2. TUBERCULOSIS OF
LARYNX
⢠Almost always associated with open
pulmonary Tuberculosis
⢠Due to contamination of sputum
containing acid fast bacilli
⢠May rarely develop by blood borne
infections which causes extensive
ulceration of mucosa
⢠Common age group : 20-40 yrs
⢠Incidence increasing due to emergence
of AIDS
3. TUBERCULOSIS OF LARYNX-
PATHOLOGY
⢠Posterior part of larynx affected than anterior
⢠Formation of submucosal tubercles which later
may caseate and ulcerate producing
undermined ulcers
⢠There may be infiltration of epiglottis and
arytenoids
⢠Self limiting to some extent â> heals with
fibrosis-> stenosis of larynx
⢠With reparative process tumor like swellings are
found called Tuberculomas
⢠there may be diffuse oedematous reaction
consistent to allergic response to AFB
4. TUBERCULOSIS OF LARYNX-
SYMPTOMS
⢠Throat pain
⢠Referred otalgia
⢠Hoarseness with weakness of voice
(earliest symptom)
⢠Painful speech
⢠dysphagia
5. TUBERCULOSIS OF LARYNX-
SIGNS
⢠Mucosal hyperemia and oedema
⢠Inter-arytenoid mamillations
⢠Undermined ulcers- mouse nibbled
appearance
⢠Turban epiglottis
⢠Ragged ulcerations on arytenoids and inter-
arytenoid region
⢠Granulation tissue in inter-arytenoid region
⢠Pale laryngeal mucosa
6.
7. TUBERCULOSIS OF LARYNX-
DIAGNOSIS
⢠Chest X-ray
⢠Sputum examination for AFB
⢠Laryngoscopic examination
⢠Biopsy of laryngeal lesion
8. TUBERCULOSIS OF LARYNX-
TREATMENT
⢠Anti tubercular drug regimen
⢠Vocal rest
⢠Nutritional supplements
9. SCLEROMA OF LARYNX
⢠Klebsiella rhinoscleromatis is the
causative organism
⢠Laryngeal involvement is seen with or
without nasal lesion
⢠Subglottic region is commonly involved
10. SCLEROMA OF LARYNX-
SYMPTOMS AND SIGNS
⢠Non specific symptoms as seen in other
chronic laryngeal infections like
hoarseness, wheeze
⢠Dyspnoea may be presenting symptom
in addition to nasal lesion
⢠Presents as smooth red swelling in
subglottic region
11. SCLEROMA OF LARYNX-
DIAGNOSIS
⢠Biopsy of the lesion
⢠Histopathology -> specimen shows
Mikulicz cells, Russell bodies, gram
negative organism within the Mikulicz
cell
⢠Culture of organism from biopsy
material
12. SCLEROMA OF LARYNX-
TREATMENT
⢠Medical ď combination of an
aminoglycoside such as gentamycin with an
anti-metabolite such as tetracyclin
⢠Steroids to reduce fibrosis
⢠Surgical
1. Endoscopic removal of granulomatous
tissue
2. Mild stenosis ď dilatation
3. Severe subglottic stenosisď tracheostomy
13. SYPHILIS OF LARYNX
⢠Now rarely seen
⢠All stages can manifest in larynx
⢠Primary lesion described rarely
⢠Tertiary stage is most importantď
gamma are seen
⢠Peri arterial infiltration and obliterative
endarteritis
⢠Prediliction for anterior part of larynx ď
epiglottis and AE folds
14. SYPHILIS OF LARYNX
⢠Oedematous mucosa with infiltration of
plasma cells, lymphocytes and giant
cells
⢠Deep ulceration with central sloughing
⢠Abundant necrotic tissue reaches and
penetrates laryngeal cartilages
⢠Considerable destruction after healing
leaves deformity of larynx and often
stenosis
15. SYPHILIS OF LARYNX-
CLINICAL FEATURES AND
MANAGEMENT
⢠Hoarseness, sometimes dysphagia, pain is
rare
⢠Oedema of mucosa leading to stridor
⢠Diagnosis only on biopsy and serological
tests
⢠Treatmentď Prolonged treatment with high
doses of penicillin
⢠Local treatment by inhalation
⢠Endoscopic removal of necrotic tissue to
maintain airway
⢠tracheostomy
16. LEPROSY OF LARYNX
⢠Caused by mycobacterium leprae (Hansen's
bacillus)
⢠Both lepromatous and tuberculoid can arise in
larynx
⢠Epiglottis and AE fold most commonly
affected
⢠Granulomatous swelling and often ulceration
and destruction in supraglottic region
⢠Epiglottis may be curled
⢠Mucosa may be studded with nodules
⢠Virchow cells ( foamy histiocytes) and
mucosal thickening seen on HPE
17. LEPROSY OF LARYNX-
TREATMENT
⢠Medicalď Dapsone, Clofazimine,
Rifampicin
⢠Surgicalď tracheostomy in cases of
stenosis
18. WEGENERâS
GRANULOMATOSIS
⢠Diffuse systemic disease of unknown cause
⢠Includes triad of necrotizing granulomatous lesion
in upper and lower respiratory tract (sinusitis,
rhinitis), vasculitis involving pulmonary arteries
and veins and necrotizing glomerulonephritis
⢠Larynx is rarely source of primary manifestation
⢠Lesion usually lies in subglottisď laryngeal
obstruction
⢠Edematous mucosa with granular appearance
which bleeds easily and sometimes ulcerates
⢠If untreated can be rapidly fatal
⢠Immunosuppressive drugs especially
cyclophosphamide are very active
⢠Steroids should be started early
19. SARCOIDOSIS OF LARYNX
⢠Chronic idiopathic granulomatous disease
also called Besnier-Boeck disease
⢠Head and neck manifestations in 10% of
whom only minor proportion have laryngeal
disease
⢠Disease is usually self limiting
⢠Pathologyď non specific granuloma later
fibrosis and hyalinization
⢠Main site involved is supraglottis
20. SARCOIDOSIS OF LARYNX- CLINICAL
FEATURES AND MANAGEMENT
⢠Hoarseness, dysphagia and dyspnoea
⢠Epiglottis and false vocal cords are swollen
and pale
⢠True cords and subglottis rarely affected
⢠Lesion can progress rapidly leading to life
threatening airway obstruction
⢠Diagnosisď biopsy
⢠Positive Kveimâs test, elevated serum
angiotensin converting enzyme is highly
suggestive
⢠Treatmentď high dose corticosteroids,
tracheostomy
21. LUPUS OF LARYNX
⢠Indolent tubercular infection associated with
lupus of nose and pharynx
⢠Involves anterior part of larynx.
⢠Epiglottis is involved first and may be
completely destroyed. disease spreads to AE
fold and ventricular bands.
⢠Painless asymptomatic condition may be
discovered incidentally
⢠Prognosis is good
⢠Treatment is anti tubercular drugs
22. MYCOSIS OF LARYNX
⢠Following mycosis can occur in the larynx
1. Candidiasis
2. Coccidioidmycosis
3. Paracoccidioidmycosis
4. Histoplasmosis
5. Blastomycosis
6. Cryptococcosis
7. aspergillosis