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Morán-Mariños C, Llanos-Tejada F, Villanueva-Villegas R, Vargas-Ponce KG, Salas-López J. Primary Tuberculosis of the Pharynx in an HIV Context: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2024; 17:11795476241251945. [PMID: 38711481 PMCID: PMC11072070 DOI: 10.1177/11795476241251945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/15/2024] [Indexed: 05/08/2024]
Abstract
Pharyngeal tuberculosis without pulmonary involvement is very rare and may be confused with malignant lesions. We present a 45-year-old female patient with a history of HIV presenting with a history of cough, sore throat, and oral ulcers with chronic use of antibiotics. The evolution would indicate a probable malignant tumor, but the biopsy was consistent with Pharyngeal TB. The patient initiated anti-tuberculosis therapy and demonstrated improved conditions and remission of ulcers. In the context of HIV, this treatment could be a major contributor to the underdiagnosis of the disease and may lead to alternative diagnoses. Therefore, it is vital to consider this condition in patients who do not respond to antibiotics.
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Affiliation(s)
- Cristian Morán-Mariños
- Unidad Especializada en Tuberculosis, Servicio de Neumología, Hospital Nacional Dos de Mayo, Lima, Perú
- Unidad de Investigación en Bibliometría, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Perú
| | - Felix Llanos-Tejada
- Unidad Especializada en Tuberculosis, Servicio de Neumología, Hospital Nacional Dos de Mayo, Lima, Perú
- Instituto de Investigaciones en Ciencias Biomédicas, Facultad de Medicina, Universidad Ricardo Palma, Lima, Perú
| | - Renzo Villanueva-Villegas
- Unidad Especializada en Tuberculosis, Servicio de Neumología, Hospital Nacional Dos de Mayo, Lima, Perú
| | | | - Juan Salas-López
- Unidad Especializada en Tuberculosis, Servicio de Neumología, Hospital Nacional Dos de Mayo, Lima, Perú
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Rubin F, Jameleddine E, Guiquerro S, Laccourreye O. Laryngeal tuberculosis in the early 21st century. Literature review of clinical, diagnostic and therapeutic data, according to SWiM guidelines. Eur Ann Otorhinolaryngol Head Neck Dis 2024; 141:147-152. [PMID: 38238187 DOI: 10.1016/j.anorl.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2024]
Abstract
OBJECTIVES Review of the scientific medical literature dedicated to clinical data, diagnosis and treatment for laryngeal tuberculosis published since the turn of the 21st century. MATERIAL AND METHODS Search of the Medline, Cochrane and Embase databases for the period 2000-2022. Selection of cohorts and case reports documenting clinical data, diagnosis and treatment for laryngeal tuberculosis. RESULTS In total, 119 articles were analyzed. Immunodepression, HIV infection, history of lung tuberculosis, general symptoms suggesting tuberculosis, smoking and associated laryngeal cancer were noted in 18%, 3%, 20% and 41% of cases, respectively. No pathognomonic symptoms or signs emerged. Voice impairment, of various types and severity, isolated and/or associated with other signs, was the most frequent laryngeal symptom, in 86% of cases. All laryngeal sites were involved, with numerous and various associations. Impaired laryngeal motion and tracheotomy were noted in 6% and 1% of cases, respectively. Time to diagnosis varied from less than 1month to 36months, for a median 3months, in case reports. Laryngeal tuberculosis was diagnosed bacteriologically with certainty in 28% of cases while diagnosis was based on indirect criteria and/or involvement of another site in the other 72%, with lung involvement in 54%. Treatment duration ranged from 6 to 24months (median, 6months), using 3 to 5 (median: 4) antitubercular antibiotics, with 4 used in 80% of cohorts and 77% of case reports. Overall rates of cure, death, treatment resistance, adverse events, and laryngeal sequelae were 99%, 0.5%, 0.5%, 6% and 5%, respectively. CONCLUSION The clinical presentation and diagnostic difficulty in laryngeal tuberculosis did not change since the end of the 20th century. Quadritherapy is highly effective, with a low resistance rate and few adverse effects or laryngeal sequelae.
