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Larynx Infectious Granulomas
Tuberculosis of the larynx occurs as a complication of the pulmonary process, infection occurs spontaneously, through sputum when the patient coughs. The larynx is affected in 8-30% of patients with pulmonary tuberculosis at a flowering age (20-40 years), more often in men. Pathomorphological forms: infiltrate, ulcer, perichondritis, essentially the stage of the disease. Usually, the posterior sections of the larynx are affected: the interchaloid space, the arytenoid cartilage and the posterior sections of the vocal folds adjacent to them. Infiltration is manifested by thickening of the mucosa, the presence of tubercles, similar to papillomas, their color is pale, thick sputum is visible. With further growth of the tissue, tuberculoma forms with subsequent ulceration: flat ulcers with saped fringed edges and a dirty bottom (granulation and sputum). With perichondritis, the arytenoid cartilage increases significantly, acquires a gelatinous appearance, mobility is limited. The final diagnosis is made in conjunction with a TB doctor, since, as mentioned above, laryngeal tuberculosis is always combined with pulmonary tuberculosis, and therefore TB doctors also conduct treatment. Differential diagnosis with other infectious granulomas and pachydermia of the larynx. Tracheotomy is extremely rare when a secondary non-specific infection that enhances swelling of the laryngeal tissues joins.
Syphilis of the larynx. There are secondary and tertiary manifestations of syphilis. Secondary 6-7 weeks after the primary chancre, tertiary - from several months to several years. Forms of syphilis of the larynx: erythema, papule (2), gum, diffuse gummous infiltrate, chondro-perichondritis (3). Erythema looks like a spotted red rash (roseol) on the vestibular folds, sometimes on the epiglottis and scoops. The vocal folds are rough ("cat tongue"). Subjective symptoms are absent (sometimes dysphonia). Papules resemble the nodules of singers, but larger, affect the voice, vestibular, lingual-epiglottis folds, epiglottis. They quickly ulcerate, merging to form wide warts with three concentric rings: an ulcer, then a gray ring of rejected epithelium, a red ring of inflamed mucosa. During this period, the patient is very contagious. Gumma of the larynx has the form of a limited infiltrate or a copper-red tumor from a pea to a nut, and quickly disintegrates with the formation of an ulcer.
Diffuse gummous infiltrate captures more extensive areas of the larynx, up to the sub-vocal space, and may produce stenosis of the larynx. At the stage of ulceration of the gum, chondroperichondritis also occurs, most often the epiglottis with its complete rejection, while the regional lymph nodes hardly respond. For a correct diagnosis of laryngeal syphilis, it is necessary to take into account the symptoms of the skin, pharyngeal mucosa, and mouth. Therefore, if you suspect syphilis, it is imperative to involve a dermatovenerologist, followed by treatment. A frequent manifestation of late syphilis is paresis of the left vocal fold (damage to the posterior muscle of the larynx) without other pathological manifestations as a result of syphilitic periaortitis and involvement of the left recurrent nerve. In the differential diagnosis of such lesions, syphilis should be excluded.
Scleroma of the larynx. If the epidemiology of previous diseases does not raise questions (Koch's bacillus, pale spirochete), then the causative agent of scleroma is not completely established, but the significance of the Frisch-Volkovich stick, which a number of authors write about, is doubtful. Scleroma has endemic areas of distribution - the west of Belarus, Ukraine. Stages of the course of scleroma: nodular, diffuse-infiltrative and cicatricial. First, small soft infiltrates are formed in the sub-vocal space, then they merge, become extensive dense, in the third stage they are scarred with a sharp narrowing of the glottis with the formation of a membrane and stenosis (Fig. 4.27). In addition to typical localization, scleromas can be affected by all other parts of the larynx, up to the lingual surface of the epiglottis. Other favorite places of defeat of the scleroma are the nasal cavity and pharynx with the formation of "wings" in the choanas and pharynx. The patient's complaints boil down to changes in voice, shortness of breath, dry throat, and crust formation. Stenosis builds up slowly over the years. Treatment: streptomycin therapy 500 thousand units per day intramuscularly, x-ray therapy. Surgical methods are also used, essentially palliative - curettage, biting of membranes, excision of scars.
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Larynx Infectious Granulomas
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