Laryngitis is inflammation of the larynx. The main symptom is an altered voice (e.g., hoarseness). Acute laryngitis is commonly caused by viral upper respiratory tract infection (URTI) or vocal strain and is typically self-limited, with complete resolution within three weeks. Laryngitis is considered chronic if symptoms last longer than three weeks. Common causes of chronic laryngitis include gastroesophageal or laryngopharyngeal reflux, smoking, and postnasal drip. Acute laryngitis with no is diagnosed clinically without any further evaluation, especially if the patient's history is consistent with viral URTI or vocal strain. Individuals with red flags of any duration and individuals with dysphonia and/or hoarseness that lasts for four weeks or longer require laryngoscopy to evaluate for alternative diagnoses. Further evaluation is guided by history, physical examination, and laryngoscopy. Laryngitis is treated with supportive measures (e.g., voice rest, hydration, and avoidance of airway irritants) and, in the case of chronic laryngitis, treatment of the underlying cause.
Etiology of acute laryngitis 
- Viral URTIs (most common cause) 
- Superinfections may occur following a viral infection.
- (rare) 
- Vocal strain, e.g., from coughing or overuse of vocal cords
Etiology of chronic laryngitis 
- Voice changes: dysphonia, hoarseness, loss of voice 
- Sore or dry throat 
- Additional symptoms depend on the underlying cause. 
- Initiate immediate in patients with . 
- Obtain a thorough medical history and physical examination. 
- If history and/or physical examination suggest a specific underlying cause, order appropriate tests, as indicated.
- Urgently refer patients to otolaryngology for laryngoscopy for any of the following:
- Recommend supportive care for laryngitis to all patients.
- Initiate management of acute laryngitis or management of chronic laryngitis as appropriate.
- Follow-up; if symptoms do not improve, consider:
The majority of patients with acute laryngitis can be diagnosed clinically and do not require diagnostic studies. 
Supportive care for laryngitis
- Vocal rest: Avoid shouting, using a loud voice, and forced whispering.
- Analgesia as needed
- Mucosal hydration
- Avoid exposure to airway irritants, e.g., via .
Management of acute laryngitis 
- Acute laryngitis is primarily a clinical diagnosis; consider diagnostic studies only: 
- If certain bacterial infections are suspected 
- To exclude differential diagnoses of laryngitis
- Typically self-limited and resolves in 1–3 weeks with supportive care only 
- Follow up within a few weeks to ensure resolution.
Antibiotics are ineffective in improving symptoms in adults with acute laryngitis. 
Management of chronic laryngitis 
- Treat the underlying cause.
- Consider changing offending medications (e.g., ACE inhibitors, inhaled corticosteroids).
- For all other causes of chronic laryngitis, confirm the diagnosis before initiating treatment, e.g.:
- Consider referral to speech pathology for adjunctive voice therapy.
- Refer patients with hoarseness and/or dysphonia lasting ≥ 4 weeks for laryngoscopy.
- Reassess response to treatment at appropriate intervals.
Diagnostic studies for laryngitis
Diagnostic studies are usually performed by otolaryngology.
- Laryngoscopy is used to assess for characteristic changes of laryngitis.
- Biopsy can be performed on lesions or for tissue culture. 
- Consider laryngeal swabs in chronic laryngitis. 
- Minimally invasive and easy to obtain
- High false negative rate 
- Red flags of hoarseness, e.g.: 
- Hoarseness and/or dysphonia lasting ≥ 4 weeks
- Hoarseness in professional voice users, e.g., professional singers, teachers 
- Suspected GERD or LPR
- Diagnostic uncertainty
Potential findings in laryngitis 
- Laryngeal inflammation with erythema and ; edema, including hyperemia of the inflamed vocal folds 
- Additional features include:
- Mucus: in LPR, allergic rhinitis 
- Pus: in bacterial infections 
- Posterior commissure hypertrophy: in GERD and LPR
- Ulcerations, nodules, and granulomas: in GERD, LPR, and chronic tuberculous laryngitis 
- Cobblestone appearance of the posterior pharyngeal wall: in GERD, LPR, and allergic rhinitis 
- Trauma: endotracheal intubation, injury, hematoma
- Acute infection of: 
- Retropharyngeal abscess
Differential diagnoses of hoarseness:
- , e.g., polyp, cyst,
- Vocal fold paralysis
- Neuromuscular and neurological diseases, e.g., ,
- See also “.”
The differential diagnoses listed here are not exhaustive.