CHRONIC LARYNGEAL DISEASES - 165 concealed by the oedema. This is a very difficult situation to manage because to take deep biopsies in a search for cancer, and to expose cartilage in so doing, is a certain way to make the perichondritis worse. It is possibly better to treat the perichondritis with ampicillin and diuretics, and to delay a biopsy for as long as possible. If the larynx is still swollen and useless 6 months after radiation therapy a total laryngectomy should be performed even if the biopsies are negative. Sections of the excised larynx in such a case will almost certainly show evidence of residual cancer. MYCOSIS OF THE LARYNX Three main fungi are found, causing the following conditions: 1. Blastomycosis. This is the most common and may attack the larynx primarily. It is found in grain workers in South America who are exposed to the fungus. The disease is a chronic granuloma and presents in the early stages as an intense inflammation of the larynx colouring it very dark red. There is a grey nodular surface with isolated yellow nodules and string-like secretions. Diagnosis is made by bacteriological examinations and biopsy. The latter is the more important since coexisting blastomycosis of the lungs may give a positive bacteriological finding. The finding of blastomycosis in the biopsy tissue is the only absolute diagnostic feature. It is treated by a prolonged course of a saturated solution of potassium iodide given in increasing doses from 0-3 ml daily until a maintenance dose of 2 ml is reached. The ultimate prognosis depends upon the state of the lungs. 2. Actinomycosis. This is due to the actinomyces organisms and the source is usually animal hides. It is very rare in the larynx and presents as a yellow granulomatous tumour with associated glandular involvement. Treatment is by penicillin, but the prognosis depends on the response of the pulmonary lesion. 3. Leptothricosis. This is due to the Leptothrix buccalis fungus and is associated with bad dental hygiene. It usually occurs at the base of the tongue, but it may involve the larynx where it produces small, white areas in otherwise healthy mucosa. The condition has to be differentiated from keratosis of the larynx and is not dangerous. Potassium iodide may be given as for blastomycosis. SCLEROMA OF THE LARYNX This disease is prevalent in Poland and other East European countries and is not unknown in Egypt and India. It starts in the nose and oral cavity and spreads downwards to involve the pharynx and larynx. The typical lesion is in the subglottic region and takes the form of a smooth red swelling covered by crusts. The patient complains of nasal obstruction followed later by hoarse- ness, wheezing and stridor. Diagnosis is made by biopsy when plasma cells and hyaline bodies are seen in granulation tissue together with the diagnostic Mikulicz cells which are large cells looking like enormous fat deposits. If it is untreated the condition progresses to laryngotracheal stenosis. The first line of treatment is streptomycin with steroids added if there is a danger of stenosis.