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Chhabra B, Vyas P, Gupta P, Sharma P, Sharma K. Incidence, Diagnosis and Treatment of Otorhinolaryngological, Head and Neck Tuberculosis: A Prospective Clinical Study. Int Arch Otorhinolaryngol 2023; 27:e630-e635. [PMID: 37876691 PMCID: PMC10593515 DOI: 10.1055/s-0043-1761173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 09/12/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Tuberculosis is a disease of diversified presentation. It affects almost all organs in the body, and otorhinolaryngological, head and neck involvement is not an exception. Objective To increase awareness about the different clinical presentations of otorhinolaryngological, head and neck tuberculosis, the techniques employed to diagnose it, and to assess the response to the treatment. Methods We conducted a prospective study of 114 patients who presented primarily with otorhinolaryngological, head and neck tuberculosis. Routine blood investigations, chest radiographs, the tuberculin test, and sputum examination for the presence of acid-fast bacilli were performed in all cases. Site-specific investigations were performed in relevant cases only. The patients were treated according to the antitubercular treatment (ATT) regimen recommended by the Indian Ministry of Health and Family Welfare's National Tuberculosis Elimination Program (NTEP), and they were followed up clinically two and six months after starting the ATT. Results Tubercular cervical lymphadenopathy was the most common clinical presentation (85.96%), followed by deep neck abscess (5.27%). Fine-needle aspiration cytology proved to be a reliable tool for the diagnosis of tubercular lymphadenopathy. Improvement at the end of 2 and 6 months of the ATT was observed in 90.35% and 96.50% of the cases respectively. Conclusion The diagnosis of otorhinolaryngological, head and neck tuberculosis requires a high index of clinical suspicion, and the ATT proved to be very effective in reducing the severity of the disease.
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Affiliation(s)
- Biban Chhabra
- Department of Otorhinolaryngology and Head and Neck Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Pratibha Vyas
- Department of Otorhinolaryngology and Head and Neck Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Priyanshi Gupta
- Department of Otorhinolaryngology and Head and Neck Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Prateek Sharma
- Department of Otorhinolaryngology and Head and Neck Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
| | - Kanika Sharma
- Department of Otorhinolaryngology and Head and Neck Surgery, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India
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Thomas N, Nambiar SS, Nampoothiri PM. Extrapulmonary Tuberculosis: An Otorhinolaryngologist's Perspective. Indian J Otolaryngol Head Neck Surg 2022; 74:5562-5568. [PMID: 36742503 PMCID: PMC9895514 DOI: 10.1007/s12070-021-02903-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 10/02/2021] [Indexed: 02/07/2023] Open
Abstract
Objective The study aimed to determine the clinical manifestations and epidemiology of extrapulmonary tuberculosis (EPTB) of the head and neck in the otorhinolaryngeal regions. There is an increase in the incidence of EPTB in recent years because of increase in immunocompromised states and development of resistant bacteria. The clinical symptoms and signs of EPTB of the otorhinolaryngeal regions overlap with that of malignancies and other diseases in otorhinolaryngology thereby requiring correct early diagnosis so as to avoid unnecessary surgeries and procedures with initiation of appropriate anti tuberculous treatment under RNTCP. Study design Our prospective study was done on 45 patients who attended the ENT OPD at a tertiary care centre in Southern India over a period of 18 months with diagnosed EPTB of the otorhinolaryngeal regions. Results The study included 29 (64.4%) patients who presented with cervical lymphadenopathy, 11 (24.4%) patients with tuberculous laryngitis, 3 (6.6%) patients with tuberculous otitis media and 1 each with nasal and oral cavity tuberculosis. In our study 6 (13.3%) patients had co-existing pulmonary tuberculosis, 8 (18%) had diabetes, 5 (11%) had past history of tuberculosis and 7 (16%) had contact with patient with tuberculosis. Conclusion A high index of suspicion of EPTB must be kept among patients where (i) the clinical symptoms are out of proportion to the signs, (ii) common treatment fails or (iii) there is persistence or recurrence of symptoms despite therapy. The challenge is in confirming diagnosis which requires histopathological examination (HPE) of the tissue specimen. The timely diagnosis and initiation of anti tuberculous treatment (ATT) as per RNTCP helps in complete recovery thereby reducing morbidity.
