What is the treatment for laryngitis?

Treatment of Laryngitis

For acute viral laryngitis, focus on symptomatic relief with voice rest, hydration, and analgesics while avoiding antibiotics and systemic corticosteroids, as these provide no proven benefit and may cause harm. 1, 2

Immediate Assessment

Before initiating standard laryngitis management, evaluate for life-threatening conditions:

• Rule out airway obstruction, particularly epiglottitis or severe laryngeal edema, especially in patients with decreased air entry 1
• Distinguish acute from chronic laryngitis based on symptom duration (acute: <3 weeks; chronic: >3 weeks) 1
• Assess for serious underlying illness including pneumonia, pulmonary embolism, or exacerbations of COPD, asthma, or bronchiectasis 1

First-Line Treatment for Acute Viral Laryngitis

The cornerstone of management is conservative, supportive care:

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

Most cases are caused by viral pathogens (parainfluenza, rhinovirus, influenza, adenovirus) and are self-limited, improving within 7-10 days even with placebo treatment 2, 3

Medications to AVOID

Antibiotics

Do not routinely prescribe antibiotics for viral laryngitis. 2, 3

• Cochrane review of 351 participants found antibiotics ineffective for objective voice outcomes in acute laryngitis 4
• Antibiotics contribute to bacterial resistance, increase healthcare costs unnecessarily, and may cause side effects including laryngeal candidiasis 2, 3
• Important caveat: Colored mucus does NOT differentiate viral from bacterial infection 1, 3

Systemic Corticosteroids

Do not routinely prescribe systemic corticosteroids for viral laryngitis in adults. 2, 3

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

Special Clinical Scenarios

Reflux-Associated Laryngitis

• Consider anti-reflux treatment if laryngoscopy shows signs of reflux laryngitis 2
• Be aware of PPI side effects: decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, and iron deficiency anemia 2
• In clinical practice, 79% of chronic laryngitis patients receive proton pump inhibitors as initial therapy 5

Bacterial Laryngitis (Epiglottitis)

• Antibiotics ARE appropriate for confirmed bacterial infection, particularly epiglottitis caused by Haemophilus influenzae type B 3, 6
• Epiglottitis requires systemic antibiotics in combination with high-dose corticosteroids (>0.3 mg/kg dexamethasone for 48 hours) 6
• This is a medical emergency requiring hospital-based treatment 6

Postinfectious Cough

If productive cough persists after acute laryngitis:

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

When to Seek 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

Patient Education

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

Critical Pitfalls to Avoid

• Do not prescribe antibiotics based on colored mucus alone, as this does not indicate bacterial infection 1, 3
• Do not use sequential antibiotics for viral postinfectious cough 1
• Carefully assess decreased air entry to exclude serious airway compromise before attributing symptoms to simple laryngitis 1