Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Acute Laryngitis Treatment & Management

  • Author: Rahul K Shah, MD, FACS, FAAP; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: Jun 01, 2016
 

Medical Care

Vaughan states that patients know that laryngitis treatment requires only time and the common-sense avoidance of vocal excess and other irritants. The following measures can help to lessen the intensity of the laryngitis while waiting for the condition to resolve:

  • Inhaling humidified air promotes moisture of the upper airway, helping to clear secretions and exudate.
  • Complete voice rest is suggested, although this recommendation is nearly impossible to follow. If the patient must speak, soft sighing phonation is best. Avoidance of whispering is best, as whispering promotes hyperfunctioning of the larynx.
  • Prevailing data do not support the use of antihistamines and corticosteroids. If a patient uses these medications, he or she may have the false impression that the laryngitis is resolving and may continue to use his or her voice, leading to further insult. The drying effect of these medicines may also be deleterious.

A patient who smokes must cease smoking in order to promote timely resolution of the acute laryngitis. If the patient's laryngitis is from an infectious etiology, continued smoking delays prompt resolution of the disease process.

A study by Müller et al indicated that a mouth and throat spray containing the osmolyte ectoine is effective against acute pharyngitis and/or laryngitis, demonstrating good to very good tolerability and reducing cervical lymph node swelling to a significantly greater degree than saline lozenges. The prospective, controlled, nonrandomized trial included 95 patients.[11]

The most common etiology for acute laryngitis is an infectious source, usually a viral upper respiratory tract infection. In 1985, Schalen observed that, at the time of the acute laryngitic episode, many patients were carriers of bacterial infectious agents, the most common of which were Branhamella catarrhalis and Haemophilus influenzae.[12] These patients experienced more severe dysphonia than patients with negative culture results.

Despite the high isolation rate of organisms from the nasopharynx, a double-blind, placebo-controlled study of patients with acute laryngitis revealed that administration of penicillin V was not advantageous in the treatment of acute laryngitis.[12] The study found that penicillin V administration did not decrease bacterial counts or alleviate symptoms. Schalen concluded that antibiotic treatment for otherwise healthy patients with acute laryngitis is currently unsupported; however, for high-risk patients and patients with severe symptoms, antibiotics may be considered. Others advocate the use of narrow-spectrum antibiotics only in the presence of an identifiable Gram stain and culture.[4]

A study by Reveiz and Cardona, from the Cochrane Database of Systematic Reviews, indicated that when objective outcomes are evaluated, antibiotic therapy does not seem to be effective for acute laryngitis, although there was some subjective indication that erythromycin can improve voice disturbance and cough. One study in the report also found a higher cure rate associated with fusafungine on the fifth day of therapy when compared with no treatment but did not find significant differences in the cure rate at later points in time. The investigators cautioned that the randomized, controlled trials used in their report had a moderate to high risk of bias and low quality of evidence.[13]

The treatment for gastroesophageal reflux disease (GERD)–related laryngitic conditions includes dietary and lifestyle modifications as well as antireflux medications. Antacid medications that suppress acid production, such as H2-receptor and proton pump blocking agents, are highly effective against gastroesophageal reflux. Of the various classes of medicines available to treat GERD, the proton pump inhibitors are the most effective.[14] Patients on prolonged antireflux therapy or with a history of long-standing GERD should be evaluated by a gastroenterologist to ensure that serious sequelae of GERD, such as Barrett esophagitis, have not manifested or do not develop.

Note that optimal timing of proton pump inhibitor intake increases its efficacy. For patients who require twice-a-day dosing, suggested dosing times that are 15-30 minutes before breakfast and dinner.[15] Katz cautions that treatment durations may be longer for patients with reflux laryngitis than for patients with other extraesophageal manifestations of GERD (eg, asthma, cough, noncardiac chest pain).

Next

Diet

Dietary restrictions are recommended for patients with GERD. These include avoidance of caffeine, fatty foods, chocolate, peppermint, and late meals (ie, < 3 h before retiring).[15] The patient should maintain hydration and fluid intake at a stress level to support requirements during the illness. The patient should drink at least 6-8 glasses (8 oz each) of water per day.

Previous
Next

Activity

Although not always possible, patients who use their voices professionally should attempt complete vocal rest. If the patient must communicate, soft sighing use of the voice causes the least vocal trauma. Patients suspected of having GERD should avoid lying down after meals and should elevate the heads of their beds.

A physician is often consulted to decide if a professional voice user should cancel or perform an engagement. A contraindication to performance is the presence of vocal fold hemorrhage or exudative laryngitis.[4] If the patient has mild laryngitis, the physician's decision whether to allow the patient to perform becomes difficult. Vaughan's guiding principle is to do no harm because tomorrow is important, also. If the professional performer wants the show to proceed, he or she should adapt the show and vocal efforts during the performance to minimize vocal abuse.

