Chronic Hyperplastic Laryngitis Research Articles

A General Survey of Pharynlaryngeal Diseases and Voice Disorders Among Basic Education Teachers in Tianjin

ObjectiveIn this study, we created a city-wide database of pharyn-laryngeal diseasess and voice disorders among basic education teachers to analyze the incidence, distribution, and risk factors of Pharyn-laryngeal diseases and voice disorders. MethodsA total of 47,823 teachers in primary and secondary schools and kindergartens of Tianjin were enrolled in this study and underwent questionnaires and throat examinations. In addition, the data were subjected to descriptive statistics, chi-square analysis, and univariate and multivariate logistic regression analyses. ResultsPharyn-laryngeal diseases and voice disorders had an overall prevalence of 69.42% among basic education teachers in Tianjin, wherein the prevalence of chronic pharyngitis, chronic hyperplastic laryngitis, and chronic simple laryngitis were the highest at 39.45%, 19.80%, and 15.59%, respectively. The results of multivariate logistic regression analysis suggest that pharyn-laryngeal diseases and voice disorders were statistically correlated with gender (P<0.001), years of teaching (P<0.001), school district (P<0.001), class size (P<0.001), subjective assessment of teachers on vocal loudness (P<0.001), neck and shoulder discomfort (P<0.001), smoking (P<0.001), psychological stress (P=0.002), and frequent habitual throat clearing (P<0.001). Furthermore, the risk factors for pharyn-laryngeal diseases and voice disorders were age (P=0.002), school district (P<0.001), class size (P=0.008), neck and shoulder discomfort (P=0.038), smoking (P<0.001), water intake habits during class (P=0.023), and frequent habitual throat clearing (P=0.001) for male teachers and for female teachers it was age (P<0.001), school district (P<0.001), daily teaching hours (P=0.005), class size (P<0.001), subjective assessment of teachers on vocal loudness (P<0.001), neck and shoulder discomfort (P<0.001), smoking (P=0.033), psychological stress (P=0.003), and frequent habitual throat clearing (P<0.001). ConclusionDue to the high prevalence of pharyn-laryngeal diseases and voice disorders among basic education teachers, throat and voice health education-related activities should be conducted for teachers, to intervene in the occurrence of pharyn-laryngeal diseases and voice disorders at an early stage.

Analysis of clinical cases of malignancy in chronic hyperplastic laryngitis

Objective . To analyze cases of malignancy in chronic hyperplastic laryngitis (CHL) among patients subject to regular medical check-up (MC) in the Dobrush district of the Gomel region. Materials and methods . Patients diagnosed with CHL who as of October 1, 2021 were subject to regular otorhinolaryngology MC in the Dobrush district of the Gomel region were included into the study. There were 39 men (64%) and 22 women (36%). The mean age of the patients was 54.5 years (from 32 to 82 years). The research methods included patient data analysis, video endoscopy of the larynx, and biopsy followed by morphological study. Results . As of October 1, 2021, the patients subject to regular otorhinolaryngology MC (from a few months to 30 years) were patients diagnosed with CHL in the Dobrush district of the Gomel region from 1991 to 2021. At the time of being diagnosed, 87% (53 of 61) of the patients were of working age; 27 (44%) patients visited doctors once a year or more rarely; 27 (44%) patients had received only outpatient treatment which consisted mainly of antibiotic therapy. During inpatient treatment, biopsy was performed in 15 (25%) patients. All the patients were called to attend the appointment for video endoscopy of the larynx. In 3 (5%) cases, the examination of the larynx revealed a pathological process suspicious of malignancy. As a result of the biopsy, cancer was detected in all the 3 cases. Conclusion . The study has analyzed cases of malignancy in CHL during the period of patient dispensary observation, identified factors contributing to malignancy: non-compliance with the terms of MC; prolonged dispensary registration without thorough examination, biopsy and verification of the CHL form; inadequate treatment including numerous ineffective courses of antibiotic therapy.

Анализ диагностики и лечения хронического гиперпластического ларингита в Республике Беларусь на примере пациентов Добрушского района Гомельской области

Objective. To analyze the current state of diagnosis and treatment of patients with chronic hyperplastic laryngitis (CHL) for the period 2010–2021 in the Republic of Belarus on the example of patients in the Dobrush District of the Gomel Region and to identify shortcomings for the subsequent development of measures to prevent malignant diseases of the larynx. Material and research methods. The material for the study was patients of the Dobrush District of the Gomel Region (61 patients: 39 (64%) men and 22 (36%) women) with a diagnosis of chronic hyperplastic laryngitis who are registered with an otorhinolaryngologist. The median age at diagnosis was 45.6 years (18 to 76 years). In the age distribution, 2 peaks were observed: from 36 to 40 years and from 51 to 55 years – 16% (10 out of 61) of the entire group, 87% of patients were of working age. Results and discussion. Patients with precancerous diseases of the larynx, who are on regular medical check-up in the Dobrush Central District Hospital, were analyzed. Age-specific incidence rates were analyzed and differentiated by gender and place of residence. The analysis of symptoms, the time spent by patients on regular medical check-up, the frequency of visits to the otorhinolaryngologist in the order of regular medical check-up was carried out. All patients had voice changes of various nature and severity: 50 (82%) patients complained of hoarseness, 6 (10%), of hoarseness, 5 (8%) had aphonia. More than half of the patients had the following complaints: feeling of a coma or a foreign body in the throat – 90%, the presence of a cough not associated with colds – 75%, and shortness of breath on exertion – 70% of patients. The median time spent by patients on regular medical check-up was 5 years (from 0 for patients registered in 2021 to 30 years). The frequency of visiting an otorhinolaryngologist in the order of regular medical check-up was from 1 time in 2–4 months (10% of patients) up to 1 time in 5 years (3%), 44% – 1 time per year, 27 (44%) patients received outpatient treatment, 5 (8%) patients received inpatient treatment, and 29 (48%) patients received both outpatient and inpatient treatment. During inpatient treatment, 16 (47%) hospitalized patients underwent surgical treatment to remove hyperplastic areas of the mucosa, the rest received antibiotic therapy, 15 (44%) patients underwent a biopsy. Conclusion. The study revealed a number of problems in the diagnosis and treatment of CHL, the main of which is the establishment of a generalized clinical diagnosis without performing a biopsy and clarifying the form of CHL and, as a result, conducting numerous ineffective courses of conservative treatment, both on an outpatient basis and in a hospital setting. It is necessary to develop a system of measures to improve the effectiveness of treatment of patients with CHL and the prevention of malignant neoplasms of the larynx.

