How should I manage a patient with laryngitis who has had symptoms for more than three weeks?

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 ¹ (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 ¹. 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 ¹. 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 ¹ (Schwartz et al., 2009).

In summary, for laryngitis lasting more than three weeks:

• Refer for specialist ENT assessment and laryngoscopy to exclude serious causes ¹ (Schwartz et al., 2009).
• Advise voice rest, hydration, and avoidance of irritants ¹.
• Consider empirical treatment for reflux if clinically indicated (Schwartz et al., 2009).
• Avoid antibiotics unless bacterial infection is evident ¹.
• Further investigations if symptoms persist despite initial management ¹ (Schwartz et al., 2009).