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Laryngitis

Key sources
The following summarized guidelines for the evaluation and management of laryngitis are prepared by our editorial team based on guidelines from the Infectious Diseases Society of America (IDSA 2023; 2018; 2015), the American College of Gastroenterology (ACG 2021), the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2018), the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN/NASPGHAN 2018), the American Academy of Family Physicians (AAFP 2018; 2012), the Finnish Pediatric Society (FPS/FMSD 2016), and the Royal Australian College of General Practitioners (RACGP 2008).
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Guidelines

1.Diagnostic investigations

Clinical assessment
Identify dysphonia in patients with altered voice quality, pitch, loudness, or vocal effort impairing communication or reducing the QoL.
B
Elicit medical history and perform a physical examination to assess for underlying causes of dysphonia and factors modifying management,
B
as well as to identify factors requiring expedited laryngeal evaluation including but not limited to:
recent surgical procedures involving the head, neck, or chest
recent endotracheal intubation
presence of concomitant neck mass
respiratory distress or stridor
history of tobacco abuse
professional voice use.
B
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  • Viral testing (influenza, low season)

  • Viral testing (influenza, flu season)

  • Viral testing (COVID-19)

  • Diagnostic imaging

2.Diagnostic procedures

Laryngoscopy: consider performing diagnostic laryngoscopy at any time in patients with dysphonia.
C
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3.Medical management

Nebulized epinephrine: administer nebulized racemic epinephrine for symptom relief in pediatric patients with laryngitis.
A

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  • Corticosteroids

  • Antibiotics

4.Nonpharmacologic interventions

Mist therapy: do not offer mist therapy to relieve the symptoms of laryngitis.
D

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  • Voice therapy

5.Therapeutic procedures

Botulinum toxin injections: offer botulinum toxin injections, or refer to a clinician who can administer botulinum toxin injections, for the treatment of dysphonia caused by spasmodic dysphonia or other types of laryngeal dystonia.
B

6.Surgical interventions

Indications for surgery: offer surgery as a therapeutic option in patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions not responding to conservative management, or glottic insufficiency.
B

7.Specific circumstances

Patients with reflux laryngitis, evaluation: obtain evaluation for non-GERD causes in patients with possible extraesophageal manifestations before ascribing symptoms to GERD.
B
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More topics in this section

  • Patients with reflux laryngitis (management)

  • Patients with reflux laryngitis (pediatric patients)

  • Patients with acute laryngotracheitis (diagnosis)

  • Patients with acute laryngotracheitis (severity assessment)

  • Patients with acute laryngotracheitis (setting of care)

  • Patients with acute laryngotracheitis (humidified air)

  • Patients with acute laryngotracheitis (oxygen supplementation)

  • Patients with acute laryngotracheitis (corticosteroids)

  • Patients with acute laryngotracheitis (nebulized epinephrine)

8.Patient education

General counseling: counsel patients with dysphonia on control/preventive measures.
B

9.Follow-up and surveillance

Serial clinical assessment: document resolution, improvement, or worsening symptoms of dysphonia or change in the QoL in patients with dysphonia after treatment or observation.
B