Tuberculosis laríngea coexistente con tuberculosis pulmonar: reporte de caso

Laryngeal tuberculosis coexisting with pulmonary tuberculosis: a case report

Introducción. La tuberculosis laríngea (TBL) representa menos del 1% de todos los casos de tuberculosis. Su diagnóstico es complejo debido a sus manifestaciones clínicas inespecíficas en la laringe.

Presentación del caso. Hombre de 78 años quien asistió al servicio de urgencias de un hospital de Bogotá D.C. (Colombia) por disnea de pequeños esfuerzos, tos seca, disfonía, odinofagia y disfagia durante los últimos 3 meses, con empeoramiento de los síntomas respiratorios en las últimas 24 horas. Los laboratorios de ingreso mostraron un nivel elevado de dímero D, por lo cual, ante la sospecha de tromboembolismo pulmonar, se realizó una angiotomografía de tórax contrastada en la que no se observaron signos de tromboembolismo, pero sí micronódulos centrolobulillares, patrón en árbol en gemación y cambios relacionados con fibrosis pulmonar previa. Debido al riesgo de broncoaspiración, se realizó una nasofbrolaringoscopia, encontrando leucoplaquia en banda ventricular derecha y pliegue vocal derecho. Ante estos hallazgos, se solicitó una biopsia de las lesiones, así como una baciloscopia y una prueba PCR para Mycobacterium tuberculosis, las cuales fueron positivas. La terapia antituberculosa (RHZE 150/75/400/275 mg) se inició 5 días después del diagnóstico, una vez se logró estabilizar su condición clínica; la biopsia se pospuso por este mismo motivo. Ante la respuesta favorable, fue dado de alta 4 días después de haber iniciado el tratamiento. La nasofibrolaringoscopia de control a los 30 días mostró una disminución considerable de las lesiones pseudotumorales en la banda ventricular y resolución completa en el pliegue vocal. En el control a los 3 meses los síntomas respiratorios habían mejorado considerablemente.

Conclusión. Aunque es una condición muy rara, la TBL debe considerarse como diagnóstico diferencial en pacientes con sintomatología inespecífica como disfonía, disfagia y odinofagia, y lesiones en la laringe, incluso en países sin una alta carga de TB como Colombia, pues el inicio oportuno de la terapia antituberculosa es fundamental para prevenir complicaciones graves dada la excelente y rápida respuesta a este tratamiento.

Introduction: Laryngeal tuberculosis (LTB) accounts for less than 1% of all tuberculosis cases. Its diagnosis is complex due to its non-specific clinical manifestations in the larynx.

Case presentation: A 78-year-old man presented to the emergency room of a hospital in Bogotá D.C. (Colombia) with exertional dyspnea, dry cough, dysphonia, odynophagia, and dysphagia over the last 3 months, with worsening of respiratory symptoms in the last 24 hours. Admission laboratory tests showed an elevated D-dimer level; therefore, due to suspected pulmonary thromboembolism, a contrast-enhanced CT chest angiography was performed. No signs of thromboembolism were observed, but centrilobular lung micronodules, a tree-in-bud pattern, and changes related to previous pulmonary fibrosis were observed. Due to the risk of aspiration, a nasopharyngoscopy was performed, finding leukoplakia on the right ventricular fold and the right vocal fold. Based on these findings, a biopsy of the lesions, acid-fast bacilli (AFB) staining, and a PCR test for Mycobacterium tuberculosis were requested, all of which were positive. Antituberculosis therapy (RHZE 150/75/400/275 mg) was initiated 5 days after diagnosis once his condition was stabilized; the biopsy was postponed for the same reason. Given the favorable response, he was discharged 4 days after starting treatment. A follow-up nasolaryngoscopy at 30 days showed a significant reduction in the pseudotumoral lesions on the ventricular fold and complete resolution on the vocal fold. At the 3-month follow-up, respiratory symptoms had improved considerably.

