Lupus is rare in the larynx. It usually occupies the structures above the vocal bands. It is most frequent in females, and usually associated with cutaneous lupus.
ETIOLOGY.—Scrofulosis and syphilis seem to be the predisposing causes. Climate may have some influence. The reason of the special proclivity of the female is undetermined. Of 9 reported cases, records of which are before the writer, 8 were in females.
PATHOLOGY AND MORBID ANATOMY.—Laryngeal lupus is usually an extension of the disease from the upper lip or the nose, extending along the nasal passages, pharynx, and palate. Destructive ulceration takes place, with irregular cicatrization and the formation of hard nodules of hyperplastic tissue of irregular conformation, varying from the size of hempseeds to that of small peas, similar to the cutaneous buccal and pharyngeal nodules.
SYMPTOMS.—These include dysphonia, dyspnoea, dysphagia, and cough. Pain is exceptional.
DIAGNOSIS.—Laryngoscopic inspection reveals the characteristic nodulation, the nature of which is inferred from the coexistence of external lupus. The disease may be confounded with lepra, syphilis, tuberculosis, or carcinoma. Discrimination from syphilis is the most difficult, and is predicated chiefly on its slow progress and on the absence of constitutional manifestations.
PROGNOSIS.—This is unfavorable. The reported cures seem to have occurred only under the influence of antisyphilitic treatment.
TREATMENT.—The prolonged use of cod-liver oil and of potassium iodide seems to be more beneficial than any other systemic treatment. Destruction of the nodules and ulcerated tissues is indicated when the diseased structures are sufficiently circumscribed and accessible. This may be done with the sharp spoon or with the electric cautery. Silver nitrate and iodine have been lauded as topical remedies.
Lepra of the Larynx.
Lepra is rare in the larynx.
ETIOLOGY.—Its cause seems to be climatic. In Europe it is most frequent in Norway and Sweden, and in America in Cuba and the West Indies.