What is the treatment for laryngitis?

Treatment of Laryngitis

Laryngitis should be managed with symptomatic care only—voice rest, hydration, and analgesics—while avoiding antibiotics and systemic corticosteroids, as these medications provide no proven benefit and carry significant risks. 1, 2

First-Line Management: Symptomatic Care

The cornerstone of laryngitis treatment is conservative, supportive care:

• 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) provide pain and fever relief 2, 3
• Avoid both loud speaking and whispering, as both strain the vocal cords 2, 3

Most acute laryngitis is viral (caused by parainfluenza, rhinovirus, influenza, or adenovirus) and self-limited, resolving spontaneously within 7-10 days regardless of treatment 2, 4. Symptoms typically last 1-3 weeks 4.

What NOT to Prescribe

Antibiotics: Strong Recommendation Against

Do not routinely prescribe antibiotics for laryngitis. 1

The evidence is clear and compelling:

• A Cochrane systematic review found antibiotics show no effectiveness in treating acute laryngitis when assessing objective outcomes 5
• A randomized trial of 100 adults found penicillin V provided no benefit over placebo for voice scores or symptom resolution 6
• Antibiotics contribute to bacterial resistance, increase healthcare costs unnecessarily, and cause side effects including laryngeal candidiasis 1, 2
• The vast majority of laryngitis is viral, making antibiotics ineffective by mechanism 1

The only exception is in immunosuppressed patients with suspected bacterial superinfection 1.

Systemic Corticosteroids: Strong Recommendation Against

Do not routinely prescribe systemic corticosteroids for laryngitis. 1, 2

Steroids carry significant risks without proven benefit:

• No evidence supports efficacy for routine laryngitis 1, 2
• Substantial adverse effects include cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, mood disorders, avascular necrosis, pancreatitis, and diabetogenesis 1, 2
• Dose-dependent risks of candidiasis and pharyngitis 1

Steroids should only be considered in specific autoimmune disorders (lupus, sarcoidosis, granulomatosis with polyangiitis) or airway compromise after proper diagnosis, with shared decision-making about risks versus limited benefits 1.

Anti-Reflux Therapy: Limited Role

Do NOT Use Empirically

Do not prescribe proton pump inhibitors (PPIs) empirically for hoarseness without GERD symptoms or laryngoscopic evidence of laryngitis. 1

The evidence shows:

• A randomized trial of 145 patients with chronic laryngeal symptoms found no benefit from esomeprazole 40 mg twice daily versus placebo for symptom scores or quality of life 1
• PPIs carry risks including decreased calcium absorption, increased hip fracture risk (especially in older adults), vitamin B12 deficiency, iron deficiency anemia, and increased pancreatitis risk 1

Consider Only With Laryngoscopic Findings

Anti-reflux treatment may be an option when laryngoscopy demonstrates signs of reflux laryngitis (erythema, edema, redundant tissue, surface irregularities of the interarytenoid mucosa, arytenoid mucosa, posterior laryngeal mucosa, or vocal folds) 1. However, even in this context, evidence is limited and inter-rater reliability for these findings is poor 1.

If used, typical dosing is twice-daily PPI for 3-4 months, though this remains an off-label indication 1.

When to Escalate Care

Refer for laryngoscopy if hoarseness persists beyond 4 weeks or if serious underlying concerns exist 1, 4.

Immediate evaluation is warranted for:

• Professional voice users who cannot afford delayed diagnosis 4
• Recent head/neck/chest surgery or intubation 4
• Concomitant neck mass 4
• Respiratory distress or stridor 4
• History of tobacco abuse (concern for malignancy) 4
• Progressive worsening of symptoms 2, 4
• Signs of airway compromise 2, 3

The 4-week threshold balances timely diagnosis of serious pathology (including laryngeal cancer) against over-utilization, as viral laryngitis typically resolves within 1-3 weeks 1, 4.

Special Populations

Pediatric Croup

In children with croup-associated hoarseness, systemic steroids have demonstrated benefit, unlike in adult laryngitis 2.

Post-Extubation Laryngeal Edema

Epinephrine nebulization may be used for post-extubation stridor in pediatric patients, with effects occurring within 30 minutes but lasting only about 2 hours 2.

Common Pitfalls to Avoid

• Do not prescribe sequential antibiotics for viral postinfectious symptoms, as this promotes resistance without benefit 3
• Colored mucus does not indicate bacterial infection—this misconception leads to inappropriate antibiotic prescribing 3
• Do not assume all laryngeal inflammation requires PPI therapy—the evidence for benefit is weak and risks are real 1
• Do not delay laryngoscopy beyond 4 weeks in persistent hoarseness, as this may delay cancer diagnosis 1