Clinical characteristics and prognosis of laryngeal tuberculosis combined with respiratory tuberculosis.

PURPOSE: To investigate the clinical characteristics, diagnosis and prognosis of patients with laryngeal tuberculosis (LTB) combined with respiratory tuberculosis. MATERIALS AND METHODS: A retrospective analysis was conducted on 134 patients who underwent endoscopy and were eventually diagnosed with LTB. The patients' demographic characteristics, clinical manifestations, endoscopic features, auxiliary examination, imaging examination and prognostic characteristics were analyzed. RESULTS: LTB patients had a median age of 45.5 years (range from 12 to 87 years) and a median course of 3.0 months (range from 0.1 to 72 months). The patients' symptoms mainly presented as hoarseness (97.0 %), abnormal sensation of pharyngeal (49.3 %), cough and sputum (41.0 %), pharyngalgia (39.6 %), dysphagia (10.4 %) and dyspnea (8.2 %). The positive rate of tuberculous symptoms was 25.4 %. Endoscopic features showed that the lesions mainly involved the glottis (87.3 %), presenting as unilateral lesions (66.7 %), near-full-length involvement (88.0 %), with mucosal waves significantly reduced (86.3 %), followed by supraglottis (43.3 %), subglottis (24.6 %) and the pharynx (15.7 %). The lesions may present as granulomatous proliferation (66.4 %), ulceration (65.7 %) or swelling and exudation (51.5 %). A total of 75 patients (56.0 %) were finally diagnosed with combined pulmonary tuberculosis (PTB), with a positive chest X-ray rate of 25.6 % and a positive chest CT rate of 71.2 %. A total of 42 patients who received anti-tuberculosis treatment were followed up, and 73.8 % of patients had significant improvement in symptoms. The morphology of the pharyngeal and laryngeal mucosa returned to basically normal (59.4 %) or scar-like (34.4 %). CONCLUSIONS: LTB is usually found in middle-aged men, and patients' symptoms are mainly hoarseness, abnormal sensation of pharyngeal, pharyngalgia, cough and sputum, and can be combined with tuberculous symptoms. These lesions mainly involve multiple subregions, mainly in the glottis, and can be combined with pharyngeal involvement. There were various types of lesions. Half of the patients were complicated with PTB, and chest CT was superior to X-ray in the detection of pulmonary lesions. After regular anti-tuberculosis treatment, the symptoms and morphology of the pharyngeal and laryngeal mucosa of most patients were significantly improved.

[The history of tuberculosis of the larynx]. / Zur Geschichte der Kehlkopftuberkulose.

The tuberculosis of the larynx was an incurable deadly infectious disease until the introduction of antituberculous drugs in therapy. Since the 18th century medical specialists investigated this kind of tuberculosis. Progresses of laryngeal diagnostic made possible a local treatment with drugs, operations and experiments with X-rays. After the development of antituberculous drugs, tuberculosis of the larynx became a curable disease.

Diagnosis of laryngeal tuberculosis in a high TB burden area.

PURPOSE: The larynx is the second most commonly affected site in the head and neck region in patients with extrapulmonary tuberculosis (TB). Despite this, the prevalence of laryngeal TB is largely unknown, particularly in areas with a high TB burden. The laboratory diagnosis of TB includes microscopy, culture and molecular testing. The aims of this study were to determine the prevalence of laryngeal TB in patients presenting with laryngeal pathology in a region with a high TB burden and to determine the optimal diagnostic methods for the diagnosis of laryngeal TB. METHODS: This was a prospective descriptive study of 80 adult patients undergoing direct laryngoscopy and biopsy for laryngeal pathology in the Department of Otorhinolaryngology, Universitas Academic Hospital, Bloemfontein, South Africa over a 1 year period. Histopathological and microbiological investigations (microscopy, Xpert MTB/RIF, and TB culture) were performed on all laryngeal biopsies. RESULTS: Five (6.25%) out of 80 patients were diagnosed with laryngeal TB. In one patient, the Xpert MTB/RIF assay was positive on the laryngeal tissue and histology showed granulomas. Two patients had granulomas on histology although the microbiological tests on the tissue were negative. Two patients had only positive tissue cultures for Mycobacterium tuberculosis. None of the biopsies had positive Ziehl-Neelsen stains. CONCLUSION: The results suggest that the diagnosis of laryngeal TB required a combination of histopathology, culture and PCR and that the Xpert MTB/RIF assay is not a sensitive test for the diagnosis of laryngeal TB.

A review of the current public health practice for contact tracing in relation to laryngeal TB in England 2012-2016.

OBJECTIVES: Contact tracing following identification of tuberculosis (TB) is well established. However, evaluation of this activity, particularly for laryngeal TB, is limited. We compare contact tracing and outcomes in response to laryngeal TB with sputum-smear-positive pulmonary TB (ss + pTB) and consider the public health response in light of our findings. STUDY DESIGN: This study is a comparative secondary analysis of retrospective data, extracted from TB surveillance systems, to determine differences in contact tracing process and outcomes between two groups. METHODS: Cases of laryngeal TB (without ss + pTB) notified in England between 2012 and 2016 were selected and matched to ss + pTB controls. Number of contacts identified and screened, along with screening outcomes were gathered from local databases. RESULTS: There were 44 laryngeal TB cases who met inclusion criteria. The median number of contacts identified per case was 3 and 4 for controls (P = 0.04). Median number of contacts screened was 3 for cases and 4 for controls. The percentage of contacts with TB was 9.7 for cases and 20.3 for controls (P < 0.01). CONCLUSION: We observed a small difference, between case and control groups, in number of contacts identified but not number screened, indicative of a broadly similar approach to contact tracing. Conversely, the difference in screening outcomes between the groups was significant. These findings highlight a potential need to further understand infectivity of laryngeal TB; and consider possible implications for public health practice.

[Optimization of the present-day diagnostics of tuberculosis of the upper respiratory tract and ears]. / Optimizatsiia diagnostiki tuberkuleza verkhnikh dykhatel'nykh putei i ukha na sovremennom étape.

This study included a total of 365 patients presenting with tuberculosis of the respiratory organs followed up based at the the Republican TB dispensary. All the patients underwent the comprehensive clinical and laboratory examination with the use of the diagnostic algorithm designed for the otorhinolaryngological examination of the patients suffering from respiratory tuberculosis. The upper respiratory tract tuberculosis was diagnosed in 46 (12.6%) of the examined patients. Laryngeal tuberculosis was documented in 44 (12.1%) patients and middle ear tuberculosis in 2 (0.5%) patients. The most informative method for the diagnostics of tuberculosis of the upper respiratory tract and the ears was a histological study that allowed to reveal more than 70% of the total number of the cases. However, this method of does not reliably confirm or exclude the diagnosis of tuberculous of the upper respiratory tract and ears in all the patients. The accurate diagnostics with the elucidation of the specific character of the pathological process is possible only on the basis of a thorough investigation and comprehensive examination of the suspected patients.

[The clinical and bacteriological study of the effectiveness of the application of silver nanoparticle for the treatment of tuberculosis]. / Kliniko-bakteriologicheskoe issledovanie éffektivnosti ispol'zovaniia nanochastits serebra dlia lecheniia tuberkuleza verkhnikh dykhatel'nykh putei.

The objective of the present study was to evaluate the expediency of the application of nano-scale silver preparations, argovit-C and vitargol, differing in concentration for the treatment of tuberculosis of the upper respiratory tract. The study was carried out based at the Karachaevo-Cherkessian TB dispensary. It has been demonstrated that the 3.3% solution of argovit-C possessed of the 100% bactericidal activity with respect to the medically-resistant mycobacteria at both maximum and minimal concentrations of isoniazid. Based on these findings, this preparation was chosen for the clinical study. It was shown to exhibit a higher therapeutic effectiveness in comparison with the standard anti-tuberculosis treatment. The authors conclude that the inhalation of the 3.3% argovit-C solution twice daily for 10 minutes during 2 months can be recommended for the local treatment of laryngeal tuberculosis.

