Management of laryngitis with symptoms persisting beyond three weeks requires careful evaluation to exclude serious underlying pathology. Persistent hoarseness or voice changes lasting more than three weeks should prompt referral for specialist assessment, including laryngoscopy, to exclude malignancy or other structural causes NICE CKS Schwartz et al. 2009. Initial management remains conservative if no red flags are present, focusing on voice rest, hydration, and avoidance of irritants such as smoking and alcohol NICE CKS. However, if symptoms persist beyond three weeks, empirical treatment with proton pump inhibitors may be considered if laryngopharyngeal reflux is suspected, as this can contribute to chronic laryngitis Schwartz et al. 2009. Antibiotics are generally not indicated unless there is clear evidence of bacterial infection NICE CKS. If symptoms continue despite conservative measures and reflux treatment, further investigations including imaging and biopsy may be warranted to rule out malignancy or other pathology NICE CKS Schwartz et al. 2009.
In summary, for laryngitis lasting more than three weeks:
- Refer for specialist ENT assessment and laryngoscopy to exclude serious causes NICE CKS Schwartz et al. 2009.
- Advise voice rest, hydration, and avoidance of irritants NICE CKS.
- Consider empirical treatment for reflux if clinically indicated Schwartz et al. 2009.
- Avoid antibiotics unless bacterial infection is evident NICE CKS.
- Further investigations if symptoms persist despite initial management NICE CKS Schwartz et al. 2009.