Conclusion: Although it is a very rare condition, LTB should be considered as a differential diagnosis in patients with non-specific symptoms (such as dysphonia, dysphagia, and odynophagia) and laryngeal lesions, even in countries without a high TB burden like Colombia. Timely initiation of anti-tuberculosis therapy is essential to prevent serious complications, given the excellent and rapid response to this treatment.

case report

Carlos Arides Vargas-Rueda1 Johan Andrés Salcedo-Cumplido2 Angela Aguirre-Rodriguez3 Luis Carlos Clavijo-Moreno1

1 Fundación Santa Fe de Bogotá - Otorhinolaryngology Department - Bogotá D.C. - Colombia.

2 Universidad del Norte - Health Sciences Division - Medical Department - Barranquilla - Colombia.

3 Fundación Santa Fe de Bogotá - Internal Medicine Department - Bogotá D.C. - Colombia.

Open access

Received: 10/05/2025

Accepted: 02/01/2026

Corresponding author: Johan Andrés Salcedo-Cumplido. Departamento de Medicina, División de Ciencias de la Salud, Universidad del Norte. Barranquilla. Colombia. E-mail: Johandres2001@hotmail.com.

Keywords: Deglutition Disorders; Dysphonia; Larynx Tuberculosis; Vocal Cords (MeSH).

Palabras clave: Trastornos de Deglución; Disfonía; Tuberculosis Laríngea; Pliegues Vocales (DeCS).

How to cite: Vargas-Rueda CA, Salcedo-Cumplido JA, Aguirre-Rodríguez A, Clavijo-Moreno LC. Laryngeal tuberculosis coexisting with pulmonary tuberculosis: a case report. Rev. Fac. Med. 2026;74:e120305. English. doi: https://doi.org/10.15446/revfacmed.v74.120305.

Cómo citar: Vargas-Rueda CA, Salcedo-Cumplido JA, Aguirre-Rodríguez A, Clavijo-Moreno LC. [Tuberculosis laríngea coexistente con tuberculosis pulmonar: reporte de caso]. Rev. Fac. Med. 2026;74:e120305. English. doi: https://doi.org/10.15446/revfacmed.v74.120305.

Copyright: ©2026 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, as long as the original author and source are credited.

Abstract

Resumen

Introduction

Laryngeal tuberculosis (LTB) is a rare form of extrapulmonary tuberculosis (EPTB) that accounts for less than 1% of all tuberculosis (TB) cases.1,2 In Colombia, according to data from the Ministry of Health and Social Protection, the prevalence of LTB in 2021 was 1 per 1 000 EPTB cases.3

In most cases, LTB manifests as a complication of active pulmonary TB (PBT).2,4 Although its symptoms have been reported as non-specific with an insidious onset suggesting simple laryngitis,4 dysphonia, dysphagia, and odynophagia are common clinical features.1,4-6

Due to its very low frequency and non-specific clinical manifestations, the timely diagnosis of LTB is a challenge, as it can mimic laryngeal cancer and is rarely suspected,1,2,4-6 so, it is essential to implement a comprehensive differential diagnostic approach. The diagnosis is confirmed through histopathological analysis, which also allows differentiating it from a neoplasm, and specific tests for TB detection, such as rapid molecular tests or sputum culture for Mycobacterium tuberculosis.1,4,6,7 Early diagnosis and timely treatment are essential for implementing infection control measures and preventing serious complications in the larynx, as LTB shows an excellent response to antituberculosis therapy, with lesions that usually achieve near-complete resolution within 2 to 3 months after initiating the treatment.7-9

The following is the case of an elderly patient with LTB secondary to active PTB who responded favorably to combined antituberculosis therapy, with near-complete resolution of laryngeal lesions and significant improvement of initial symptoms 30 days after starting the treatment. This case report aims to provide further evidence on the management of a rare condition such as LTB in patients with advanced comorbidities, like the elderly.

Case presentation

A 78-year-old male, a businessman, born in and residing in Bogotá D.C. (Colombia), presented to the emergency room of a tertiary care hospital in Bogotá D.C. due to clinical signs and symptoms over the last three months of progressively worsening dyspnea on mild exertion, persistent dry cough, dysphonia, odynophagia, dysphagia, and arthralgia and myalgia in the upper and lower limbs. The patient also reported an acute worsening of respiratory symptoms within the last 24 hours, with an oxygen saturation of 79% during the examination in the emergency room; however, he had no fever nor contact with individuals presenting with respiratory symptoms.

