No abstract

Unrecognized laryngeal tuberculosis (TB) poses a significant hazard to otolaryngologists. However, the changing manifestations of TB in patients with human immunodeficiency virus (HIV) infection can make its diagnosis difficult. In our population of 146 patients with TB involving the head and neck, HIV infection was present in 70 cases (48%). The prevalence of laryngeal TB in this population was 5.5% (8 patients). Concomitant HIV infection was present in 2 (25%) of 8 patients with laryngeal TB. A delay in the diagnosis of laryngeal TB occurred in 100% of patients with HIV infection, compared with 17% of non-HIV-infected patients (P = .055). The cause of the delayed diagnosis was multifactorial, mainly the presence of multiple confounding variables and the carcinoma-like appearance of the laryngeal TB lesions in HIV-infected patients. To reduce risk for transmission of TB to health care providers, a high level of suspicion must be present for all patients with laryngeal lesions, especially those with HIV infection.

Skepticism has surrounded the existence of branchial cleft carcinoma since the entity was first described in 1882. However, a landmark work of 1950 established four criteria for the diagnosis of branchial cleft carcinoma, the most important criterion being histologic proof of carcinoma arising from a normal cyst epithelium. Of the 43 cases found in an extensive review of the literature, only 7 cases have satisfied all four of the criteria. To this we add 2 patients who had recurrent infections of a cervical cyst as children and later developed carcinoma within these structures. Additionally, we propose a minor modification to the 1950 criteria and a paradigm for diagnosis and management of these lesions.

No abstract

These data suggest that tuberculosis should be considered in the differential diagnosis of all head and neck lesions in patients infected with HIV, even in the absence of pulmonary involvement. Purified protein derivative testing should be done liberally in these patients, with realization that the sensitivity of purified protein derivative testing is reduced in patients with AIDS. Fine-needle aspiration biopsy should be the key diagnostic test in this patient population, with open surgical biopsy reserved for highly suspicious cases in which other measures were not diagnostic.