Factors Associated with Clinical and Topographical Features of Laryngeal Tuberculosis

Abstract

Introduction: Laryngeal tuberculosis (LTB) is the most frequent granulomatous disease of the larynx and represents less than 2% of extrapulmonary TB cases. There are no pathognomonic clinical and endoscopic features of this disease and studies on LTB that can assist in its diagnostic characterization are lacking.

Objective: To identify factors associated with clinical and topographical features of LTB.

Method: a retrospective cross-sectional study was conducted from the medical records of 36 patients with confirmed LTB diagnosis.

Results: Dysphonia and cough were the main symptoms presented by patients and the true vocal folds the most frequently affected site. The average of the duration of the disease evolution was significantly higher in patients with dysphonia than in patients without this symptom. We observed association between dysphonia and true vocal fold lesions and between odynophagia and lesions in the epiglottis, arytenoids and aryepiglottic folds. Odynophagia was more frequent in individuals with lesions in four or more laryngeal sites. Weight loss equal or above 10% of the body weight was more frequent in patients with odynophagia as first symptom and in patients with ulcerated lesion. Dyspnea on exertion was more frequent in individuals with more extensive laryngeal lesions. The percentage of smokers with lesions in four or more laryngeal sites was greater than that found in non-smokers. Laryngeal tissue fragment bacilloscopy and culture examinations were less positive than sputum ones.

Conclusions: Smoking appears to be associated with the development of more extensive LTB lesions, and LTB with dyspnea on exertion and odynophagia with consequent impairment of nutritional status. We emphasize the need for histopathologic confirmation, once positive sputum bacteriological examinations seem not to necessarily reflect laryngeal involvement.

Fig 1

Pictures of images obtained by Videolaryngoscopy: a- Hyperemic and flat lesion, with smooth surface of right true vocal fold—example of nonspecific inflammatory lesion. b- Hyperemic lesion, with exophytic appearance with rough surface located in the false vocal folds–example of granulomatous lesion. c- Example of ulcerated lesion with fibrin located in aryepiglottic fold and right arytenoid region.d- Example of erosive lesion of the right half of the epiglottis. Source: Files of the Department of Otorhinolaryngology of the Evandro Chagas National Institute of Infectious Diseases (INI)-FIOCRUZ.