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Affiliation(s)
- F Rubin
- Clinique St-Vincent, 8, rue de Paris, CS 71027, 97404 Saint-Denis cedex, Reunion.
| | - E Jameleddine
- Université Paris Cité, Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale, HEGP, Assistance publique des Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
| | - S Guiquerro
- Université Paris Cité, Bibliothèque Universitaire Necker, 160, rue de Vaugirard, 75015 Paris, France
| | - O Laccourreye
- Université Paris Cité, Service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale, HEGP, Assistance publique des Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France
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Nerurkar NK, Jahnavi. Laryngeal Tuberculosis: Current Patterns of Presentation and Management. Indian J Otolaryngol Head Neck Surg 2024; 76:904-909. [PMID: 38440428 PMCID: PMC10908953 DOI: 10.1007/s12070-023-04316-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/21/2023] [Indexed: 03/06/2024] Open
Abstract
Background Laryngeal tuberculosis (TB) is the commonest granulomatous condition found in the larynx and may be primary or secondary. With the recrudescence of tuberculosis and development of multidrug resistance, the classical disease trend of laryngeal tuberculosis is changing its manifestations. The aim of our study is to describe the various patterns of presentations of laryngeal tuberculosis in the current era and consequently its changing management protocols. Results In this retrospective study, out of 890 patients who visited our voice and swallowing clinic in our study period, 10 were diagnosed as granulomatous conditions [1.1%] and 3 of these were confirmed cases of tuberculosis involving the larynx [0.3%]. Secondary laryngeal TB was found in 1 of our patients with a "dirty larynx picture". Primary laryngeal TB was seen in 2 patients, one patient presented with a unilateral congested vocal fold and the other with bilateral striking zone leukoplakia. Conclusion The clinical pattern of presentation of laryngeal tuberculosis has changed over the years. None of the patients of primary or secondary laryngeal tuberculosis had the classical constitutional symptoms of tuberculosis. In patients with laryngeal tuberculosis along with routine TB workup, surgical excision with histopathological testing is essential for accurate diagnosis in primary laryngeal TB and the "dirty larynx" picture aids in the diagnosis of secondary laryngeal TB. The healing and vocal outcomes are good in both primary and secondary laryngeal TB, once the appropriate antitubercular regimen has been started.
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Affiliation(s)
- Nupur Kapoor Nerurkar
- Bombay Hospital Voice and Swallowing Centre, Bombay Hospital & Medical Research Centre, 2nd Floor MRC, Mumbai, 400020 Maharashtra India
| | - Jahnavi
- Bombay Hospital Voice and Swallowing Centre, Bombay Hospital & Medical Research Centre, 2nd Floor MRC, Mumbai, 400020 Maharashtra India
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Pandiyan H, Sivanand N, Sathish Kumar S. Isolated Laryngeal Tuberculosis: a Diagnostic Dilemma. Indian J Otolaryngol Head Neck Surg 2022; 74:2308-2310. [PMID: 36452854 PMCID: PMC9702101 DOI: 10.1007/s12070-020-02139-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/02/2020] [Indexed: 11/25/2022] Open
Abstract
Laryngeal tuberculosis is a rare condition, isolated laryngeal tuberculosis without pulmonary manifestations is even more rare. Patients usually presents with voice change, difficulty in swallowing and other constitutional symptoms. The symptoms and findings can look like malignancy in most of the cases. Here, we present a case of primary laryngeal tuberculosis without pulmonary tuberculosis. A 24 year old man who presented to us with hoarseness of voice with 1 year duration. Laryngoscopic study showed a proliferative growth in the epiglottis, aryepiglottic folds and vocal cords and was diagnosed to have laryngeal tuberculosis on histopathology by the typical appearance of granuloma and caseous necrosis. The patient was started on standard antitubercular therapy and he had an excellent response to the same within 6 months. Isolated laryngeal tuberculosis should be suspected in patients with laryngeal complaints with no pulmonary symptoms, especially in a developing country like India where pulmonary tuberculosis is prevalent. Even though isolated laryngeal tuberculosis cases are rare, we should keep in mind the possibility of tuberculosis in the differential diagnosis of laryngeal tumors, as the incidence of tuberculosis is steadily increasing.
