164 THE LARYNX, BRONCHI AND OESOPHAGUS
SYPHILIS OF THE LARYNX
This is now even rarer than tuberculosis. It may be congenital or acquired and
is more common in males than females.
Congenital syphilis of the larynx is a very severe condition which in
appearance resembles chronic hypertrophic laryngitis.
Of the acquired types, the primary and secondary stages are rarely seen in
the larynx, but if they do occur, the anterior half of the glottis and the
epiglottis are most often affected. Gumma may occur in any part of the
larynx and it presents as a smooth swelling which may later ulcerate. Diag-
nosis is by biopsy, but this must be confirmed by the battery of appropriate
serological tests. Treatment should be supervised by the appropriate
ARTHRITIS OF THE CRICO-ARYTENOID JOINT
The crico-arytenoid joint and the cricothyroid joints are both synovial, and
may be affected by the same types of arthritis affecting synovial joints else-
where in the body. It is thus possible to get rheumatoid arthritis, infective
arthritis or gout of the larynx. Other causes of fixation of the joints are
perichondritis (due to irradiation, tuberculosis or syphilis) or trauma. In the
acute phase the joint is swollen and limited in movement, causing a large,
swollen, red, immobile arytenoid. The patient is dysphonic and has severe
pain hi the larynx which is made worse by talking.
After several such attacks the joint becomes less inflamed, but more fixed.
If the joint is fixed in the adducted position the voice will be quite good, but if
it is fixed hi the abducted position the characteristic feature is air wastage
with a breathy voice.
The diagnosis is made by the appropriate laboratory tests for rheumatoid
arthritis and the degree of fixation is established by attempting to mobilize the
joint during direct laryngoscopy. This latter step is necessary to differentiate
arthritis from a recurrent laryngeal nerve paralysis.
In the acute phase treatment is symptomatic and it may be necessary to add
steroids to the analgesic medication. A close watch should be kept on the
patient in case respiratory obstruction occurs from oedema. In the chronic
phase no treatment is necessary if the position in which the joint is fixed is in
adduction so that there is a good voice. If it is not, then some form of
cordopexy or arytenoid operation should be performed (see Chapter 38, p.
PERICHONDRITIS OF THE LARYNX
Because of the number of cartilages involved in the make-up of the laryngeal
framework it is not unusual to find perichondritis as a response to many
disease processes. Formerly it used to be seen not uncommonly as part of the
symptom complex of tuberculosis, lupus and syphilis, and it was also seen in
typhoid, diphtheria and acute infectious fevers. Nowadays it most commonly
presents as a complication of irradiation for carcinoma of the larynx. Should
the larynx become swollen, painful and oedematous after radiotherapy the
problem is to know whether or not there is a recurrence of the tumour