What is the treatment for laryngitis?

Treatment for Laryngitis

Laryngitis should be treated with voice rest, adequate hydration, and analgesics for symptom relief, while avoiding antibiotics and systemic corticosteroids, which lack proven benefit and may cause harm. 1, 2

First-Line Symptomatic Management

The cornerstone of laryngitis treatment focuses on conservative measures that promote healing without pharmacologic intervention:

• Voice rest is essential to reduce vocal fold irritation and allow mucosal recovery 1, 3
• Avoid both loud speaking and whispering, as both strain the vocal cords and impede healing 1, 3
• Maintain adequate hydration to preserve mucosal moisture and reduce irritation 1, 3
• Use analgesics or antipyretics (acetaminophen or NSAIDs) for pain or fever relief as needed 1, 3

Most cases of acute laryngitis are viral in origin (parainfluenza, rhinovirus, influenza, adenovirus) and self-limited, with improvement occurring within 7-10 days even without specific treatment 1, 2

Medications to Explicitly Avoid

Antibiotics Have No Role in Typical Viral Laryngitis

Do not prescribe antibiotics for routine laryngitis. High-quality evidence demonstrates no objective benefit in treating acute laryngitis with antibiotics 1, 2, 4. A Cochrane review of randomized controlled trials found that antibiotics do not improve objective voice scores and provide only modest subjective benefits that do not outweigh their risks 4.

The harms of inappropriate antibiotic use include:

• Promotion of bacterial antibiotic resistance 1, 2
• Unnecessary healthcare costs 1, 2
• Risk of laryngeal candidiasis 1, 2
• Potential medication side effects without clinical benefit 1

Systemic Corticosteroids Should Not Be Routinely Used

Avoid systemic corticosteroids for typical adult laryngitis due to lack of efficacy evidence and significant potential adverse effects 1, 2. The risks include cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, increased infection risk, and mood disorders 1.

Special Clinical Scenarios

Reflux-Associated Laryngitis

• Consider anti-reflux treatment if laryngoscopy demonstrates signs of reflux laryngitis 1
• Be aware that proton pump inhibitors carry risks including decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, and iron deficiency anemia 1
• Despite widespread use (79% of patients in one cohort received PPIs), this should be reserved for documented reflux disease 5

Pediatric Croup with Laryngeal Involvement

• Systemic steroids have demonstrated benefit in pediatric patients with croup and associated hoarseness 1
• Epinephrine nebulization may be used for post-extubation stridor from laryngeal edema, with effects occurring within 30 minutes but lasting only approximately 2 hours 1

When Antibiotics May Be Appropriate

Antibiotics should only be considered in specific circumstances:

• Immunocompromised patients 2
• Confirmed bacterial infection (not presumed based on colored mucus) 2
• Bacterial laryngotracheitis with mucosal crusting and increased work of breathing 2
• True bacterial epiglottitis (supraglottic laryngitis), which requires antibiotics in combination with corticosteroids 6

Critical Pitfalls to Avoid

The Colored Mucus Misconception

Colored mucus does NOT differentiate viral from bacterial infection 3, 2. This common misconception leads to inappropriate antibiotic prescribing. True bacterial infection requires high fever (≥39°C/102.2°F) for at least 3 consecutive days plus thick colored mucus 2.

When to Escalate Care

Refer for additional evaluation if:

• Symptoms persist beyond 2-3 weeks 1, 2
• Progressive worsening of symptoms occurs 1, 2
• Signs of airway compromise develop 1, 2
• Suspicion of bacterial superinfection arises 1, 2
• Decreased air entry requires careful assessment to exclude serious airway compromise before attributing symptoms to simple laryngitis 3

Patient Education Points

• Explain the viral nature of most laryngitis cases and the expected 7-10 day time course 1, 2
• Emphasize voice conservation techniques and adequate hydration 1, 2
• Clearly advise against requesting antibiotics or steroids for typical viral laryngitis 1
• Dysphonia is the leading sign of chronic laryngitis, while dyspnea is the leading sign of acute laryngitis and indicates more severe disease 6