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Affiliation(s)
- Harsha Pandiyan
- Department of ENT, Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bengaluru, Karnataka India
| | - Nikhil Sivanand
- Department of ENT, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Pillaiyarkuppam, Pondicherry, India
| | - S. Sathish Kumar
- Department of ENT, Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bengaluru, Karnataka India
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Migliorelli A, Mazzocco T, Bonsembiante A, Bugada D, Fantini M, Elli F, Stacchini M. Laryngeal tubercolosis: a case report with focus on voice assessment and review of the literature. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:407-414. [DOI: 10.14639/0392-100x-n2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/18/2022] [Indexed: 12/24/2022]
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Raj R, Sud P, Saharan N, Virk RS. Laryngeal tuberculosis: a neglected diagnosis. BMJ Case Rep 2022; 15:e248095. [PMID: 35131802 PMCID: PMC8823138 DOI: 10.1136/bcr-2021-248095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 11/04/2022] Open
Abstract
A 24-year-old woman visited the Ear Nose Throat (ENT) outpatient department with complaints of hoarseness for 2 months not responding to conservative management. Laryngoscopic examination revealed a whitish ulceroproliferative lesion in the anterior commissure and anterior two-thirds of bilateral true vocal cords with surrounding necrosis. In view of the above findings, the patient was planned for biopsy under general anaesthesia. Intraoperative findings showed multiple whitish necrotic friable tissue involving anterior two-thirds of bilateral false vocal cords, ventricle, bilateral true vocal cords, both aryepiglottic folds and laryngeal surface of epiglottis. Postoperative histopathology was consistent with tuberculosis. A pulmonology consultation was taken, and the patient was started on anti-tuberculosis chemotherapy. One month post therapy, the voice was symptomatically better. A flexible fibreoptic laryngoscopic examination was done, which revealed almost complete resolution of the lesion with minimal ulceration at the anterior one-third of right true vocal cord.
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Affiliation(s)
- Reshma Raj
- ENT, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parul Sud
- ENT, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Neha Saharan
- Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh Virk
- ENT, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Swain SK, Behera IC, Sahu MC. Primary Laryngeal Tuberculosis: Our Experiences at a Tertiary Care Teaching Hospital in Eastern India. J Voice 2020; 33:812.e9-812.e14. [PMID: 29773323 DOI: 10.1016/j.jvoice.2018.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/19/2018] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Primary laryngeal tuberculosis is a chronic bacterial infection of the larynx by Mycobacterium tuberculosis without affecting the lungs. It is a rare type of extrapulmonary tuberculosis seen in clinical practice. OBJECTIVES This study aimed to evaluate the clinical presentation, diagnosis, and treatment of primary laryngeal tuberculosis at a tertiary care teaching hospital in eastern India. MATERIALS AND METHODS This is a retrospective study of 11 cases of primary laryngeal tuberculosis managed between December 2013 and January 2018. The detailed clinical presentations, investigations, and treatment of primary laryngeal tuberculosis of the patients were studied. RESULTS Primary laryngeal tuberculosis is common in men with mean age of 38.63 years. Hoarseness of the voice is the most common symptom, and the most common site for primary laryngeal tuberculosis is the vocal fold with ulcerative lesion. Endoscopic examinations of the larynx in laryngeal tuberculosis are nonspecific and are to be confused with laryngeal cancer. Histopathological and bacteriological examinations are confirmatory tests for the diagnosis. After confirmation of the diagnosis, all patients had taken antitubercular therapy for 6 months, which gave excellent outcome. CONCLUSIONS Delayed diagnosis or untreatable laryngeal tuberculosis will lead to high morbidity and mortality of the patient. Although primary laryngeal tuberculosis has nonspecific clinical presentations, it is very important to have a high index of suspiciousness to rule out tubercular lesion in the larynx as this disease is curable.
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Affiliation(s)
- Santosh Kumar Swain
- Department of Otorhinolaryngology, IMS and SUM Hospital, Siksha "O" Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India.
