---
title: "Tuberculosis of Larynx - Etiopathogenesis, Clinical Features, Diagnosis & Treatment"
description: "ENT notes on Tuberculosis of Larynx - Etiopathogenesis, Symptoms & signs, investigations, treatment and complications."
source: "The ENT Resident"
author: "Dr. Mausumi Das"
canonical_url: "https://www.theentresident.com/ent-notes-lectures/tuberculosis-larynx-turban-epiglottis-mouse-nibbled-appearance"
categories: ["Larynx and Trachea"]
video: "https://www.youtube.com/watch?v=yoNLl93dQ-U"
image: "https://media.theentresident.com/og-images/tuberculosis-larynx-turban-epiglottis-mouse-nibbled-appearance.png"
---

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

ENT notes on Tuberculosis of Larynx - Etiopathogenesis, Symptoms & signs, investigations, treatment and complications. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=yoNLl93dQ-U

## 🗣️ 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**

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### 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?

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### 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

| Appearance | Finding |
| --- | --- |
| Mammillated appearance | Swelling of interarytenoid region |
| Mouse-nibbled appearance | Irregular ulceration of vocal cords |
| Turban epiglottis | Pseudoedema of epiglottis |

---

### 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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## About This Note

This free ENT note on Tuberculosis of Larynx - Etiopathogenesis, Clinical Features, Diagnosis & Treatment was written by Dr. Mausumi Das and is paired with a corresponding video lecture.

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