Laryngeal tuberculosis: A case of a non-healing laryngeal lesion

Primary Laryngeal Tuberculosis: Our Experiences at a Tertiary Care Teaching Hospital in Eastern India

INTRODUCTION

Primary laryngeal tuberculosis is a chronic bacterial infection of the larynx by Mycobacterium tuberculosis without affecting the lungs. It is a rare type of extrapulmonary tuberculosis seen in clinical practice.

OBJECTIVES

This study aimed to evaluate the clinical presentation, diagnosis, and treatment of primary laryngeal tuberculosis at a tertiary care teaching hospital in eastern India.

MATERIALS AND METHODS

This is a retrospective study of 11 cases of primary laryngeal tuberculosis managed between December 2013 and January 2018. The detailed clinical presentations, investigations, and treatment of primary laryngeal tuberculosis of the patients were studied.

RESULTS

Primary laryngeal tuberculosis is common in men with mean age of 38.63 years. Hoarseness of the voice is the most common symptom, and the most common site for primary laryngeal tuberculosis is the vocal fold with ulcerative lesion. Endoscopic examinations of the larynx in laryngeal tuberculosis are nonspecific and are to be confused with laryngeal cancer. Histopathological and bacteriological examinations are confirmatory tests for the diagnosis. After confirmation of the diagnosis, all patients had taken antitubercular therapy for 6 months, which gave excellent outcome.

CONCLUSIONS

Delayed diagnosis or untreatable laryngeal tuberculosis will lead to high morbidity and mortality of the patient. Although primary laryngeal tuberculosis has nonspecific clinical presentations, it is very important to have a high index of suspiciousness to rule out tubercular lesion in the larynx as this disease is curable.

Association between Chronic Laryngitis and Particulate Matter Based on the Korea National Health and Nutrition Examination Survey 2008-2012

Background

Chronic laryngitis (CL) has been described as chronic inflammation of the larynx. CL have various causes such as long-term smoking, acid reflux, voice overuse, bronchitis, allergies, pneumonia, excessive exposure to toxic chemicals and complications from the flu or a chronic cold. However, the prevalence of CL and role of air pollution in the etiology is uncertain.

Objective

The aim of this study was to investigate the relationship between CL and particulate matter with aerodynamic diameter less than 10 μm (PM₁₀) in South Korea using data from the Korea National Health and Nutrition Examination Surveys (KNHANES) during 2008–2012.

Methods

KNHANES is a cross-sectional survey of the civilian, non-institutionalized population of South Korea (n = 21,116). A field survey team that included an otolaryngologist moved with a mobile examination unit and performed interviews and physical examinations. The mean annual concentrations of ambient PM10, SO2, O3, NO2, and CO levels in Korea were determined from monitoring station data. Multiple logistic regression was used to examine the relationship of air pollution to CL.

Results

Among the population ≥ 19 years of age, the weighted prevalence of CL was 3.37 ± 0.30% (95% confidence interval, 2.79–3.95%). CL was more prevalent in men, current smokers, and those with lower household income and prevalence increased with age. A significant decrease over time was observed in the prevalence of CL (P for trend = 0.0049) and the annual average concentrations of PM₁₀ (P for trend < 0.0001) from 2008 to 2012. In a multivariate model, the factors associated with CL included PM₁₀ (odds ratio [OR], 1.378, p = 0.0457), age (OR, 1.020, p<0.0001), sex (OR, 0.734, p = 0.0179), and smoking status (OR, 1.438, p = 0.0054).

Conclusion

Elevated PM10 exposures could be associated with increased risk of CL in South Koreans. Further epidemiological and experimental studies are necessary to clarify the impact of chronic PM₁₀ exposure on CL.

Association between Obesity and Chronic Laryngitis in Women--Data from the Korea National Health and Nutrition Examination Survey

BACKGROUND

This study aimed to investigate the relationship between obesity and chronic laryngitis in South Korea using data from the Korea National Health and Nutrition Examination Surveys (KNHANES) collected during 2008-2010.

