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Health condition · Clinically reviewed

Laryngitis, acute and chronic voice loss — voice rest, reflux management and when to refer.

Inflammation of the voice box. Acute laryngitis follows viral infection; chronic laryngitis raises the question of reflux, smoking or malignancy — a hoarse voice for >3 weeks warrants ENT review.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Every claim is checked against NICE, ENT UK and specialist voice society sources you can see at the end.

  • 03

    Current for 2026

    Reflects current UK ENT practice on hoarseness, laryngopharyngeal reflux and 2-week-wait referral thresholds.

Key facts

Laryngitis at a glance.

The essentials, in plain English — acute versus chronic, the role of voice rest and reflux, and the threshold that sends you to ENT.

  • What it is

    Inflammation of the vocal cords and larynx (voice box), causing hoarseness or complete loss of voice.

  • Acute vs chronic

    Acute laryngitis usually follows a viral infection and settles in days. Chronic laryngitis lasts more than three weeks.

  • Voice rest is key

    Voice rest and hydration are the mainstay for acute laryngitis — antibiotics are rarely needed.

  • Smoking and alcohol

    Smoking and heavy alcohol use are the major drivers of chronic laryngitis and laryngeal cancer.

  • Reflux (LPR)

    Laryngopharyngeal reflux is a common contributor to chronic hoarseness — treated with PPI and lifestyle change.

  • When to refer

    Hoarseness lasting more than three weeks warrants ENT review and laryngoscopy to exclude a laryngeal lesion.

Why this guide matters

A common complaint — with one dangerous mimic.

Most laryngitis is trivial and self-limiting. But a hoarse voice can also be the first sign of laryngeal cancer — the three points below shape the plan.

  • Duration is the deciding line

    Under three weeks and viral, treat conservatively. Beyond three weeks, refer to ENT for laryngoscopy.

  • Reflux is the hidden driver

    Laryngopharyngeal reflux causes chronic hoarseness without heartburn — worth a trial of PPI and lifestyle changes.

  • Voice therapy is definitive

    For voice professionals and chronic cases, speech and language therapy outperforms any medication.

How the diagnosis is made

From a hoarse voice to a settled plan.

The steps a UK GP and ENT team will normally follow, in order — so you know what to expect and why.

  1. 01

    Recognising

    Symptom and voice history

    Onset, duration, smoking history, alcohol intake and voice use (teaching, singing, calling) — all shape the assessment.

  2. 02

    Recognising

    Rule out red-flag features

    Weight loss, haemoptysis, dysphagia, neck lump or hoarseness beyond three weeks require urgent workup.

  3. 03

    Recognising

    Consider LPR as a trigger

    Ask about heartburn, throat clearing, globus and nocturnal reflux — LPR is a frequent hidden driver.

  4. 04

    Confirming

    Voice therapy referral (chronic)

    Speech and language therapy is offered for chronic hoarseness, muscle tension dysphonia and vocal misuse.

  5. 05

    Confirming

    ENT laryngoscopy (>3 weeks)

    Flexible nasendoscopy or laryngoscopy inspects the vocal cords for nodules, polyps, leukoplakia or malignancy.

  6. 06

    Managing

    CT or MRI if mass suspected

    Cross-sectional imaging is added when a laryngeal mass or nerve palsy is seen, to stage disease and plan surgery.

  7. 07

    Managing

    Voice and speech therapy plan

    A tailored programme addressing vocal hygiene, technique and reflux control — often the definitive treatment.

Typical timeline: 3–6 weeks from first review to a settled plan.

Symptoms

What laryngitis actually looks like.

Hoarseness is the headline, but the pattern of dryness, cough and reflux features shapes what to do next.

  • Hoarseness

    A rough, breathy or strained voice — the hallmark symptom of laryngitis.

  • Dry throat

    A persistent dry or scratchy feeling, worse with talking or in dry air.

  • Sore throat

    Discomfort in the throat, often accompanying an acute viral illness.

  • Frequent cough / throat-clearing

    A dry, tickly cough or the constant urge to clear the throat — a classic LPR pattern.

  • Loss of voice

    Aphonia — a complete inability to produce voice, usually short-lived in acute laryngitis.

  • Heartburn / LPR features

    Reflux, acid taste or nocturnal cough pointing to laryngopharyngeal reflux as a driver.

  • Singer’s / voice-professional risk

    Teachers, singers, call-centre staff and coaches are at higher risk of vocal cord injury.

  • Red flag

    Hoarseness >3 weeks, weight loss or haemoptysis — 2-week-wait ENT referral to exclude laryngeal cancer.

Treatment

How laryngitis is treated in the UK.

Conservative care first, reflux management for the chronic pattern, and ENT referral where hoarseness persists — what each option does, and where it belongs.

  • Voice rest and hydration

    The mainstay for acute laryngitis — avoid whispering (which strains the cords) and drink plenty of water.