| | - Ishwar Chandra Behera
- Department of Community Medicine, IMS and SUM Hospital, Siksha "O" Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
| | - Mahesh Chandra Sahu
- Directorate of Medical Research, IMS and SUM Hospital, Siksha "O" Anusandhan (Deemed to be University), Bhubaneswar, Odisha, India
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Lou ZC, Li X. Leukoplakia or LPR: The Misdiagnosis of Laryngeal Tuberculosis. EAR, NOSE & THROAT JOURNAL 2019; 100:549S-553S. [PMID: 31779475 DOI: 10.1177/0145561319891264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The objective is to reduce the rates of misdiagnosis and inappropriate treatment of laryngeal tuberculosis (LTB). STUDY DESIGN Retrospective case series. MATERIALS AND METHODS Medical records of 3 histopathology-confirmed cases at a tertiary medical center from 2000 to 2018. RESULTS Seventeen patients with LTB included in this study. Of the 17 patients, 16 patients were male and 1 was female; 11 patients had a history of smoking. Odynophagia was the chief complaint in 6 cases, and 11 patients complained of hoarseness. The appearance of the affected larynx was ranged from diffuse swelling (n = 7, 41.2%), mucosa white lesion (n = 5,29.4%), and granulomatous tumors (n = 2, 11.76%), and these features presented together (n = 2, 11.76%). Seventeen patients with LTB were misdiagnosed as acute epiglottitis in 4 (23.5%) patients, acute laryngitis in 1 (5.9%) patient, leukoplakia in 5 (29.4%) patients, laryngopharyngeal reflux (LPR) in 6 (35.3%) patients, and laryngocarcinoma in 1 (5.9%) patient. Chest computed tomography reported old pulmonary tuberculosis in 2 (11.7%) patients, active pulmonary tuberculosis in 7 (41.2%) patients, and normal lung status in 8 (47.1%) patients. Histopathological examination reported Mycobacterium tuberculosis infection by revealing epithelioid cell granulomas with Langhans-type giant cells in 14 (82.4%) patients and epithelioid cell granulomas with caseous necrosis and Langhans-type giant cells in 3 (17.6%) patients. CONCLUSIONS Laryngeal tuberculosis was easily misdiagnosed as acute epiglottitis or leukoplakia because of diffuse swelling of the epiglottis or white lesions over the true vocal cord, especially patients with increasing LTB were misdiagnosed as LPR with the enhancement of LPR awareness among otolaryngologist. Clinicians should be aware of the possibility of LTB for chronic intractable laryngitis with failure treatment of proton pump inhibitor and recurrent acute epiglottitis with foreign body injury.
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Affiliation(s)
- Zheng Cai Lou
- Department of Otorhinolaryngology, 118369Yiwu Central Hospital, Yiwu, Zhejiang, China
| | - Xiuguo Li
- Department of Otolaryngology, 117947Jining No. 1 People's Hospital, Jining, Shandong, China
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Agarwal R, Gupta L, Singh M, Yashaswini N, Saxena A, Khurana N, Chaudhary D. Primary Laryngeal Tuberculosis: A Series of 15 Cases. Head Neck Pathol 2018; 13:339-343. [PMID: 30251032 PMCID: PMC6684667 DOI: 10.1007/s12105-018-0970-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 09/20/2018] [Indexed: 11/24/2022]
Abstract
Tuberculosis usually involves the lungs, but can also involve various other organs. Extra pulmonary tuberculosis is very rarely confined to the larynx in the absence of an associated pulmonary lesion. In this retrospective study, clinicopathological characteristics of patients with final diagnosis of laryngeal tuberculosis (LTB) were reviewed. The diagnosis of LTB was based on: (1) the existence of chronic granulomatous inflammation with caseous necrosis in the histopathology of laryngeal lesions or (2) the presence of laryngeal lesions with atypical histopathology (chronic granulomatous inflammation) which had a complete response to anti-tuberculosis therapy. Fifteen cases with a diagnosis of LTB were collected. The patients' age ranged between 24 and 75 years with a mean of 49 years. On laryngoscopy, 66.6% of cases (10/15) had an ulceroproliferative lesion while the remaining 33.3% of cases (5/15) had an exophytic growth. The pathology of laryngeal lesions revealed chronic granulomatous inflammation with caseous necrosis in nine cases and chronic granulomatous inflammation without necrosis in six cases. Nine out of 15 cases (60%) showed presence of acid-fast bacilli on Ziehl-Neelsen stain. Any evidence of pulmonary tuberculosis was ruled out by chest X-ray findings. The response to anti-tuberculosis therapy was desirable in all patients. Since the introduction of anti-tuberculous therapy, the incidence of LTB has declined. However, with the incidence of TB increasing, the overall incidence of laryngeal involvement may be on the rise. This study highlights the importance to consider the rare possibility of LTB in the presence of non-specific clinical and laryngoscopic signs and to confirm this by histological examination.
