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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.


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

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


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