laryngeal tuberculosis

Laryngeal Tuberculosis: A Rare but Serious Condition

Laryngeal tuberculosis (LTB) is a rare form of tuberculosis that affects the larynx, also known as the voice box. It is a type of extrapulmonary tuberculosis, which means it occurs outside of the lungs.

Symptoms and Presentation

The most common symptoms associated with LTB are:

• Hoarseness or weakness of the voice [10][15]
• Dysphonia (difficulty speaking) [5]
• Dysphagia (difficulty swallowing) [1][6]
• Odynophagia (painful swallowing) [15]
• A dry hacking cough [15]

In some cases, patients may also experience hemoptysis (coughing up blood), respiratory obstruction, or other nonspecific constitutional symptoms like fever or localized pain.

Incidence and Prevalence

Laryngeal tuberculosis is a rare disease, with an incidence of 1% [10]. It can occur in any laryngeal anatomic site, but the true vocal cords are the most commonly affected area [15].

Diagnosis and Confusion with Cancer

LTB can be easily confused clinically with laryngeal cancer due to its similar symptoms. Therefore, a correct diagnosis is crucial for proper treatment.

Treatment and Management

The treatment of LTB involves antitubercular therapy (ATT) and other supportive measures to manage the symptoms and prevent complications.

References:

[1] Context result 4 [5] Context result 5 [6] Context result 6 [10] Context result 10 [15] Context result 15

Common Signs and Symptoms of Laryngeal Tuberculosis

Laryngeal tuberculosis, a rare form of extrapulmonary tuberculosis, can cause various symptoms that affect the throat and respiratory system. The following are some common signs and symptoms associated with this condition:

• Hoarseness: A persistent change in voice tone or pitch is one of the most common symptoms of laryngeal tuberculosis [3][4][5][6].
• Painful Swallowing (Odynophagia): Difficulty swallowing due to pain or discomfort in the throat is another frequent symptom [9][10].
• Cough: A persistent cough, sometimes accompanied by blood or sputum, can be a sign of laryngeal tuberculosis [11][12].
• Shortness of Breath: In some cases, patients may experience shortness of breath due to respiratory obstruction caused by the infection [4][7].
• Fever and Chills: Systemic symptoms like fever and chills can occur in some cases, although they are not as common as local symptoms [8][10].

Other Possible Symptoms

In addition to these primary symptoms, laryngeal tuberculosis may also cause:

• Difficulty Swallowing (Dysphagia): Some patients may experience difficulty swallowing due to pain or discomfort in the throat.
• Blood in Sputum: Coughing up blood or sputum can be a sign of laryngeal tuberculosis, especially if it persists for an extended period.

Important Notes

It's essential to note that these symptoms can also be indicative of other conditions, such as cancer or other infections. A proper diagnosis by a healthcare professional is necessary to confirm the presence of laryngeal tuberculosis.

References:

[1] Context result 9 [2] Context result 3 [3] Context result 4 [4] Context result 5 [5] Context result 6 [6] Context result 8 [7] Context result 10 [8] Context result 11 [9] Context result 12

Diagnostic Tests for Laryngeal Tuberculosis

Laryngeal tuberculosis (LTB) can be challenging to diagnose due to its nonspecific clinical presentation. However, several diagnostic tests can help confirm the diagnosis.

• Biopsy: A biopsy of the affected area is considered the gold standard for diagnosing laryngeal TB. It involves taking a sample of tissue from the larynx and examining it under a microscope for the presence of Mycobacterium tuberculosis [4][5].
• Sputum Smear: Sputum smear microscopy is another diagnostic test used to detect acid-fast bacilli (AFB) in the sputum. A positive result can confirm the diagnosis of laryngeal TB [6].
• Chest X-ray and CT Scan: Chest x-rays and CT scans may show apical infiltrates, cavitary lesions, or other abnormalities that suggest pulmonary tuberculosis, which can be associated with laryngeal TB [11].
• Purified Protein Derivative (PPD) Skin Testing: PPD skin testing is a diagnostic test used to detect the presence of M. tuberculosis infection in the body. A positive result may indicate exposure to TB, but it does not confirm laryngeal TB specifically.
• Laryngoscopy and Stroboscopy: Laryngoscopy and stroboscopy can help visualize the affected area and identify characteristic lesions associated with laryngeal TB [12].
• Mycobacterial Culture: Mycobacterial culture is a laboratory test that can confirm the presence of M. tuberculosis in the sputum or tissue sample.

It's essential to note that a combination of these diagnostic tests may be necessary to confirm the diagnosis of laryngeal TB, especially in cases where the clinical presentation is nonspecific [13].

References: [4] by Ü TAŞKIN — A complete blood count, biochemical parameters, and serologic tests ... [5] by Ü TAŞKIN — Odynophagia is the most significant symptom in differential diagnosis of laryngeal ... [6] Nonspecific clinical presentation of laryngeal tuberculosis poses a diagnostic challenge. An accurate diagnosis requires histopathological examination and AFB ... [11] The diagnosis of laryngeal tuberculosis is based on a combination of findings—positive purified protein derivative (PPD) skin testing, characteristic findings on chest radiography, including apical infiltrates and cavitary lesions, and positive sputum samples. [12] A complete knowledge regarding the visual and morphologic features of LTB on laryngoscopy is needed for the early detection and diagnosis of LTB. Our study revealed the lesion sites, sizes, and morphologic features of LTB. These parameters were also correlated with patient clinical symptoms. [13] Primary laryngeal tuberculosis (PLTB) is a rare condition. The symptoms and findings are not specific in most of the cases. Patients are diagnosed essentially based on histopathological examination and mycobacterial culture.

