Extraganglionary Localization of Tuberculosis in Otorhinolaryngology: Rare Presentations About 29 Cases

Abstract

The extra nodal tuberculosis is a rare disease in Ear, Nose and Throat. The aim of this work is to study the epidemiological, clinical, therapeutic profiles of rare locations of ENT extra nodal tuberculosis. This is a retrospective study between June 2003 and June 2019, including 29 cases of ENT extra nodal tuberculosis. There were 6 cases of laryngeal tuberculosis, 5 cases of nasopharyngeal tuberculosis, 5 cases of salivary gland tuberculosis, 3 cases of tonsillar tuberculosis, 1 case of tuberculous retropharyngeal abscess, 3 cases of nasal tuberculosis, 3 cases of tuberculosis of the middle ear, 1 case of thyroid tuberculosis, 1 case of tuberculosis of the bony palate, and 1 case of mandibular tuberculosis. All ages were affected with a predominance of young adults. The clinical signs, as well as radiological or endoscopic examinations, were not specific. The diagnosis was based on histology and/or bacteriology. Antibacillary therapy was instaured in all cases. Extra nodal tuberculosis in ENT is rare. It is dominated by the laryngeal location. It must be considered as a differential diagnosis in front of any atypical symptoms, particularly in endemic countries.

Mycobacterium tuberculosis Resides in Macrophages in Laryngeal Tuberculosis: A Case Report

“…This unique observation indicates that the pathology of laryngeal tuberculosis does not differ from that of pulmonary tuberculosis, two related forms of tuberculosis, suggesting a common natural history, relying on the colonization of tissues by the lymphatic pathway [18]. The portal of entry may indeed be the larynx itself [10], as laryngeal tuberculosis clinically appears as primary in 40% of laryngeal tuberculosis cases and is the unique involvement of the larynx in the absence of pulmonary tuberculosis. Alternatively, secondary laryngeal tuberculosis may develop by M. tuberculosis spreading from pulmonary tuberculosis [19].…”

“…Symptoms appear gradually, ranging from hoarseness to difficulty swallowing, and the diagnosis is usually delayed [9]. Its rare appearance explains why it is often overlooked when vocal difficulties are diagnosed [10], challenging the differential diagnosis consisting of non-specific laryngitis, granulomatous diseases and tumors of the larynx [11]. Appropriate management involves tissue biopsy followed by pathological examination for the presence of caseous granulomas and detection of the causative agent, M. tuberculosis [12].…”