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Affiliation(s)
- Nittu Thomas
- Department of ENT, Government Medical College, Kozhikode, Kerala 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 Otorhinolaryngol Ital 2022; 42:407-414. [DOI: 10.14639/0392-100x-n2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/18/2022] [Indexed: 12/24/2022]
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Abstract
Tuberculosis involving organs other than the lungs is termed as 'extra pulmonary tuberculosis'. Tuberculosis (TB) remains a worldwide public health problem despite the fact that the causative organism was discovered more than 100 years ago. The present study was conducted to assess different manifestations of tuberculosis affecting the ear, nose and throat (ENT) in patients attending the outpatient department in a total of 520 cases of tuberculosis. One hundred and eight cases were of extra pulmonary tuberculosis. Sixty nine cases had the manifestations of TB in the ENT region. These included patients with tuberculous cervical lymphadenopathy (91.35), laryngeal TB (4.3%), tuberculous otitis media (1.4%), nasal TB (1.4%) and oral tuberculosis (1.4%). Extra pulmonary tuberculosis constitutes about 15-20% of all tuberculosis cases as per WHO survey and it is 20.6% in the present study.
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Affiliation(s)
- Shilpam Sharma
- Department of ENT, Vardhaman Mahaveer Medical College and Safdarjung Hospital, New Delhi, India
| | - Amit Kumar Rana
- Department of Otorhinolaryngology and Head Neck Surgery, SRMS Institute of Medical Sciences, Bareilly (UP), India
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Ng CL, Liu X, Tan NJH, Prasad VMN, Lee P. Pulmonary melioidosis with laryngeal involvement: an unusual site of infection. Thorax 2018; 73:thoraxjnl-2017-211046. [PMID: 29374089 DOI: 10.1136/thoraxjnl-2017-211046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/29/2017] [Accepted: 01/05/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Chew Lip Ng
- Department of Ear, Nose & Throat (ENT)-Head & Neck Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Xuandao Liu
- Department of Ear, Nose & Throat (ENT)-Head & Neck Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | | | - Vyas Malur Narayan Prasad
- Department of Ear, Nose & Throat (ENT)-Head & Neck Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Pyng Lee
- Division of Respiratory and Critical Care Medicine, University Medicine Cluster, National University Hospital, Singapore, Singapore
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Dias A, Monteiro F, Silva J, Duarte R. Caso clínico de ronquera de dos años de duración: ¿comenzó en el pulmón? Arch Bronconeumol 2017; 53:457-458. [DOI: 10.1016/j.arbres.2016.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 11/15/2016] [Accepted: 12/04/2016] [Indexed: 11/21/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bruzgielewicz A, Rzepakowska A, Osuch-Wójcikewicz E, Niemczyk K, Chmielewski R. Tuberculosis of the head and neck - epidemiological and clinical presentation. Arch Med Sci 2014; 10:1160-6. [PMID: 25624854 PMCID: PMC4296055 DOI: 10.5114/aoms.2013.34637] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 02/12/2012] [Accepted: 09/03/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of our retrospective study was to review the clinical and epidemiological presentation of head and neck tuberculosis. MATERIAL AND METHODS We analyzed the history of 73 patients with head and neck tuberculosis hospitalized in the Department of Otolaryngology, Medical University of Warsaw, between 1983 and 2009. RESULTS We found that 26 (35.6%) patients presented with lymph node tuberculosis, 20 (27.4%) with laryngeal tuberculosis, 10 (13.7%) with oropharyngeal tuberculosis, 9 (12.3%) with salivary gland tuberculosis, 3 (4.1%) with tuberculosis of paranasal sinuses, 3 (4.1%) with aural tuberculosis, and 2 (2.7%) with skin tuberculosis in the head and neck region. Within the group of patients with lymph node tuberculosis in 15 cases there were infected lymph nodes of the 2(nd) and 3(rd) cervical region and in 11 infected lymph nodes of the 1(st) cervical region. In 5 cases of laryngeal tuberculosis there was detected coexistence of cancer. Oropharyngeal tuberculosis in 7 cases was localized in tonsils, where in 1 case coexisting cancer was diagnosed. Chest X-ray was performed in all cases and pulmonary tuberculosis was identified in 26 (35.6%) cases. CONCLUSIONS We conclude that tuberculosis still remains a problem and must be taken into consideration in the diagnostic process. The coincidence of tuberculosis and cancer is remarkable in the head and neck region.
