Otorhinolaryngology

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Browsing Otorhinolaryngology by Author "Moncho, M."

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    Manifestation and diagnosis of tuberculosis of the larynx at the Universitas Academic Hospital Bloemfontein
    (University of the Free State, 2018-10) Matimba, Abongile; Moncho, M.; Musoke, J.; Seedat, R. Y.
    Introduction and Aim: Tuberculosis (TB) is the most frequent granulomatous disease involving the larynx. However, the incidence is unknown at Bloemfontein. Hence, the aim of this study was to determine the incidence, clinical presentation and optimal diagnostic methods for laryngeal TB in patients presenting with laryngeal lesions to Universitas academic hospital in Bloemfontein. Methods: This was a prospective study conducted over one year from 1 May 2017 to 30 April 2018. All patients (n=80) undergoing direct laryngoscopy under general anaesthesia were included and a biopsy was sent for histopathological examination, Xpert MTB/RIF and TB microscopy, culture and sensitivity. Results: Of the 80 patients, five (6,25%) were diagnosed with laryngeal TB. The median age at presentation was 56,0 years (range 18.1- 83.5 years) with the majority 64 (80%) being males. The most common symptom was dysphonia in all five patients with laryngeal TB. The most frequent endoscopic presentation was a granulomatous like lesion, present in three patients, followed by tumour and ulcerofungative lesion in one patient each. Three patients with laryngeal TB patients had active pulmonary lesions (cavities in the upper lobes) and (hilar lymph nodes) and two had inactive pulmonary lesions (upper lobe fibrosis) on CXR.The diagnosis of laryngeal TB was based on histology alone in two patients, histology, together with a positive tissue Xpert MTB/RIF in another patient and on positive tissue TB cultures in the last two patients.None of the biopsy specimens submitted to histology or microbiology were positive on direct microscopy for AFB. Conclusion: We diagnosed TB in 6.25% (5/80) of patients who presented with laryngeal lesions. The diagnosis of laryngeal TB required a combination of histopathology, culture and PCR.The successful management of patients with laryngeal TB requires a high clinical index of suspicion, prompt diagnosis and early initiation of anti-tuberculosis chemotherapy.