Syphilis of larynx

Syphilis of the larynx is observed much less often than the nose or pharynx. Very rarely the larynx is affected by congenital syphilis.

Causes of larynx syphilis

Syphilis is a venereal disease caused by a pale treponema discovered in 1905 by F.Schaudin and E.Hoffmann. In rare cases with syphilis of the larynx, the primary affect (chancre) is localized on the epiglottis and cherpalodnagortane fold, where the pathogen comes from an external source of infection through the oral cavity with saliva. In the secondary period acquired by infection with syphilis, the lesion of the larynx arises relatively often (the hematogenous pathway) and manifests itself in the form of diffuse erythema, combining, as a rule, with a similar reaction of the nasal mucosa, oral cavity and pharynx. With secondary congenital syphilis, the larynx can also be affected in infants, which, however, goes unnoticed. In the Tertiary period, the lesion of the larynx manifests itself most pronounced changes, however at this stage of syphilitic infection the larynx is rarely affected. Neurosyphilis can be manifested by paresis or paralysis of the internal muscles of the larynx, most often abductors, which leads to laryngeal stenosis as a result of the predominance of adductors innervated by recurrent nerves (Gerhard syndrome).

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10],

Pathological anatomy

Primary syphilis of the larynx manifests itself in the form of a dirty gray ulcer with raised margins of cartilaginous density and regional cervical lymphadenitis. With secondary syphilis of the larynx, characteristic mucous deposits appear in its mucous membrane in the form of whitish spots, adjacent to diffuse areas of hyperemia. In the Tertiary period, diffuse subepithelial infiltrates appear in the form of gummy formations, which, undergoing disintegration, turn into deep crater-like ulcers with steeply breaking edges and a dirty gray bottom. Attachment of secondary infection causes laryngeal edema, perichondritis and necrosis of its cartilage. On recovery, this process is completed by massive cicatricial scarring of the larynx and seizure.

Symptoms of larynx syphilis

A characteristic feature of syphilis of the larynx (in contrast to its other inflammatory diseases) is a significant disproportion between pronounced destructive changes and very weak subjective sensations. Only after joining the secondary infection there is a pronounced pain syndrome with otodonia and dysphagia. Dysphonia is observed in the secondary period, when there is diffuse catarrhal inflammation of the mucous membrane, and in the Tertiary period, when the destructive process touches the vocal apparatus.

Respiratory function of the larynx begins to suffer only in the Tertiary period, when the laryngeal cavity is filled with one or a lot of infiltrates, their gummous decay, ulcers and scars stenosing the larynx.

When laryngoscopy in the primary period, an enlarged epiglottis and cherpalodnarhort folds appear on their ulcer surface, as well as regional lymphadenitis: painless enlarged lymph nodes that have a tight elastic consistence can be disintegrated to form dermal fistulas. In secondary syphilis of the larynx, its mucous membrane acquires a bright red color (syphilitic enanthema - with simultaneous damage to the oral cavity and pharynx). On the mucosa, grayish-white raids occur with even boundaries or papules that rise above the rest of the mucous membrane, located on the epiglottis and cherpalodnagorranean folds, less often along the edges of the vocal folds. In some cases, small erosions occur on the mucosa. As a rule, the secondary larynx syphilis quickly passes, but within the next two years can recur.

In the Tertiary period, the infiltrates of the red-cyanotic color are found in the larynx, usually appearing on the threshold of the larynx, sometimes in the region of the respiratory gutter (difficulty breathing) or in the lining space. Each such infiltrate (single or in the number of two or three) forms syphilitic gumma, which lasts (weeks and months) is preserved in its original form, and then quickly disintegrates, forming an ulcer, ending with scarring.

The clinical course of syphilis of the larynx is determined by the nature of the disease (the cause of its occurrence) and the stage at which the larynx lesion appeared. With timely treatment, a specific inflammatory process can be eliminated without subsequent persistent organic lesions of the larynx, with the greatest effectiveness possible if treatment is initiated in the primary or secondary stage of syphilis. In tertiary syphilis, it is also possible to prevent significant destruction of the larynx, but if they have not yet occurred, or if secondary infection has not occurred. In the latter case, these disruptions are almost inevitable.

Diagnosis of larynx syphilis

The diagnosis of general syphilitic infection is established on the basis of known symptoms and serological reactions. Difficulties can arise in this case with the so-called seronegative syphilis. With this form of syphilis, or when it continues to go unnoticed for a long time, a specific disease in the larynx begins, especially with secondary syphilis in the stage of diffuse erythematous manifestations, which can be taken as banal laryngitis. Suspicions of syphilis of the larynx can occur when mucosal lesions are found on the mucous membranes of grayish-white color and papules, which, however, may be confused with aphthae, herpes, or pemphigus of the larynx. If there is any doubt in the diagnosis, the patient is given serological tests and referred to the dermatovenerologist.

In the Tertiary period in the diffuse infiltrative form of laryngeal syphilis, the latter can be mistaken for chronic hypertrophic laryngitis, but a single circumscripta infiltrate should always cause suspicion of syphilis of the larynx. Often, with ulceration of gum or in the event of secondary perichondritis, these phenomena are mixed with tuberculosis of the larynx or cancer of the larynx, therefore, for the final diagnosis of the patient for differential diagnosis should be examined by specific methods for these diseases (lung radiography, serological reactions, biopsy, etc.). In differential diagnosis, one should not forget about the possibility of having so-called mixts, that is, combinations of syphilis and tuberculosis of the larynx, syphilis and laryngeal cancer, and also that in the Tertiary period, serological tests can be negative, and a biopsy can not give convincing results . In these cases, ex jubantibus is diagnosed with antisyphilitic treatment.

[11], [12], [13], [14]

Treatment of larynx syphilis

Treatment of larynx syphilis should be early and vigorous in order to prevent devastating effects in the larynx. It is conducted in the appropriate hospital. The otorhinolaryngologist controls the objective state of the larynx, evaluates its functions, especially the respiratory one, and, if necessary, provides emergency assistance in the event of respiratory obstruction. When cicatricial stenosis of the larynx occurs, appropriate plastic surgery is performed to remove them, but only after the final cure for syphilis and repeated seronegative results.

Prognosis for syphilis of the larynx

The prognosis for syphilis of the larynx concerns basically the state of its function, which may suffer to some extent depending on those destructive changes that occur in the tertiary period of syphilis, both from the effect of the syphilitic lesions of the larynx, especially with a second-associated infection. With regard to the prognosis for the general condition of the patient and his life, it depends entirely on the stage of the disease and the treatment for syphilis of the larynx and can only be established by the appropriate specialist.