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Affiliation(s)
| | - Anna Rzepakowska
- Otolaryngology Department, Warsaw Medical University, Warsaw, Poland
| | | | | | - Rafał Chmielewski
- Otolaryngology Department, Warsaw Medical University, Warsaw, Poland
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Akkara SA, Singhania A, Akkara AG, Shah A, Adalja M, Chauhan N. A Study of Manifestations of Extrapulmonary Tuberculosis in the ENT Region. Indian J Otolaryngol Head Neck Surg 2013; 66:46-50. [PMID: 24605301 DOI: 10.1007/s12070-013-0661-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 05/13/2013] [Indexed: 10/26/2022] Open
Abstract
Though tuberculosis (TB) primarily affects lungs, extra pulmonary tuberculosis (EPTB) is also common, especially in high disease load areas and mainly manifests in ENT region. To study the different manifestations of tuberculosis in ENT region in terms of presentation, disease process, treatment and outcome. Records of patients diagnosed and treated for TB in the ENT region at our institute's DOTS centre for a two and half year period were analysed for presenting complaints, examination findings, diagnostic features, treatment modes and outcome. Out of 3750 cases diagnosed as TB, 230 had EPTB. 211 cases had ENT manifestations. Majority of the cases were male and in the fourth decade of life. Commonest manifestation was cervical lymphadenopathy with 201 cases. Fine needle aspiration cytology was mostly diagnostic and category I anti TB treatment (AKT) achieved cure. The six cases of TB otitis media presented with ear discharge, sometimes bloody and had varied tympanic membrane findings and facial palsy in two cases with different types and degrees of hearing loss. Diagnosis was confirmed by histology of tissue removed during surgery. Patients completed category I AKT. Hearing and facial palsy did not improve. There were three cases of TB laryngitis and one of nasal TB both of which were confirmed by tissue diagnosis and responded well to AKT. Most of the results in the present study conform to findings of other studies. High degree of suspicion is necessary to reach diagnosis. Category I AKT is effective. Some cases may require surgery.
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Affiliation(s)
- Stani Ajay Akkara
- Deparment of Respiratory Medicine, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India
| | - Ankit Singhania
- Department of ENT, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India
| | - Ajay George Akkara
- Department of ENT, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India ; C-1, Staff Quarters, Sumandeep Vidyapeeth Campus, Vadodara, 391760 Gujarat India
| | - Arti Shah
- Deparment of Respiratory Medicine, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India
| | - Mayur Adalja
- Deparment of Respiratory Medicine, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India
| | - Nirali Chauhan
- Department of ENT, Smt. B. K. Shah Medical Institute & Research Centre, Piparia, Waghodia, Vadodara, 391760 Gujarat India
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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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Bhat VK, Latha P, Upadhya D, Hegde J. Clinicopathological review of tubercular laryngitis in 32 cases of pulmonary Kochs. Am J Otolaryngol 2009; 30:327-30. [PMID: 19720251 DOI: 10.1016/j.amjoto.2008.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Accepted: 07/06/2008] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim is to study the current clinical features of tubercular laryngitis in adult patients with pulmonary involvement in the absence of other nontubercular comorbidities. MATERIALS AND METHODS Medical records of histopathology confirmed cases with pulmonary Kochs in a tertiary medical center of a developing country from 1993 to 2007. RESULTS Thirty-two biopsy-proven cases of laryngeal tuberculosis with pulmonary involvement were found. Patients' ages ranged from 16 to 65 years. The male-to-female ratio was 4.3:1. Hoarseness of voice was the commonest symptom. Most of them were associated with advanced fibrocavitary tuberculosis of the lungs. In the larynx, multiple, granulomatous, bilateral lesions were the commonest. Most of these lesions could be reversed with appropriate antituberculous treatment. CONCLUSION Laryngeal tuberculosis with classic presentation continues to exist in developing countries. It can be the very first indication that the patient has tuberculosis. Hence, the otolaryngologist needs to remain vigilant to consider it in the differential diagnosis of chronic laryngeal disease.
