162 THE LARYNX, BRONCHI AND OESOPHAGUS
c. Avoidance of Pollutants. It is essential to stop smoking and to take steps
to avoid or lessen exposure to environmental factors.
d. Local Applications. Laryngeal sprays are difficult to use and have no
direct therapeutic value; they are, however, comforting and medications such
as glucose in glycerine or oil of pine may be used. The tongue is held forwards
as for an indirect laryngoscopy and the laryngeal spray is introduced into the
pharynx nozzle downwards. As the spray is used the patient inspires deeply.
Sprays are especially helpful in atrophic laryngitis.
e. Endoscopic Procedures. Vocal cord stripping is of use in oedematous and
hypertrophic laryngitis. It should be confined to one vocal cord at a time
since the infection will inevitably involve the anterior commissure which, if
bared on both sides, may lead to the formation of a laryngeal web. In most
cases a biopsy will be required to confirm the diagnosis.
LEUCOPLAKIA OF THE LARYNX
The word 'leucoplakia* is derived from the Greek meaning a white patch. In
the larynx these 'white patches' nearly always occur on the dorsum of the
vocal cords. No assessment of their malignant potential can be made by
naked eye examination alone and so each area of leucoplakia of the larynx
must be' removed and submitted to histology. From this two reports are
possible: (a) Keratosis. In this condition the white patch is due to a heaping up
of keratin. This is quite benign and never becomes malignant, (b) Dysplasia.
Although pathologists differ in their interpretation of the severity of this
state, all will probably agree that this is the stage before carcinoma-in-situ.
Dysplasia is pre-malignant and patients whose leucoplakia shows evidence of
dysplasia should be put on a cancer follow-up schedule.
If the condition progresses to the stage of carcinoma-in-situ (see p. 184) the
affected vocal cords should be carefully stripped using microlaryngoscopy and
the specimen sectioned. If there are any areas of invasive cancer radiotherapy
should be used but provided that it stays at the carcinoma-in-situ stage
radiotherapy is contra-indicated. A policy of repeated vocal cord stripping
should be adopted.
Pachydermia of the larynx is a condition of unknown aetiology and until the
aetiology is discovered, it would seem reasonable, on the basis of its natural
course, to include it under the heading of chronic diseases of the larynx.
The name describes a heaping up of red or grey granulation tissue in the
interarytenoid area. Occasionally this tissue spills anteriorly on to the vocal
processes and the posterior ends of the vocal cords (Plate VII, 3). As the
granular area replaces the thin mucosa on the medial surface of the vocal
processes this mucosa becomes worn away and damaged by repeated com-
pression when the vocal processes meet in talking. This results in cartilage v
becoming exposed and in the surrounding granulation tissue becoming raised.
Tfais configuration is known as a 'contact ulcer* and forms part of the clinical
pietere of pachydennia.
The uiost lucent thoughts on the aetiology suggest that, with an incompetent
cardia, acid refluxes up the oesophagus as the patient lies down at night thus