minutes but last only about 2 hours 2

Patient Education

Explain to patients: 1, 2

• The viral nature of most laryngitis cases
• Expected time course (7-10 days for improvement)
• Voice conservation techniques
• Why antibiotics and steroids are not appropriate for typical viral laryngitis
• When to return for re-evaluation (symptoms beyond 2-3 weeks, worsening dyspnea, airway compromise)