Regarding relevant personal history, the patient had been diagnosed with coronary artery disease, which required coronary angioplasty with stent placement in the posterior descending artery. Additionally, he had prediabetes (without pharmacological management), gastroesophageal reflux disease, hypothyroidism, and pulmonary fibrosis. He also reported a history of tobacco use (5 pack-year index), having quit 10 years prior to the consultation. His surgical history included an exploratory laparotomy secondary to abdominal trauma due to a gunshot wound. Due to his comorbidities, he was on permanent treatment with the following medications: losartan (100 mg/day), amlodipine (5 mg/day), acetylsalicylic acid (100 mg/day), pantoprazole (40 mg/day), levothyroxine (25 mcg/day), atorvastatin (20 mg/day), and inhaled budesonide/formoterol.

Physical examination upon admission revealed a respiratory rate of 22 breaths per minute, a baseline oxygen saturation of 79%, adequate respiratory effort, oropharynx without posterior discharge, and bibasilar crackles and rhonchi on cardiothoracic auscultation. Admission laboratory tests showed preserved renal function, normal serum sodium level, blood glucose levels within the expected range, an elevated D-dimer level, and normal white blood cell count with slight neutrophil predominance. Additionally, arterial blood gas test analysis reported a slightly alkaline pH and low oxygen levels, without significant alterations in ventilation or acid-base metabolism. Finally, screening tests for HIV, influenza A and B virus, and SARS-CoV-2 were performed, all of which were negative (Table 1).

Table 1. Laboratory tests upon admission.

Test		Result	Normal range
Complete blood count	Leucocytes (x10³/μL)	9 200	4 000-10 000
	Neutrophils (x10³/μL)	5 300	2 000-7 500
	Lymphocytes (x10³/μL)	1 800	1 000-4 800
	Monocytes (x10³/μL)	1 500	200-1 000
	Hemoglobin (g/dL)	12.3	13.0-17.0
	Hematocrit (%)	36.5	40.0-54.0
	Platelets (x10³/μL)	290 000	150 000-450 000
Other tests	D-dimer (μg/mL)	1 020	<0.5
	BUN (mg/dL)	21	6-20
	Serum creatinine (mg/dL)	0.76	0.6-1.1
	Blood glucose (mg/dL)	95	70-110
	Sodium (mEq/L)	136.18	135-145
Antigens	SARS-CoV-2 antigen	Negative	-
	HIV type 1 and 2	Non-reactive	-
	Influenza A-B antigen	Negative	-
Arterial gas	pH	7.46	7.35-7.45
	PaCO2 (mmHg)	34	35-45
	PaO2 (mmHg)	46.6	75-100
	HCO3 (mEq/L)	24.5	22-28
	Base excess (mEq/L)	0.0	-
	Lactate (mmol/L)	0.9	0.5-2.2
	PaO2/FiO2ratio (mmHg)	222	>300 (normal)

Source: Own Elaboration.

Given the high D-dimer level reported in the admission tests, and to rule out pulmonary thromboembolism, a contrast-enhanced chest angiography was performed. Although no signs of acute or chronic thromboembolism were detected, the following were observed: multiple centrilobular lung micronodules, a tree-in-bud pattern, and changes related to pulmonary fibrosis, predominantly in the upper lobes (Figure 1). Considering the patient’s symptoms, comorbidities, and the acute worsening of respiratory symptoms, he was admitted to the general hospital ward.

A

B

Figure 1. Contrast-enhanced CT pulmonary angiogram. A) Axial view; B) Coronal view.

Source: Images obtained during the study.

Considering these findings, on the second day of hospitalization, the patient was assessed by specialists from the pulmonology service, who, after establishing that he had an airway infection, and taking into account his medical history, started antibiotic therapy with cefepime (2 mg every 8 hours for 8 days). They also requested the following studies: pulmonary function tests, screening for autoimmune diseases (antinuclear antibodies, rheumatoid factor, and anti-cyclic citrullinated peptide, anti-SS-B, anti-Smith, anti-ribonucleoprotein, anti-myeloperoxidase, and anti-proteinase 3 antibodies), sputum culture, cardiac function evaluation, and a consultation with the otolaryngology (ENT) service due to the risk of aspiration.

On the fourth day of hospitalization, the patient was evaluated by specialists from the ENT service, who performed a fiberoptic nasopharyngolaryngoscopy, showing perforation of the nasal septum, turbinate hypertrophy, speckled leukoplakia in the right ventricular fold (Figure 2A) and speckled leukoplakia completely involving the right vocal fold (Figure 2B). Despite these findings, vocal fold mobility was preserved, with complete glottic closure and anterior commissure free of lesions.

