Treatment of Acute Laryngitis
Acute laryngitis should be managed with supportive care only—antibiotics and corticosteroids are not recommended for routine use, as the condition is self-limited and resolves within 7-10 days regardless of treatment. 1, 2
Primary Management Approach
Supportive Care (First-Line Treatment)
- Analgesics or antipyretics for pain or fever relief 2, 3
- Adequate hydration to maintain mucosal moisture 2
- Voice rest to reduce vocal fold irritation 2, 3
- Throat lozenges for symptomatic pain relief 3
The vast majority of acute laryngitis cases are viral in origin (caused by parainfluenza viruses, rhinovirus, influenza, and adenovirus), making antibiotics ineffective 2, 3. A Cochrane systematic review of randomized controlled trials found that antibiotics provide no objective improvement in voice scores or clinical outcomes 4, 5.
What NOT to Prescribe
Antibiotics Are Not Indicated
- Do not routinely prescribe antibiotics for acute laryngitis 1, 2, 4
- Antibiotics show no objective benefit in treating acute laryngitis based on high-quality randomized controlled trials 4, 5
- While erythromycin showed minimal subjective improvement at one week (RR 0.7,95% CI 0.51-0.96), this is not clinically relevant and does not justify routine use 4, 5
- Antibiotic misuse contributes to bacterial resistance, unnecessary costs, and potential side effects including laryngeal candidiasis 2
Corticosteroids Are Not Routinely Indicated
- The American Academy of Otolaryngology-Head and Neck Surgery recommends against empiric corticosteroid use for laryngitis before laryngeal visualization 1, 2
- There is no supporting evidence for efficacy in routine acute laryngitis 1, 2
- Even short-term corticosteroid use carries documented risks including sleep disturbances, mood disorders, gastrointestinal effects, metabolic complications, and infection risk 1
Expected Clinical Course
- Most cases resolve spontaneously within 7-10 days 1, 2, 3
- Viral symptoms typically last 1-3 weeks regardless of treatment 3
- Patients should be counseled about this self-limited nature to set appropriate expectations 1, 2
When to Escalate Care
Perform Laryngoscopy If:
- Hoarseness persists beyond 2-4 weeks without a known benign cause 1, 3
- Progressive worsening of symptoms occurs 2
- Signs of airway compromise develop (stridor, respiratory distress) 2, 3
- Suspicion of bacterial superinfection arises 2
- Patient has recent head/neck/chest surgery or intubation 3
- Concomitant neck mass is present 3
- History of tobacco abuse exists 3
No patient should wait longer than 3 months for laryngeal examination if symptoms persist 1
Special Circumstances Where Treatment May Differ
Professional Voice Users
- Corticosteroids may be considered only in professional voice users with confirmed allergic laryngitis who are acutely dependent on their voice 1
- This exception requires laryngoscopy before treatment to confirm the diagnosis 1
- Shared decision-making must discuss limited evidence and documented risks 1
- Standard dosing would be prednisolone 50 mg per day for 3 days 1
Bacterial Superinfection (Rare)
- Antibiotics may be appropriate for confirmed bacterial infection (not empiric use) 2
- Consider in immunocompromised patients 2
- Bacterial laryngotracheitis with mucosal crusting and increased work of breathing may warrant antibiotics 2
Common Pitfalls to Avoid
Do Not Be Misled by Colored Mucus
- Colored mucus does NOT differentiate viral from bacterial infection 2
- True bacterial infection requires high fever (≥39°C) for at least 3 consecutive days PLUS thick colored mucus 2
Do Not Prescribe Empirically Without Visualization
- Empiric steroid use without laryngoscopy may delay appropriate diagnosis and treatment of serious underlying conditions 1
- Always visualize the larynx before considering corticosteroid therapy 1
Avoid Anti-Reflux Medications Unless Indicated
- Anti-reflux medications should only be used if there are concurrent signs or symptoms of gastroesophageal reflux disease 1
- Do not prescribe empirically for laryngitis alone 1