1. GRANULOMATOUS
CONDITIONS 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

7. TUBERCULOSIS OF LARYNX-
DIAGNOSIS
• Chest X-ray
• Sputum examination for AFB
• Laryngoscopic examination
• Biopsy of laryngeal lesion

8. TUBERCULOSIS OF LARYNX-
TREATMENT
• Anti tubercular drug regimen
• Vocal rest
• Nutritional supplements

9. SCLEROMA OF LARYNX
• Klebsiella rhinoscleromatis is the
causative organism
• Laryngeal involvement is seen with or
without nasal lesion
• Subglottic region is commonly involved

10. 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

11. 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

12. SCLEROMA OF LARYNX-
TREATMENT
• Medical  combination of an
aminoglycoside such as gentamycin with an
anti-metabolite such as tetracyclin
• Steroids to reduce fibrosis
• Surgical
1. Endoscopic removal of granulomatous
tissue
2. Mild stenosis  dilatation
3. Severe subglottic stenosis tracheostomy

13. 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

14. 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

15. 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

16. LEPROSY OF LARYNX
• Caused by mycobacterium leprae (Hansen's
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

17. LEPROSY OF LARYNX-
TREATMENT
• Medical Dapsone, Clofazimine,
Rifampicin
• Surgical tracheostomy in cases of
stenosis

18. 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

19. 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

20. 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

21. 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

22. MYCOSIS OF LARYNX
• Following mycosis can occur in the larynx
1. Candidiasis
2. Coccidioidmycosis
3. Paracoccidioidmycosis
4. Histoplasmosis
5. Blastomycosis
6. Cryptococcosis
7. aspergillosis