Previous
 
 
Contributor Information and Disclosures
Author

Rahul K Shah, MD, FACS, FAAP Associate Professor of Otolaryngology and Pediatrics, Associate Surgeon-in-Chief, Medical Director, Peri-operative Services, Children's National Medical Center, George Washington University School of Medicine and Health Sciences; Attending Physician, Department of Otolaryngology, Children's National Medical Center

Rahul K Shah, MD, FACS, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American College of Medical Quality, American Association for Physician Leadership, American College of Surgeons, Triological Society, Massachusetts Medical Society, Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Erik Kass, MD Chief, Department of Clinical Otolaryngology, Associates in Otolaryngology of Northern Virginia

Erik Kass, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, American Association for Cancer Research, American Rhinologic Society

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

John M Truelson, MD, FACS Chairman, Division of Head and Neck Surgery, Associate Professor, Department of Otorhinolaryngology, University of Texas Southwestern Medical Center at Dallas

John M Truelson, MD, FACS is a member of the following medical societies: American Head and Neck Society, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, Phi Beta Kappa, Texas Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Stanley Shapshay, MD, to the development and writing of this article.

References
  1. Bhattacharyya N. The prevalence of pediatric voice and swallowing problems in the United States. Laryngoscope. 2015 Mar. 125 (3):746-50. [Medline].

  2. Roy N, Kim J, Courey M, Cohen SM. Voice disorders in the elderly: a national database study. Laryngoscope. 2016 Feb. 126 (2):421-8. [Medline].

  3. Ng ML, Gilbert HR, Lerman JW. Some aerodynamic and acoustic characteristics of acute laryngitis. J Voice. 1997 Sep. 11(3):356-63. [Medline].

  4. Vaughan CW. Current concepts in otolaryngology: diagnosis and treatment of organic voice disorders. N Engl J Med. 1982 Sep 30. 307(14):863-6. [Medline].

  5. Cohen SM, Kim J, Roy N, Asche C, Courey M. Direct health care costs of laryngeal diseases and disorders. Laryngoscope. 2012 Jul. 122(7):1582-8. [Medline].

  6. Postma GN, Koufman JA. Laryngitis. Bailey BJ, ed. Head and Neck Surgery-Otolaryngology. 2nd ed. Philadelphia, Pa: Lippincott-Raven; 1998. 731-739.

  7. Thompson L. Herpes simplex virus laryngitis. Ear Nose Throat J. 2006 May. 85(5):304. [Medline].

  8. Turley R, Cohen SM, Becker A, Ebert CS Jr. Role of rhinitis in laryngitis: another dimension of the unified airway. Ann Otol Rhinol Laryngol. 2011 Aug. 120(8):505-10. [Medline].

  9. Bhattacharyya N. The prevalence of voice problems among adults in the United States. Laryngoscope. 2014 Apr 29. [Medline].

  10. Schalén L. Acute laryngitis in adults: diagnosis, etiology, treatment. Acta Otolaryngol Suppl. 1988. 449:31. [Medline].

  11. Muller D, Lindemann T, Shah-Hosseini K, et al. Efficacy and tolerability of an ectoine mouth and throat spray compared with those of saline lozenges in the treatment of acute pharyngitis and/or laryngitis: a prospective, controlled, observational clinical trial. Eur Arch Otorhinolaryngol. 2016 Apr 28. [Medline].

  12. Schalen L, Christensen P, Eliasson I, et al. Inefficacy of penicillin V in acute laryngitis in adults. Evaluation from results of double-blind study. Ann Otol Rhinol Laryngol. 1985 Jan-Feb. 94(1 Pt 1):14-7. [Medline].

  13. Reveiz L, Cardona AF. Antibiotics for acute laryngitis in adults. Cochrane Database Syst Rev. 2015 May 23. 5:CD004783. [Medline].

  14. Modlin IM, Moss SF, Kidd M, et al. Gastroesophageal reflux disease: then and now. J Clin Gastroenterol. 2004 May-Jun. 38(5):390-402. [Medline].

  15. Katz PO. Gastroesophageal reflux disease--state of the art. Rev Gastroenterol Disord. 2001. 1(3):128-38. [Medline].

  16. Reveiz L, Cardona AF, Ospina EG. Antibiotics for acute laryngitis in adults. Cochrane Database Syst Rev. 2007 Apr 18. CD004783. [Medline]. [Full Text].

  17. [Guideline] Kahrilas PJ, Shaheen NJ, Vaezi MF, Hiltz SW, Black E, Modlin IM, et al. American Gastroenterological Association Medical Position Statement on the management of gastroesophageal reflux disease. Gastroenterology. 2008 Oct. 135(4):1383-1391, 1391.e1-5. [Medline].

  18. Donoso A, Linares M, Leon J, et al. Activated charcoal laryngitis in an intubated patient. Pediatr Emerg Care. 2003 Dec. 19(6):420-1. [Medline].

  19. Dworkin JP. Laryngitis: types, causes, and treatments. Otolaryngol Clin North Am. 2008 Apr. 41(2):419-36, ix. [Medline].

  20. Reveiz L, Cardona AF, Ospina EG. Antibiotics for acute laryngitis in adults. Cochrane Database Syst Rev. 2005 Jan 25. CD004783. [Medline].

  21. Spiegel JR, Hawkshaw M, Markiewicz A, et al. Acute laryngitis. Ear Nose Throat J. 2000 Jul. 79(7):488. [Medline].

 
Previous
Next
 
This view depicts the larynx of a 62-year-old woman with an intermittent history of exudative acute laryngitis that was treated conservatively. Courtesy of Ann Kearney, Palo Alto, Calif.
This view depicts the larynx of a 53-year-old woman, a sixth-grade science teacher, whose chief symptom was a hoarse and breathy voice. Note the alternating areas of erythema and normal mucosa on the vocal folds. Also note irregularities in the contour of the vocal folds. Courtesy of Ann Kearney, Palo Alto, Calif.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.