Treatment of Laryngitis
For typical acute viral laryngitis, provide symptomatic management with voice rest, hydration, and analgesics—do NOT prescribe antibiotics or systemic corticosteroids routinely, as they provide no benefit and cause harm. 1, 2, 3
Initial Assessment
Before initiating treatment, determine the type and severity of laryngitis:
- Rule out life-threatening conditions first: Assess for airway obstruction, epiglottitis, or severe laryngeal edema, particularly if decreased air entry is present 4
- Classify by duration: Acute laryngitis (symptoms <3 weeks) versus chronic laryngitis (symptoms >3 weeks) 4
- Identify the etiology: Most cases are viral (parainfluenza, rhinovirus, influenza, adenovirus) and self-limited, resolving in 7-10 days 1, 2, 3
First-Line Treatment for Acute Viral Laryngitis
Symptomatic management is the cornerstone of treatment:
- Voice rest: Essential to reduce vocal fold irritation and promote healing—avoid both loud speaking AND whispering, as both strain the vocal cords 2, 3, 4
- Adequate hydration: Maintains mucosal moisture and reduces irritation 2, 3, 4
- Analgesics/antipyretics: Use acetaminophen or NSAIDs for pain or fever relief 2, 3, 4
What NOT to Prescribe
Antibiotics: Strong Recommendation Against
Do not routinely prescribe antibiotics for acute laryngitis. 1, 2, 3
The American Academy of Otolaryngology-Head and Neck Surgery provides Grade A evidence showing:
- No objective benefit in treating acute viral laryngitis 1, 2
- Systematic reviews demonstrate no benefit of penicillin or erythromycin 1
- Harms include: bacterial antibiotic resistance, unnecessary healthcare costs, side effects, and risk of laryngeal candidiasis 2, 3
Important caveat: Colored mucus does NOT indicate bacterial infection 2, 4. Antibiotics may only be appropriate for:
- Confirmed bacterial infection with high fever (≥39°C) for ≥3 consecutive days plus thick colored mucus 2
- Immunocompromised patients 2
- Bacterial laryngotracheitis with mucosal crusting and increased work of breathing 2
Systemic Corticosteroids: Recommendation Against
Do not routinely prescribe systemic corticosteroids for viral laryngitis in adults. 1, 2, 3
- Lack of supporting evidence for efficacy 1, 2, 3
- Significant potential adverse effects: cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, mood disorders 3
- Exception: Pediatric croup with associated hoarseness may benefit from systemic steroids 3
When to Consider Additional Evaluation
Laryngoscopy is mandatory before prescribing voice therapy to establish diagnosis and rule out pathology not amenable to conservative management 1
Refer for additional evaluation 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
Special Considerations
Reflux-Associated Laryngitis
If laryngoscopy shows signs of reflux laryngitis AND the patient has concomitant esophageal GERD symptoms, consider PPI therapy (once- or twice-daily for 3-4 months) 1, 3
Critical distinction: The American Gastroenterological Association provides Grade D evidence (recommend against) for PPI therapy in suspected reflux laryngitis WITHOUT concomitant esophageal GERD symptoms 1. The causal relationship remains controversial and unproven in isolated laryngitis 1.
Be aware of PPI side effects: decreased calcium absorption, increased hip fracture risk, vitamin B12 deficiency, iron deficiency anemia 3
Voice Therapy
Advocate for voice therapy when hoarseness reduces voice-related quality of life, but only after laryngoscopy confirms the diagnosis 1
Patient Education
Explain to patients: