TUBERCULOSIS OF THE LARYNX.
Definition. — A. tuberculous, primary or secondary, infiltration of the glandu lar elements and connective tissue of the larynx characterized by tumefaction and ulceration and giving rise to dysphagia, aphonia, and dyspncea.
Symptoins.—Tnberculosis of the lar ynx is often present in cases of pulmo nary tuberculosis, and, were all the lat ter systematically examined laryngoscop ically, lesions, so situated as to preclude active subjective symptoms, would be found in the majority of cases. Unless marked hoarseness, aphonia, or local pain be complained of, the larynx re ceives but little attention; were it other wise, a greater degree of comfort could be afforded consumptives than they ob tain when the pulmonary disorder is alone treated.
The larynx may become infected either through the lymphatics or di rectly through invasion of the laryngeal tissues proper by the bacillus of tuber culosis. Whether an erosion is necessary or not in the latter case is not estab lished; it is believed, however, that such an erosion is necessary.
Slight hoarseness, short periods of aphonia,—a couple of seconds' duration at times,—a sensation of dryness, and local heat represent the early symptoms generally met with. If there is a pul monary trouble, the symptoms of the latter, especially the cough, cause the laryngeal trouble to be attributed to it. After a period varying in length, the local pain is increased by deglutition, and sometimes radiates to the ears. The hoarseness is now apt to become aggra vated or the voice may be completely lost.
I Cough is not severe, as a rule; but it is peculiar, being usually husky and I lacking in resonance. The general health may continue to be good as far as active constitutional symptoms are con cerned, until the distress during deglu tition becomes such as to cause the pa tient to reduce the amount of food lie takes to avoid the pain the act involves. Indeed, the dysphagia is such sometimes as to render the taking of any food a source of dread to the patient, and con stitutes the most marked of all the symp toms. It is especially severe when the epiglottis is the seat of the tuberculous ulceration or when the pharynx is af fected. In fatal cases it is apt to per
sist and to become steadily aggravated. The pulse, temperature, and other gen eral symptoms are those of pulmonary phthisis, but emaciation progresses more rapidly than in the latter disease, the pain during deglutition causing the pa tient to abstain from food as much as possible.
Examination of the larynx during the early stages usually reveals a characteris tic feature: a pale-yellowish tinge, which sometimes reaches to absolute pallor. In the majority of cases a typical sign also appears: a pyriform swelling, or "club bing," of the arytenoids, which causes these prominences to resemble small cushions if they are both enlarged, which is not always the case. In some in stances, however, the larynx may be as red as usual, and even appear congested. After a short time, grayish superficial erosions may be detected, which, after awhile, become deeper and sharp-edged, and are surrounded by a narrow, red areola. A thick, tenacious secretion usually collects over them which can only be removed with difficulty. The morbid process then extends in various directions until almost any part of the larynx and neighboring tissue is in volved in the general trouble. Various excrescences or tumors may appear, so situated, sometimes, as to compromise the laryngeal aperture.
Diagnosis.—The pallor of the mucous membrane, especially marked posteriorly, the club-shaped masses over the carti lages of Wrisberg and Santorini, and, in a large proportion of cases, the turban like epiglottis give the larynx a charac teristic appearance when the local process is at all active. The ulcers are more superficial than those of a syphilitic larynx, and appear grayish rather than yellow, as is the latter disease. The syphilitic ulcer is "punched out,'' with perpendicular and crenelated edges, and the areola is dark in hue. The cancerous ulcer tends to be raised by underlying accumulation of morbid elements, and is totally devoid of the pallor peculiar to tuberculosis. The pain is usually most acute during deglutition in tuberculosis, during phonation in syphilis, and con stant in cancer.