Mouse nibbled appearance of vocal cord is seen in

TUBERCULOSIS OF LARYNX AETIOLOGY :- It is almost always secondary to pulmonary tuberculosis, mostly affecting males in middle age group. Tubercle bacilli reach the larynx by bronchogenic or haematogenous routes. PATHOLOGY:- Disease affects posterior pa of larynx more than anterior. Pas affected are: (i) interarytenoid fold, (ii) ventricular bands, (iii) vocal cords and (iv) epiglottis, in that order. Tubercle bacilli, carried by sputum from the bronchi, settle and penetrate the intact laryngeal mucosa paicularly in the interarytenoid region (bronchogenic spread). This leads to formation of submucosal tubercles which may later caseate and ulcerate. Laryngeal mucosa appears red and swollen due to cellular infiltration (pseudoedema). Stages of perichondritis and cailage necrosis are not commonly seen these days. SYMPTOMS AND SIGNS :- They would greatly depend on the stage of tuberculosis. Weakness of voice is the earliest symptom followed by hoarseness. Ulceration in the larynx gives rise to severe pain which may radiate to the ears. Swallowing is painful with marked dysphagia in later stages. LARYNGEAL EXAMINATION:- 1. Hyperaemia of the vocal cord in its whole extent or confined to posterior pa with impairment of adduction is the first sign. 2. Swelling in the interarytenoid region giving a mamillated appearance. 3. Ulceration of vocal cord giving mouse-nibbled appearance. 4. Superficial ragged ulceration on the arytenoids and interarytenoid region. 5. Granulation tissue in interarytenoid region or vocal process of arytenoid. 6. Pseudoedema of the epiglottis "turban epiglottis." 7. Swelling of ventricular bands and aryepiglottic folds. 8. Marked pallor of surrounding mucosa. Ref:- Dhingra; pg num:-293