Tuberculosis of Larynx - Etiopathogenesis, Clinical Features, Diagnosis & Treatment

🗣️ Tuberculosis of Larynx

Laryngeal tuberculosis is an infection of the larynx caused by Mycobacterium tuberculosis.

• Relatively uncommon site of the disease compared to the lungs
• More common in males

Etiopathogenesis of Laryngeal Tuberculosis

1- Secondary Laryngeal TB - Most Common (~95% cases)

Occurs secondary to Pulmonary tuberculosis.

2- Primary Laryngeal TB - Very Rare (1–5% cases)

Causative Organism 👉 Mycobacterium tuberculosis

What are the modes of Spread in Laryngeal Tuberculosis?

What are the pathological changes seen in Laryngeal Tuberculosis?

Sites Involved in Laryngeal Tuberculosis

Most Common Site of Laryngeal Tuberculosis 👉 Posterior part of the larynx, especially the glottic region

Why is the Posterior Part Most Commonly Involved?

📍 Sites in Decreasing Order of Frequency:

1- Interarytenoid fold & Arytenoid cartilages

2- Ventricular bands

3- Vocal cords

4- Epiglottis

Clinical Features of Laryngeal Tuberculosis

Symptoms of Laryngeal Tuberculosis

• History of pulmonary tuberculosis
• Weakness of voice
• Hoarse voice
• Dysphonia
• Pain on speaking
• Productive cough
• Odynophagia
• Dysphagia
• Referred otalgia
• Dyspnea
• Stridor
• Fever with chills and rigors
• Laryngeal tenderness
• Cervical lymphadenopathy
• Hemoptysis
• Weight loss

What is the Earliest Symptom seen in Laryngeal Tuberculosis?

When does Odynophagia occur in Laryngeal Tuberculosis?

When does Referred otalgia occur in Laryngeal Tuberculosis?

When is laryngeal tenderness seen in Laryngeal Tuberculosis?

Laryngoscopic Findings in Laryngeal Tuberculosis

• Hyperemia of the vocal cords
• Swelling of interarytenoid region → Mammillated appearance
• Ulceration of vocal cords → Mouse-nibbled appearance of Vocal cords
• Superficial ragged ulceration on arytenoids and interarytenoid region
• Granulation tissue in interarytenoid region or vocal process of arytenoids
• Pseudoedema of epiglottis → Turban epiglottis
• Swelling of ventricular bands
• Swelling of aryepiglottic folds
• Marked pallor of surrounding mucosa
• Shallow laryngeal inlet
• Indolent ulcers

What is the earliest sign seen in Laryngeal Tuberculosis?

⭐ Typical Appearances in Laryngeal TB

Investigations of Laryngeal Tuberculosis

1- Chest X-ray / CT Chest

To look for pulmonary tuberculosis

2- CT Neck

• Extent of disease
• Cervical lymphadenopathy

3- Tissue & Sputum Culture for Acid-Fast Bacilli (AFB)

4- Mantoux Test

5- Stroboscopy

To assess the extent of disease

6- Biopsy for Histopathology - Gold Standard

Why is Biopsy Important in Laryngeal Tuberculosis?

🔬 Histopathology Findings

• Granulomas with caseating necrotic center
• Langhans-type giant cells
• Epithelioid cells
• Mycobacteria

Treatment of Laryngeal Tuberculosis

Treatment is primarily Medical. Surgery is very rarely required.

1- Securing the Airway

In patients with dyspnea and stridor, the airway is secured first.

Tracheostomy may be required.

2- Antitubercular Therapy (ATT)

What is the antitubercular therapy regimen for laryngeal tuberculosis?

3- Adjunct Treatment

• Voice rest
• Analgesics (if needed)
• Nutritional support

⚠️ Role of Steroids

❌ Avoid routine use of steroids

✅ Used only when specifically indicated

Example: Significant laryngeal edema causing airway obstruction

What is the Role of Surgery in Laryngeal Tuberculosis?

Differential Diagnosis of Laryngeal Tuberculosis

• Malignancy of larynx
• Chronic laryngitis
• Granulomatous diseases (Sarcoidosis, Histoplasmosis)
• Fungal infections
• Syphilis

Complications of Laryngeal Tuberculosis

Seen when treatment is delayed or the patient does not respond to treatment:

• Cricoarytenoid joint arthritis / fixation
• Laryngeal stenosis
• Anterior / Posterior commissure webs
• Scarring & dysphonia
• Chondritis
• Chondronecrosis

🧠 Viva Pearls

• Laryngeal tuberculosis is more common in males.
• About 95% of laryngeal TB cases are secondary to pulmonary tuberculosis.
• Primary laryngeal TB is very rare.
• Most common site involved is the posterior part of the larynx.
• Interarytenoid fold is the most common site of involvement.
• Swelling of the interarytenoid region gives a mammillated appearance.
• Ulceration of vocal cords gives a mouse-nibbled appearance.
• Pseudoedema of the epiglottis gives a turban epiglottis.
• Biopsy for histopathology is the gold standard investigation.
• Treatment is primarily medical with antitubercular therapy.
• Routine use of steroids is avoided.
• Destructive surgery is avoided as most lesions respond to antitubercular therapy.

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