INTRALARYNGEAL AND INTRATRACHEAL TUMORS.
Within the larynx tumors may occupy the space beneath the glottis, where they are referred to as subglottic; they may grow from the structure of the vocal cords and become intraglottic, or they may spring from above the glottis and from the aryteno-epiglottic fold. Certain forms of benign tumor are relatively common in this location, while others are almost unknown. The former include cysts, papillomas, fibromas, angiomas, and adenomas, as well as the ordinary granulomas.
A nodular lesion seen upon the vocal cords, especially in singers, which is hyperplastic in character, irritative in origin, and often called “singer’s node,” is frequently found upon the edges of the cords, either as a single or bilateral lesion. The adjoining structures are usually quite vascular. These lesions occur in those who abuse their voices, as, for instance, in amateur singers and newsboys. The nodules themselves vary in size from that of a pin’s head to that of a split pea. The condition produces hoarseness and impairment of the voice, is recognized with the laryngoscope, and is amenable to treatment, which should consist in absolute rest from vocal effort and gentle astringent and stimulating applications. If the node project very far it may be removed by the intralaryngeal guillotine.
Laryngeal polypi include the forms of benign tumor above mentioned, most of which assume in time a polypoid form, and cause impairment of function according to their location.
Fig. 481
Multiple papilloma of larynx. (Bergmann.)
Papilloma is by all means the most common of these growths, and may present either the vascular type, bleeding easily and growing rapidly, or the firmer and denser type from admixture with fibromatous tissue. It occurs frequently in the young, and may even be present in the newborn. Here it can scarcely be detected with the laryngoscope, but may be felt with the finger. Cysts take their origin from the mucosa, save those which, possibly of embryonic character, protrude into or encroach upon the larynx from without ([Fig. 481]).
Symptoms.
—The symptoms of benign intralaryngeal growths are largely irritative, including cough, with hoarseness and change of voice, and going on to production of dyspnea in proportion to the size which they attain. Later complete aphonia, with spasm of the glottis, may be the result of their presence, while pedunculated growths, or polypi with long pedicles, may cause aggravated symptoms by circumstances of position, the patient being much of the time relatively free. Hoarseness, dyspnea, and cough, without other evidences of inflammation or epidemic disease, should always lead to careful inspection with the laryngoscope, and this will reveal the size and situation of the growth. These examinations can be made with cocaine and give satisfactory information. Only in young children are they difficult, or sometimes impossible. Even in an infant with a hoarse cry and spasmodic or suffocative attacks the condition may be suspected.