What is the treatment for laryngitis?

Treatment of Laryngitis

Laryngitis should be managed with conservative symptomatic treatment including voice rest, adequate hydration, and analgesics, while avoiding antibiotics and systemic corticosteroids, which provide no proven benefit and carry significant risks. 1, 2, 3

First-Line Conservative Management

Voice rest is the cornerstone of treatment to reduce vocal fold irritation and promote healing. 1, 3 Patients should avoid both loud speaking and whispering, as both strain the vocal cords. 1, 3

• Adequate hydration maintains mucosal moisture and reduces irritation. 1, 2, 3
• Analgesics or antipyretics (acetaminophen or NSAIDs) can be used for pain or fever relief. 1, 2, 3
• Most viral laryngitis resolves within 7-10 days even with placebo treatment, and within 1-3 weeks for typical cases. 2, 3

Medications to Avoid

Antibiotics Are Not Indicated

Antibiotics should not be prescribed for viral laryngitis. 2, 3 A Cochrane systematic review found no objective benefit from antibiotics (penicillin V or erythromycin) in treating acute laryngitis when measuring objective voice scores. 4, 5 While erythromycin showed some subjective improvement in voice disturbance at one week, these modest benefits do not outweigh the risks of antibiotic resistance, adverse effects, and unnecessary costs. 4, 5

• Antibiotics contribute to bacterial resistance without clinical benefit. 2, 3
• They may cause side effects including laryngeal candidiasis. 3
• Colored mucus does not differentiate viral from bacterial infection and should not guide antibiotic prescribing. 1

Systemic Corticosteroids Should Be Avoided

Systemic corticosteroids should not be routinely prescribed due to lack of efficacy evidence and significant potential adverse effects including cardiovascular disease, hypertension, osteoporosis, cataracts, impaired wound healing, infection risk, and mood disorders. 2, 3

When to Perform Laryngoscopy

Laryngoscopy should be performed at 4 weeks if symptoms persist to visualize the larynx and vocal folds, as this timing balances allowing spontaneous resolution while preventing diagnostic delay for serious conditions. 2

• Earlier laryngoscopy is indicated for professional voice users with significant work impairment. 2
• Symptoms persisting beyond 2-3 weeks, progressive worsening, signs of airway compromise, or suspicion of bacterial superinfection require additional evaluation. 3

Anti-Reflux Therapy: Only After Laryngoscopy

Anti-reflux medications should NOT be prescribed empirically for hoarseness without laryngoscopic evidence of laryngitis or GERD symptoms. 6, 2 The American Academy of Otolaryngology-Head and Neck Surgery recommends against prescribing anti-reflux medications for patients with hoarseness without signs or symptoms of gastroesophageal reflux disease. 6

When Anti-Reflux Therapy May Be Considered

Anti-reflux therapy is an option only if laryngoscopy demonstrates inflammatory findings such as erythema, edema, redundant tissue, and/or surface irregularities of the inter-arytenoid mucosa, arytenoid mucosa, posterior laryngeal mucosa, and/or vocal folds. 6, 2

Important caveats about PPI therapy:

• PPIs may interfere with calcium absorption and increase hip fracture risk in older adults. 6
• PPIs decrease vitamin B12 absorption in a dose-dependent manner. 6
• PPIs may decrease iron absorption and cause iron deficiency anemia. 6
• Acid-suppressing drugs are associated with increased risk of pancreatitis. 6

Critical Assessment Points

Before attributing symptoms to simple laryngitis, rule out life-threatening conditions:

• Immediate evaluation is needed to exclude airway obstruction, particularly epiglottitis or severe laryngeal edema, in patients with decreased air entry. 1
• Assess for serious illness including pneumonia or pulmonary embolism. 1
• Evaluate for exacerbation of preexisting conditions such as COPD, asthma, or bronchiectasis. 1

Patient Education

Explain the viral nature of most laryngitis cases and the expected 1-3 week resolution time. 2, 3 Emphasize voice conservation techniques and adequate hydration. 2, 3 Inform patients that antibiotics provide no benefit for viral laryngitis and that laryngoscopy will be necessary if symptoms persist beyond 3-4 weeks to identify the underlying cause. 2