Overview: Laryngeal Tuberculosis (TB)
Laryngeal tuberculosis is a rare form of extrapulmonary tuberculosis that affects the vocal cords and nearby structures, usually spreading from an existing lung infection. Though uncommon, it carries significant clinical importance due to its implications for voice, swallowing, and airway function.
How It Develops
This condition most often arises through hematogenous spread—the dissemination of Mycobacterium tuberculosis from a pulmonary source—or by direct extension from adjacent sites in the respiratory tract. Patients may or may not have obvious lung involvement.
Clinical Presentation
Hoarseness or changes in voice quality are typically the earliest signs.
Symptoms may include painful swallowing, throat discomfort, cough, low-grade fever, weight loss, and fatigue.
Systemic signs such as anemia, leukocytosis, or hyponatremia can occur, especially in advanced cases.
Physical and endoscopic examination may reveal ulcerations, nodules, or swelling on vocal cords or laryngeal mucosa.
Diagnosis
Biopsy of the laryngeal lesion confirmed by histopathology or culture remains the gold standard.
Sputum studies, chest imaging, and modern molecular tests (e.g. nucleic acid amplification) help identify pulmonary TB, which is present in a majority of cases.
Because laryngeal TB may mimic malignancy, malignancies such as squamous cell carcinoma, and other granulomatous conditions must be ruled out.
Treatment Approach
Standard first-line treatment mirrors that of pulmonary TB: a four‑drug regimen—isoniazid, rifampin, pyrazinamide, and ethambutol—for a total of 6 months.
Close monitoring during therapy is essential, liver tests, blood counts, and visual acuity if ethambutol is used.
Directly Observed Therapy (DOT) is recommended to ensure adherence and reduce the risk of drug resistance.
Broader Context
About 20% of all TB cases involve extrapulmonary sites, which can include lymph nodes, bones, meninges, and the larynx itself.
Extrapulmonary tuberculosis often presents with non‑specific symptoms and can be challenging to diagnose without a high clinical index of suspicion.