Laryngeal Tuberculosis

Laryngeal tuberculosis is the most common ENT tuberculosis, usually spread via the airway from open pulmonary TB; primary cases are rare. It is mostly secondary to severe pulmonary TB or other organ tuberculosis, spread by contact, hematogenous, or lymphatic routes. Contact infection occurs when bacilli-laden sputum adheres to the laryngeal mucosa or folds, and bacteria invade deep mucosa via micro-abrasions or gland duct openings. Pathological types: (1) Infiltrative: mucosal epithelial thickening, typical tubercles in the lamina propria with varying fibrosis and lymphocyte infiltration. (2) Ulcerative: characterized by tuberculous ulcers with caseous necrosis on the surface, underlain by tuberculous granulation and fibrous scar tissue; adjacent squamous epithelium often shows papillary or pseudocarcinomatous hyperplasia. (3) Mass-forming: marked fibrous connective tissue proliferation forming masses; tubercles are surrounded by abundant fibrous tissue with inconspicuous caseation. Laryngeal TB readily spreads to adjacent tissues and via lymphatics causing cervical lymph node TB.

Common Symptoms

Aphonia; hoarseness; dyspnea; sore throat; laryngeal edema

Causes and Pathogenesis

Mycobacterium tuberculosis infection. Primary cases are rare; most are secondary to severe pulmonary TB or other organ TB, spread by contact, hematogenous, or lymphatic routes. It prefers the posterior larynx, vocal cords, ventricular bands, and epiglottis. Pathological types: (1) Infiltrative: subepithelial lymphocyte infiltration forming nodules with localized congestion and edema. (2) Ulcerative: tubercles undergo caseous necrosis forming ulcers that can extend deep to perichondrium and cartilage, especially epiglottic and arytenoid cartilages; secondary pyogenic infection may form abscesses. (3) Proliferative: late infiltrative foci with fibrosis forming tuberculomas. Risk factors include immunosuppression (20%), diabetes, chronic gastric disease after subtotal gastrectomy, and AIDS.

Treatment

Drug therapy, supportive therapy

Preventive Measures

Social level: Governments should increase TB control, provide free treatment, and cure pulmonary TB patients. BCG only reduces severe TB mortality; better vaccines are needed. Personal level: Balance work and rest, avoid obesity to reduce diabetes, and seek early detection, treatment, and cure. Do not pick the nose to avoid introducing bacilli; do not use TB patients' utensils. Patients with infectious TB should voluntarily self-isolate to protect family, friends, and the public.

Department to Visit

It is recommended to visit the ENT department; an appointment can be booked on this platform before the visit.

Warm reminder: The above information is for health science reference only and cannot replace professional medical diagnosis. If you have related symptoms, please seek medical attention at a regular hospital promptly.