  • Humidification

    Steam inhalation or a room humidifier soothes irritated mucosa and eases dry throat.

  • Address LPR (PPI + lifestyle)

    A proton pump inhibitor with dietary and posture changes for suspected laryngopharyngeal reflux.

  • Voice / speech therapy

    Structured therapy for vocal hygiene, technique and muscle tension — the definitive treatment for many chronic cases.

  • Antibiotics (bacterial superinfection only)

    Not routinely indicated — reserved for confirmed bacterial infection with systemic features.

  • Corticosteroid short-course (severe)

    A short oral steroid course occasionally used for severe acute laryngitis, especially in voice professionals.

  • Smoking cessation

    Stopping smoking is the single most important step for chronic laryngitis and cancer prevention.

  • ENT laryngoscopy + biopsy if suspicious

    Direct laryngoscopy under anaesthetic with biopsy where leukoplakia, ulceration or mass is seen.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or ENT specialist knows your history and can tell you which parts apply to you.

  • NICE. Clinical Knowledge Summary — Hoarseness.

  • ENT UK. Guidance on hoarseness and voice disorders.

  • British Voice Association. Voice care and vocal health resources.

  • Royal College of Speech and Language Therapists. Voice therapy standards.

Red flags

When hoarseness points to something else.

Most laryngitis is trivial. These are the situations that need urgent ENT input to rule out laryngeal cancer or a serious cause.

  • Hoarseness >3 weeks

    Persistent voice change beyond three weeks warrants urgent ENT review with laryngoscopy to exclude cancer.

  • Weight loss

    Unexplained weight loss with hoarseness is a red flag for laryngeal or hypopharyngeal malignancy.

  • Haemoptysis

    Coughing up blood needs urgent 2-week-wait referral and cross-sectional imaging.

  • Dysphagia

    Difficulty swallowing alongside voice change suggests an upper aerodigestive tract lesion.

  • Neck lump

    A palpable neck mass with hoarseness may reflect nodal spread from a laryngeal primary.

  • Smoker >45

    Any hoarseness in a smoker aged over 45 should prompt urgent ENT assessment.

  • Post-neck-radiotherapy

    New or changing hoarseness after head and neck radiotherapy requires prompt specialist review.

  • Recurrent laryngeal nerve palsy

    A paralysed vocal cord on scope raises the question of a thoracic or mediastinal cause — CT chest is indicated.

  • Fungal laryngitis (inhaler + immunosuppression)

    Consider Candida laryngitis in inhaled-steroid users and immunosuppressed patients — treatable with antifungals.

Living with it

Simple habits that protect the voice long-term.

Four things that make the biggest difference day to day — voice rest done properly, hydration, reflux control and expert voice therapy.

A quiet reminder

Silence — not whispering — rests the voice.

Whispering strains the vocal cords. If your voice needs a rest, be genuinely quiet rather than whispering.

  1. 01 Rest

    Rest the voice, don’t whisper

    Whispering strains the vocal cords more than gentle speech. Aim for quiet, easy voicing or full silence.

  2. 02 Hydrate

    Water beats lozenges

    Steady sips of water through the day keep the mucosa moist — a simple, powerful habit.

  3. 03 Reflux

    Treat the reflux you can’t feel

    LPR often has no heartburn. Trial a PPI, raise the bedhead and avoid late meals if hoarseness lingers.

  4. 04 Technique

    Book voice therapy early

    Speech and language therapy prevents nodule recurrence and rebuilds a durable voice for professionals.

Frequently asked

Everything we get asked about laryngitis.

Quick answers on duration, antibiotics, whispering, reflux and when to worry.

  • How long does acute laryngitis last?

    Most viral acute laryngitis settles within seven to ten days with voice rest and hydration. Symptoms lasting beyond three weeks are classed as chronic and warrant ENT review.

  • Do I need antibiotics for laryngitis?

    Almost never. The vast majority of acute laryngitis is viral, and antibiotics are only used where a bacterial infection with systemic features is confirmed.

  • Is whispering better than talking?

    No. Whispering actually strains the vocal cords more than gentle, relaxed speech. If you need to rest your voice, be truly quiet rather than whispering.

  • What is laryngopharyngeal reflux (LPR)?

    LPR is reflux of stomach contents up to the throat and voice box. Unlike classical heartburn, it often causes only hoarseness, throat clearing, cough and a lump-in-throat feeling.

  • When should I worry about hoarseness?

    Any hoarseness lasting more than three weeks, or associated with weight loss, coughing up blood, dysphagia or a neck lump, needs urgent ENT referral to exclude laryngeal cancer.

  • Can inhalers cause laryngitis?

    Yes — inhaled corticosteroids can cause fungal (Candida) laryngitis. Rinsing the mouth after each dose and using a spacer reduce the risk.

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