Palatopharyngoplasty for treatment of nasopharyngeal stenosis secondary to extra-laryngeal tuberculosis.

Nasopharyngeal stenosis is a rare sequela of extra-laryngeal tuberculosis that can adversely impact the quality of life of afflicted patients. Relying solely on the oropharyngeal airway, patients often complain of inspiratory dryness and decreased sensation of airflow as the nasal mucosa and turbinate complex is entirely excluded from the breathing mechanism. Often times, the oropharyngeal inlet can be narrowed as well, limiting the air flow through the oropharyngeal airway. In those circumstances, patients often require tracheostomy for establishment of a reliable airway. We present the unique case of a previously tracheotomized patient with nasopharyngeal stenosis secondary to tuberculosis successfully treated with a modified palatopharyngoplasty to reestablish a patent naso-oropharyngeal airway. During the follow-up period, the patient was decannulated and highly satisfied with his respiratory status. Although rare and more commonly used in the treatment of sleep apnea, palatopharyngoplasty can be a viable option for the treatment of naso-oropharyngeal stenosis and should be kept in the armamentarium of reconstructive craniofacial surgeons.

[The clinical and pathological features of laryngeal tuberculosis].

OBJECTIVE: To investigate the clinical and pathological features of laryngeal tuberculosis. METHODS: The clinical data of 75 patients with laryngeal tuberculosis from Jan 2010 to Jan 2013 in our hospital were studied retrospectively. There were 50 male and 25 female patients, aged from 18 to 91 years, with a median age of 44 years. The course of disease was 1 to 19 months. RESULTS: The prominent presenting symptoms were hoarseness (n=59, 79%), and sore throat (n=48, 64%). Systemic symptoms included fatigue with weight loss (n=26, 35%) and fever (n=17, 23%). Primary laryngeal tuberculosis was found in 23 patients (31%) while secondary laryngeal tuberculosis together with pulmonary tuberculosis in 52 patients (69%). There were 2 or less lesions in the larynx in 44 patients, while multiple lesions were found in 31 patients. Vocal cords were the most common sites affected(n=51, 68%), followed by epiglottis(n=41, 55%). Proliferation was the main type of lesions (n=34, 45%). After pathologic diagnosis, all patients received systemic anti-tuberculosis therapy, and the prognosis was good. CONCLUSIONS: Severe local symptoms of the larynx with slightly general symptoms are the clinical characteristics of laryngeal tuberculosis for the time being. Primary laryngeal tuberculosis often present with fewer (2 or less) lesions. Different morphology of laryngeal lesions can exist at the same time. The diagnosis of laryngeal tuberculosis depends on pathological biopsy. The treatment should be systemic anti-tuberculosis therapy.

Laryngeal tuberculosis in the United States of America: a forgotten disease.

Laryngeal tuberculosis (TB) was a common manifestation of TB in the early twentieth century, but now represents only 1% of all cases. Most modern case series of laryngeal TB originate outside the USA. We report a case of laryngeal TB from our institution and review other US cases published between 1970 and 2012. One hundred twenty-seven cases were identified. The mean patient age was 49 y and 28% were female. The mean duration of symptoms was 19 weeks. Dysphonia and weight loss were the most common manifestations, seen in 96% and 47% of cases, respectively. These symptoms were usually attributed to malignancy initially. Most cases involved the vocal cords. Eighty-six percent of cases had underlying pulmonary involvement. Mortality was 3%. In the USA, laryngeal TB is rarely suspected and often confused with malignancy. This infection should be considered in patients with unexplained dysphonia and weight loss.

Laryngeal tuberculosis in the early 21st century. Literature review of clinical, diagnostic and therapeutic data, according to SWiM guidelines.

