Treatment of Laryngitis
Primary Treatment Approach
Laryngitis should be managed with symptomatic care only—voice rest, hydration, and analgesics—while avoiding antibiotics and systemic corticosteroids, as these provide no benefit and cause harm. 1, 2
First-Line Symptomatic Management
- Voice rest is essential to reduce vocal fold irritation and promote healing 2
- 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, as both strain the vocal cords 2
Most acute laryngitis is self-limited and resolves within 7-10 days regardless of treatment, with viral symptoms typically lasting 1-3 weeks 2, 4. This natural history makes aggressive intervention unnecessary and potentially harmful.
What NOT to Prescribe
Antibiotics: Strong Recommendation Against
Do not routinely prescribe antibiotics for laryngitis. 1, 2 The evidence is clear and compelling:
- A Cochrane review found antibiotics show no objective benefit in treating acute laryngitis 1, 5
- Acute laryngitis is caused by viral pathogens (parainfluenza, rhinovirus, influenza, adenovirus), not bacteria 1, 2
- Antibiotic misuse contributes to bacterial resistance, unnecessary costs, side effects (rash, diarrhea, vomiting), and increased risk of laryngeal candidiasis 1, 3
- Even when erythromycin showed modest subjective improvements at one week, these benefits do not outweigh the harms 5
Systemic Corticosteroids: Avoid Routine Use
Do not routinely prescribe systemic corticosteroids for laryngitis. 1, 2 The guideline is explicit:
- No supporting evidence for efficacy in typical laryngitis 2, 3
- Significant adverse effects include cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, and mood disorders 2
- Steroids should only be used when the diagnosis is known and treatment is targeted, particularly in professional voice users, after shared decision-making about risks and limited benefits 1
When to Consider Exceptions
Antibiotics May Be Appropriate In:
- Immunocompromised patients (e.g., laryngeal tuberculosis in renal transplant or HIV patients) 1, 3
- Confirmed bacterial infections such as pertussis outbreaks or bacterial laryngotracheitis with mucosal crusting, stridor, and increased work of breathing 1, 3
- The diagnosis must be established before initiating therapy 1
Special Clinical Scenarios:
- Reflux-associated laryngitis: Consider anti-reflux treatment if laryngoscopy shows reflux laryngitis signs, but be aware of PPI side effects (decreased calcium absorption, increased hip fracture risk, vitamin B12 and iron deficiency) 2
- Pediatric croup with hoarseness: Systemic steroids have shown better outcomes in this specific context 2
When to Escalate Care
Perform diagnostic laryngoscopy and consider additional evaluation for: 1, 2, 4
- Symptoms persisting beyond 2-3 weeks (or 4 weeks for laryngoscopy indication) 2, 4
- Progressive worsening of symptoms 2, 3
- Signs of airway compromise or stridor 2, 4
- Suspicion of bacterial superinfection 2, 3
- Professional voice users who cannot afford to wait weeks for resolution 4
- Recent head/neck/chest surgery or intubation 4
- Concomitant neck mass 4
- History of tobacco abuse 4
Patient Education Points
- The viral nature of most laryngitis cases and expected 7-10 day time course 2, 3
- Voice conservation techniques and the importance of adequate hydration 2, 3
- Why antibiotics and steroids are not recommended for typical viral laryngitis 2, 3
- When to return for re-evaluation (symptoms beyond 2-3 weeks or worsening) 2