Laryngeal Tuberculosis: Current Patterns of Presentation and Management

Abstract

Background: Laryngeal tuberculosis (TB) is the commonest granulomatous condition found in the larynx and may be primary or secondary. With the recrudescence of tuberculosis and development of multidrug resistance, the classical disease trend of laryngeal tuberculosis is changing its manifestations. The aim of our study is to describe the various patterns of presentations of laryngeal tuberculosis in the current era and consequently its changing management protocols.

Results: In this retrospective study, out of 890 patients who visited our voice and swallowing clinic in our study period, 10 were diagnosed as granulomatous conditions [1.1%] and 3 of these were confirmed cases of tuberculosis involving the larynx [0.3%]. Secondary laryngeal TB was found in 1 of our patients with a "dirty larynx picture". Primary laryngeal TB was seen in 2 patients, one patient presented with a unilateral congested vocal fold and the other with bilateral striking zone leukoplakia.

Conclusion: The clinical pattern of presentation of laryngeal tuberculosis has changed over the years. None of the patients of primary or secondary laryngeal tuberculosis had the classical constitutional symptoms of tuberculosis. In patients with laryngeal tuberculosis along with routine TB workup, surgical excision with histopathological testing is essential for accurate diagnosis in primary laryngeal TB and the "dirty larynx" picture aids in the diagnosis of secondary laryngeal TB. The healing and vocal outcomes are good in both primary and secondary laryngeal TB, once the appropriate antitubercular regimen has been started.

Keywords: Dirty Larynx; ESR; Primary Laryngeal Tuberculosis; Secondary Laryngeal Tuberculosis; Tuberculosis.

Fig. 1

- Intra-operative image showing a left congested vocal fold

Fig. 2

- Histopathology [Hematoxylin – Eosin stain, magnification 40x] revealing necrotising caseating epithelioid granulomas surrounded by chronic inflammatory cell infiltrate [ Red arrows]

Fig. 3

- Flexible videolaryngoscopic image showing bilateral vocal fold leukoplakia at the striking zone

Fig. 4

- Flexible videolaryngoscopic image showing white patches [ slough like appearance] over the entire larynx, including the infraglottis appearing as a “dirty larynx” picture