Acute laryngitisMANAGEMENT

ENT AND MAXILLOFACIAL PRESENTATIONS · 12 SECTIONS

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414 items

☷ Legend

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Cardiovascular Presentations66▾

Respiratory Presentations47▾

Neurological Presentations77▾

Gastrointestinal Presentations63▾

Genitourinary and Reproductive Presentations44▾

Infectious Disease Presentations146▾

Trauma Presentations88▾

Toxicologic Presentations67▾

Psychiatric Presentations25▾

Musculoskeletal and Rheumatologic Presentations89▾

Dermatology Presentations21▾

Environmental and Exposure Presentations26▾

Hematologic and Oncologic Presentations30▾

Pediatric-Specific Presentations13▾

Endocrine and Metabolic Presentations42▾

ENT and Maxillofacial Presentations21▾

Acute laryngitis Acute pharyngitis Bezold's Abscess Cerumen impaction Epistaxis (anterior)Epistaxis (Posterior)Labyrinthitis Ludwig's Angina Malignant Otitis Externa Marcus Gunn Pupil Mastoiditis Meniere's Disease Nasal Bone Fracture Nasal foreign body Nasal Septal Hematoma Otitis externa Otitis Media Sinusitis Sudden Sensorineural Hearing Loss Tympanic membrane perforation Vestibular Neuronitis

Ophthalmologic Presentations15▾

Obstetric Presentations17▾

Systemic and Miscellaneous Presentations15▾

01Approach to the Critical Patient/attcp32

Airway and Red Flags

›Airway risk screen

›Stridor

›Drooling

›Muffled voice

›Tripod positioning

›Respiratory distress

›Inability to swallow secretions

›Rapid symptom progression hours

›Toxic appearance

›Suspected epiglottitis or deep neck infection

›Angioedema concern

›Immediate escalation triggers

›If stridor with increased work of breathing, airway team activation

›If suspected epiglottitis, avoid agitating exam, controlled airway plan

›If impending obstruction, prepare for awake technique and surgical airway backup