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Affiliation(s)
- Radhika Agarwal
- Department of Pathology, Maulana Azad Medical College, Delhi, India
| | - Latika Gupta
- Department of Pathology, Maulana Azad Medical College, Delhi, India
| | - Meeta Singh
- Department of Pathology, Maulana Azad Medical College, Delhi, India
| | | | - Ashima Saxena
- Department of ENT, Maulana Azad Medical College, Delhi, India
| | - Nita Khurana
- Department of Pathology, Maulana Azad Medical College, Delhi, India
| | - Dimple Chaudhary
- Department of Pathology, Maulana Azad Medical College, Delhi, India
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Nishiike S, Irifune M, Doi K, Osaki Y, Kiuchi N. Tuberculous Otitis Media: Clinical Aspects of 12 Cases. Ann Otol Rhinol Laryngol 2016; 112:935-8. [PMID: 14653361 DOI: 10.1177/000348940311201104] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The clinical features of tuberculous otitis media (TOM) have changed. This study was performed to evaluate changing trends in the clinical manifestations of TOM. We reviewed a series of 12 cases of TOM (13 ears) recently treated at Osaka Prefectural Habikino Hospital. The results showed a mean age of 41 years and a male predominance of 1.4 to 1. Central or total perforations of the tympanic membrane were observed in most cases, but none of the patients had multiple perforations. Nine patients (75%) had active pulmonary tuberculosis. Normal lung status or inactive pulmonary tuberculosis was significantly more frequent in the older age group. Diagnosis of primary TOM required more time than that of secondary TOM. Most cases of primary TOM had high infectiousness of the primary lesion. We summarize the clinical features of patients who should be evaluated for TOM.
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Affiliation(s)
- Suetaka Nishiike
- Department of Otolaryngology, Suita Municipal Hospital, Suita, Osaka, Japan
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Wang CC, Lin CC, Wang CP, Liu SA, Jiang RS. Laryngeal tuberculosis: A review of 26 cases. Otolaryngol Head Neck Surg 2016; 137:582-8. [PMID: 17903574 DOI: 10.1016/j.otohns.2007.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Revised: 03/18/2007] [Accepted: 04/02/2007] [Indexed: 11/20/2022]
Abstract
Objectives To review the clinical characteristics of laryn-geal tuberculosis. Study Design Retrospective case series. Subjects and Methods Medical records of 26 histopa-thology-confirmed cases in a tertiary medical center from 1992 to 2006. Results The female patients were significantly younger than male patients. Hoarseness is the most common symptom (84.6%) because true vocal fold is most commonly involved (80.8%). Infection usually involves unilateral (66.7%) and right-side larynx but multiple subsites of the larynx (57.7%). The appearance of the affected larynx may have mixed features and change before diagnosis. Laryngeal tuberculosis is usually misdiagnosed as laryngeal cancer, especially in patients with malignant signs such as enlarged cervical lymph nodes and vocal fold immobility. Chest film is better than sputum examinations for screening. Conclusion We should be especially alert about TB infection when facing young female patients with unusual laryngeal lesions. Extensive laser excision before diagnosis should be avoided because after antituberculous treatment, prognosis is usually good and vocal fold immobility could be reversible.
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Affiliation(s)
- Chen-Chi Wang
- Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan.
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Reis JGC, Reis CSM, da Costa DCS, Lucena MM, Schubach ADO, Oliveira RDVC, Rolla VC, Conceição-Silva F, Valete-Rosalino CM. Factors Associated with Clinical and Topographical Features of Laryngeal Tuberculosis. PLoS One 2016; 11:e0153450. [PMID: 27077734 PMCID: PMC4831755 DOI: 10.1371/journal.pone.0153450] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 03/30/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Laryngeal tuberculosis (LTB) is the most frequent granulomatous disease of the larynx and represents less than 2% of extrapulmonary TB cases. There are no pathognomonic clinical and endoscopic features of this disease and studies on LTB that can assist in its diagnostic characterization are lacking. Objective To identify factors associated with clinical and topographical features of LTB. Method a retrospective cross-sectional study was conducted from the medical records of 36 patients with confirmed LTB diagnosis. Results Dysphonia and cough were the main symptoms presented by patients and the true vocal folds the most frequently affected site. The average of the duration of the disease evolution was significantly higher in patients with dysphonia than in patients without this symptom. We observed association between dysphonia and true vocal fold lesions and between odynophagia and lesions in the epiglottis, arytenoids and aryepiglottic folds. Odynophagia was more frequent in individuals with lesions in four or more laryngeal sites. Weight loss equal or above 10% of the body weight was more frequent in patients with odynophagia as first symptom and in patients with ulcerated lesion. Dyspnea on exertion was more frequent in individuals with more extensive laryngeal lesions. The percentage of smokers with lesions in four or more laryngeal sites was greater than that found in non-smokers. Laryngeal tissue fragment bacilloscopy and culture examinations were less positive than sputum ones. Conclusions Smoking appears to be associated with the development of more extensive LTB lesions, and LTB with dyspnea on exertion and odynophagia with consequent impairment of nutritional status. We emphasize the need for histopathologic confirmation, once positive sputum bacteriological examinations seem not to necessarily reflect laryngeal involvement.
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Affiliation(s)
- João Gustavo Corrêa Reis
- Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute (IOC), FIOCRUZ, Rio de Janeiro, RJ, Brazil
- Department of Bronchoesophagolaryngology and Head and Neck Surgery, Bonsucesso Federal Hospital, Rio de Janeiro, RJ, Brazil
| | - Clarissa Souza Mota Reis
- Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Daniel César Silva da Costa
- Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute (IOC), FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | - Márcia Mendonça Lucena
- Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Department of Otorhinolaryngology and Ophthalmology, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Armando de Oliveira Schubach
- Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | | | - Valéria Cavalcanti Rolla
- Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
| | - Fátima Conceição-Silva
- Laboratory of Immunoparasitology, Oswaldo Cruz Institute (IOC), FIOCRUZ, Rio de Janeiro, RJ, Brazil
- * E-mail: (CMVR); (FCS)
| | - Cláudia Maria Valete-Rosalino
- Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- Department of Otorhinolaryngology and Ophthalmology, Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail: (CMVR); (FCS)
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El Beltagi AH, Khera PS, Alrabiah L, Al Shammari NFJ. Case Report: Acute tuberculous laryngitis presenting as acute epiglottitis. Indian J Radiol Imaging 2012; 21:284-6. [PMID: 22223941 PMCID: PMC3249944 DOI: 10.4103/0971-3026.90690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The incidence of laryngeal tuberculosis (TB), which had dropped dramatically after the institution of modern anti-TB chemotherapy, has shown recent reemergence. It is important to be aware of its possibility, especially as it can present with nonspecific upper airway symptoms and a frequent lack of constitutional manifestations. We report such a case presenting as acute epiglottitis, with diffuse involvement of the supraglottic larynx associated with reactivation lung TB.
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Affiliation(s)
- Ahmed H El Beltagi
- Department of Clinical Radiology, Al Sabah Hospital, Ministry of Health, Kuwait City, Kuwait
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Khan NU, Wallis S, Siddiqui N. Laryngeal tuberculosis: a diagnosis not to be missed. BMJ Case Rep 2009; 2009:bcr11.2008.1228. [PMID: 21686402 DOI: 10.1136/bcr.11.2008.1228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 66-year-old Caucasian female was referred to the ear, nose and throat outpatient by her general practitioner with complaints of worsening sore throat, hoarseness of voice and productive cough for 3 months. The patient also had a history of rigors and evening temperature. She was using long-term steroids for nephrotic syndrome. The patient was treated for pulmonary tuberculosis as a child. An exophytic left supraglottic mass involving the left aryepiglottic fold, epiglottis and left vocal cord was revealed on fibre-optic laryngoscopy. The diagnosis of laryngeal tuberculosis was confirmed on repeat biopsy. The sputum smear was also positive for acid-fast bacilli. Chest x ray reported fibrosis of the right upper lobe indicating tuberculosis. The patient was started on anti-tuberculous treatment and made a steady recovery. There is reactivation of pulmonary tuberculosis in our case report with secondary involvement of larynx probably due to long-term use of steroids for nephrotic syndrome.
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Affiliation(s)
- Naeem Ullah Khan
- Birmingham City Hospital, ENT, Dudley Road, Birmingham, B18 7QH, UK
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[Epilaryngeal tuberculosis: epidemiologic, clinical and healthcare considerations]. ACTA ACUST UNITED AC 2008; 125:155-9. [PMID: 18538743 DOI: 10.1016/j.aorl.2008.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 03/12/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report a case of laryngeal tuberculosis and to consider tuberculosis management in ENT practice. MATERIAL AND METHODS A 44-year-old man, a smoker with pulmonary sarcoidosis experienced dysphonia with dysphagia. Laryngeal fibroscopy revealed an ulcerated epiglottic lesion. Direct laryngoscopy was performed to detect carcinoma, laryngeal sarcoidosis or tuberculosis. The histologic study revealed granulomatosis with giant cells and caseous necrosis. Tissue culture identified Mycobacterium tuberculosis. RESULTS Antituberculosis therapy decreased dysphonia and dysphagia. Isolated ulceration disappeared at three months. Pulmonary infiltration decreased in radiography. The discovery of this case of laryngeal tuberculosis instigated hospital and community tuberculosis surveillance. CONCLUSION The ENT specialist should be aware of laryngeal tuberculosis in suspicious lesions. Mandatory declaration of such cases can motivate setting up tuberculosis surveillance.
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Wang PH, Wang HC, Cheng PW, Cheng SL, Tsai CC. Hoarseness in asthmatic patients: the side effect of inhaled steroid or not? J Asthma 2008; 44:823-6. [PMID: 18097857 DOI: 10.1080/02770900701743788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hoarseness is one of the possible side effects of inhaled steroid in asthmatic patients as well as a common presenting feature of laryngeal tuberculosis. We report an asthmatic patient on inhaled corticosteroid treatment who presented with a 3-month history of hoarseness. Laryngeal tuberculosis without pulmonary involvement was diagnosed by laryngeal biopsy and microbiologic studies. Laryngeal tuberculosis should be considered in asthmatic patients who present with hoarseness, at least in regions in which tuberculosis is prevalent.
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Affiliation(s)
- Ping-Huai Wang
- Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan
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Yelken K, Guven M, Topak M, Gultekin E, Turan F. Effects of antituberculosis treatment on self assessment, perceptual analysis and acoustic analysis of voice quality in laryngeal tuberculosis patients. The Journal of Laryngology & Otology 2007; 122:378-82. [PMID: 17592656 DOI: 10.1017/s0022215107008961] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate the effects of antituberculosis treatment on the voice quality of laryngeal tuberculosis patients, measured by patient self-assessment, perceptual analysis and acoustic analysis. MATERIALS AND METHODS A total of 14 laryngeal tuberculosis patients were enrolled. Laryngeal tuberculosis was established either by biopsy and histopathological examination or by rapid regression of the laryngeal lesions after antituberculosis medication. Before and after treatment, all patients were evaluated perceptually (on a scale of zero to three), and 12 assessed their own voices using the voice handicap index-10 scale. Acoustic analysis was performed to allow objective evaluation. RESULTS Patients' ages ranged from 21 to 72 years (mean, 41). The male to female ratio was 12:2. Eight patients (57 per cent) had tuberculous involvement of the epiglottis, four (28 per cent) had involvement of the aryepiglottic fold and eight (57 per cent) had involvement of the false vocal folds. The glottis was the less commonly involved part of the larynx, including true vocal folds (28 per cent, n = 4) and posterior commissure (14 per cent, n = 2). Perceptual evaluation, on a scale of zero to three, gave the patients a median score of six; after commencement of treatment, the median score decreased to two. The mean voice handicap index-10 score decreased from 24 to 12 after treatment. An obvious improvement in acoustic analytical parameters was also found following treatment. CONCLUSIONS Antituberculosis treatment clearly improved the voice outcomes of laryngeal tuberculosis patients, according to self-assessment, perceptual analysis and acoustic analysis.
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Affiliation(s)
- K Yelken
- Department of Otolaryngology, Medical Faculty, Gaziomanpasa University, Tokat, Turkey.
