Tuberculosis of the larynx.

Abstract

T UBERCULOSIS OF THE LARYNX is almost always associated with active pulmonary tuberculosis and has become a rare disease as a result of the effectiveness of antibiotic therapy. Until 1940 it occurred in 25%30% of patients having sputum positive for tubercle bacilli.3*5 Indeed, one of the authors, who was a radiologist in a hospital for tuberculosis, recalls that patients with tuberculous laryngitis were always at hand. By the late 1940s the incidence had diminished to 3%-6%. At present it is difficult to find an example. More importantly, it is now observed most frequently in elderly men, especially those with poor nutrition, many of whom are alcoholics with neglected cavitary pulmonary tuberculosis.’ In almost all instances, the disease results from tubercle bacilli carried to the larynx in the sputum from an active focus in the lungs.‘*2 The pulmonary lesion is usually exudative or caseating, and cavity formation is commonly observed. Occasionally, the bacilli may reach the larynx via the cervical lymphatics from an apparently benign tuberculous process in the pulmonary apex, producing scant sputum that is negative for acid-fast bacilli.3 Rarely, the larynx may be involved along with other organs in miliary tuberculosis.’ Primary tuberculous laryngitis is almost unknown6 The tubercle bacilli, carried in the sputum, tend to be deposited most often in areas of stratified squamous epithelium, ie, the posterior portions of the vocal cords and aryepiglotic folds, over the arytenoids, and on the epiglottis.‘,’ Columnar epithelium appears to be more resistant.4 Preexisting abrasions or inflammation are also favored sites.2 Once deposited, the bacilli burrow beneath the epithelium and initiate the formation of subepithelial microtubercles as well as a host reaction that is at first exudative with considerable edema. As the tubercles coalesce, there follows a proliferative and infiltrative process, the typical tuberculous granuloma, giving the mucosa a lumpy appearance. Further progression results in caseation, ulceration, and secondary infection.4 The infection may cause perichondritis and chondritis with additional swelling, especially of the arytenoids