OBJECTIVES: Review of the scientific medical literature dedicated to clinical data, diagnosis and treatment for laryngeal tuberculosis published since the turn of the 21st century. MATERIAL AND METHODS: Search of the Medline, Cochrane and Embase databases for the period 2000-2022. Selection of cohorts and case reports documenting clinical data, diagnosis and treatment for laryngeal tuberculosis. RESULTS: In total, 119 articles were analyzed. Immunodepression, HIV infection, history of lung tuberculosis, general symptoms suggesting tuberculosis, smoking and associated laryngeal cancer were noted in 18%, 3%, 20% and 41% of cases, respectively. No pathognomonic symptoms or signs emerged. Voice impairment, of various types and severity, isolated and/or associated with other signs, was the most frequent laryngeal symptom, in 86% of cases. All laryngeal sites were involved, with numerous and various associations. Impaired laryngeal motion and tracheotomy were noted in 6% and 1% of cases, respectively. Time to diagnosis varied from less than 1month to 36months, for a median 3months, in case reports. Laryngeal tuberculosis was diagnosed bacteriologically with certainty in 28% of cases while diagnosis was based on indirect criteria and/or involvement of another site in the other 72%, with lung involvement in 54%. Treatment duration ranged from 6 to 24months (median, 6months), using 3 to 5 (median: 4) antitubercular antibiotics, with 4 used in 80% of cohorts and 77% of case reports. Overall rates of cure, death, treatment resistance, adverse events, and laryngeal sequelae were 99%, 0.5%, 0.5%, 6% and 5%, respectively. CONCLUSION: The clinical presentation and diagnostic difficulty in laryngeal tuberculosis did not change since the end of the 20th century. Quadritherapy is highly effective, with a low resistance rate and few adverse effects or laryngeal sequelae.

Atypical presentation of oral and laryngeal tuberculosis in an adolescent.

Extrapulmonary manifestation of tuberculosis (TB) in the adolescent population in the head and neck region may be atypical in the site of involvement, symptomatology and clinical presentation. We report a case of the management of oral and laryngeal TB in an early adolescent female who presented with ulceration over the palate and tonsillar region with uvula destruction and laryngeal symptoms and aim to highlight the atypical extrapulmonary manifestations of TB in the head and neck region in adolescent age group.

Laryngeal tuberculosis, the great deceiver: A series of 10 cases.

BACKGROUND: Laryngeal involvement is rare in tuberculosis, representing around 1% of all cases of this infection worldwide. Given the larynx' location in the airway, this form of tuberculosis is of particular importance because it is highly contagious. With our hospital being in a high tuberculosis burden area, we propose to characterize the clinical presentation, evolution, and laryngoscopy findings of a series of laryngeal tuberculosis cases in order to reduce misdiagnosis. METHODS: Epidemiological and clinical data from 10 patients diagnosed with laryngeal tuberculosis in the Otorhinolaryngology department of (Blinded for manuscript) between January 2011 and December 2021 were retrieved and analyzed. RESULTS: There were eight males and two females. Seven patients had a history of smoking and alcohol abuse and four had silicosis. Hoarseness was the most reported symptom (n = 9). The most frequent site of involvement were the true vocal cords (n = 6). All patients but one had concomitant active pulmonary tuberculosis. Patients had full resolution of laryngeal symptoms between 4 and 16 weeks after initiating antituberculosis treatment. CONCLUSION: Laryngeal tuberculosis is indeed a great deceiver. On one hand it can look like a simple polypoid lesion or simulate laryngopharyngeal reflux; but on the other hand its risk factors, symptoms and appearance simulate laryngeal carcinoma like no other. Since most patients present with concomitant pulmonary tuberculosis, all suspect laryngeal lesions should perform a chest radiograph prior to rigid laryngoscopy. Antituberculosis treatment is effective in both alleviating symptoms and reducing the risk of transmission.