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Lim JY, Kim KM, Choi EC, Kim YH, Kim HS, Choi HS. Current clinical propensity of laryngeal tuberculosis: review of 60 cases. Eur Arch Otorhinolaryngol 2006; 263:838-42. [PMID: 16835742 DOI: 10.1007/s00405-006-0063-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Accepted: 02/07/2006] [Indexed: 10/24/2022]
Abstract
Although laryngeal tuberculosis is not frequent, it still occurs with an increasing incidence of pulmonary tuberculosis. Clinical pattern and spread mechanism of this disease have also changed as well. This study was performed to examine the current propensity seen in laryngeal tuberculosis and the clinical characteristics of this disease in patients showing atypical clinical pattern. The medical and videostroboscopic records of 60 patients with laryngeal tuberculosis diagnosed from the year 1994 to 2004 at the department of otorhinolaryngology in Severance Hospital were analyzed. The age of the patients ranged from 25 to 78 years, with their average age being 49.7 years. The ratio between men and women was 1.9:1. The major symptom encountered was hoarseness (96.6%). Clinically, granulomatous (n=22) and ulcerative types (n=11) of laryngeal tuberculosis were still prevalent, however, the incidence of atypical types such as polypoid (n=16) and nonspecific (n=11) were on the rise. Among the 27 cases that showed polypoid or nonspecific types, unilateral lesion was seen in 20 cases (74%). The most frequently affected area by this disease was true vocal cord, followed by false vocal cord, epiglottis, arytenoids and posterior commissure. Active pulmonary tuberculosis was present in 28 (46.7%), inactive pulmonary tuberculosis in 20 (33.3%), normal lung status in 12 cases (20%). Primary laryngeal tuberculosis was present in 9 cases (15%). Single lesion, polypoid and nonspecific type were prevalent in patients with inactive tuberculosis or normal lungs status. Physicians should be aware of the changes in the clinical pattern of laryngeal tuberculosis, which poses serious complications and risk of spreading.
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Affiliation(s)
- Jae-Yol Lim
- Department of Otorhinolaryngology, Institute of Logopedics and Phoniatrics, Yongdong Severance Hospital, Yonsei University College of Medicine, 146-92 Dokok Dong, Kangnam Gu, CPO Box 1217, Seoul 135-720, Korea
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Nalini B, Vinayak S. Tuberculosis in ear, nose, and throat practice: its presentation and diagnosis. Am J Otolaryngol 2006; 27:39-45. [PMID: 16360822 DOI: 10.1016/j.amjoto.2005.07.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Indexed: 11/17/2022]
Abstract
PURPOSE The aim of this study was to increase awareness of the different presentations of head and neck tuberculosis (TB) and to discuss its diagnostic difficulties. MATERIALS AND METHOD A retrospective analysis of patients who presented to us, at a secondary referral hospital, primarily with TB of head and neck was done from January 1999 to July 2003. RESULTS A total of 117 patients presented with primary head and neck TB during the study period. Most of these (95%) had cervical lymphadenopathy, 2 patients had laryngeal TB, and there was 1 patient each of TB of cervical spine, oropharynx, ear, and retropharyngeal abscess. Forty-one were males, and 76 were females. Thirty percent of cases had associated lung or other organ TB. Nine percent gave history of previous or subsequent TB. CONCLUSIONS 1) Diagnosing TB requires a high index of suspicion. 2) Tuberculosis of the cervical lymph nodes is the commonest presentation followed by laryngeal TB. 3) Fine needle aspiration cytology (FNAC) is a reliable and easy way to diagnose TB. However, newer diagnostic tests will increase the yield of positive cases and should be used whenever required. 4) In the larynx, the vocal cords were the commonest site affected and laryngeal TB need not be associated with lung TB or positive sputum always. 5) Patients who have TB of head and neck must be investigated to exclude pulmonary or systemic TB. 6) In cases of previous or subsequent TB infection, culture and drug sensitivity is indicated to reduce the problem of multiple drug resistance.
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Affiliation(s)
- Bhat Nalini
- Department of ENT, BARC Hospital, Anushakti Nagar, Mumbai, India.
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Abstract
Mycobacterial infections are grouped into infections caused by M. tuberculosis and those caused by the atypical mycobacterial organisms. Tuberculosis is a systemic disease, with cervical lymphadenitis of the head and neck being the most common extrapulmonary manifestation of the disease. It is important to use imaging, histopathologic examination, and culture to differentiate tuberculosis from atypical mycobacterial infections, because treatments differ. Tuberculosis is best treated as a systemic disease, with anti-tuberculosis medication. The atypical infections can be addressed as local infections and are amendable to surgical therapy.
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Affiliation(s)
- Karsten Munck
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, 400 Parnassus Avenue, A-730, San Francisco, CA 94143, USA
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