Monitoring and Initial Stabilization

›Physiologic priorities

›Oxygenation targets

›SpO2 94-98% if hypoxemia

›SpO2 88-92% if chronic hypercapnia risk

›Work of breathing trend

›Accessory muscle use

›Fatigue

›Supportive measures

›Humidified air

›Upright position

›NPO if aspiration risk or airway concern

›IV access if dehydration or severe symptoms

Key Concepts

›Syndrome framing

›Acute laryngitis as laryngeal mucosal inflammation with dysphonia

›Viral upper respiratory infection as most common cause

›Airway-threatening mimics require early recognition and separate pathway

›Antibiotics not routinely indicated in uncomplicated acute laryngitis

02History/hx54

Symptom Pattern and Timeline

›Core symptom cluster

›Hoarseness

›Sudden onset after URI symptoms

›Voice fatigue

›Sore throat

›Odynophagia

›Cough

›Dry cough

›Post-infectious cough pattern

›Fever

›High fever concern for bacterial infection or influenza

›Time course

›Duration less than 3 weeks as acute

›Persistent dysphonia more than 3 weeks as urgent laryngeal evaluation trigger

›Recurrent episodes as reflux or irritant exposure consideration

Exposures and Risk Factors

›Infectious exposures

›Sick contacts

›Influenza or COVID circulation exposure

›Pertussis exposure

›Irritant and mechanical triggers

›Smoking

›Vaping

›Occupational fumes or chemicals

›Recent voice overuse

›Recent shouting or singing

›Reflux risk

›Heartburn

›Regurgitation

›Nocturnal cough

›Throat clearing

›High-risk contexts

›Immunocompromised state

›Diabetes

›Recent head and neck surgery

›Inhaled corticosteroid use

›Prior intubation

›Professional voice user needs rapid voice restoration strategy

Red Flag History

›Airway danger symptoms

›Stridor

›Drooling

›Inability to swallow

›Rapidly worsening dyspnea

›Alternate diagnosis clues

›Neck swelling

›Trismus

›Unilateral severe throat pain

›Foreign body sensation after choking event

›Allergic trigger with lip or tongue swelling

›Malignancy risk features

›Dysphonia more than 3 weeks

›Hemoptysis

›Unintentional weight loss

›Neck mass

›Heavy smoking history

03Physical Exam/exam38

General and Airway Assessment

›Airway and breathing findings

›Voice quality

›Hoarseness

›Aphonia

›Breathy voice

›Stridor presence and timing

›Inspiratory

›Biphasic

›Respiratory effort

›Retractions

›Tachypnea

›Fatigue

›Hydration status

›Dry mucous membranes

›Tachycardia

›Toxicity screen

›Ill appearance

›Altered mental status

›High fever pattern

Head and Neck Exam

›Oropharynx and oral cavity

›Tonsillar exudate

›Uvular deviation

›Posterior pharyngeal bulge

›Pooling of secretions

›Neck

›Cervical lymphadenopathy

›Tenderness along anterior neck

›Submandibular swelling

›Crepitus concern for perforation

›Laryngeal and voice-related exam

›Cough character

›Throat clearing

›Wheeze versus stridor differentiation

PITFALLS

›High-risk misses

›Epiglottitis without obvious oropharyngeal findings

›Deep neck infection with minimal early throat findings

›Angioedema with initially isolated voice change

›Persistent hoarseness as malignancy or vocal fold paralysis indicator

04Differential Diagnosis/ddx28

Life-Threatening and Time-Critical

›High-acuity diagnoses

›Epiglottitis (ICD-10 J05.1)

›Fever

›Drooling

›Stridor

›Deep neck space infection

›Peritonsillar abscess (ICD-10 J36)

›Retropharyngeal abscess (ICD-10 J39.0)

›Ludwig angina (ICD-10 K12.2)

›Angioedema (ICD-10 T78.3)

›Lip or tongue swelling

›Urticaria absent possible

›Foreign body (ICD-10 T17)

›Sudden onset after choking

Common Mimics and Associated Conditions

›Upper airway inflammatory syndromes

›Viral URI with dysphonia (ICD-10 J06.9)

›Acute pharyngitis (ICD-10 J02.9)

›Acute tonsillitis (ICD-10 J03.90)

›Croup or acute laryngotracheitis in children (ICD-10 J05.0)

›Noninfectious laryngeal causes

›Laryngopharyngeal reflux (ICD-10 K21.9)

›Vocal fold hemorrhage

›Vocal fold nodules or polyps

›Muscle tension dysphonia

›Neurologic and structural

›Vocal fold paralysis

›Stroke or brainstem process with dysphonia and dysphagia

›Laryngeal malignancy (ICD-10 C32)