METHODS

KNHANES was a cross-sectional survey of the civilian, non-institutionalized population of South Korea (n = 13,819). Obesity status was measured by using BMI and waist circumference.

RESULTS

Among the population over 19 years of age, the prevalence of chronic laryngitis was 4.0 ± 0.4%. Chronic laryngitis was significantly associated with age, BMI, waist circumference, fat proportion, both systolic and diastolic blood pressure, fasting blood sugar, triglycerides, and high-density lipoprotein cholesterol in women. Old age and current smoking were significantly associated with chronic laryngitis in men. Obese women were at a higher risk for chronic laryngitis than women without obesity (odds ratio (OR) 2.022, 95% confidence interval (95% CI) 1.412-2.895) after further adjustment for confounders. Women with abdominal obesity were also at higher risk for chronic laryngitis (OR 1.475, 95% CI 1.024-2.126).

CONCLUSION

Obese women in Korea have an elevated risk for developing chronic laryngitis. Further epidemiological and experimental studies are necessary to clarify the impact of obesity on this condition.

Interferon-γ release assay in the diagnosis of laryngeal tuberculosis

CONCLUSION

The T-SPOT test for Mycobacterium tuberculosis infection (T-SPOT.TB) can be used for early diagnosis of laryngeal tuberculosis (TB).

OBJECTIVE

The incidence of TB is increasing on a global scale. Laryngeal TB is the most common extrapulmonary form of TB and its early diagnosis is still difficult. This study investigated the performance of the interferon-γ release assay in the diagnosis of laryngeal TB.

METHODS

A total of 83 patients with laryngeal neoplasms were confirmed to have laryngeal TB by pathology, acid-fast staining, and/or fluorescence quantitative PCR. In addition, 52 patients with vocal cord polyps were enrolled as the control group. Two groups underwent both T-SPOT.TB and tuberculin skin test (TST).

RESULTS

T-SPOT.TB was positive in 75 cases in the laryngeal TB group and 4 cases in the control group, showing a sensitivity of 90.3% (75/83) and a specificity of 92.3% (48/52). The TST was positive in 42 cases and 20 cases, respectively, in these two groups. Obviously, TST and T-SPOT.TB were significantly different in terms of sensitivity when applied for detection of laryngeal TB (p < 0.05).

Incidence of Chronic Laryngitis

Objectives:

We describe the incidence of chronic laryngitis (CL) and identify the most common presenting symptoms and initial treatments used.

Methods:

We retrospectively identified patients with a diagnosis of CL who were seen among a primary care cohort at an urban academic medical center from 2009 to 2010. The incidence of CL was calculated. Symptoms, first-visit treatment, smoking, and demographics were recorded.

Results:

Of a population of 40,317 people, 280 received a new diagnosis of CL over a 2-year period, representing a yearly incidence of 3.47 cases per 1,000 people. The subjects consisted of 160 women and 120 men. Race was recorded as black (126), Hispanic (47), white (68), or other (39). The mean age was 52.9 years (range, 20 to 90 years). The initial therapies included proton pump inhibitors (79%), voice therapy (17%), nasal steroid (13%), antihistamine (4%), amitriptyline (4%), other (17%), and none (11%). The most common symptoms were dysphonia (53%), pain/soreness (45%), globus sensation (40%), cough (33%), excessive throat clearing (28%), and dysphagia (32%). An otolaryngologist saw 93% of the cases.

Conclusions:

The yearly CL incidence was 3.47 per 1,000 people. Up to 21% of the population may develop CL in their lifetime. Most of the patients in this cohort were referred to otolaryngologists, and the majority were treated with proton pump inhibitors. Dysphonia, globus sensation, and pain were the most common symptoms. Population surveys could be used to define undiagnosed disease and the overall prevalence of CL.