Exploring the Complexities: Understanding the Clinicopathological Spectrum of Tuberculosis in the Head-and-neck Region.

INTRODUCTION: Tuberculosis (TB) affecting the head-and-neck area can often resemble cancer, leading to misdiagnosis and delayed treatment. A better understanding of this condition is necessary for early diagnosis and prompt treatment initiation. This study examines the clinical and pathological characteristics of different types of TB in the head-and-neck region. METHODS: This retrospective study analyzed patients diagnosed with TB in the head-and-neck region at a health center between January 1, 2018, and January 1, 2024. The study population consisted of patients who were diagnosed with TB of the head and neck. RESULTS: The study analyzed data from 30 patients, comprising 14 (47%) males and 16 (53%) females, all of whom tested negative for HIV. Most cases (15, 50%) were observed in the age group of 15-24 years, with 5 (15.6%) subjects falling in the age bracket of 0-14 years. Among the types of lesions detected, cervical tubercular adenitis was the most frequently observed lesion, found in 22 (73%) subjects. Females are more susceptible to cervical tubercular adenitis, while males are more likely to experience laryngeal TB. CONCLUSION: The clinical manifestation of TB affecting the head-and-neck region can exhibit a diverse range of symptoms, which may lead to misinterpretation and diagnostic errors. Therefore, health-care practitioners must understand and include the condition in differential diagnoses.

[Primary mucosal tuberculosis of head and neck region: a clinicopathologic analysis of 47 cases].

OBJECTIVE: To study the clinicopathologic features, histologic diagnosis and differential diagnosis of primary mucosal tuberculosis (TB) in the head and neck region. METHODS: Forty-seven cases of primary mucosal TB of the head and neck region were studied by hematoxylin-eosin and Ziehl-Neelsen stains. The clinical and pathologic features were analyzed with review of the literature. RESULTS: The patients included 26 male and 21 female, with mean age 47.1 years (range 14-84 years). There were three sinonasal TB, 19 nasopharyngeal TB, two oropharyngeal TB, 18 laryngeal TB, four middle ear TB, one salivary gland TB and one laryngeal TB complicating laryngeal cancer. The initial symptoms were nasal obstruction, mucopurulent rhinorrhea, epistaxis, snoring, hoarseness, dysphagia, odynophagia, serous otitis, hearing loss, tinnitus, and otalgia. Physical examination result was variable, from an apparently normal mucosa, to an evident mass, or a mucosa with an adenotic or swollen appearance, ulcers, leukoplakic areas, and various combinations thereof. CT and MRI findings included diffuse thickening, a soft-tissue mass, calcification within the mass and bone destruction resembling malignancy. Histologic examination showed granulomas with a central necrotic focus surrounded by epithelioid histiocytes and multinucleated Langhan's giant cells. Acid-fast bacilli were difficult to demonstrate but found in 13/45 cases. Follow-up data were available in 42 patients. CONCLUSIONS: Primary TB arising in the head and neck mucosa is rare. It may mimic or co-exist with other conditions. The characteristic histopathology is a granuloma with central caseous necrosis and Langhans'giant cells. Identification of acid-fast bacilli and bacteriologic culture confirm the diagnosis of mycobacterial disease.

Laryngeal tuberculosis in patients treated with adalimumab: a casual or causal connection?

This article presents two consecutive cases of laryngeal tuberculosis in patients treated with a specific anti-tumour necrosis factor-alpha (adalimumab), with a focus on their diagnostic process and therapeutic management. Both patients presented with aspecific chronic laryngeal symptoms that had been worsening for a few months in one case and for almost 1 year in the other one. They were both studied with fibreoptic laryngoscopy and contrast-enhanced CT and MRI scans. In both cases, the laryngeal biopsy proved negative to Ziehl-Neelsen test, while positive to Koch's bacillus sensitive to rifampicin at PCR test. Both patients completely responded to standard antitubercular antibiotic therapy with rifampicin, isoniazid, pyrazinamide and etambutol protocol.In the differential diagnosis of such patients, laryngeal tuberculosis should be considered due to the reasonable linkage between the immunosuppressant therapy with adalimumab and the tuberculosis infection/reactivation.

