Department of ENT Unit -5, Christian Medical College, Vellore, India.
Department of ENT Unit -5, Christian Medical College, Vellore, India.
J Voice. 2022 Nov;36(6):880.e13-880.e19. doi: 10.1016/j.jvoice.2020.09.009. Epub 2020 Sep 29.
Isolated aspergillus laryngitis is rare and often diagnosed after surgical excision or biopsy for a suspected premalignant or malignant pathology. Unlike other systemic or localized aspergillosis, there are no specific guidelines for isolated laryngeal aspergillosis. Our experience of dealing with a wide variety of isolated laryngeal aspergillosis showed that this entity is very responsive to medical therapy, making extensive debridement (as often carried out in surgically accessible aspergillosis) unnecessary as it would invariably lead to long-term dysphonia.
A retrospective analysis of all cases of isolated aspergillus laryngitis that presented to our hospital over the past 5 years was carried out. All patients with confirmed histopathological diagnosis of aspergillus infection were included.
Twelve patients (five males and seven females) aged 28-54 years, who were diagnosed with aspergillus laryngitis presented with dysphonia. The most common involved site was the true vocal cords. All patients underwent cautious biopsies either in the operating theatre or in-office using a channeled fiber-optic laryngoscope. On histopathological examination, eight had invasive aspergillus infection while others showed variety of noninvasive involvement including colonization of cysts and carcinoma in situ. The most common species isolated was Aspergillus fumigatus. Appropriate antifungal chemotherapy was prescribed after ruling out systemic involvement. None of the patients showed recurrence or residual lesions on follow-up and reported significantly improved voice.
This study highlights the wide spectrum of presentation of isolated aspergillus laryngitis with Aspergillus fumigatus being the most common organism isolated. Even the invasive variant is a medically treatable condition with voriconazole being the drug of choice. The importance of cautious biopsies and resections for voice preservation is also emphasized. To our knowledge, this is the largest report on isolated aspergillus laryngitis.
孤立性曲霉菌喉炎罕见，通常在因疑似癌前或恶性病变而进行外科切除或活检后诊断。与其他系统性或局限性曲霉菌病不同，孤立性喉曲霉菌病没有特定的指南。我们处理各种孤立性喉曲霉菌病的经验表明，这种疾病对药物治疗反应非常好，不需要广泛清创（如在可手术的曲霉菌病中经常进行），因为这将不可避免地导致长期声音嘶哑。
对过去 5 年来我院就诊的所有孤立性曲霉菌喉炎患者进行回顾性分析。所有经组织病理学确诊为曲霉菌感染的患者均纳入研究。
12 例（5 例男性，7 例女性）年龄 28-54 岁，诊断为曲霉菌喉炎，表现为声音嘶哑。最常见的受累部位是真声带。所有患者均在手术室或使用带通道纤维喉镜的诊室进行谨慎活检。组织病理学检查显示，8 例为侵袭性曲霉菌感染，其余病例表现为多种非侵袭性病变，包括囊肿和原位癌的定植。最常见的分离菌株为烟曲霉菌。排除系统性感染后，给予适当的抗真菌化疗。所有患者在随访中均未见复发或残留病变，声音明显改善。
本研究强调了孤立性曲霉菌喉炎的广泛表现，其中烟曲霉菌是最常见的分离菌株。即使是侵袭性变体也是一种可通过药物治疗的疾病，伏立康唑是首选药物。还强调了谨慎活检和切除以保留声音的重要性。据我们所知，这是关于孤立性曲霉菌喉炎的最大报告。
