What is the treatment for laryngitis?

Treatment of Laryngitis

The primary treatment for laryngitis is symptomatic management with voice rest, adequate hydration, and analgesics—antibiotics and systemic corticosteroids should NOT be routinely prescribed for typical viral laryngitis. 1, 2, 3

Initial Assessment

Before initiating standard laryngitis management, immediately evaluate for:

• Life-threatening airway obstruction, particularly epiglottitis or severe laryngeal edema, especially in patients with decreased air entry 1
• Duration of symptoms to classify as acute (< 3 weeks), subacute, or chronic laryngitis 1
• Serious underlying illness including pneumonia or pulmonary embolism 1
• Exacerbation of preexisting conditions such as COPD, asthma, or bronchiectasis 1

First-Line Treatment for Acute Viral Laryngitis

Core Symptomatic Management

• Voice rest to reduce vocal fold irritation and promote healing 1, 2, 3
• Adequate hydration to maintain mucosal moisture 1, 2, 3
• Analgesics or antipyretics (acetaminophen or NSAIDs) for pain or fever relief 1, 2, 3
• Avoid speaking loudly or whispering, as both strain the vocal cords 1, 2

Expected Course

• Acute laryngitis is typically self-limited with improvement within 7-10 days even with placebo treatment 2
• Most cases are caused by viral pathogens including parainfluenza viruses, rhinovirus, influenza, and adenovirus 2, 3

Medications to AVOID

Antibiotics

Do NOT routinely prescribe antibiotics for viral laryngitis because:

• They show no objective benefit in treating acute laryngitis 2, 3, 4
• They contribute to bacterial antibiotic resistance 2, 3
• They increase healthcare costs unnecessarily 2
• They may cause side effects including laryngeal candidiasis 2, 3
• A Cochrane review found no significant differences in objective voice scores with penicillin V or erythromycin compared to placebo 4

Exceptions where antibiotics may be appropriate:

• Immunocompromised patients 3
• Confirmed bacterial infection 3
• Bacterial laryngotracheitis with mucosal crusting and increased work of breathing 3

Systemic Corticosteroids

Do NOT routinely prescribe systemic corticosteroids due to:

• Lack of supporting evidence for efficacy 2, 3
• Potential for significant adverse effects including cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, and mood disorders 2

Exception: In pediatric patients with croup and associated hoarseness, systemic steroids have shown better outcomes 2

Special Clinical Scenarios

Postinfectious Cough (Subacute)

If productive cough persists after acute laryngitis:

• Inhaled ipratropium bromide as initial treatment for postinfectious cough 1
• First-generation antihistamine/decongestant combination for upper airway cough syndrome symptoms 1
• Avoid sequential antibiotics, as this promotes antibiotic resistance without clinical benefit 1

Reflux-Associated Laryngitis

For chronic laryngitis with suspected GERD component:

• Consider anti-reflux treatment ONLY if laryngoscopy shows signs of reflux laryngitis 2
• PPI therapy (once or twice daily) is recommended ONLY for patients with suspected extraesophageal GERD syndrome (laryngitis) WITH a concomitant esophageal GERD syndrome 5
• There is insufficient evidence to recommend PPIs for laryngitis in the absence of concomitant esophageal GERD symptoms 5
• Be aware of PPI side effects: decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, and iron deficiency anemia 2

Chronic Bronchitis with Laryngitis

• Smoking cessation is the most effective intervention 1
• Short-acting inhaled β-agonist, inhaled ipratropium bromide, or combined long-acting β-agonist with inhaled corticosteroid may improve cough 1

When to Pursue Additional Evaluation

Refer or investigate further if:

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

Critical Pitfalls to Avoid

• Colored mucus does NOT differentiate viral from bacterial infection—this misconception leads to inappropriate antibiotic prescribing 1, 3
• Decreased air entry requires careful assessment to exclude serious airway compromise before attributing symptoms to simple laryngitis 1
• Do not prescribe sequential antibiotics for viral postinfectious cough 1

Patient Education

• Explain the viral nature of most laryngitis cases and expected time course of 7-10 days 2, 3
• Recommend voice conservation techniques and adequate hydration 2, 3
• Advise against the use of antibiotics and steroids for typical viral laryngitis 2