=Definition.=—An inflammation of the laryngeal tissues of tuberculous
origin.
=Osteopathic Etiology= and =Pathology=.—Tuberculosis of the larynx
is commonly secondary to pulmonary tuberculosis. In a few cases the
laryngeal invasion may be of primary origin. In either instance there
will be found a disturbed innervation or altered blood supply of
the larynx that predisposes to the multiplication and growth of the
bacilli. The osteopathic lesions are similar to those found in other
involvements of the larynx.
=Pathologically=, the mucous membrane is inflamed and swollen,
and exhibits scattered tubercles, which are usually about the
blood-vessels. The tubercles cluster, caseate and leave shallow,
irregular ulcers. There is thickening of the mucosa about the ulcer,
and the ulcer is generally covered by a grayish exudate. They may erode
the true vocal cords, often destroying them completely. The ulcers
slowly involve the tissues in all directions, causing perichondritis
with necrosis of the cartilages. The mucous membrane of the pharynx,
esophagus, fauces, and tonsils may be involved, and the epiglottis may
be completely destroyed.
This disorder, strictly, should be discussed under pulmonary
tuberculosis for, as heretofore stated, it is generally a secondary
affection; the larynx being invaded by the tubercular bacilli in the
sputum arising from the bronchial tubes and lungs. The bacilli in
inspired air may primarily invade the laryngeal mucosa. However, in
either case the circulation of the mucosa is not normal and osteopathic
correction of the same is effective.
=Symptoms.=—Huskiness of the voice, followed by hoarseness, and in
advanced stages aphonia, are prominent symptoms. A hacking cough is
usually present and the patient complains of pain in the throat,
particularly on coughing, swallowing or speaking. The loss of voice,
painful speaking or whispering are quite characteristic. When the
ulceration of the tissues of the larynx has progressed to a later
stage, dysphagia, suffocation and distressing paroxysms of cough occur.
=Diagnosis.=—Is not difficult, as pulmonary phthisis is usually
associated with it. Examination of the sputum for the specific bacilli
will be conclusive.
=Prognosis.=—The prognosis is not of the best at any time. On the
whole, it is unfavorable.
=Treatment.=—In this disease osteopathic treatment has been quite
effectual. Cases of primary origin are more successfully treated than
when of secondary cause, although one will be surprised many times at
the results obtained when the disorder is not primary. The treatment
must necessarily be both constitutional and local. Care of the general
health as to hygiene and diet is absolutely necessary. The food must
be nutritious and non-irritating. Scraped beef, raw oysters, raw eggs,
soups and gruel are required. In cases where difficulty of deglutition
occurs, it may be largely overcome if the patient hangs his head over
the side of the bed and sucks through a tube liquid nourishment placed
in a dish upon the floor.
The local treatment required is careful, persistent work over the
larynx and adjacent tissues. The treatment is given to increase the
blood supply to the diseased tissues so that healing may take place,
and that the bacteria may be deprived of the conditions favorable to
their activity. Treatment along the cervical spine and upper dorsal
will aid in correcting the vasomotor disorders that exist. Local
application of hot water will assist in relieving the pain. When
pulmonary phthisis exists, attention and correction of it is important;
in fact, is of primary consideration in laryngeal affection.