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Affiliation(s)
- Vikram K Bhat
- Department of Otolaryngology, Head and Neck Surgery, Karnataka Institute of Medical Sciences, Hubli, India.
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Barbosa de S Á LC, Meirelles RC, Tavares Atherino CC, Carvalhaes Fernandes JR, Ferraz FR. Laryngo-pharyngeal Tuberculosis. Braz J Otorhinolaryngol 2008; 73:862-866. [PMID: 18278238 PMCID: PMC9450674 DOI: 10.1016/s1808-8694(15)31188-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2006] [Accepted: 05/09/2006] [Indexed: 11/02/2022] Open
Abstract
UNLABELLED Tuberculosis of the Larynx and pharynx only is rare. However, in the last few years, the number of tuberculosis cases in general have had a dramatic increase, thus increasing the possibility of isolated laryngo-pharyngeal lesions. AIM To report a case of isolated laryngo-pharyngeal tuberculosis in a pregnant, immunocompetent host. CASE REPORT A 30- year-old pregnant female had complained of odynophagia for the last ten months. There were no other respiratory or systemic symptoms. An oro-pharyngeal granulomatous lesion was found, and the biopsy revealed acid-fast bacilli. There were no clinical or radiologic pulmonary findings. She was submitted successfully to an tuberculosis treatment protocol for nine months. CONCLUSIONS The authors point out the epidemiological importance of tuberculosis and the need for a higher degree of suspicion when dealing with uncommon upper airway lesions to make an early diagnosis.
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Affiliation(s)
- Leonardo Conrado Barbosa de S Á
- ENT Resident - Pedro Ernesto University Hospital - Ro de Janeiro. M.S Student - General Surgery - Federal University of Rio de Janeiro Medical School - FM-UFRJ
| | - Roberto Campos Meirelles
- PhD, Adjunct Professor of Otorhinolaryngology - School of Medical Sciences - Universidade do Estado do Rio de Janeiro
| | | | | | - Fabiana Rocha Ferraz
- Medical Resident - Pedro Ernesto University Hospital - Universidade do Estado do Rio de Janeiro. MD. Otorhinolaryngology Department - Pedro Ernesto University Hospital - da Universidade do Estado do Rio de Janeiro
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Saroul N, Vellin JF, Baud O, Nohra O, Kemeny JL, Gilain L. [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] [What about the content of this article? (0)] [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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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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kenmochi M, Ohashi T, Nishino H, Sato S, Tanaka Y, Koizuka I, Shinagawa T. A case report of difficult diagnosis in the patient with advanced laryngeal tuberculosis. Auris Nasus Larynx 2003; 30 Suppl:S131-4. [PMID: 12543178 DOI: 10.1016/s0385-8146(02)00137-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a patient with severe laryngeal tuberculosis (LTB) involving thyroid cartilage and combined with whole-bone metastasis. A 57-year-old male had presented only with hoarseness. Radiological findings were indicative of suspected metastasis from a malignant tumor. However, tuberculosis was considered by histopathological findings, and so sputum samples were tested for acid-fast bacilli and purified protein derivatives of tuberculin in order to detect the presence of LTB. A polymerase chain reaction confirmed the diagnosis. Anti-tuberculous medications were effective in resolving the hoarseness, and the removal of the mass in the right wing of thyroid cartilage was confirmed by computed tomography (CT).
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Affiliation(s)
- Mutsumi Kenmochi
- Department of Otolaryngology, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, 1197-1, Yasashi-chou, Asahi-ku, 241-0811, Yokohama, Japan.
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Abstract
Laryngeal tuberculosis is usually a complication of pulmonary tuberculosis. Recent studies have described a change in the clinical features of laryngeal tuberculosis. We present 15 cases of laryngeal tuberculosis treated at the Osaka Prefectural Habikino Hospital between 1993 and 2000. The results showed a mean age of 51 years, a male predominance by 2.75 to 1, and a 20% incidence (n = 3) of negative chest radiographic findings. The prominent presenting symptom was hoarseness (73.3%), and systemic symptoms were relatively rare. Seven patients showed ulcerative lesions, 5 showed granulomatous lesions, and the remaining 3 showed nonspecific inflammatory lesions in the larynx. Laryngeal lesions did not show any predilection for specific laryngeal sites in our series. In contrast to earlier studies, our study shows variations in clinical features of laryngeal tuberculosis. Physicians should consider tuberculosis in the differential diagnosis of laryngeal disease.
