Tubercular Laryngitis: A Rebirth?

Abstract

Objective: The aim of this study is to highlight the changing clinical patterns of laryngeal tuberculosis (TB) and to increase the awareness of this uncommon manifestation of extrapulmonary TB which will help the clinician in early diagnosis and appropriate management of this condition. Materials and methods: A retrospective analysis was done of 34 suspected cases of tubercular laryngitis who presented to our institution from January 2009 to December 2011. All of these patients were subjected to hematological tests, sputum microscopy, and radiological investigations. Results: Out of these 34 patients, hematological profile, sputum testing, and radiological profile was positive for TB in 13 patients who were started on antitubercular treatment. Out of 13, 1 patient had resolution of cough but persistent hoarseness and was diagnosed as having severe epithelial dysplasia. Twentyone patients were tested negative for TB and were diagnosed as chronic laryngitis (11), histoplasmosis (1), amyloidosis (2), sarcoidosis (1), and invasive squamous cell carcinoma (4). Primary laryngeal TB was diagnosed in two cases. Conclusion: Laryngeal TB, though rare, is increasingly presenting to the otolaryngologists nowadays due to increase in the number of immunocompromised hosts and development of resistant microorganisms. It presents with nonspecific symptoms and can often be missed leading to delay in diagnosis and treatment. Starting empirical steroids without diagnosis may flare up the TB. It often mimics and occasionally may coexist with laryngeal malignancy. Thus the clinician should be vigilant and should always consider laryngeal TB as an important differential for laryngeal lesions.