TUBERCULOSIS OF LARYNX
• It is almost always secondary to pulmonary tuberculosis, mostly affecting males in middle age group.
• Common age group 20 - 40 years
• Tubercle bacilli reach the larynx by bronchogenic or haematogenous routes.
PATHOLOGY
• Disease affects posterior part of larynx more than anterior.
• Parts affected are: in that order
• (i) interarytenoid fold
• (ii) ventricular bands
• (iii) vocal cords
• (iv) epiglottis
• It is Tubercle bacilli, carried by sputum from the bronchi, settle and penetrate the intact laryngeal mucosa particularly in the interarytenoid region (bronchogenic spread).
• This leads to formation of submucosal tubercles which may later caseate and ulcerate.
• Laryngeal mucosa appears red and swollen due to cellular infiltration (pseudoedema).
• Stages of perichondritis and cartilage necrosis are not commonly seen these days.
SYMPTOMS AND SIGNS
• They would greatly depend on the stage of tuberculosis.
• Weakness of voice is the earliest symptom followed by hoarseness.
• Ulceration in the larynx gives rise to severe pain which may radiate to the ears.
• Swallowing is painful with marked dysphagia in later stages.
LARYNGEAL EXAMINATION
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Hyperaemia of the vocal cord in its whole extent or confined to posterior part with impairment of adduction is the first sign.
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Swelling in the interarytenoid region giving a mamillated appearance.
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Ulceration of vocal cord giving mouse-nibbled appearance.
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Superficial ragged ulceration on the arytenoids and interarytenoid region.
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Granulation tissue in interarytenoid region or vocal process of arytenoid.
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Pseudoedema of the epiglottis “turban epiglottis."
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Swelling of ventricular bands and aryepiglottic folds.
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Marked pallor of surrounding mucosa.
DIAGNOSIS
• X-ray chest and sputum examination, biopsy of laryngeal lesion is essential to exclude carcinoma and differentiate it from other condition.
TREATMENT
• Treatment is the same as for pulmonary tuberculosis.
• Voice rest is important.