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Affiliation(s)
- Suetaka Nishiike
- Department of Otolaryngology and Sensory Organ Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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20
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Abstract
A number of inflammatory and granulomatous lesions can involve the larynx and pharynx. These conditions are generally difficult to diagnose because of the range of symptoms. This article reviews the following conditions: supraesophageal complications of reflux disease, relapsing polychondritis, Wegener granulomatosis, sarcoidosis, tuberculous laryngitis, Teflon (polytetrafluoroethylene fluoropolymer resin; DuPont, Wilmington, DE) granuloma, amyloidosis, rheumatoid arthritis, and systemic lupus erythematosus. The purpose is to provide a brief review of each disease and its manifestations, symptoms, diagnosis, and treatment.
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Affiliation(s)
- T A Loehrl
- Department of Otolaryngology and Communication Sciences, Dysphagia Institute, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI 53226, USA
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21
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Abstract
We report 11 patients with laryngeal tuberculosis seen in our hospital, January 1990 to July 2000. Eight were men and all cases presented with dysphonia and/or disphagia. In 8 pulmonary tuberculosis was associated. Mycobacterium tuberculosis was isolated from the sputum in 7 patients. Granulomatous laryngitis was demonstrated in the eight patients with laryngeal biopsy. The evolution with medical treatment was favourable in all patients.
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Affiliation(s)
- M Montejo
- Unidad de Enfermedades Infecciosas, Hospital de Cruces, Bilbao
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22
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Abstract
The resurgence of tuberculosis has been of increasing concern to public health. Laryngeal and cutaneous tuberculosis have long been regarded as two of the most infectious forms of the disease. In this article, we re-emphasize the public health consequences of a case of laryngeal TB, which must be considered in the differential diagnosis of a patient with persistent fever, cough, weight loss, and hoarseness.
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Affiliation(s)
- J C Sherrell
- Department of Internal Medicine, The University of Tennessee College of Medicine, Memphis 38163, USA
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23
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Abstract
OBJECTIVES/HYPOTHESIS Despite the dramatic decrease in the incidence of laryngeal tuberculosis, the disease has gained new interest as a result of claims that it has changed its clinical patterns. The aim of this study is to evaluate the changing trends in clinical manifestations of laryngeal tuberculosis. STUDY DESIGN Retrospective clinical analysis. METHODS Clinical analysis of 22 patients with pathologically confirmed laryngeal tuberculosis was carried out retrospectively. RESULTS Patients' ages ranged from 22 to 75 years. The male-to-female ratio was 2.14 to 1. The most frequent chief complaint was hoarseness. The true vocal cord and the false vocal cord were commonly involved, and 11 patients showed single lesions. Among 22 patients, only 7 had active pulmonary tuberculosis, and 9 were proven to have normal lung status. The patients with active pulmonary tuberculosis showed more ulcerative and multiple lesions. The patients with normal lung status showed nonspecific, polypoid, and single lesions. All patients responded satisfactorily to antituberculous medication. CONCLUSIONS The clinical manifestations of laryngeal tuberculosis have changed and seem to be different from those of classic reports. It can even occur without pulmonary tuberculosis, and the characteristics of lesions seem to be more nonspecific. It might be important to consider tuberculosis in the differential diagnosis of nonspecific laryngeal disease.
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Affiliation(s)
- J E Shin
- Department of Otolaryngology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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24
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Sutbeyaz Y, Ucuncu H, Murat Karasen R, Gundogdu C. The association of secondary tonsillar and laryngeal tuberculosis: a case report and literature review. Auris Nasus Larynx 2000; 27:371-4. [PMID: 10996500 DOI: 10.1016/s0385-8146(00)00055-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tonsillar and laryngeal tuberculosis are rare diseases. We report a case with a tonsillar and laryngeal lesion. Histopathological and bacteriological examinations established the diagnosis of tonsillar and laryngeal tuberculosis associated with asymptomatic pulmonary focus.