Figure 2. Fiberoptic nasopharyngolaryngoscopy. A) Speckled leukoplakia in the right ventricular fold; B) Speckled leukoplakia completely involving the right vocal fold.

In view of the patient’s clinical manifestations and imaging findings, on the fifth day of hospitalization, a laryngeal biopsy was requested to rule out a potential neoplasm. Additionally, sputum samples were collected for TB screening—acid-fast bacilli (AFB) staining and polymerase chain reaction (PCR) for M. tuberculosis—to rule out a possible infection, despite the low epidemiological incidence in the area. Similarly, enteral nutrition via a nasogastric tube was initiated; however, due to difficulties in the procedure, a peripherally inserted central catheter (PICC) was placed on the sixth day to initiate parenteral nutrition.

On the seventh day of hospitalization, the PCR and AFB staining results came back positive, confirming the presence of active PTB with suspected LTB. On the ninth day of hospitalization, the laryngeal biopsy was postponed due to the patient’s hemodynamic and respiratory instability, as well as the high risk of transmission. In addition, a percutaneous endoscopic gastrostomy was considered due to dysphagia secondary to laryngeal lesion, which was performed on the 11th day of hospitalization.

Once the patient’s clinical condition was stable, combined antituberculosis therapy (RHZE 150/75/400/275 mg) was initiated on the 12th day of hospitalization for the management of pulmonary and laryngeal coinfection. Following clinical improvement, the patient was discharged 16 days after admission.

At the 30-day follow-up fiberoptic nasopharyngolaryngoscopy, a reduction of almost 80% in the volume of the pseudotumorous lesion on the right ventricular fold was observed (Figure 3A), along with a right vocal fold free of lesions (Figure 3B). On the other hand, although the patient reported significant improvement of the initial symptoms, he still presented a persistent mild cough, which was attributed to his underlying pulmonary conditions. It was indicated to continue with the established combined antituberculosis therapy and the biopsy was once again postponed given the patient’s advanced age and the favorable treatment outcomes.

Figure 3. Follow-up fiberoptic nasopharyngolaryngoscopy. A) Reduction of the speckled lesion on the right ventricular fold; B) Right vocal fold free of lesions.

At the 3-month follow-up appointment, respiratory symptoms had considerably improved, and the patient was instructed to continue with the antituberculosis therapy established in the continuation phase with rifampicin and isoniazid (RH 150/75 mg). Table 2 presents the timeline of the clinical case.

Table 2. Timeline.

Day	Events
1	Emergency room admission, laboratory workup, CT pulmonary angiogram, and admission order
2	Pulmonology evaluation, initiation of antibiotic therapy, and request for sputum culture and autoimmune screening
4	ENT evaluation and fiberoptic nasopharyngolaryngoscopy
5	Request for laryngeal biopsy and TB screening; initiation of enteral nutrition
6	Peripherally inserted central catheter placement
7	Report of positive TB results
9	Laryngeal biopsy postponed due to hemodynamic instability
11	Percutaneous endoscopic gastrostomy
12	Initiation of combined antituberculosis therapy
16	Hospital discharge
30-day follow-up	Follow-up nasopharyngolaryngoscopy showing improvement of lesions
3-month follow-up	Initiation of the treatment continuation phase

TB: tuberculosis.

Source: Own elaboration.

Discussion

LTB is a very rare form of EPTB that usually occurs in the context of active PTB, although it can also manifest in isolation.1,2,4,6 This article describes the case of an immunocompetent elderly patient with a simultaneous diagnosis of PTB and LTB, an extremely rare occurrence in clinical practice.4-6

The early stages of LTB are characterized by edema and hyperemia of the vocal folds, while more advanced forms are associated with a “coated larynx” appearance, i.e., a grayish, purulent layer that may cause necrosis of the surface epithelium, with torn, exophytic edges, poorly defined margins, and presence of soft vegetations.4 Its diagnosis is often complex due to the non-specificity of the symptoms and its clinical and endoscopic similarity to laryngeal malignancies; consequently, early detection requires an interdisciplinary approach.2,4,6,7 This stresses the importance of maintaining a comprehensive diagnostic approach, since LTB may occur even in the absence of evident pulmonary manifestations.5-7

