The condition is frequently referred to as laryngeal phthisis, and is mainly to be distinguished from syphilitic laryngitis, or occasionally from commencing malignant disease. Local symptoms include those of chronic laryngeal catarrh, with hoarseness, impairment of voice, sensation of dryness within the larynx, and frequent short, hacking, unsatisfying cough. To these features are later added more or less pain, especially in deglutition, while aphonia will finally succeed dysphonia. When the epiglottis and the structures near it are involved there are more irritation and pain. Dyspnea is a measure of the encroachment upon the breathing space left by the progress of the disease. Infiltration of all the parts within and later of those around the larynx finally takes place, and with further implication nervous reflex symptoms are added to those above mentioned. Cough is usually a distressing feature; the sputum varies in amount; saliva is increased in flow, and the expectoration is frequently streaked with blood. In advanced disease the sufferings of the patient become excessive, while constitutional symptoms keep pace with those of the local disease. Thus anemia, emaciation, debility, insomnia, and general malaise cause the patient great discomfort, and, coupled with his terminal local symptoms, make death an absolute relief.
With the laryngoscope varying pictures may be seen, either of ulceration or of general involvement of the entire interior of the larynx, which will be tumefied, irregularly swollen, ulcerating here and there, while the vocal bands show thickening and roughenings as well as ulcerations. Gummatous outgrowths may be seen at almost any point and in various stages of ulceration. A more distinctly lupoid form of tuberculosis is also occasionally seen in the larynx, where it assumes more of the nodular appearance characteristic of lupus, the nodules coalescing or disappearing by ulceration, which may leave a dense, cicatricial tissue after healing. Primary lupus of the larynx is rare.
Tuberculous lesions of the larynx are mainly to be recognized with the laryngoscope, but they, like all other local diseases in this location, produce alteration and final loss of voice, with difficulty of breathing, reflex cough, and are accompanied by general constitutional symptoms, according as the disease is purely local or an expression of a general affection.
Treatment.
—Treatment should be both local and general. The latter may be summarized by stating that all measures, including proper climatic environment, which are found to be of advantage in ordinary tuberculous disease, will prove of equal advantage here. There should be avoidance of exposure to all irritation—coal gas, tobacco smoke, vitiated air, etc.—while absolute rest of the vocal organs should be prescribed and all attempts at singing or unnecessary speaking be prohibited. All measures regarded as of value in general tuberculosis will find an equally wide field for their activities.
Local treatment is directed toward amelioration of discomfort and improvement of local lesions. The former may be afforded by steam inhalations with some soothing, volatile antiseptic added to the spray, such as methol, oil of eucalyptus, some gentle opiate, or anything that may give local anodyne effect. Cough may also be treated by the milder anodynes, of which cocaine or heroine will serve for most instances. Sleep is to be secured by some of the ordinary hypnotics. Local applications may be made by an applicator guided by the laryngoscopic mirror, by the medical attendant, or through watery or oleaginous solutions in a spray. For absolute local relief a mild cocaine solution, followed by the use of a very weak solution of silver nitrate, lactic acid (C. P.), or even the more thorough treatment of local ulceration by means of the laryngeal curette or touching with the point of the galvanocaustic loop, may give relief. The treatment of laryngeal tuberculosis rarely comes within the domain of surgery proper, until the disease has reached a degree necessitating some radical measure, such as thyrotomy, with erasion of the affected tissue, or possibly a laryngectomy, with complete removal of an organ which is too thoroughly diseased to warrant hope of repair.
SYPHILIS OF THE LARYNX.
Syphilis of the larynx is more common than tuberculosis, the lesions usually belonging to the later stages of the diseases, including especially mucous patches, and the ulcerative expressions, with or without the formation of small gummatous tumors. The loss of voice is rarely as pronounced, and the entire course of the disease is accompanied by less irritative and offensive features than is tuberculosis. Diagnosis will be materially assisted by the discovery of suggestive expressions of syphilis, either in adjoining or distant parts. Thus if mucous patches appear within the larynx they will also be seen within the mouth. Ulcers which are produced by syphilis have well-defined edges, and are rarely multiple; while those produced by tuberculosis are more often multiple, are seated upon an anemic base, produce more distortion of laryngeal structures, and more residue of cicatricial tissue at points where healing has occurred.
Treatment.
—The treatment of laryngeal syphilis is essentially constitutional, for nearly every local expression will clear up under the influence of properly directed remedies. However, when local symptoms are uncomfortable or depressing they may be treated as are those of tuberculosis, by soothing sprays and the local application of anesthetics, astringents, and the like.