Laryngeal tuberculosis: about 04 cases.

The purpose of this study is to present epidemiological, clinical, radiological, histological characteristics and treatment of laryngeal tuberculosis. It is also aimed at making the point about diagnosis difficulties. This retrospective study was conducted over three years; it concerned 4 cases, 3 males and one female. The average age was 35 years. Three of the 4 cases have had a cervical CT scan. All patients have had a laryngoscopy with biopsy and anatomopathological study. The onset modes of the disease have been progressive for all the patients. Topographical study has shown two epiglottic locations, one at the vocal cords and the other one at the posterior commissure. The diagnosis was orientated in the 3 cases by the CT scan and confirmed by anatomopathological exam in all cases. All patients have received anti-TB drugs with good evolution. The laryngeal location of tuberculosis is unusual. The clinical picture is nonspecific, raising the issue of differential diagnosis with tumor pathology. Sectional imaging and CT scan can guide the diagnosis and a positive diagnosis is often discovered on the occasion of a tumor biopsy of a pseudo-tumor lesion. Treatment is based on anti-TB drugs.

Tuberculous retropharyngeal abscess as a cause of oropharyngeal dysphagia.

Tuberculosis is known to affect almost every organ in the body, but its manifestations in the head and neck region are quite rare. A tuberculous retropharyngeal abscess is a very rare condition and can be the cause of oropharyngeal dysphagia. It is usually secondary to tuberculosis of the spine and has the potential of significant morbidity and mortality if not treated appropriately. We present a case of a 74-year-old man with a retropharyngeal abscess with no evidence of spinal tuberculosis.

Laryngeal tuberculosis presenting as laryngeal carcinoma.

Tuberculosis (TB) accounts for the highest number of mortalities among infectious diseases worldwide. Laryngeal TB is an extremely rare presentation of TB. It has many similarities to laryngeal carcinoma, one of the three most common cancers among males in the city, with an age standardized rate of 8.6. The associated risk factors of laryngeal carcinoma i.e. smoking, paan, betel nut usage and alcohol use also tend to be concentrated in the same demographic background as that of TB, creating a diagnostic dilemma. We present a case of granulomatous laryngeal TB, in a 40 year old male, with characteristic presenting features of laryngeal carcinoma i.e. persistent hoarseness and weight loss. He had no associated symptoms of fever, night sweats, cough or dysphagia, nor did he have any history of tobacco or irritant use. There was no history of tuberculosis (TB) contact. He was initially worked up for laryngeal carcinoma; however laryngoscopic biopsy revealed laryngeal TB. We present this case to emphasize the point that although primary laryngeal tuberculosis is a rarity, it must not be overlooked as a possibility when evaluating dysphonia and/or considering laryngeal carcinoma.

Laryngeal tuberculosis: a neglected diagnosis.

A 24-year-old woman visited the Ear Nose Throat (ENT) outpatient department with complaints of hoarseness for 2 months not responding to conservative management. Laryngoscopic examination revealed a whitish ulceroproliferative lesion in the anterior commissure and anterior two-thirds of bilateral true vocal cords with surrounding necrosis. In view of the above findings, the patient was planned for biopsy under general anaesthesia. Intraoperative findings showed multiple whitish necrotic friable tissue involving anterior two-thirds of bilateral false vocal cords, ventricle, bilateral true vocal cords, both aryepiglottic folds and laryngeal surface of epiglottis. Postoperative histopathology was consistent with tuberculosis. A pulmonology consultation was taken, and the patient was started on anti-tuberculosis chemotherapy. One month post therapy, the voice was symptomatically better. A flexible fibreoptic laryngoscopic examination was done, which revealed almost complete resolution of the lesion with minimal ulceration at the anterior one-third of right true vocal cord.