Laryngeal Involvement in Connective Tissue Disorders. Is it Important for Patient Management?

Abstract

Connective tissue disorders (CTDs) involve multiple organ systems and may have a significant impact on the overall health and quality of life of the affected individuals. The present paper aims to review the current knowledge on the laryngeal manifestations of CDTs, and describe the available diagnostic and treatment options. Systematic literature review in Medline and other database sources. Information from related books was also included. Prospective controlled, double-blind prospective, prospective, and transversal cohort studies, case series, case reports, systematic reviews, and consensus papers. Laryngeal involvement mostly occurs in rheumatoid arthritis (13-75% of patients). It is not uncommon in active and progressive clinical course, though can also occur in silent or inactive CDTs. The crico-arytenoid joint is the most commonly affected site. Common symptoms include throat pain, dyphonia and hoarseness. Careful clinical assessment of the larynx by flexible naso-endoscopy, video-stroboscopy, or direct laryngoscopy, and appropriate imaging are required for pertinent patient management. Stridor is a sign of a life-threatening condition, and may require prompt surgical intervention. However, mild symptomatology may mislead clinicians, and the related diagnosis may be significantly delayed. The current evidence as identified in the present study suggest that laryngeal manifestations of CDTs are often underdiagnosed, due to a range of nonspecific symptoms. A multidisciplinary team approach with ENT input is necessary to improve the overall patient management.

Epiglottitis in Patients With Preexisting Autoimmune Diseases: A Nationwide Case–Control Study in Taiwan

“…Inconsistent conclusions have been drawn regarding whether patients with autoimmune disease are predisposed to epiglottitis, 25 and studies investigating the autoimmune disease-epiglottitis relationship are limited. [12][13][14]16,17,26 Based on our literature review, the present research is the first populationbased study on the epiglottitis-autoimmune disease association.…”

Otolaryngological Manifestations of Systemic Diseases

“…Oropharyngeal or nasal involvement (ulcerations) is noted in 90% of patients and is included in the diagnostic criteria [7]; more rarely other manifestations may be noted such as trigeminal neuralgia, facial nerve involvement, vocal cord palsy or specific laryngeal involvement and hearing abnormalities [4,7,47,55,56]. The disease is due to a lymphocytic infiltration of the exocrine glands, mainly salivary and lacrimal, causing a drying up of their secretions [57].…”

“…Oropharyngeal mucosal involvement and cervical polyadenopathy are among the diagnostic criteria for Kawasaki disease [55], and perforations of the nasal septum can be seen in cryoglobulinemia and the primary antiphospholipid syndrome [22].…”

Erkrankungen des rheumatischen Formenkreis mit Manifestation im Larynx

“…Fakultativ kann auch eine extraartikuläre Organmanifestation vorliegen. Eine laryngeale Beteiligung wird bei bis zu 75 % der Patienten beschrieben [12]. Am Larynx können entweder eine Arthritis des Cricoarytenoidgelenks (CA-Gelenk), oder Rheumaknoten in der Schleimhaut bzw.…”