Laryngeal syphilis is much less common than that of the nose or throat infection. Very rarely the larynx is affected by congenital syphilis. In rare cases with syphilis of the larynx, the primary affect (chancre) is localized on the epiglottis and aryepiglottic fold, where the pathogen comes from an external source with saliva.
In the primary period, there are enlarged epiglottis and aryepiglottic folds, as well as ulcers on the surface, regional lymphadenitis. Painless, densely elastic consistency enlarged lymph nodes are disintegrated with the formation of an external fistula.
In the secondary period, the larynx lesion occurs relatively often (the hematogenous pathway) and is manifested by diffuse erythema, usually combined with a similar reaction of the nasal mucosa, oral cavity, and pharynx. The mucous membrane acquires a bright red color (syphilitic enanthema - with simultaneous damage to the oral cavity and pharynx). On the mucosa, grayish-white raids are formed with even boundaries or in the form of a papule rising above the rest of the mucosa, located on the epiglottis and aryepiglottic fold (1).
Laryngeal syphilis stages:
- Secondary syphilis (white mucous deposits on the root of the tongue, epiglottis and on aryepiglottic folds).
- Tertiary syphilis (gum on the eve of the larynx, ulcer on the left vocal crease).
- Tertiary syphilis (cicatricial deformity of the epiglottis).
In the Tertiary period, the lesion of the larynx is rare but manifests itself in the most pronounced changes. In the larynx, infiltrates of red-cyanotic color are found, which usually appear on the threshold of the larynx, sometimes in the area of the respiratory cicle (difficulty breathing) or in the lining space. Each such infiltrate (single or in the number of two or three) forms syphilitic gum (2), which persists for weeks and months in its original form, and then rapidly disintegrates, forming an ulcer ending in scarring (3).
Neurosyphilis can be manifested by paresis or paralysis of the internal muscles of the larynx, most often abductors, which leads to stenosis of the larynx caused by the predominance of adductors (Gerhard's syndrome).
With congenital syphilis, the larynx lesion is possible in infants, which remains unnoticed for a long time.
Symptoms and clinical course of syphilis of the larynx.
The clinical course is determined by the stage of the general infectious process, in which the larynx lesion occurs.
A characteristic feature of syphilis of the larynx (in contrast to its other inflammatory diseases) is a significant difference between pronounced destructive changes and very weak subjective sensations. Only after the secondary infection is associated, there is a pain syndrome with otodonia and dysphagia. Dysphonia is observed in the secondary period when there is diffuse catarrhal inflammation of the mucous membrane, and in the Tertiary period, when the destructive process touches the vocal apparatus. Respiratory function of the larynx begins to suffer only in the Tertiary period when in the larynx there are infiltrates, their decay, ulcers and scar processes.
Diagnosis of laryngeal syphilis.
The beginning specific disease of the larynx, especially with secondary syphilis at the stage of diffuse erythematous manifestations, can be taken as banal laryngitis. Suspicions for syphilis can occur when to appear on the mucous membrane of peculiar mucous deposits of grayish-white color and papules, which can be confused with aphthae, herpes or pemphigus of the larynx. If there are doubts in the presence of syphilis, serological tests are performed and the patient is referred to the dermatovenerologist.
In the Tertiary period with the diffuse infiltrative form of laryngeal syphilis, the latter can be mistaken for chronic hypertrophic laryngitis, but a single infiltrate should always cause suspicion of syphilis of the larynx. Often, with ulceration of gummy or with the emergence of secondary perichondritis, these phenomena are mixed with tuberculosis or laryngeal cancer. Therefore, for the final diagnosis of the patient in order to carry out a differential diagnosis, it should be examined by methods specific for these diseases (lung radiography, serological reactions, biopsy, etc.). In differential diagnosis, one should not forget about the possibility of the presence of so-called mixts, that is, the combination of syphilis with other productive diseases of the larynx, and also the fact that in the Tertiary period, serological tests can be negative, and biopsy can be unconvincing. In these cases, antisyphilitic treatment is carried out.
Treatment of laryngeal syphilis.
With timely treatment, the inflammatory process in the larynx can be eliminated without persistent organic lesions, and the greatest effectiveness can be achieved if treatment is started in the primary or secondary stage of syphilis. In tertiary syphilis, it is also possible to prevent the significant destruction of the larynx, but only if they have not yet occurred or have not joined the secondary infection. In the latter case, these disruptions are almost inevitable.
Treatment is conducted in the appropriate hospital. The otorhinolaryngologist controls the objective state of the larynx, evaluates its functions, especially the respiratory one, and if necessary, provides emergency assistance in the event of the respiratory obstruction. When there is scarring of the larynx, plastic surgery is performed, but only after the final cure for syphilis and repeated seronegative results.
The prognosis is mainly concerned with the state of the laryngeal function, which can suffer from destructive changes that occur in the Tertiary period. With regard to the prognosis for the general condition of the patient and his life, it depends entirely on the stage of the disease and the specific treatment being conducted.