Factors Associated with Clinical and Topographical Features of Laryngeal Tuberculosis

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.

[Laryngeal tuberculosis masquerading as carcinoma. Report of one case and literature review]

Since the introduction of antituberculous medications, the incidence of laryngeal tuberculosis (LTB) has decreased. However, it is a fact the increasing number of cases of pulmonary or extrapulmonary TB mainly caused by the Acquired Immunodeficiency Syndrome. We report the clinical case of a 72 years old male with dysphonia secondary to LTB which masqueraded a carcinoma. It's certain diagnosis was the histopathologic exam of the biopsy obtained by microsurgery. There was a residual TB in lung after a complete study of Internal Medicine Department.

Laryngeal tuberculosis masquerading as carcinoma

With the advance of effective anti-tuberculosis drugs and the natural decline of tuberculosis (TB) in the developed world, the incidence of laryngeal TB has decreased and remains stable. However, compared to the situation in the past, the otolaryngologist may encounter uncommon clinical presentation of laryngeal TB nowadays. We describe one such case presenting with a laryngeal lesion with clinical and radiological features of a neoplastic rather than an infectious process.

Laryngeal tuberculosis: a report of 15 cases

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.

[Laryngeal tuberculosis. A rare, but important differential diagnosis to chronic laryngitis]

A middle-aged native Danish man became aphonic with chronic laryngitis. The symptoms persisted despite antibiotic treatment, and chest X-ray disclosed a central pulmonary infiltrate. Histopathology on specimens from the larynx and lung and microscopy and culture of the sputum revealed primary lung tuberculosis with spread to the larynx. At presentation, laryngeal tuberculosis often mimics non-specific chronic laryngitis or laryngeal carcinoma. It should be suspected when the clinical course is unusual. Tuberculosis may develop in the absence of risk factors.

Laryngeal tuberculosis: an important diagnosis

The incidence of laryngeal tuberculosis is increasing worldwide. To ensure early diagnosis it is important for physicians and otolaryngologists to recognize its cardinal signs and symptoms. We present two recent cases of laryngeal tuberculosis that presented to our department. We outline potential pitfalls in diagnosis, and highlight the importance of obtaining a tissue diagnosis. The literature is reviewed, and the treatment options outlined.

The association of secondary tonsillar and laryngeal tuberculosis: a case report and literature review

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.

Tuberculosis of the pyriform fossa--a rare entity

Tuberculosis of the pharynx is less common than tuberculosis of the larynx. We present a rare case of tuberculosis of the pyriform fossa which clinically masqueraded as a malignancy. Our patient showed a prompt improvement in symptoms after commencing antitubercular treatment.

[Laryngeal tuberculosis: a diagnosis not to be forgotten]

Tuberculosis of the larynx has become a rarity since the discovery of streptomycin in 1944. In this article a personal case history is described, together with a review of the literature and an analysis of the main clinical features of tuberculosis of the larynx. The pseudo-tumoural form of tuberculosis is often indicative of the presence of pulmonary tuberculosis, but may also occur in isolation. Histology is often the only definitive diagnostic test.

Subglottic stenosis secondary to tuberculosis

Although the incidence of laryngeal tuberculosis has been declining over the past 30 years, it should still be considered in the differential diagnosis of patients with laryngeal pathology. In contrast to the pre-chemotherapy era, few, if any, signs of pulmonary tuberculosis are seen in such cases, and presentation is similar to either chronic non-specific laryngitis or carcinoma. The subglottis is a site rarely involved in laryngeal tuberculosis. Tissue biopsy and culture are diagnostic and a full course of antituberculous chemotherapy usually resolves the condition. Airway insufficiency due to fibrosis, however, often necessitates surgical intervention. We present a case where the only laryngeal manifestation of tuberculosis was subglottic stenosis.

CT findings of laryngeal tuberculosis: comparison to laryngeal carcinoma

PURPOSE

Our goal was to describe the appearance of laryngeal tuberculosis using CT, with the intent of identifying features distinguishing laryngeal tuberculosis and carcinoma.

METHOD

CT scans of 12 patients with laryngeal tuberculosis were analyzed retrospectively. Clinical symptoms, laryngoscopic exams, and presence of pulmonary tuberculosis on chest radiographs were also reviewed.

RESULTS

In laryngeal tuberculosis, bilateral involvement was noted in nine patients (75%), while unilateral involvement was seen in three (25%). Diffuse thickening of the free margin of the epiglottis was a characteristic and frequent finding in tuberculosis (n = 6, 50%). No deep submucosal infiltration of the preepiglottic and paralaryngeal fat spaces was seen even when there was extensive involvement of the laryngeal mucosa. Cartilage destruction was not found in any case.

CONCLUSION

Characteristic CT findings of laryngeal tuberculosis include bilateral involvement, thickening of the free margin of the epiglottis, and good preservation of the preepiglottic and paralaryngeal fat spaces even in the presence of extensive mucosal involvement. By comparison, laryngeal carcinoma presented unilateral involvement, infiltration of the preepiglottic and paralaryngeal fat spaces by a submucosal mass, cartilage destruction, and extralaryngeal invasion.

