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==Medical Therapy==
==Medical Therapy==
*Correct treatment depends on a correct diagnosis of the underlying cause of laryngitis.
*The most prevalent cause of a missed diagnosis of laryngeal [[cancer]] is a belief that persistent hoarseness is due to laryngitis.
*Should hoarseness last for more than 3 weeks, one should consult an otolaryngologist for an examination including direct visualization of the vocal cords. This examination may also detect the presence of [[vocal fold nodules|vocal cord nodules]].


Correct treatment depends on a correct diagnosis of the underlying cause of laryngitis. The most prevalent cause of a missed diagnosis of laryngeal [[cancer]] is a belief that persistent hoarseness is due to laryngitis. Should hoarseness last for more than 3 weeks, one should consult an otolaryngologist (ear, nose, and throat physician) for an examination including direct visualization of the vocal cords. This examination may also detect the presence of [[vocal fold nodules|vocal cord nodules]], a structural change resulting in persistent hoarseness or loss of voice.
''If laryngitisis due to a viral cause:''
 
If laryngitis is due to a viral cause:
 
* [[Ibuprofen]] and [[aspirin]] may help alleviate fever and some of the discomfort associated with laryngitis.
* [[Ibuprofen]] and [[aspirin]] may help alleviate fever and some of the discomfort associated with laryngitis.
* Patients are advised to avoid [[Speech communication|speaking]] when possible.  They are instructed to speak softly, but to avoid whispering, which further strains the voice.<ref>Mayoclinic.com.  2006.  [http://www.mayoclinic.com/health/laryngitis/DS00366/DSECTION=9 Laryngitis: Self care]</ref>
* Patients are advised to avoid [[Speech communication|speaking]] when possible.  They are instructed to speak softly, but to avoid whispering, which further strains the voice.<ref>Mayoclinic.com.  2006.  [http://www.mayoclinic.com/health/laryngitis/DS00366/DSECTION=9 Laryngitis: Self care]</ref>
* [[Nasal breathing]] is very important so as not to dry the [[throat]].
* Throat clearing is not advised. The act of clearing one's throat may aggravate the laryngitis.
* Throat clearing is very bad. The act of clearing one's throat is very stressful and may aggravate the laryngitis.
* Airborne irritants such as smoke and allergens may exacerbate the condition.
* Mouth rinses containing [[alcohol]] can dry the throat and may exacerbate a viral case of laryngitis. However, these can be helpful when the cause of the infection is bacterial.
* Humidifiers and warm showers can also help alleviate some symptoms.
* Humidifiers and warm showers can also help alleviate some symptoms.
* Airborne irritants such as smoke and allergens may exacerbate the condition.
* [[Steroids]] may be prescribed to help accelerate the healing if significant inflammation is present.
* Gargling with a salt water rinse is suggested. Mouth rinses containing [[alcohol]] can dry the throat and may exacerbate a viral case of laryngitis. However, these can be helpful when the cause of the infection is bacterial.
* A tea of [[ginger]] may help reduce swelling of the vocal cords and relieve symptoms.
* [[Steroid]] medications may be prescribed to help accelerate the healing of the inflammation present.


If laryngitis is due to [[gastroesophageal reflux]]:
''If laryngitis is due to [[gastroesophageal reflux]]:''
* An H2-antagonist (e.g.: ranitidine) or a proton-pump inhibitor (PPI) (e.g.: omeprazole, esomeprazole, pantoprazole) may be prescribed for a period of 4-6 weeks.


* The patient may be instructed to take a nonprescription medication such as Zantac or Prilosec for a period of 4-6 weeks.
''If laryngitis is due to a bacterial organism:''
 
* The patient may be prescribed a course of antibiotics however, there is little evidence to demonstrates the efficacy of oral antibiotics for laryngitis.
If laryngitis is due to a bacterial or fungal infection:
* The patient may be prescribed a course of antibiotics or anti-fungal medication.