Despite its nonspecific symptomatology, the most frequent clinical signs and symptoms of LTB are dysphonia, dysphagia, and odynophagia.1,4-7,10 Furthermore, the most commonly affected sites are the vocal folds, ventricular folds, epiglottis, and arytenoids.4,7,10 In our patient, besides dysphonia, dysphagia, and odynophagia, LTB affected the ventricular fold and the right vocal fold, although vocal fold mobility was preserved.10

Concerning odynophagia, which occurs due to ulceration or perichondritis of the epiglottis or the arytenoid or cricoid cartilages, it is a frequent symptom (25-50% of cases, even in early stages) to be considered. In fact, it has been reported that the concomitant presence of odynophagia and progressive dysphonia is a finding highly suggestive of LTB.5 In this regard, nasolaryngoscopy is an essential procedure to guide the diagnosis, as it allows for the visualization of laryngeal lesions;1,11 however, since these lesions share similar characteristics with laryngeal carcinoma, the primary use of laryngoscopy is to perform biopsies of the lesions to confirm the diagnosis.1,4-6,11

Confirmation of LTB in our patient was based on standard microbiological methods for TB diagnosis, namely PCR testing for M. tuberculosis detection, which, together with sputum culture, has been described as a reliable tool to this end.1,4-7 Nevertheless, histopathological analysis of laryngeal lesions remains the gold standard for a definitive diagnosis, as it also allows to differentiate it from other conditions, particularly laryngeal cancer.1,4-6,11 It should be noted that in the present case, despite being a fundamental pillar for diagnostic confirmation,1,4,7,12,13 laryngeal lesion biopsy was postponed due to the patient’s clinical condition during his hospital stay and was postponed again given his advanced age and favorable response to the initiated antituberculosis treatment.

Although histopathological confirmation of LTB was not possible due to the patient’s clinical condition, based on clinical and laryngoscopic findings, as well as molecular and microbiological confirmation of M. tuberculosis, empirical antituberculosis therapy with first-line drugs was initiated following a scheme described in the literature for the treatment of drug-susceptible TB:7,11 rifampicin, isoniazid, pyrazimide, and ethambutol (RHZE 150/75/400/275 mg) during the intensive phase (first 2 months), and rifampicin and isoniazid (RH 150/75 mg) during the continuation phase (4 months).11 The patient showed a favorable response, with a reduction in respiratory and swallowing symptoms and a significant decrease (approximately 80%) in laryngeal lesions one month after initiating treatment. This is consistent with the literature, which has reported that LTB has an excellent response to these drugs, with near-complete resolution of the lesions within 2 to 3 months after starting therapy.7,8

The similarity between the clinical presentation of LTB and other laryngeal diseases—such as pseudotumors and, particularly, laryngeal cancer—poses a considerable diagnostic challenge.11,13 This overlap of symptoms underscores the importance of a detailed clinical and paraclinical evaluation, as a delayed diagnosis could favor disease progression and increase the risk of systemic complications in patients.13

Conclusions

Although laryngeal tuberculosis is a rare entity, it must be considered as a differential diagnosis in patients with non-specific symptoms such as dysphonia, dysphagia, odynophagia, and laryngeal lesions, regardless of the TB burden in the country or region.14 Timely initiation of antituberculosis therapy prevents severe complications due to the excellent and rapid response to this treatment.

While fiberoptic nasopharyngolaryngoscopy is essential for identifying and characterizing laryngeal lesions, the diagnosis must be histopathologically confirmed to rule out other differential diagnoses, especially laryngeal carcinoma. However, in individuals for whom a short-term biopsy is not feasible, but who present with clinical and laryngoscopic findings suggestive of LTB, as well as microbiological and molecular confirmation of M. tuberculosis infection, antituberculosis therapy should be initiated as soon as possible, since the response to treatment can guide the definitive diagnosis, as occurred in our patient.

Finally, this case report highlights the importance of a multidisciplinary approach for the timely detection of a rare and non-specific condition such as LTB.

Ethical considerations

For the preparation of this case report, the patient’s informed consent was obtained, whereby the patient’s signature authorized the use of his clinical data.

Conflicts of interest

None stated by the authors.

Funding

None stated by the authors.

Acknowledgments

None stated by the authors.

References

1.Mouhsine A, Belkouch A, Temsamani H, Atmane EM, Rokhssi R, Berrada Y, et al. Laryngeal tuberculosis: about 04 cases. Pan Afr Med J. 2023;45:193. doi: 10.11604/pamj.2023.45.193.5325. PMID: 38020358; PMCID: PMC10656593.

