Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-04T18:43:45.862Z Has data issue: false hasContentIssue false

Tuberculosis presenting as bilateral vocal fold palsy: case report and review of otolaryngological manifestations of tuberculosis

Published online by Cambridge University Press:  03 August 2011

C E Rennie*
Affiliation:
Department of Otolaryngology, St George's Hospital, London, UK
I Pai
Affiliation:
Department of Otolaryngology, St George's Hospital, London, UK
D Selvadurai
Affiliation:
Department of Otolaryngology, St George's Hospital, London, UK
*
Address for correspondence: Ms Catherine Rennie, Department of Otolaryngology, St George's Hospital, Blackshaw Road, London SW17 0QT, UK Fax: +44 (0)207 886 1847 E-mail: [email protected]

Abstract

Objective:

We report a rare case of tuberculosis presenting with bilateral vocal fold palsy.

Method:

Case report and discussion of ENT manifestations of tuberculosis.

Case report:

A 39-year-old man presented with stridor and bilateral vocal fold palsies, and underwent an emergency tracheostomy. Intra-operatively, a mass was identified overlying the thyroid cartilage. Fine needle aspiration cytology of this mass showed well formed granulomas but negative Ziehl–Nielsen staining. Computed tomography showed the mass to be surrounding the thyroid cartilage, causing airway occlusion; pulmonary infiltrates were also seen. The patient was commenced on tuberculosis treatment. Subsequent sputum samples from the tracheostomy confirmed the diagnosis. The patient responded very well to treatment, and was successfully decannulated after one week.

Conclusion:

The incidence of tuberculosis in the UK is increasing, particularly in urban areas. The otolaryngologist may encounter a wide variety of presentations. Diagnosis requires a high index of clinical suspicion.

Type
Clinical Records
Copyright
Copyright © JLO (1984) Limited 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Tuberculosis Update March 2010. In: http://www.hpa.org.uk [26-6-2010]Google Scholar
2NICE Guidelines Tuberculosis March 2006. In: http://www.nice.org.uk/page.aspx?o=guidelines.completed [26-6-2010]Google Scholar
3Nalini, B, Vinayak, S. Tuberculosis in ear, nose, and throat practice: its presentation and diagnosis. Am J Otolaryngol 2006;27:3945CrossRefGoogle ScholarPubMed
4Soda, A, Rubio, H, Salazar, M, Ganem, J, Berlanga, D, Sanchez, A. Tuberculosis of the larynx: clinical aspects of 19 patients. Laryngoscope 1989;99:1147–50CrossRefGoogle Scholar
5Shin, JE, Nam, SY, Yoo, SJ, Kim, SY. Changing trends in clinical manifestations of laryngeal tuberculosis. Laryngoscope 2000;110:1950–3CrossRefGoogle ScholarPubMed
6Tong, FM, Chow, SK. Primary tuberculous tracheitis. J Laryngol Otol 1998;112:579–80Google Scholar
7Iype, EM, Ramdas, K, Pandey, M, Jayasree, K, Thomas, G, Sebastian, P et al. Primary tuberculosis of the tongue: report of three cases. Br J Oral Maxillofacial Surg 2001;39:402–3Google Scholar
8Sethi, A, Sareen, D, Sabherwal, A, Malhotra, V. Primary parotid tuberculosis: varied clinical presentations. Oral Dis 2006;12:213–15Google Scholar
9Waldman, SR, Levine, HL, Sebek, BA, Parker, W, Tucker, HM. Nasal tuberculosis: a forgotten entity. Laryngoscope 1981;91:1116Google Scholar
10Butt, AA. Nasal tuberculosis in the 20th century. Am J Med Sci 1997;313:332–5Google Scholar
11Hup, AK, Haitjema, T, de Kuijper, G. Primary nasal tuberculosis. Rhinology 2001;39:47–8Google ScholarPubMed
12Chmielik, LP, Ziolkowski, J, Koziolek, R, Kulus, M, Chmielik, M. Ear tuberculosis: clinical and surgical treatment. Int J Pediatr Otorhinolaryngol 2008;72:271–4Google Scholar
13Pageeh, NA, Lamothe, A. Tuberculosis of the retropharyngeal space. J Otolaryngol 1998;27:43–5Google Scholar
14Al Soub, H. Retropharyngeal abscess associated with tuberculosis of the cervical spine. Tubercle Lung Dis 1996;77:563–5Google Scholar
15Steingart, K, Henry, M, Ng, V, Hopewell, PC, Ramsay, A, Cunningham, J et al. Fluorescence versus conventional sputum smear microscopy for tuberculosis: a systematic review. Lancet Infect Dis 2006;6:570–81Google Scholar
16Drobniewski, F, Caws, M, Gibson, A, Young, D. Modern laboratory diagnosis of tuberculosis. Lancet Infect Dis 2003;3:141–7Google Scholar
17Pai, M, Riley, LW, Colford, JM Jr.Interferon-gamma assays in the immunodiagnosis of tuberculosis: a systematic review. Lancet Infect Dis 2004;4:761–76CrossRefGoogle ScholarPubMed
18Lee, KS, Song, KS, Lim, TH, Kim, PN, Kim, IY, Lee, BHL. Adult-onset pulmonary tuberculosis: findings on chest radiographs and CT scans. Am J Roentgenol 1993;160:753–8CrossRefGoogle ScholarPubMed
19Ormerod, LP, McCarthy, OR, Rudd, RM, Horsfield, N. Short course chemotherapy for pulmonary tuberculosis. Respir Med 1991;85:291–4Google Scholar
20Raviglione, MC, Uplekar, MW. WHO's new Stop TB Strategy. Lancet 2006;367:952–5CrossRefGoogle ScholarPubMed
21Guidelines for the Programmatic Management of Drug-resistant Tuberculosis. Geneva: World Health Organization, 2006Google Scholar