PAPILLOMA OF THE LARYNX Malignant neoplasms in the larynx during childhood, when they occur, are usually in the form of the sarcoma or epithelioma. Benign growths are much commoner, particularly three varieties; the singer's nodes, the granuloma, and the papilloma. The nodes usually result from a catarrhal laryngitis. The granuloma accompanies operative procedures, and the pressure ulceration following incubation.
The laryngeal papillorna occurs more frequently in boys than in girls. It i8 sometimes congenital, and may occur as a result of inflam matory affections of the larynx. It may be single or multiple, and sometimes attains a large size. It is usually situated on the true vocal cords, and either takes the form of a simple smooth node, or a lobular growth as large as a raspberry, with a broad base. Small papillornata do not always produce disturbances. But aS a rule new growths in the larynges of children cause more trouble than in adults.
The first symptom is a change in the voice, which becomes worse until complete hoarseness results. Cough is usually present, and as the growth develops, difficulty in breathing, to the point of alarming suffo cative attacks, occurs. In some of the cases the symptoms develop
slowly. This is particularly true of the congenital cases, in which the papilloma grows very slowly.
In another class of cases, the course is rapid, necessitating prompt attention. In still another class, the symptoms gradually subside, and finally disappear entirely. In such cases the growth disappeared spontaneously.
The diagnosis, and there is usually time enough to make it, is settled by a laryngeal examination.
The prognosis is favorable, first because of the chance for a spon taneous cure, secondly beeause this form of new growth does not de velop into carcinoma, and thirdly- because after removal recurrences are not frequent.
Treatment of the papilloma itself is not always necessary. Pap illornata have been coughed out spontaneously. Operative interfer ence is usually necessary however. Intubation bas been suecessful in some eases, but the best method of treatment consists in the endo laryngeal removal of the growths, many sittings being often necessary. Lary-ngo-fissure must often be employed, and when urgent symptoms arise, tracheotomy should be performed.