If persistent hoarseness or loss of voice is a result of [[vocal fold nodules|vocal cord nodules]]:
If persistent hoarseness or loss of voice is a result of [[vocal fold nodules|vocal cord nodules]]:
* Physicians may recommend a course of treatment that may include a surgical procedure and/or speech therapy.
* Surgical resection of the nodule and/or speech therapy may be recommended.
* Reduction of high-impact stress to the vocal cords caused by loud, frequent, and rapid speech is recommended.
* Reduction of high-impact stress to the vocal cords caused by loud, frequent, and rapid speech is recommended.


===Antibiotic Therapy===
===Antibiotic Therapy===
* Antibiotic use is not associated with significant improvement of objective symptoms<ref name="Reveiz-2005">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | last3 = Ospina | first3 = EG. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume =  | issue = 1 | pages = CD004783 | month =  | year = 2005 | doi = 10.1002/14651858.CD004783.pub2 | PMID = 15674965 }}</ref><ref name="Reveiz-2007">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | last3 = Ospina | first3 = EG. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume =  | issue = 2 | pages = CD004783 | month =  | year = 2007 | doi = 10.1002/14651858.CD004783.pub3 | PMID = 17443555 }}</ref><ref name="Reveiz-2013">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume = 3 | issue =  | pages = CD004783 | month =  | year = 2013 | doi = 10.1002/14651858.CD004783.pub4 | PMID = 23543536 }}</ref> and is not indicated in the treatment of acute laryngitis.<ref name="Schwartz-2009">{{Cite journal  | last1 = Schwartz | first1 = SR. | last2 = Cohen | first2 = SM. | last3 = Dailey | first3 = SH. | last4 = Rosenfeld | first4 = RM. | last5 = Deutsch | first5 = ES. | last6 = Gillespie | first6 = MB. | last7 = Granieri | first7 = E. | last8 = Hapner | first8 = ER. | last9 = Kimball | first9 = CE. | title = Clinical practice guideline: hoarseness (dysphonia). | journal = Otolaryngol Head Neck Surg | volume = 141 | issue = 3 Suppl 2 | pages = S1-S31 | month = Sep | year = 2009 | doi = 10.1016/j.otohns.2009.06.744 | PMID = 19729111 }}</ref>
* [[Penicillin V]] and [[erythromycin]] may be used; however, they were only shown to be effective using subjective measures.


* Antibiotic use is not associated with significant improvement of objective symptoms<ref name="Reveiz-2005">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | last3 = Ospina | first3 = EG. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume =  | issue = 1 | pages = CD004783 | month =  | year = 2005 | doi = 10.1002/14651858.CD004783.pub2 | PMID = 15674965 }}</ref><ref name="Reveiz-2007">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | last3 = Ospina | first3 = EG. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume =  | issue = 2 | pages = CD004783 | month =  | year = 2007 | doi = 10.1002/14651858.CD004783.pub3 | PMID = 17443555 }}</ref><ref name="Reveiz-2013">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume = 3 | issue =  | pages = CD004783 | month =  | year = 2013 | doi = 10.1002/14651858.CD004783.pub4 | PMID = 23543536 }}</ref> and is not indicated in the treatment of acute laryngitis.<ref name="Schwartz-2009">{{Cite journal  | last1 = Schwartz | first1 = SR. | last2 = Cohen | first2 = SM. | last3 = Dailey | first3 = SH. | last4 = Rosenfeld | first4 = RM. | last5 = Deutsch | first5 = ES. | last6 = Gillespie | first6 = MB. | last7 = Granieri | first7 = E. | last8 = Hapner | first8 = ER. | last9 = Kimball | first9 = CE. | title = Clinical practice guideline: hoarseness (dysphonia). | journal = Otolaryngol Head Neck Surg | volume = 141 | issue = 3 Suppl 2 | pages = S1-S31 | month = Sep | year = 2009 | doi = 10.1016/j.otohns.2009.06.744 | PMID = 19729111 }}</ref>
* Fusafungine, a locally acting antibiotic, has been shown to increase the number of asymptomatic patients by the fifth day of disease.


