Syphilis of the larynx

Syphilis of the larynx is observed much less frequently than of the nose or pharynx. The larynx is extremely rarely affected by congenital syphilis.

Causes of laryngeal syphilis

Syphilis is a venereal disease caused by Treponema pallidum, discovered in 1905 by F. Schaudinn and E. Hoffmann. In rare cases of laryngeal syphilis, the primary lesion (chancre) is localized on the epiglottis and aryepiglottic fold, where the pathogen enters from an external source of infection through the oral cavity with saliva. In the secondary period of acquired syphilis, laryngeal lesions occur relatively often (hematogenous route) and manifest themselves as diffuse erythema, usually combined with a similar reaction of the mucous membrane of the nose, oral cavity and pharynx. In secondary congenital syphilis, laryngeal lesions are also possible in infants, which, however, go unnoticed. In the tertiary period, laryngeal lesions manifest themselves with the most pronounced changes, but at this stage of syphilitic infection, the larynx is rarely affected. Neurosyphilis can manifest itself as paresis or paralysis of the internal muscles of the larynx, most often the abductors, which leads to stenosis of the larynx as a result of the predominance of the adductors innervated by the recurrent nerves (Gerhardt syndrome).

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Pathological anatomy

Primary syphilis of the larynx manifests itself as a dirty-gray ulcer with raised edges of cartilaginous density and regional cervical lymphadenitis. In secondary syphilis of the larynx, characteristic mucous deposits in the form of whitish spots appear on its mucous membrane, adjacent to diffuse areas of hyperemia. In the tertiary period, diffuse subepithelial infiltrates appear in the form of gummatous formations, which, undergoing decay, turn into deep crater-shaped ulcers with steeply breaking edges and a dirty-gray bottom. The addition of a secondary infection causes edema of the larynx, perichondritis and necrosis of its cartilages. Upon recovery, this process ends with massive cicatricial disfigurement of the larynx and its stenosis.

Symptoms of syphilis of the larynx

A characteristic feature of laryngeal syphilis (in contrast to other inflammatory diseases) is a significant disproportion between pronounced destructive changes and very weak subjective sensations. Only after the addition of a secondary infection does a pronounced pain syndrome with otodia and dysphagia occur. Dysphonia is observed in the secondary period, when diffuse catarrhal inflammation of the mucous membrane occurs, and in the tertiary period, when the destructive process affects the vocal apparatus.

The respiratory function of the larynx begins to suffer only in the tertiary period, when the laryngeal cavity is filled with one or more infiltrates, their gummatous decay, ulcers and scars, stenotic larynx.

During laryngoscopy in the primary period, an enlarged epiglottis and aryepiglottic folds are detected, ulcers appearing on their surface, as well as regional lymphadenitis: painless enlarged lymph nodes with a dense-elastic consistency can undergo disintegration with the formation of cutaneous fistulas. In secondary syphilis of the larynx, its mucous membrane acquires a bright red color (syphilitic enanthem - with simultaneous damage to the oral cavity and pharynx). Grayish-white plaques with smooth borders or papules rising above the rest of the mucous membrane are formed on the mucous membrane, located on the epiglottis and aryepiglottic folds, less often along the edges of the vocal folds. In some cases, small erosions appear on the mucous membrane. As a rule, secondary syphilides of the larynx quickly pass, but can recur over the next two years.

In the tertiary period, red-blue infiltrates are found in the larynx, usually occurring in the vestibule of the larynx, sometimes in the area of the respiratory gap (difficulty breathing) or in the subglottic space. Each such infiltrate (single or two or three) forms a syphilitic gumma, which remains in its original form for a long time (weeks and months), and then quickly disintegrates, forming an ulcer ending in scarring.

The clinical course of laryngeal syphilis is determined by the nature of the disease (the cause of its occurrence) and the stage at which the larynx lesion occurred. With timely treatment, the specific inflammatory process can be eliminated without subsequent persistent organic lesions of the larynx, and the greatest effectiveness can be achieved if treatment is started in the primary or secondary stage of syphilis. In tertiary syphilis, significant destruction of the larynx can also be prevented, but only if it has not yet occurred, or a secondary infection has not yet occurred. In the latter case, these destructions are almost inevitable.

Diagnosis of laryngeal syphilis

The diagnosis of general syphilitic infection is established on the basis of known symptoms and serological reactions. Difficulties may arise in the case of so-called seronegative syphilis. In this form of syphilis or when it goes unnoticed for a long time, the onset of a specific disease in the larynx, especially in secondary syphilis at the stage of diffuse erythematous manifestations, may be mistaken for banal laryngitis. Suspicions of laryngeal syphilis may arise when peculiar mucous deposits of a grayish-white color and papules are detected on the mucous membrane, which, however, may be confused with aphthae, herpes or pemphigus of the larynx. If doubts arise about the diagnosis, the patient undergoes serological tests and is referred to a dermatovenerologist.

In the tertiary period, with diffuse infiltrative syphilis of the larynx, the latter may be mistaken for chronic hypertrophic laryngitis, but a single circumscripta infiltrate should always raise suspicion of laryngeal syphilis. Often, with ulceration of the gumma or with the development of secondary perichondritis, these phenomena are confused with tuberculosis of the larynx or laryngeal cancer, therefore, to establish a final diagnosis, the patient must be examined for differential diagnostics using methods specific to these diseases (x-ray of the lungs, serological reactions, biopsy, etc.). In differential diagnostics, one should not forget about the possibility of the presence of so-called mixts, i.e. combinations of syphilis and tuberculosis of the larynx, syphilis and laryngeal cancer, as well as the fact that in the tertiary period, serological tests may be negative, and biopsy may not give convincing results. In these cases, ex jubantibus diagnostics are performed with antisyphilitic treatment.

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Treatment of syphilis of the larynx

Treatment of laryngeal syphilis should be early and vigorous to prevent destructive consequences in the larynx. It is carried out in the appropriate hospital. The otolaryngologist monitors the objective condition of the larynx, evaluates its functions, especially respiratory, and, if necessary, provides emergency care in the event of respiratory obstruction. In the event of cicatricial stenosis of the larynx, appropriate plastic surgeries are performed to eliminate them, but only after final recovery from syphilis and repeated receipt of seronegative results.

Prognosis for laryngeal syphilis

The prognosis for laryngeal syphilis concerns mainly the state of its function, which may suffer to one degree or another depending on the destructive changes that occur in the tertiary period of syphilis, both from the action of syphilitic lesions of the larynx itself, and especially with secondary infection. As for the prognosis for the general condition of the patient and his life, it entirely depends on the stage of the disease and the treatment of laryngeal syphilis and can only be established by an appropriate specialist.