Laryngeal tuberculosis
| Laryngeal tuberculosis | |
|---|---|
| Other names | Tuberculous laryngitis; tuberculosis of the larynx |
| Specialty | Otorhinolaryngology, infectious diseases |
| Symptoms | Hoarse voice, painful swallowing, dysphagia, cough[1] |
| Causes | Infection of the larynx by Mycobacterium tuberculosis[2] |
| Diagnostic method | Laryngoscopy, chest imaging, microbiological testing and biopsy[3] |
| Differential diagnosis | Laryngeal cancer, chronic laryngitis, sarcoidosis, granulomatosis with polyangiitis[2] |
| Treatment | Combination antimicrobial therapy for tuberculosis[4] |
| Prognosis | Usually good with treatment[1] |
Laryngeal tuberculosis is an infection of the larynx by Mycobacterium tuberculosis, the bacterium that causes tuberculosis (TB).[2] It is an uncommon form of respiratory and extrapulmonary tuberculosis, accounting for about 1 per cent of reported TB cases in modern reviews. It usually occurs with pulmonary tuberculosis, but infection confined to the larynx, called primary or isolated laryngeal tuberculosis, also occurs.[1]
The most frequent symptom is a change in the voice, usually hoarseness or dysphonia. Painful swallowing, difficulty swallowing and cough are also common. The symptoms and appearance on laryngoscopy are not specific and may resemble laryngeal cancer or chronic laryngitis. Diagnosis therefore combines examination of the larynx with chest imaging, testing for M. tuberculosis, and often a laryngeal biopsy.[3] Treatment follows multidrug regimens used for other forms of tuberculosis and usually produces a good outcome.[4][1]
Signs and symptoms
[edit]No symptom or laryngoscopic finding is specific to laryngeal TB. In the 2024 review, 86 per cent of patients had some form of voice impairment. Other reported symptoms included odynophagia, dysphagia, sore throat, cough and shortness of breath. General symptoms of tuberculosis, such as fever, night sweats and weight loss, may be absent.[1]
Any part of the larynx may be affected. The true vocal folds are the most frequently reported site, followed by the false vocal folds, epiglottis and arytenoid region. Lesions may be ulcerative, granulomatous, swollen, polyp-like or exophytic. They may occur at one site or at several sites.[2] Impaired movement of the larynx is uncommon. Severe swelling or vocal-fold immobility can rarely cause stridor and airway obstruction; the 2024 review recorded impaired movement in 6 per cent of cases and tracheotomy in 1 per cent.[1]
Cause and transmission
[edit]Laryngeal tuberculosis can develop when bacilli in infected respiratory secretions directly contaminate the larynx. The bacteria may also reach it through the blood or lymphatic system. Secondary disease associated with pulmonary TB is more common, while primary laryngeal tuberculosis is diagnosed when no other focus of active TB is found.[2] In a 2024 review of published cases, 54 per cent had confirmed pulmonary involvement.[1]
The infection produces granulomatous inflammation, which may ulcerate the laryngeal lining. Healing can cause fibrosis and alter the structure and vibration of the vocal folds, sometimes leaving persistent voice impairment.[2]
Like pulmonary TB, laryngeal TB can spread through airborne transmission when an infected person coughs, speaks or sings.[5] It is treated as an infectious respiratory form of TB rather than as a generally non-infectious extrapulmonary site. The United States Centers for Disease Control and Prevention recommends airborne and standard precautions for suspected or confirmed laryngeal TB in health-care settings.[6]
Diagnosis
[edit]Laryngoscopy is used to locate and describe the lesions, but their appearance cannot reliably distinguish tuberculosis from cancer or other inflammatory disease. Chest radiography or computed tomography is used to look for pulmonary TB. Sputum is examined by acid-fast staining, nucleic-acid amplification and mycobacterial culture when respiratory involvement is suspected.[2][1]
A laryngeal biopsy permits histopathological examination and microbiological testing. Typical tissue findings include granulomas, caseous necrosis and Langhans giant cells, but these features and acid-fast bacilli may be absent. Culture and polymerase chain reaction testing can also be negative, especially in paucibacillary disease. A prospective study in a high-burden setting found that no single microscopy, culture, molecular or histological test detected every case and recommended using the methods in combination.[3]
The principal differential diagnosis is laryngeal cancer, which can produce similar symptoms, risk factors and endoscopic findings; cancer and TB can also occur together. Other alternatives include chronic laryngitis, sarcoidosis, fungal infection, granulomatosis with polyangiitis, leprosy, syphilis and rhinoscleroma.[2] Diagnostic delay is common: among case reports assessed in the 2024 review, the median time to diagnosis was three months and the longest was 36 months.[1]
Treatment
[edit]For adults with drug-susceptible extrapulmonary TB, the World Health Organization's core six-month regimen consists of isoniazid, rifampicin, pyrazinamide and ethambutol for two months, followed by isoniazid and rifampicin for four months. The regimen is adjusted according to drug-susceptibility results, adverse effects and national guidance. Drug-resistant disease requires a different regimen.[4]
Symptoms and visible lesions often improve within weeks to months after effective treatment begins. Airway obstruction may require urgent intubation or tracheotomy. After the infection has resolved, persistent dysphonia caused by scarring may be treated with voice therapy; evidence for additional larynx-specific treatments is limited.[2][1]
Prognosis
[edit]Outcomes are generally favourable when the infection is recognised and treated. The 2024 literature review reported cure in 99 per cent of published cases, with death and treatment resistance each reported in 0.5 per cent. Laryngeal sequelae were reported in 5 per cent.[1] These outcomes were drawn largely from case reports and observational cohorts rather than randomised trials.