05Laboratory Tests/lt27

Routine Testing Strategy

›Testing approach

›No routine labs for uncomplicated acute laryngitis

›Labs for systemic toxicity or airway-risk phenotype

›Focused testing guided by suspected alternative diagnosis

Infectious Workup When Indicated

›Targeted infectious tests

›Respiratory viral NAAT when result changes management

›Influenza testing in high-risk or treatment window

›SARS-CoV-2 testing per local policy and risk

›Group A streptococcus testing when Centor phenotype present

›Fever

›Tonsillar exudate

›Tender anterior cervical nodes

›Absence of cough

›CBC for deep neck infection concern

›Leukocytosis supportive but non-specific

›Normal WBC does not exclude severe infection

›Blood cultures for sepsis phenotype

›Hypotension

›High fever

›Rigors

Metabolic and Supportive Labs

›Severity-guided supportive labs

›Basic metabolic panel for dehydration

›Creatinine trend for volume status

›Electrolytes for vomiting or poor intake

›Venous blood gas for severe respiratory distress

›Hypercapnia as fatigue marker

›Interpretation limited in upper airway obstruction

06Diagnostic Tests/dt41

Scoring Systems

›Decision support tools

›No validated adult acute laryngitis severity score

›Red flag pathway for airway-risk symptoms

›Persistent dysphonia pathway for laryngeal visualization

›Westley croup score for pediatric stridor phenotype

›Level of consciousness

›Cyanosis

›Stridor

›Air entry

›Retractions

›Mild score 2 or less as outpatient typical

›Moderate score 3-7 as observation and treatment

›Severe score 8 or more as high risk airway escalation

MRI

›MRI indications

›Suspected malignancy or soft tissue mass when CT non-diagnostic

›Suspected skull base or neurologic process with vocal fold paralysis

›MRI limitations

›Not first-line in acute airway risk

›Time and positioning constraints in unstable patients

›CT neck with IV contrast

›Indications

›Deep neck infection concern

›Retropharyngeal abscess concern

›Ludwig angina concern

›Suspected tumor with airway symptoms

›Interpretation pearls

›Rim-enhancing collection supportive of abscess

›Airway narrowing extent estimation

›Pitfalls

›Early infection without discrete collection

›Transfer delays in patients with impending obstruction

›CT chest

›Indications

›Suspected recurrent laryngeal nerve palsy from mediastinal mass

›Hemoptysis with malignancy concern

Ultrasound

›Point-of-care ultrasound adjuncts

›Submandibular and neck soft tissue ultrasound

›Cellulitis versus abscess pattern

›Guidance for procedural planning support

›Lung ultrasound when lower airway component suspected

›Alternative cause of dyspnea

07Disposition/dispo21

Discharge Criteria

›Safe outpatient profile

›No stridor

›No drooling

›Able to tolerate oral intake

›No respiratory distress

›No deep neck infection concern

›Symptom duration less than 3 weeks without malignancy risk features

›Follow-up planning

›Primary care follow-up if improving within 48-72 hours

›ENT referral if dysphonia persists more than 3 weeks

›ENT referral sooner for smokers with persistent dysphonia

Observation or Admission Criteria

›Higher level of care triggers

›Stridor or increased work of breathing

›Dehydration requiring IV fluids

›Immunocompromised status with systemic symptoms

›Suspected epiglottitis

›Suspected deep neck infection

›Need for repeated nebulized epinephrine in child with croup phenotype

›Transfer criteria

›Airway intervention capability needed

›ENT or anesthesia support unavailable locally

08Treatment/t89

Supportive Care

›Symptom relief bundle

›Voice relative rest

›Avoid whispering as strain risk

›Avoid shouting and prolonged talking

›Hydration strategy

›Oral fluids

›Warm fluids as tolerated

›Humidification

›Cool mist humidifier

›Steam exposure with burn risk counseling

›Irritant avoidance

›Smoking cessation counseling

›Vaping cessation counseling

›Avoid alcohol excess during acute phase

Analgesia and Antipyretics

›Non-opioid analgesia options

›Acetaminophen PO

›Adult 650 mg every 6 hours as needed

›Adult maximum 3000 mg per day typical

›Pediatric 15 mg/kg per dose every 4-6 hours as needed

›Pediatric maximum 60 mg/kg per day typical

›Ibuprofen PO

›Adult 400 mg every 6-8 hours as needed

›Adult maximum 2400 mg per day typical

›Pediatric 10 mg/kg per dose every 6-8 hours as needed

›Pediatric maximum 40 mg/kg per day typical

Corticosteroids

›Steroid role

›Consider for significant laryngeal edema with voice-critical needs

›Professional voice user

›Severe dysphonia impacting function

›Avoid routine use in mild uncomplicated cases

›Dexamethasone dosing options

›Adults

›Dexamethasone PO or IM 10 mg once

›If diabetes, hyperglycemia risk counseling

›If infection concern for deep neck space, steroids only with appropriate antibiotic plan

›Pediatrics with croup phenotype

›Dexamethasone PO or IM 0.6 mg/kg once

›Maximum 10 mg

›Lower-dose regimens 0.15-0.3 mg/kg as alternative by local protocol

Cough and Throat Symptom Adjuncts

›Symptomatic adjuncts

›Honey for cough in children older than 1 year

›Avoid under 1 year due to botulism risk

›Throat lozenges

›Aspiration risk in young children

›Short-term antitussive

›Avoid in respiratory compromise

Reflux-Directed Therapy

›Reflux suspicion management

›Lifestyle measures

›No meals within 3 hours of bedtime

›Head-of-bed elevation

›Avoid trigger foods individualized

›Proton pump inhibitor trial when symptoms and exam suggest laryngopharyngeal reflux

