108 THE PHARYNX AND NASOPHARYNX mistakes, and in these cases corrective measures, such as slower delivery allowing for adequate pauses for inspiration, and the pitching of the voice in a lower key should be advised, It may be necessary for the patient to consult a teacher of voice production. Granules may be destroyed by 25 per cent silver nitrate on a fine wool-tipped probe under local anaesthetic by spraying with cocaine hydrochloride. The use of an electric cautery or a diathermy for this purpose calls for general anaesthesia. Local gargles of hydrogen peroxide or ferric chloride and local painting with MandPs paint are of secondary use. ATROPHIC PHARYNGITIS This accompanies atrophic rhinitis. The main complaint is of dryness in the throat, and the posterior pharyngeal wall is glazed and covered with a little dry secretion. The nose must always be examined for evidence of atrophy. Treatment is largely that of the nasal condition, but crusting in the pharynx may be removed by local spraying with a warm alkaline solution, or an oily spray such as parolein. KERATOSIS OF THE PHARYNX This is an uncommon condition found in either sex usually between the ages of 15 and 30. It is due to a horny outgrowth from the crypts of the tonsils and is composed of keratinized epithelial cells which are arranged in concentric layers within the tonsillar crypts. The cause is unknown, but is thought to be a metaplasia. On examination, white or yellow excrescences are seen projecting from the crypts. There is no evidence of infection, and the horny growths cannot be wiped off (Plate VI, 2). Occasionally they may be seen on the posterior pharyngeal wall, and they have been described in the larynx. As a rule there are no symptoms, but they may cause some irritation in the throat. Generally the growths are found accidentally by the patient on looking into his throat. The condition is harmless and no treatment is required beyond re- assurance that the condition is not malignant. Spontaneous disappearance of the excrescences often occurs. Should the patient insist on treatment, removal of the tonsils is indicated.