Laryngeal tuberculosis: CT findings

OBJECTIVE

The purpose of this study was to evaluate the CT findings of laryngeal tuberculosis (TB).

SUBJECTS AND METHODS

CT scans, laryngoscopic examinations, and chest radiographs of 12 patients (21-63 years old) with histologically (n = 8) or bacteriologically (n = 4) confirmed laryngeal TB were retrospectively reviewed.

RESULTS

Bilateral diffuse thickening of the vocal cords and diffuse thickening and increased density of the aryepiglottic folds and paralaryngeal tissues were present in all patients. Diffuse thickening of the epiglottis was observed in seven patients. In four patients, a focal mass was noted in the anterior portions of the vocal cords (n = 3) or tip of the epiglottis (n =1). Destruction or sclerosis of cartilage was not found. Subglottic extension of the lesion was suspected in only one patient. Enlarged cervical lymph nodes were found in five patients. On laryngoscopic examinations, swelling of the vocal cords (n = 12) or epiglottis (n = 6) was present in all patients and was bilateral in nine patients. Vocal cord mobility was impaired in only one patient. Radiographic findings consistent with active pulmonary TB were present in all patients.

CONCLUSION

Although the CT appearances of laryngeal TB are not specific, the possibility of laryngeal TB should be raised when bilateral and diffuse laryngeal lesions are encountered without destruction of the laryngeal architecture in patients with pulmonary TB.

[Primary laryngeal tuberculosis caused by Mycobacterium bovis]

It is suggested that laryngeal tuberculosis is a common complication of pulmonary tuberculosis. The most frequent germ is Mycobacterium tuberculosis. We present a case in which a infrequent bacillus, Mycobacterium bovis, was isolated without lung afectation. Considerations about morphologic and microbiologic findings are discussed.

Paediatric laryngeal tuberculosis presenting with stridor

A rare case of laryngeal tuberculosis in a 15-month-old Indian child is described. The unusual mode of presentation with stridor, suspicious radiological signs and papillomatous nature of the laryngeal lesion are highlighted.

Tuberculosis presenting as laryngeal stridor in a child

A three and a half-year-old boy developed stridor after insertion of grommets for bilateral secretory otitis media. Despite treatment with steroids systemically and locally, antibiotics and an antihistamine, the stridor worsened. Microlaryngotracheobronchoscopy (MLB) demonstrated laryngeal granulations, in which, by auramine and Ziehl-Neelsen staining, acid-fast bacilli were seen, and from which subsequently Mycobacterium tuberculosis grew in culture. Following the MLB the child became comatosed and a clinical diagnosis of tuberculosis involving the central nervous system was made. Despite quadruple antituberculous chemotherapy he died 8 days later. A Mantoux test was negative and a chest radiograph was normal. Acid-fast bacilli were not demonstrated on repeated examinations of cerebrospinal fluid, nor were they grown ante mortem or post mortem from samples of cerebrospinal fluid.

Tuberculous granuloma of the epiglottis

A case of tuberculous granuloma of the epiglottis is presented. The presenting symptoms were hoarseness and painful dysphagia, and the laryngoscopic appearances resembled carcinoma. Histological examination of the biopsy material was diagnostic, emphasising the difficulty of diagnosis in the general population.

The changing pattern of laryngeal tuberculosis

Laryngeal tuberculosis is now an uncommon disease in the United Kingdom. A series of ten cases is reported. In contrast to the pre-chemotherapy era, when the disease was associated with advanced cavitated pulmonary tuberculosis and was highly infectious, it now presents in a manner similar to laryngeal carcinoma except that painful dysphagia is a prominent symptom. All such patients should have a chest X-ray carried out as part of their initial investigation. Sputum is almost always positive for tubercle bacilli on direct films. Direct laryngoscopy and biopsy are necessary if a carcinoma is suspected. The change of pattern of the disease may be due to the fact that the larynx now usually becomes involved by haematogenous spread rather than by direct spread along the airways. Laryngeal tuberculosis is now no more infectious than pulmonary tuberculosis, and responds well to antituberculous chemotherapy. Symptoms resolve completely within three weeks if corticosteroids are given in combination.

Laryngeal tuberculosis

Laryngeal lesions observed in patients with pulmonary tuberculosis are most likely tuberculous. Although tuberculosis and carcinoma may be indistinguishable clinically and radiographically, specific radiographic studies better delineate the lesion and may suggest its true etiology. Five cases of laryngeal tuberculosis referred to M.D. Anderson Hospital and Tumor Institute as carcinoma of the larynx are described and illustrated. In the acute exudative type, inflammatory disease was suspected, but in the chronic localized lesion, carcinoma was the primary consideration. The histologic diagnosis was established by biopsy.

Tuberculosis of the larynx masquerading as carcinoma

A patient with laryngeal and pulmonary tuberculosis is described. The similarity between the clinical presentation and gross appearance of laryngeal carcinoma and tuberculosis in this patient and others reported in the literature is emphasized. Laryngeal biopsy is necessary to establish the correct diagnosis, but this must be done only after the proper precautions are taken to reduce the risk of infection to the physician performing the biopsy. Examination of the chest x-ray and acid-fast stain of the sputum are rapid and highly reliable screening tests for laryngeal tuberculosis.