What is the recommended treatment for a patient with laryngitis?

Treatment of Laryngitis

For typical viral laryngitis, focus on symptomatic relief with voice rest, hydration, and analgesics—avoid antibiotics and systemic corticosteroids as they provide no meaningful benefit and carry unnecessary risks. 1, 2

First-Line Management

The cornerstone of treatment is conservative symptomatic care:

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

Most cases are self-limited, with improvement occurring within 7-10 days even with placebo treatment 2

What NOT to Prescribe

Antibiotics Should Be Avoided

• Do not routinely prescribe antibiotics for viral laryngitis—they show no objective benefit in treating acute laryngitis 1, 4
• Antibiotics contribute to bacterial resistance, increase healthcare costs unnecessarily, and may cause side effects including laryngeal candidiasis 1, 2
• A Cochrane review of 351 participants found no significant differences in objective voice scores between antibiotic and placebo groups 4
• The modest subjective benefits (erythromycin reducing voice disturbance at one week) do not outweigh the risks of adverse effects and antibiotic resistance 4

Systemic Corticosteroids Should Be Avoided

• Do not routinely prescribe systemic corticosteroids for viral laryngitis in adults due to lack of supporting evidence for efficacy 1, 2
• Potential adverse effects include cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, and mood disorders 2

Common Pitfalls to Avoid

• Colored mucus does NOT differentiate viral from bacterial infection—this misconception leads to inappropriate antibiotic prescribing 1, 3
• True bacterial infections present with high fever (≥39°C/102.2°F) for at least 3 consecutive days PLUS thick colored mucus 1
• Do not use sequential antibiotics for viral postinfectious cough, as this promotes antibiotic resistance without clinical benefit 3

When to Consider Additional Evaluation

Reassess or refer if any of the following are present:

• Symptoms persisting beyond 2-3 weeks 1, 2
• Progressive worsening of symptoms 1, 2
• Signs of airway compromise or decreased air entry 1, 3
• Suspicion of bacterial superinfection 1, 2

Special Clinical Scenarios

Bacterial Laryngitis (Rare)

Antibiotics may be appropriate for:

• Immunocompromised patients 1
• Confirmed bacterial infection 1
• Bacterial laryngotracheitis with mucosal crusting and increased work of breathing 1

Reflux-Associated Laryngitis

• Consider anti-reflux treatment if laryngoscopy shows signs of reflux laryngitis 2, 5
• Be aware of PPI side effects: decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, and iron deficiency anemia 2

Postinfectious Cough Component

• Inhaled ipratropium bromide can be used as initial treatment for postinfectious cough 3
• A first-generation antihistamine/decongestant combination can be used for upper airway cough syndrome symptoms 3

Patient Education

• Explain the viral nature of most laryngitis cases and expected time course of 7-10 days 1, 2
• Recommend voice conservation techniques and adequate hydration 1, 2
• Advise against the use of antibiotics and steroids for typical viral laryngitis 2

Etiology

Most cases are caused by viral pathogens including parainfluenza viruses, rhinovirus, influenza, and adenovirus 1, 2, 6