==References==
==References==

Revision as of 16:37, 8 October 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2], Alonso Alvarado, M.D. [3]

Overview

Patients with viral laryngitis are treated with supportive therapy, whereas patients with laryngitis due to infectious causes other than viral infections are treated with antimicrobial therapy. Medical therapy for laryngitis due to gastroesophageal reflux includes acid suppression therapy such as either omeprazole or ranitidine . Surgery is usually reserved for patients with persistent laryngitis due to vocal cord nodules.

Medical Therapy

  • Correct treatment depends on a correct diagnosis of the underlying cause of laryngitis.
  • The most prevalent cause of a missed diagnosis of laryngeal cancer is a belief that persistent hoarseness is due to laryngitis.
  • Should hoarseness last for more than 3 weeks, one should consult an otolaryngologist for an examination including direct visualization of the vocal cords. This examination may also detect the presence of vocal cord nodules.

If laryngitisis due to a viral cause:

  • Ibuprofen and aspirin may help alleviate fever and some of the discomfort associated with laryngitis.
  • Patients are advised to avoid speaking when possible. They are instructed to speak softly, but to avoid whispering, which further strains the voice.[1]
  • Throat clearing is not advised. The act of clearing one's throat may aggravate the laryngitis.
  • Airborne irritants such as smoke and allergens may exacerbate the condition.
  • Mouth rinses containing alcohol can dry the throat and may exacerbate a viral case of laryngitis. However, these can be helpful when the cause of the infection is bacterial.
  • Humidifiers and warm showers can also help alleviate some symptoms.
  • Steroids may be prescribed to help accelerate the healing if significant inflammation is present.

If laryngitis is due to gastroesophageal reflux:

  • An H2-antagonist (e.g.: ranitidine) or a proton-pump inhibitor (PPI) (e.g.: omeprazole, esomeprazole, pantoprazole) may be prescribed for a period of 4-6 weeks.

If laryngitis is due to a bacterial organism:

  • The patient may be prescribed a course of antibiotics however, there is little evidence to demonstrates the efficacy of oral antibiotics for laryngitis.

If persistent hoarseness or loss of voice is a result of vocal cord nodules:

  • Surgical resection of the nodule and/or speech therapy may be recommended.
  • Reduction of high-impact stress to the vocal cords caused by loud, frequent, and rapid speech is recommended.

Antibiotic Therapy

  • Antibiotic use is not associated with significant improvement of objective symptoms[2][3][4] and is not indicated in the treatment of acute laryngitis.[5]
  • Penicillin V and erythromycin may be used; however, they were only shown to be effective using subjective measures.
  • Fusafungine, a locally acting antibiotic, has been shown to increase the number of asymptomatic patients by the fifth day of disease.

References

  1. ↑ Mayoclinic.com. 2006. Laryngitis: Self care
  2. ↑ Reveiz, L.; Cardona, AF.; Ospina, EG. (2005). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (1): CD004783. doi:10.1002/14651858.CD004783.pub2. PMID 15674965.
  3. ↑ Reveiz, L.; Cardona, AF.; Ospina, EG. (2007). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (2): CD004783. doi:10.1002/14651858.CD004783.pub3. PMID 17443555.
  4. ↑ Reveiz, L.; Cardona, AF. (2013). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev. 3: CD004783. doi:10.1002/14651858.CD004783.pub4. PMID 23543536.
  5. ↑ Schwartz, SR.; Cohen, SM.; Dailey, SH.; Rosenfeld, RM.; Deutsch, ES.; Gillespie, MB.; Granieri, E.; Hapner, ER.; Kimball, CE. (2009). "Clinical practice guideline: hoarseness (dysphonia)". Otolaryngol Head Neck Surg. 141 (3 Suppl 2): S1–S31. doi:10.1016/j.otohns.2009.06.744. PMID 19729111. Unknown parameter |month= ignored (help)
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