Granulomatous conditions of larynx

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  • 1. GRANULOMATOUSCONDITIONS OF LARYNX DEPT OF OTORHINOLARYNGOLOGY JJM M C DAVANAGERE
  • 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 –> 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. TUBERCULOSIS OF LARYNX- DIAGNOSIS• Chest X-ray• Sputum examination for AFB• Laryngoscopic examination• Biopsy of laryngeal lesion
  • 7. TUBERCULOSIS OF LARYNX- TREATMENT• Anti tubercular drug regimen• Vocal rest• Nutritional supplements
  • 8. SCLEROMA OF LARYNX• Klebsiella rhinoscleromatis is the causative organism• Laryngeal involvement is seen with or without nasal lesion• Subglottic region is commonly involved
  • 9. 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
  • 10. 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
  • 11. SCLEROMA OF LARYNX- TREATMENT• Medical  combination of an aminoglycoside such as gentamycin with an anti-metabolite such as tetracyclin• Steroids to reduce fibrosis• Surgical1. Endoscopic removal of granulomatous tissue2. Mild stenosis  dilatation3. Severe subglottic stenosis tracheostomy
  • 12. SYPHILIS OF LARYNX• Now rarely seen• All stages can manifest in larynx• Primary lesion described rarely• Tertiary stage is most important gamma are seen• Peri arterial infiltration and obliterative endarteritis• Prediliction for anterior part of larynx  epiglottis and AE folds
  • 13. 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
  • 14. 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• Treatment Prolonged treatment with high doses of penicillin• Local treatment by inhalation• Endoscopic removal of necrotic tissue to maintain airway• tracheostomy
  • 15. LEPROSY OF LARYNX• Caused by mycobacterium leprae (Hansens 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
  • 16. LEPROSY OF LARYNX- TREATMENT• Medical Dapsone, Clofazimine, Rifampicin• Surgical tracheostomy in cases of stenosis
  • 17. WEGENER’S 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 subglottis 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
  • 18. 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• Pathology non specific granuloma later fibrosis and hyalinization• Main site involved is supraglottis
  • 19. 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• Diagnosis biopsy• Positive Kveim’s test, elevated serum angiotensin converting enzyme is highly suggestive• Treatment high dose corticosteroids, tracheostomy
  • 20. 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
  • 21. MYCOSIS OF LARYNX• Following mycosis can occur in the larynx1. Candidiasis2. Coccidioidmycosis3. Paracoccidioidmycosis4. Histoplasmosis5. Blastomycosis6. Cryptococcosis7. aspergillosis