Voice quality does not always return to its previous level because inflammation and healing can scar the vocal folds. In a 2005 case report that followed vocal function before, during and after treatment, swelling and hoarseness improved, but videostroboscopy continued to show a reduced mucosal wave, limited vibration of the affected vocal fold and incomplete glottic closure; the patient's breathy voice persisted. The authors attributed these findings to fibrotic change in the lamina propria.[7] Other possible complications include vocal-fold immobility, laryngeal stenosis and, rarely, critical airway obstruction.[2]
Epidemiology
[edit]Laryngeal involvement became much less common after effective antituberculosis drugs were introduced. Modern reviews estimate that it represents about 1 per cent of TB cases.[2]
A 2022 review of 308 patients found that 64.3 per cent were male and that the mean ages in the included series ranged from 44.6 to 56.5 years. The studies came from seven countries and mainly included patients treated in referral centres, so these figures may not represent the general population.[2]
History
[edit]Anatomical descriptions of laryngeal lesions associated with tuberculosis date to seventeenth-century autopsies. During the nineteenth century, physicians established their association with pulmonary disease, and the development of the laryngeal mirror in 1854 enabled examination in living patients. By the early twentieth century, laryngeal TB was commonly associated with cavitary pulmonary TB and was regarded as a sign of advanced disease.[8] One modern review estimated that laryngeal involvement accounted for about 25 per cent of TB cases in the first decades of that century, compared with about 1 per cent in the modern period.[2]
Before effective antimicrobial treatment, management of tuberculosis commonly involved sanatorium care, with rest, outdoor air, exercise, nutrition and isolation. These measures were used for TB generally rather than as a proven larynx-specific cure.[9] The introduction of drugs including streptomycin and isoniazid during the 1940s and 1950s was followed by a marked decline in pulmonary TB and laryngeal involvement.[8]
Documented historical cases
[edit]People documented as having laryngeal tuberculosis include the writer Franz Kafka, whose pulmonary tuberculosis spread to his larynx in 1924,[10] and the Scottish Poor Clare nun Margaret Sinclair, who was admitted to a sanatorium with tuberculosis of the throat in April 1925 and died that November.[11]
References
[edit]- 1 2 3 4 5 6 7 8 9 10 11 Rubin, F.; Jameleddine, E.; Guiquerro, S.; Laccourreye, O. (May 2024). "Laryngeal tuberculosis in the early 21st century: Literature review of clinical, diagnostic and therapeutic data, according to SWiM guidelines". European Annals of Otorhinolaryngology, Head and Neck Diseases. 141 (3): 147–152. doi:10.1016/j.anorl.2024.01.001.
- 1 2 3 4 5 6 7 8 9 10 11 12 13 Migliorelli, Andrea; Mazzocco, Tommaso; Bonsembiante, Anna; Bugada, Daniele; Fantini, Marco; Elli, Fabrizia; Stacchini, Marco (October 2022). "Laryngeal tubercolosis: a case report with focus on voice assessment and review of the literature". Acta Otorhinolaryngologica Italica. 42 (5): 407–414. doi:10.14639/0392-100X-N2091. PMC 9793137. PMID 36541378.
- 1 2 3 Matimba, Abongile; Moncho, Masego; Musoke, Jolly; Seedat, Riaz Y. (2020). "Diagnosis of laryngeal tuberculosis in a high TB burden area". European Archives of Oto-Rhino-Laryngology. 277: 2137–2140. doi:10.1007/s00405-020-05976-y. PMID 32328829.
- 1 2 3 "Treatment of extrapulmonary TB". WHO TB Knowledge Sharing. World Health Organization. Retrieved 12 July 2026.
- ↑ Jensen, Paul A.; Lambert, Lauren A.; Iademarco, Michael F.; Ridzon, Renee (30 December 2005). "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005". MMWR Recommendations and Reports. 54 (RR-17): 1–141. Retrieved 12 July 2026.
- ↑ "Appendix A: Type and Duration of Precautions Recommended for Selected Infections and Conditions". Infection Control. Centers for Disease Control and Prevention. 7 February 2025. Retrieved 12 July 2026.
- ↑ Özüdoğru, E.; Çaklı, H.; Altuntaş, E. E.; Gürbüz, M. K. (December 2005). "Effects of laryngeal tuberculosis on vocal fold functions: case report". Acta Otorhinolaryngologica Italica. 25 (6): 374–377. PMC 2639896. PMID 16749607.
- 1 2 Sá, Leonardo Conrado Barbosa de; Meirelles, Roberto Campos; Atherino, Ciríaco Cristóvão Tavares; Fernandes, José Roberto Carvalhaes; Ferraz, Fabiana Rocha (November–December 2007). "Laryngo-pharyngeal tuberculosis". Brazilian Journal of Otorhinolaryngology. 73 (6): 862–866. doi:10.1016/S1808-8694(15)31188-5. PMC 9450674.
- ↑ Martini, M.; Gazzaniga, V.; Behzadifar, M.; Bragazzi, N. L.; Barberis, I. (15 December 2018). "The history of tuberculosis: the social role of sanatoria for the treatment of tuberculosis in Italy between the end of the 19th century and the middle of the 20th". Journal of Preventive Medicine and Hygiene. 59 (4): E323–E327. doi:10.15167/2421-4248/jpmh2018.59.4.1103. PMC 6319124. PMID 30656236.
- ↑ Williams, Joy (5 July 2013). "'Kafka: The Years of Insight,' by Reiner Stach". The New York Times. Retrieved 12 July 2026.
- ↑ "The Venerable Margaret Sinclair". Margaret Sinclair National Shrine. Retrieved 12 July 2026.
