TUMORS OF THE LARYNX AND LUNGS.
Tumors of the Larynx.
Symptoms.—The location of a laryn geal tumor, its size, and its nature bear considerable influence upon the symp tomatology. A growth situated ante riorly in the anterior commissure may, though small, so prevent approximation of the cords as to cause complete loss of voice; on the other hand, a large soft growth located below the cords may not interfere with adduction and only give rise to the symptoms of chronic laryn gitis. Paroxysmal hoarseness is often ob served in such cases, especially after loud talking or laughing. A small tumor situ ated above the cords may also give rise to very little trouble and cause no sub jective symptom. In the great majority of cases, however, persistent hoarseness is the first manifestation. Dyspncea fol lows and gradually increases until or thopncea is threatened. If at this stage the nature of the trouble be not recog nized and the growth extirpated, the pa tient dies asphyxiated. Small growths with long pellicles are apt to titillate the laryngeal mucous membrane, and give rise to cough or spasmodic retching. A rattling noise or coarse gurgling is also sometimes heard when such growths are present.
Laryngeal tumors may be benign or malignant.
Benign Tumors.—Benign tumors usu ally grow slowly, and dyspncea only comes on late in their history, unless an acute cold or any local inflammation causes temporary infiltration of the tis sues, when dangerous symptoms may suddenly supervene.
Singers' small growths, usually observed on the superior surface of the cords, or near their edge, and usually in the anterior thirds, are the re sult of overuse of the voice. The first manifestation is fatigue unusually soon after beginning to sing; this is followed by gradually increasing hoarseness. The tumor varies from a pin's head to a small split pea, in size, and forms the centre of an areola. Often the same spot in the opposite cord is also the seat of a growth.
There are often several on both cords.
Papilloma.—This variety of growth is commonly met with, especially in chil dren, and represents over one-half of all laryngeal tumors encountered in practice. It is ascribed to inflammatory disorders of the larynx, especially when in subjects suffering from diathetic disorders, or showing familial traces of syphilis or tu berculosis. They are often attached to the anterior portion of the cord, near the commissure, and may be sessile or pedun culated. The numerous papilke cause their surface sometimes to resemble that of a raspberry, especially when dark red in color. They may be yellowish, white, or pinkish. They are occasionally ob served at birth, the infant being aphonic and showing evidence of dyspncea. Digi tal examination is necessary to recognize the condition in small children. These growths are only benign in young sub jects, but when they occur after middle life they should be looked upon with suspicion. Tuberculous growths of the larynx may be taken for a papilloma.
Fibroma.—Fibromata may be assimi lated to nasal polypus, though they are more opaque and resistant to pressure. They are smooth and usually sessile or pear-shaped, may be whitish gray or reddish, the latter color being due to san guineous extravasation, through cough ing, hemming, etc. They are generally found near the anterior commissure upon the cords, below them, or upon the ven tricular bands. They sometimes become sufficiently large to completely fill the larynx and cause asphyxia. Overuse of the voice is also thought to be their main cause; they are usually found in men.
The other varieties of benign growths occasionally met with in the larynx are cysts, angioma, chondroma and adenoma, and lipoma.