Treatment Options for Laryngeal Tuberculosis

Laryngeal tuberculosis, a rare form of extrapulmonary tuberculosis, requires prompt and effective treatment to prevent complications and ensure proper healing.

• Anti-tuberculous medications: The primary treatment for laryngeal tuberculosis involves the use of anti-tuberculous medications, which target the causative agent Mycobacterium tuberculosis. These medications typically include a combination of isoniazid, rifampicin, pyrazinamide, and ethambutol.
• Standard 6-month regimen: A standard 6-month treatment regimen is commonly used to treat laryngeal tuberculosis. This regimen includes the use of rifampicin, isoniazid, pyrazinamide, and ethambutol for the first 2 months, followed by a maintenance phase with isoniazid and rifampicin for an additional 4 months.
• Treatment effectiveness: Studies have shown that treatment consisting of three drugs (rifampicin, isoniazid, and pyrazinamide) can be effective against extrapulmonary tuberculosis, including laryngeal tuberculosis. However, the optimal treatment regimen may vary depending on individual patient factors and the severity of the disease.
• Importance of adherence: Adherence to the prescribed treatment regimen is crucial for achieving a successful outcome in patients with laryngeal tuberculosis. Patients should be closely monitored by healthcare professionals to ensure proper medication administration and to address any potential side effects or complications.

References:

• [1] A Gautam (2023) - This regimen, which included isoniazid, rifampicin, pyrazinamide, and ethambutol, not only targeted the causative agent Mycobacterium tuberculosis but also helped to prevent the development of drug-resistant strains.
• [5] H Matsuura (2017) - The patient received a standard 6-month anti-tuberculous treatment (rifampicin, isoniazid, pyrazinamide, and ethambutol), which was effective in treating the laryngeal tuberculosis.
• [10] Laryngeal tuberculosis is often treated with a combination of anti-tuberculous medications, including isoniazid, rifampicin, pyrazinamide, and ethambutol.

Differential Diagnosis of Laryngeal Tuberculosis

Laryngeal tuberculosis (LTB) can be challenging to diagnose due to its similarity in presentation with other conditions, such as carcinoma and chronic laryngitis. The differential diagnosis for LTB includes:

• Carcinoma of the larynx: This is a major concern in the differential diagnosis of LTB, as it may have a deceptive clinical, laryngoscopic, and even histological presentation [1].
• Chronic laryngitis: This condition can also present with similar symptoms to LTB, making it difficult to differentiate between the two [6, 11, 13].
• Ordinary laryngitis: This is another condition that may be considered in the differential diagnosis of LTB, particularly if there are no specific symptoms or findings suggestive of tuberculosis [6, 11, 13].

Key Symptoms and Findings

The following symptoms and findings can help differentiate LTB from other conditions:

• Odynophagia: This is a significant symptom that should be kept in mind during differential diagnosis between tuberculosis and carcinoma, being less typical of the latter [8].
• Hoarseness: This is a common symptom of LTB, particularly if it is caused by a lesion on the vocal folds [15].

Importance of Histopathological Examination

In many cases, clinically, differential diagnosis in laryngeal tuberculosis and laryngeal cancer can be difficult, warranting a histopathological examination to confirm the diagnosis [6].

Other Conditions to Consider

It is also essential to consider other conditions that may mimic LTB, such as:

• Pharyngo-laryngeal tuberculosis: This condition was more common in the early XX century and should be considered in the differential diagnosis of larynx carcinoma [15].
• Epiglottic tuberculosis: This is a rare form of tuberculosis that can present with similar symptoms to LTB, making it essential to consider this condition in the differential diagnosis [14].

Conclusion

In conclusion, the differential diagnosis of laryngeal tuberculosis includes carcinoma of the larynx, chronic laryngitis, ordinary laryngitis, and other conditions. A combination of clinical findings, histopathological examination, and consideration of other conditions can help confirm the diagnosis of LTB.

References:

[1] Agarwal R (2019) [13] [2] Mouhsine A (2023) [1, 6, 13] [3] Taskin Ü (no reference number) [4] Bouatay R (2024) [13] [5] Richter B et al. (2001) [14] [6] Fei B et al. (no reference number) [7] Wu Z et al. (no reference number) [8] Min K et al. (no reference number) [9] Köhler G et al. (no reference number) [10] Ridder GJ et al. (2001) [14] [11] Fradis M et al. (no reference number) [12] Richter B et al. (2001) [14] [13] Fei B et al. (Acta Otolaryngol 2013; 133(5): 533-538) [13] [14] Richter B et al. (Ann Otol Rhinol Laryngol 2001; 110:197–201) [14] [15] Fradis M et al. (no reference number)