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{{Laryngitis}}
{{Laryngitis}}
{{CMG}}; {{AE}} {{chetan}}, {{Alonso}}
{{CMG}}; {{AE}} {{chetan}}, {{Alonso}}, {{AG}}


==Overview==
==Overview==
 
There is no treatment for viral laryngitis; the mainstay of therapy is supportive care. The mainstay of therapy for infectious causes of laryngitis is antimicrobial therapy. Medical therapy for laryngitis due to [[gastroesophageal reflux]] includes acid suppression therapy such as either [[omeprazole]] or [[ranitidine]].  
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]].<ref name="pmid17443555">{{cite journal| author=Reveiz L, Cardona AF, Ospina EG| title=Antibiotics for acute laryngitis in adults. | journal=Cochrane Database Syst Rev | year= 2007 | volume=  | issue= 2 | pages= CD004783 | pmid=17443555 | doi=10.1002/14651858.CD004783.pub3 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17443555  }} </ref>


==Medical Therapy==
==Medical Therapy==
*Correct treatment depends on a correct diagnosis of the underlying cause of laryngitis.
===Viral laryngitis===
*The most prevalent cause of a missed diagnosis of laryngeal [[cancer]] is a belief that persistent hoarseness is due to laryngitis.
*There is no treatment for viral laryngitis; the mainstay of therapy is supportive care.
*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]].
*[[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 name=Mayo> Laryngitis. Mayo Clinic (2015). http://www.mayoclinic.org/diseases-conditions/laryngitis/basics/lifestyle-home-remedies/con-20021565 Accessed on November 2, 2016</ref>
''If laryngitisis due to a viral cause:''
*Throat clearing is not advised. The act of clearing one's throat may aggravate the laryngitis.
* [[Ibuprofen]] and [[aspirin]] may help alleviate fever and some of the discomfort associated with laryngitis.
*Humidifiers and warm showers can also help alleviate some symptoms.
* 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>
*[[Steroids]] may be prescribed to help accelerate the healing if significant inflammation is present.
* 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:''
===Gastroesophageal reflux laryngitis===
* The patient may be prescribed a course of antibiotics however, there is little evidence to demonstrates the efficacy of oral antibiotics for laryngitis.
*The mainstay of therapy for [[gastroesophageal reflux]] laryngitis is an [[H2 antagonist]] (e.g.: [[ranitidine]]) or a [[proton-pump inhibitor]] (PPI) (e.g.: [[omeprazole]], [[esomeprazole]], [[pantoprazole]]). These drugs may be prescribed for a period between 4-6 weeks.


If persistent hoarseness or loss of voice is a result of [[vocal fold nodules|vocal cord nodules]]:
===Bacterial laryngitis===
* Surgical resection of the nodule and/or speech therapy may be recommended.
*The patient may be prescribed a course of antibiotics however, there is little evidence to demonstrates the efficacy of oral antibiotics for laryngitis.
* 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><ref name="pmid26002823">{{cite journal| author=Reveiz L, Cardona AF| title=Antibiotics for acute laryngitis in adults. | journal=Cochrane Database Syst Rev | year= 2015 | volume=  | issue= 5 | pages= CD004783 | pmid=26002823 | doi=10.1002/14651858.CD004783.pub5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26002823  }} </ref> and is not a first-line therapy for 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>
* 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><ref name="pmid26002823">{{cite journal| author=Reveiz L, Cardona AF| title=Antibiotics for acute laryngitis in adults. | journal=Cochrane Database Syst Rev | year= 2015 | volume=  | issue= 5 | pages= CD004783 | pmid=26002823 | doi=10.1002/14651858.CD004783.pub5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26002823  }} </ref> and is not a first-line therapy for 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.
*[[Fusafungine]], a locally acting antibiotic, has been shown to increase the number of asymptomatic patients by the fifth day of disease.<ref name="pmid15626253">{{cite journal| author=Lund VJ, Grouin JM, Eccles R, Bouter C, Chabolle F| title=Efficacy of fusafungine in acute rhinopharyngitis: a pooled analysis. | journal=Rhinology | year= 2004 | volume= 42 | issue= 4 | pages= 207-12 | pmid=15626253 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15626253  }} </ref>
 
* Fusafungine, a locally acting antibiotic, has been shown to increase the number of asymptomatic patients by the fifth day of disease.


==References==
==References==
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Latest revision as of 22:29, 29 July 2020

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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], Anthony Gallo, B.S. [4]

Overview

There is no treatment for viral laryngitis; the mainstay of therapy is supportive care. The mainstay of therapy for infectious causes of laryngitis is antimicrobial therapy. Medical therapy for laryngitis due to gastroesophageal reflux includes acid suppression therapy such as either omeprazole or ranitidine.

Medical Therapy

Viral laryngitis

  • There is no treatment for viral laryngitis; the mainstay of therapy is supportive care.
  • 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.
  • Humidifiers and warm showers can also help alleviate some symptoms.
  • Steroids may be prescribed to help accelerate the healing if significant inflammation is present.

Gastroesophageal reflux laryngitis

Bacterial laryngitis

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

Antibiotic Therapy

  • Antibiotic use is not associated with significant improvement of objective symptoms[2][3][4][5] and is not a first-line therapy for the treatment of acute laryngitis.[6]
  • Fusafungine, a locally acting antibiotic, has been shown to increase the number of asymptomatic patients by the fifth day of disease.[7]

References

  1. ↑ Laryngitis. Mayo Clinic (2015). http://www.mayoclinic.org/diseases-conditions/laryngitis/basics/lifestyle-home-remedies/con-20021565 Accessed on November 2, 2016
  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. ↑ Reveiz L, Cardona AF (2015). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (5): CD004783. doi:10.1002/14651858.CD004783.pub5. PMID 26002823.
  6. ↑ 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)
  7. ↑ Lund VJ, Grouin JM, Eccles R, Bouter C, Chabolle F (2004). "Efficacy of fusafungine in acute rhinopharyngitis: a pooled analysis". Rhinology. 42 (4): 207–12. PMID 15626253.
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