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Affiliation(s)
- Y Sutbeyaz
- Department of Otolaryngology, Atatürk University School of Medicine, Tip Fakültesi, Patoloji Anabilim Dalt, 25420, Erzurum, Turkey
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25
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Abstract
BACKGROUND Tuberculosis is the most common non-pyogenic infection encountered among renal transplant recipients in India. Although the lung is the most common site of involvement, a number of extrapulmonary organs can be involved. There is often a delay in diagnosis and institution of effective chemotherapy when there is an unusual site of involvement. METHODS AND RESULTS We report two renal transplant recipients with laryngeal tuberculosis who presented with prolonged hoarseness of voice and painful dysphagia. Acid-fast bacilli were demonstrated on laryngeal biopsy and smear. Fever and pulmonary involvement were seen in only one patient. This is the first report of laryngeal tuberculosis in renal transplant recipients. CONCLUSIONS Laryngeal tuberculosis should be suspected in renal transplant recipients who develop hoarseness of voice and odynophagia. Demonstration of acid-fast bacilli on biopsy or smear obtained by direct laryngoscopy helps in determining the diagnosis.
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Affiliation(s)
- V Jha
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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26
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Ng DK, Hui Y, Law AK, Ho JC. Tuberculous laryngitis in a child. Respirology 1999. [DOI: 10.1046/j.1440-1843.1999.00174.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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27
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Affiliation(s)
- R Ulloa
- Division of Infectious Diseases, National Children's Hospital, San Jose, Costa Rica
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28
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Kandiloros DC, Nikolopoulos TP, Ferekidis EA, Tsangaroulakis A, Yiotakis JE, Davilis D, Adamopoulos GK. Laryngeal tuberculosis at the end of the 20th century. J Laryngol Otol 1997; 111:619-21. [PMID: 9282198 DOI: 10.1017/s0022215100138137] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Despite the dramatic reduction in the incidence of laryngeal tuberculosis after the 1950s, the topic has now gained new interest due to claims that the disease has changed its clinical pattern. In the past, the typical patient was 20-40 years old with ulcerated laryngeal lesions, perichondritis, and advanced cavitary lung disease. We studied nine cases of laryngeal tuberculosis confirmed by histological examination. The microlaryngoscopy revealed tumour-like lesions and/or chronic non-specific laryngitis. There were no significant ulcerations or signs of perichondritis. The patients' ages ranged from 48.5 years to 69.3 years (mean, 59.4 years). In three of our patients (33 per cent) we did not find any pulmonary involvement, thus suggesting primary laryngeal tuberculosis or haematogenous spread. In conclusion, the numerous physicians who deal with the various laryngeal symptoms and diseases should be aware of the existence of laryngeal tuberculosis and the changing patterns of the disease (at least in the developed countries).
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Affiliation(s)
- D C Kandiloros
- Department of Otolaryngology, Athens University School of Medicine, Greece
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29
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Abstract
As the prevalence of tuberculosis in the U.K. increases, uncommon clinical presentations of the disease may be encountered by the otolaryngologist. We describe just such a case, where a caucasian patient presented with laryngeal lesion, considered to be highly suspicious of a neoplastic process rather than an infective one. We discuss the pathogenesis of tuberculous laryngitis, and review the differential diagnosis and management of the condition.
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30
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Holm E, Seibaek M, Iversen PB. Two cases of otolaryngeal tuberculosis in a Danish married couple. J Laryngol Otol 1995; 109:1080-1. [PMID: 8551125 DOI: 10.1017/s0022215100132074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AbstractTwo cases of otolaryngeal tuberculosis which appeared in a married couple are described.
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Affiliation(s)
- E Holm
- Department of Medicine, Amtssygehuset, Roskilde, Denmark
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31
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 34-1994. A 38-year-old alcoholic man with six months of increasing hoarseness and a laryngeal mass. N Engl J Med 1994; 331:728-34. [PMID: 7702649 DOI: 10.1056/NEJM199409153311108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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32
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Affiliation(s)
- M C Tong
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital
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33
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Abstract
Oropharyngeal tuberculosis is a rare presentation of the disease even in the presence of extensive pulmonary tuberculosis. A case is described in which a retropharyngeal abscess, causing stridor and threatening respiratory obstruction, was the only manifestation of Mycobacterium tuberculosis infection.
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Affiliation(s)
- N Carroll
- Department of Medicine, Royal Liverpool Hospital
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