PULMONARY AND LARYNGEAL TUBERCULOSIS - ST UDY OF 26 PATIENTS

A description is reported of tuberculosis cases (TBC) with symptomatic laryngeal involvement diagnosed and treated from 1982 to 1994. Twenty -six out of 2,800 (0.9%) patients diagnosed with TBC had laryngeal sym ptoms. Twelve patients underwent laryngeal biopsy and the disease was diagnosed in 11; the remaining 15 patients were diagnosed on the basis of the typical lesions at laryngoscopy and resolution with specific t herapy; in all of them there was a pulmonary TBC associated. The mean time of clinical laryngeal symptoms was five months and the most commo n symptom was dysphonia. There were factors which increased the risk f or TBC in 16 patients (61.5%), alcoholism being the most common sympto m in 10 (38%) patients. X-Ray examination revealed bilateral infiltrat es or cavitation in 81% of patients. Sputum examination for acid-fast bacilli was positive in 15 (58%) and culture for Mycobacterium tubercu losis was positive in all of them. All patients adhered correctly to t he therapeutic regimen and the clinical course was towards healing: no patient had laryngeal carcinoma after one year of follow-up. The inci dence of symptomatic laryngeal TBC in our environment is low and usual ly presents in patients with risk factors, particularly alcoholism, wi th a long evolution of the disease and associated with extensive pulmo nary TBC. The coexistence with laryngeal carcinoma is exceptional; the refore, when the association of laryngeal symptoms and active pulmonar y TBC is present it is reasonable to reserve the laryngeal biopsy for those patients with lymph node enlargement, risk factors, or when symp toms persist after a correct therapeutic regime has been instituted.