Sarcoidosis of the larynx: causes, symptoms, diagnosis, treatment

Detailed information on sarcoidosis, as a benign granulomatosis (disease) Bénier-Beck-Schaumann, was given in the article " Sarcoidosis of the nose ". Here we only recall that this disease develops at the level of a reticulogistiocytic system with a chronic course characterized by the formation of specific granulomas in various organs and tissues.

Unlike tuberculosis and syphilitic granulomas, sarcoid granulomas, like leprous granulomas, are subjected not to necrotic changes, but to primary scarring, which distorts the structure of the affected organs and disrupts their functions.

[1], [2], [3], [4], [5], [6], [7]

What causes sarcoidosis of the larynx?

Sarcoidosis of the larynx develops for unknown reasons. According to modern ideas, sarcoidosis is a disease of impaired immunoreactivity with a special reaction of the body to the effect of various environmental factors.

Pathogenesis of laryngeal sarcoidosis

Sarcoidosis infiltrates occur in the reticuloendothelial tissues in the form of piles of epithelioid, sometimes giant cells surrounded by lymphocytes. These infiltrates appear in the lymphoid apparatus of the respiratory tract, especially in the basal lymph nodes of the lungs, as well as in the spleen, liver, pituitary, choroid, parotid and other glands, manifested in other cases by Heerford syndromes (subchronic febrile uveoparotitis: prolonged subfebrile body temperature, is the development of nodotic iridocyclitis, chronic parotitis, other salivary glands, mammary glands, testes and ovaries are often affected, often the neurological symptoms of the sarcoid larynx, caused by defeat of the cranial nerves, more often of the facial, oculomotor and spinal nerves, brainstem and signs of irritation of the meninges) or Mikulich - gradual painless generalized symmetrical swelling of the salivary and lacrimal glands; Often the mucous glands of the oral cavity, pharynx and larynx are involved in the process; the disease lasts for years; late complications - an increase in lymph nodes, jaundice, an increase in the liver and spleen. Occasionally, there are phenomena of lacunar osteitis in the bones of the skull, pelvis, sternum and bones of the nose. According to the statistics of the Romanian author N. Lazeanu et al. (1962), of the 59 patients they observed with sarcoidosis of different locations, 13 had a laryngeal lesion.

Symptoms of sarcoidosis of the larynx

The general condition with isolated lesion of the larynx practically does not suffer. Patients report such symptoms of sarcoidosis of the larynx as: some discomfort in phonation, more often than usual, a feeling of perspiration, sometimes a transitory sensation of a foreign body in the larynx.

The endoscopic picture of the larynx has the appearance of covering the mucous membrane of polypoid formations in the form of nodes or swellings with a smooth surface. These formations do not resemble inflammatory infiltrates, are clearly isolated from the surrounding mucous membrane of normal appearance, are not subjected to ulceration and necrosis. They are located mainly in the ventricles of the larynx or in the vocal folds. In other cases, these formations take the form of diffuse infiltrates, which are combined with similar formations in the nasal cavity, pharynx and on the skin. The disease progresses slowly, for many years, and is observed mainly in middle-aged people. Often, such individuals turn to the ENT doctor who leads them, as patients with chronic hypertrophic laryngitis, without suspecting that they have sarcoidosis of the larynx. The general condition does not suffer.

Diagnosis of laryngeal sarcoidosis

Diagnosis of laryngeal sarcoidosis is difficult only with isolated lesions of the larynx, which is very rare. In the presence of lesions of the nasopharynx, lungs, skin, liver, etc., the presence of sarcoidosis of the larynx should be suspected, but the final diagnosis is established by histological examination.

Differentiate sarcoidosis of the larynx from polyps, papillomas, tuberculosis, lupus, syphilis and malignant tumors of the larynx.

[8], [9], [10]

Treatment of laryngeal sarcoidosis

Treatment of sarcoidosis of the larynx is similar to that described in the article " Sarcoidosis of the nose ". Infiltrates, causing violations of the lantern and respiratory functions of the larynx, are surgically removed from the endolaryngeal access under the "cover" of antibiotics and corticosteroids.