Objective <p>This study aimed to elucidate the contemporary clinical characteristics and evolving trends of laryngeal tuberculosis(LTB), thereby providing evidence for optimizing clinical diagnostic and therapeutic strategies.</p> Methods <p>We conducted a retrospective analysis of the clinical data from patients diagnosed with LTB at a single-center medical institution in northern China between July 2014 and June 2025.</p> Results <p>A total of 49 patients with LTB were included in this study, predominantly males aged 55–64 years. The most common presenting symptom was hoarseness (67.34%), while systemic symptoms were infrequent. Laryngoscopic examination revealed diverse lesion morphologies, with the mixed-pattern type being the most prevalent (38.78%). Furthermore, lesions frequently involved two or more laryngeal subsites (65.31%). Chest CT findings indicated that 73.47% of patients had concomitant active or inactive pulmonary tuberculous foci. Laboratory investigations showed a PPD-positive rate of 55.10% and a sputum smear-positive rate for acid-fast bacilli of 38.88%. Among the 32 patients who underwent pathological biopsy, classic histopathological features, including epithelial granulomas with caseous necrosis, were observed. Following anti-tuberculosis treatment, the laryngeal lesions showed significant improvement or complete resolution in the vast majority of patients.</p> Conclusion <p>Diagnosing LTB is often challenging due to its clinical resemblance to other laryngeal pathologies. Otorhinolaryngologists should consistently consider LTB in the differential diagnosis, particularly for patients with high-risk factors for tuberculosis who present with polymorphic lesions involving multiple laryngeal sites on laryngoscopy. Re-evaluating and thoroughly understanding the shifting trends in the clinical presentation of LTB are crucial for achieving early identification and accurate diagnosis of this disease.</p> Clinical trial number <p>Not applicable.</p>