Autoimmune Disorders Affecting the Larynx: Review of Laryngoscopic Findings and Approach to Multidisciplinary Management

The prevalence of autoimmune diseases has been increasing globally. Many disorders have manifestations within the larynx and patients may present initially to the otolaryngologist with breathing, voice, or swallow concerns. This review focuses on the laryngotracheal manifestations of various autoimmune diseases and associated laryngoscopic abnormalities that commonly occur with autoimmune disease, including infraglottic stenosis, bamboo nodules, cricoarytenoid joint ankylosis, supraglottic stenosis, and multilevel airway stenosis. Commonly implicated autoimmune disorders including granulomatosis with polyangiitis (GPA), ANCA-negative GPA, rheumatoid arthritis, Sjögren's syndrome, systemic lupus erythematosus (SLE), pemphigus vulgaris, ankylosing spondylitis, sarcoidosis, relapsing polychondritis, and IgG4-related disease are reviewed with emphasis on clinical presentation, typical laryngoscopic findings, diagnostic criteria, and therapeutic options specific to the larynx. A systematic multi-disciplinary approach between the otolaryngologist and rheumatologist is presented. Prompt identification of a laryngeal abnormality as being potentially related to autoimmune disease and direct communication with rheumatology colleagues can offer patients medical treatment options in addition to procedural intervention and may offer long-term benefits to laryngeal function and overall disease-specific health.