Acute Laryngitis Treatment & Management
- Author: Rahul K Shah, MD, FACS, FAAP; Chief Editor: Arlen D Meyers, MD, MBA more...
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.
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. 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. 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.
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.
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. 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. 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).
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). 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.
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. 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.
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