2.Teixeira-Marques F, Estêvão R, Mota CP, Lousan N. Laryngeal tuberculosis, the great deceiver: A series of 10 cases. Indian J Tuberc. 2024;71(3):238-41. doi: 10.1016/j.ijtb.2024.07.001. PMID: 39111930.

3.Colombia. Ministerio de Salud y Protección Social (MinSalud). Informe de evento. Tuberculosis año 2022 [Internet]. Bogotá D.C.: MinSalud; 2022 [cited 2025 May 10]. Available from: https://tinyurl.com/4b249cm7.

4.El Ayoubi F, Chariba I, El Ayoubi A, Chariba S, Essakalli L. Primary tuberculosis of the larynx. Eur Ann Otorhinolaryngol Head Neck Dis. 2014;131(6):361-4. doi: 10.1016/j.anorl.2013.10.005. PMID: 25443690.

5.Celis-Preciado CA, Valencia-Murillo MM, Ayala-Copete AM, Rodríguez-Sarmiento JL, Lasso-Apráez JI. Tuberculosis laríngea y pulmonar en un hombre inmunocompetente de 45 años: presentación de un caso. Univ. Méda. 2023;64(3):1-8. doi: 10.11144/Javeriana.umed64-3.tlpi.

6.Lugo-Machado JA, García-Ramírez PE, Gutiérrez-Pérez ML, Medina-Valentón E, Pacheco-Sánchez AA. Tuberculosis laríngea secundaria a foco pulmonar primario inadvertido: caso clínico. Acta Otorrinolaringol Cir Cabeza Cuello. 2022;50(3):202-6. doi: 10.37076/acorl.v50i3.600.

7.Rubin F, Jameleddine E, Guiquerro S, Laccourreye O. Laryngeal tuberculosis in the early 21st century. Literature review of clinical, diagnostic and therapeutic data, according to SWiM guidelines. Eur Ann Otorhinolaryngol Head Neck Dis. 2024;141(3):147-52. doi: 10.1016/j.anorl.2024.01.001. PMID: 38238187.

8.Roy KP, Datta DJ, Madam S, Kodoru PK. Tuberculosis of the Larynx: A Review of Two Cases. Int J Phonosurg Laryngol. 2017;7(1):27-30. doi: 10.5005/jp-journals-10023-1138.

9.Raj R, Sud P, Saharan N, Virk RS. Laryngeal tuberculosis: a neglected diagnosis. BMJ Case Rep. 2022;15(2):e248095. doi: 10.1136/bcr-2021-248095. PMID: 35131802; PMCID: PMC8823138.

10.Gao M, Cheng L, Wang Q, Yang Q, Wang X, Li Y, et al. Clinical characteristics and prognosis of laryngeal tuberculosis combined with respiratory tuberculosis. Am J Otolaryngol. 2024;45(1):104115. doi: 10.1016/j.amjoto.2023.104115. PMID: 37979215.

11.Mogoantă CA, Osman A, Georgescu AM, Mitroi AM, Busuioc CI, Tănase I, et al. Head and neck tuberculosis: a rare diagnosis and the role of surgical biopsy and histopathological evaluation in extrapulmonary disease. Pathogens. 2025;14(5):479. doi: 10.3390/pathogens14050479. PMID: 40430798; PMCID: PMC12114414.

12.Nerurkar NK, Jahnavi Laryngeal Tuberculosis: Current Patterns of Presentation and Management. Indian J Otolaryngol Head Neck Surg. 2024;76(1):904-9. doi: 10.1007/s12070-023-04316-w. PMID: 38440428; PMCID: PMC10908953.

13.Yadav V, Kaur J, Tiwana B.S, Bhagat S, Rajdev S. Primary Subglottic Laryngeal Tuberculosis Mimicking as Malignancy: A rare case Report. Indian J Otolaryngol Head Neck Surg. 2024;76(6):6003-5. doi: 10.1007/s12070-024-05045-4. PMID: 39559153; PMCID: PMC11569098.

14.World Health Organization (WHO). WHO global lists of high burden countries for tuberculosis (TB), TB/HIV and multidrug/rifampicin-resistant TB (MDR/RR-TB), 2021-2025. Geneva: WHO; 2021 [cited 2026 Jan 3]. Available from: https://tinyurl.com/2vy925fc.