›Omeprazole PO 20 mg daily

›Trial duration 4-8 weeks

›Reassess need to continue

Antibiotics

›Antibiotic stewardship

›No antibiotics for routine viral acute laryngitis

›Antibiotics only for suspected bacterial process or specific pathogens

›When bacterial laryngitis suspected

›Severe systemic symptoms

›High fever

›Toxic appearance

›Focal purulence with concerning course

›Immunocompromised host with progressive symptoms

›Empiric options when indicated

›Amoxicillin-clavulanate PO

›Adult 875 mg twice daily for 5-7 days

›If penicillin allergy non-anaphylaxis, cephalosporin per local protocol

›If anaphylaxis history, alternative class selection

›Azithromycin PO

›Adult 500 mg day 1

›Adult 250 mg daily days 2-5

›QT prolongation risk consideration

›Suspected diphtheria pathway

›Airway precautions and isolation

›Droplet precautions

›Contact precautions if cutaneous concern

›Antitoxin via public health pathway

›Erythromycin or penicillin regimen per public health guidance

Airway-Risk Phenotypes

›Croup treatment bundle

›Nebulized epinephrine for stridor at rest

›Racemic epinephrine 2.25% nebulized 0.5 mL

›Dilute in 3 mL normal saline

›Repeat dosing based on response and observation protocol

›L-epinephrine 1 mg/mL nebulized 5 mL as alternative

›Observation for rebound symptoms

›Escalation criteria

›If persistent stridor after epinephrine, admission consideration

›If hypoxemia or fatigue, ICU consideration

09Special Populations/sp29

Pregnancy

›Pregnancy considerations

›Airway edema physiologic risk

›Lower threshold for airway escalation if stridor

›Cautious sedation avoidance in airway concern

›Medication safety

›Acetaminophen preferred first-line

›NSAID avoidance in third trimester

›Dexamethasone single dose generally acceptable when clinically indicated

›Infectious testing

›Influenza treatment window and risk stratification as high risk group

Geriatric

›Geriatric considerations

›Malignancy risk higher with persistent dysphonia

›Earlier ENT referral threshold

›Medication safety

›NSAID renal and GI bleeding risk

›Steroid delirium and hyperglycemia risk

›Dehydration risk

›Lower threshold for IV fluids and observation

Pediatrics

›Pediatrics considerations

›Croup phenotype common cause of hoarseness and barking cough

›Stridor at rest as severity marker

›Poor oral intake as dehydration marker

›Medication dosing

›Weight-based dosing verification

›Avoid honey under 1 year

›Return precautions emphasis

›Stridor

›Retractions

›Cyanosis

10Background/b21

Epidemiology

›Epidemiologic framing

›Viral URI as most common etiology for acute laryngitis

›Typical duration days to 2 weeks

›Persistent dysphonia beyond 3 weeks requires evaluation for noninfectious causes

Pathophysiology

›Mechanism

›Laryngeal mucosal inflammation

›Vocal fold edema

›Altered vibration leading to hoarseness

›Irritant contribution

›Smoke and reflux as inflammatory drivers

›Airway risk mechanisms in mimics

›Supraglottic edema in epiglottitis

›Subglottic edema in croup

Therapeutic Considerations

›Treatment rationale

›Supportive care as mainstay for viral etiology

›Antibiotic avoidance to reduce adverse effects and resistance

›Steroid use reserved for significant edema or voice-critical needs

›Reflux management when clinical pattern supports laryngopharyngeal reflux

›Evidence and guideline alignment

›Avoid empiric antibiotics in uncomplicated acute laryngitis (consistent across primary care and ENT guidance)

›ENT visualization recommended for persistent dysphonia more than 3 weeks or earlier with red flags

11Patient Discharge Instructions/pdi22

copy discharge instructions

›Home care

›Voice rest with normal speaking volume

›Avoid whispering

›Drink fluids regularly

›Use cool mist humidifier

›Avoid smoke and vaping

›Acetaminophen or ibuprofen as directed for pain and fever

›Expected course

›Hoarseness often improves within several days

›Full recovery commonly within 1-2 weeks

›Return to ED now

›Trouble breathing

›Noisy breathing or stridor

›Drooling

›Trouble swallowing or inability to keep fluids down

›Blue lips or face

›Severe weakness or dehydration

›Rapidly worsening symptoms

›Follow-up

›If hoarseness lasts more than 3 weeks, ENT assessment

›Earlier follow-up if smoking history and persistent hoarseness

›Earlier follow-up if neck lump, coughing blood, or weight loss

12References/r12

Guidelines and Evidence Summaries

›Reference set

›Primary care guidance on acute laryngitis emphasizing supportive care and avoiding routine antibiotics

›Otolaryngology guidance on dysphonia evaluation and laryngeal visualization for persistent hoarseness

›Pediatric croup clinical pathways including dexamethasone and nebulized epinephrine for stridor at rest

›Public health guidance for diphtheria evaluation and antitoxin access pathways

Coding and Terminology

›Coding anchors

›ICD-10 J04.0 acute laryngitis

›ICD-10 J05.0 acute obstructive laryngitis (croup)

›ICD-10 J05.1 acute epiglottitis

›ICD-10 J36 peritonsillar abscess

›ICD-10 J39.0 retropharyngeal and parapharyngeal abscess

›ICD-10 T78.3 angioedema

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.