Lepra of the larynx

Along with leprosy of the nose, leprosy of the larynx is quite common in endemic foci. As early as 1897, at the International Conference of Leprologists, general statistical data were presented, according to which leprosy of the larynx was observed in 64% of all patients with this disease (Gluck).

According to observations by Romanian authors, out of 39 patients with ENT leprosy, only 3 had lepromatous nodes in the larynx, while most of the remaining patients had only various forms of chronic non-specific laryngitis. According to world statistics, laryngeal leprosy in the overwhelming majority of cases manifests itself in the lepromatous form and very rarely in the neurological form.

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Pathogenesis of laryngeal leprosy

Solitary lepromatous infiltrates arising in the larynx do not have clear boundaries, in other cases these infiltrates have the character of multiple nodules with a granulomatous structure. Infiltrates consist of vacuolated cells, plasma cells and histiocytes, have the ability to spread in breadth and depth, often affecting the cartilaginous tissue of the larynx. The causative agent of leprosy (Hensen's bacillus) is determined in large quantities in the form of sheaf-like agglomerations both inside the vacuolated cells and outside them. Infiltrates undergo disintegration, causing extensive destruction of the larynx and leading to massive scars that disfigure and stenose the larynx.

Symptoms of laryngeal leprosy

In the initial stage, laryngeal leprosy manifests itself as a short-term acute inflammatory reaction (hyperemia and swelling of the mucous membrane), gradually turning into chronic "dry" laryngitis, which can last for many years. A distinctive feature of this laryngitis is that when trying to treat it as a regular chronic atrophic laryngitis, instead of improving, the condition of the laryngeal mucosa worsens and the lepromatous infection itself becomes active. However, most often, small nodular formations of a bluish or whitish-gray color soon appear against the background of the atrophic mucosa, which, merging, are transformed into nodular infiltrates located mainly on the epiglottis and in the vestibule of the larynx. From here, lepromatous infiltrates spread to the vocal folds and subglottic space. The edge of the epiglottis appears unevenly thickened, papillary in shape, which is given to it by nodular formations of different sizes - from a millet pea grain. Sometimes these infiltrates acquire a papillomatous appearance.

The laryngeal ventricles are filled with diffuse infiltrates with an uneven surface of pale yellow color. Sometimes these infiltrates merge with the vocal folds, forming massive conglomerates that narrow the respiratory gap and pose a threat to the patient's life. In the subglottic space, which can only be examined by direct laryngoscopy, these infiltrates acquire a circular shape, which aggravates the impairment of the respiratory function of the larynx. Sometimes ulcers form on the epiglottis, arytenoid region and, less often, on the vocal folds, which are the cause of secondary perichondritis. All these changes tend to heal quickly, after which deep scars remain, disfiguring and stenotic the larynx.

Lepromatous lesions of the larynx are painless due to the ability of the microorganism to secrete a special toxin that causes complete anesthesia (temperature, tactile and pain) of the affected tissue, which is observed not only in the nervous form of leprosy, but also in the lepromatous form.

Phonatory and respiratory disorders in laryngeal leprosy are constant phenomena, the severity of which depends on the localization and size of the infiltrates and the subsequent sclerosing process.

Diagnosis of laryngeal leprosy

The diagnosis is established without any particular difficulties, since changes in the larynx occur later than the cutaneous, nasal and pharyngeal manifestations of leprosy, when the diagnosis of this otolaryngological disease has already been established.

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Treatment of laryngeal leprosy

If a disorder of the respiratory function of the larynx occurs that threatens the patient's life, a tracheotomy is performed. As for laryngeal stenosis, it will be discussed below, in the relevant section of this chapter.

What is the prognosis for laryngeal leprosy?

Laryngeal leprosy has a serious prognosis and largely depends on the general immunobiological state of the patient's body. With good resistance of the patient or with timely use of complex immunomodulatory treatment, a relatively benign form of leprosy develops - tuberculoid, which is well treatable. The prognosis for laryngeal leprosy is aggravated by the possibility of critical respiratory failure, the occurrence of perichondritis and ulcers with the addition of a secondary infection and its spread to the perilaryngeal region and mediastinum with all the negative consequences that follow.