THE ACTIVITY OF CIRCULATING PROTEASOMES IN TUMOR AND PRECANCEROUS DISEASES OF THE HEAD AND NECK ORGANS

Introduction. Identification of persons with a high oncological risk to squamous cell carcinoma of the head and neck region is an urgent problem for the early diagnosis of this disease. The activity of circulating proteasomes can be a criterion for predicting the risk of the larynx and oral cavity cancers in patients with precancerous diseases of the upper respiratory and gastrointestinal tracts. The aim of the study is to investigate the chymotrypsin-like and caspase-like activities of circulating serum proteasomes depending on the localization of precancerous and neoplastic diseases of the larynx and oral cavity. Material and Methods. The study population consisted of 35 patients with histologically verified HNSCC (T1–3N0–3M0), 15 patients with chronic hyperplastic laryngitis (CHL) and oral leukoplakia, and 10 healthy volunteers who did not have chronic upper respiratory tract diseases in the acute stage. The median age of the patients was 53 ± 5.3 years. Results. An increase in the studied proteasome activities was found in the blood serum of patients with malignant tumors as compared with patients with chronic hyperplastic diseases associated with precancerous changes, as well as in the larynx and oral cavity cancers groups as compared with healthy donors. At the same time, depending on the localization of the pathological process, it was shown that only the chymotrypsin-like activity of the circulating pool of proteasomes significantly differs both in the groups of oral cancer leukoplakia, and in the groups of laryngeal cancer chronic hyperplastic laryngitis with dysplastic epithelial lesions. In addition, differences were found between chymotrypsin-like and caspase-like activities of circulating serum proteasomes in patients with chronic hyperplastic laryngitis with oral dysplasia and leukoplakia. Conclusion. The results obtained indicate that the determination of the CTp activity of the circulating pool of proteasomes can be used as a criterion for predicting the risk of the larynx and oral cavity cancers in patients with precancerous diseases of the larynx and oral cavity.

Клиническая характеристика предраковых поражений гортани

Currently, the issues of differential diagnosis of precancerous lesions of the larynx and their prognosis remain unresolved. The study of the characteristic clinical signs of precancerous lesions of the larynx remains an urgent problem. The article presents the clinical characteristics of precancerous lesions of the larynx based on the results of video laryngoscopy, morphological analysis of the tumor, data of an objective examination, and complaints. The main symptoms were cough (80.56%), as well as voice deterioration after voice load (75.0%), and persistent voice changes in the form of husky or hoarse voice 72.22% and 58.33%, respectively. A significant prevalence of the frequency of sensation of a foreign body, difficulty in breathing, and choking when eating was established in the papillomatosis group in comparison with patients with chronic hyperplastic laryngitis. In chronic hyperplastic laryngitis, on the other hand, the number of complaints of voice changes increased: voice deterioration after voice load was noted, hoarseness, and aphonia. According to video laryngoscopy, among patients with hyperplastic laryngitis, the majority (84.6%) had a thickening and/or uneven relief of the mucous membrane of the vocal folds, and in patients with papillomatous changes in the larynx, single neoplasms prevailed (72.7%) on one of the vocal folds. It is worth noting that during the morphological examination the clinical and endoscopic diagnosis was confirmed in all patients. The results obtained confirm the feasibility and necessity of examining the upper respiratory tract using modern, high-tech endoscopic techniques and taking biopsy material in patients with chronic inflammatory diseases of the larynx.

Association of mRNA Expression Levels of LRP1 and Actin-Binding Proteins with the Development of Laryngeal and Laryngopharyngeal Squamous Cell Carcinoma.

We analyzed the association of the level of mRNA expression of the main endocytosis receptor LRP1 and actin-binding proteins (ezrin, profilin-1, cofilin-1, and adenylyl cyclase-associated protein 1) with the development and metastasis of laryngeal and laryngopharyngeal squamous cell carcinoma. The mRNA expression was evaluated in paired tissue samples using quantitative reverse transcription real-time PCR (RT-qPCR) and SYBR Green reagents. The study included 38 patients with stage T1-4N0-1M0 laryngeal and laryngopharyngeal squamous cell carcinoma and 10 patients with chronic hyperplastic laryngitis or grade II-III epithelial dysplasia. The expression of LRP1 in patients with laryngeal and laryngopharyngeal squamous cell carcinoma depended on the stage of the tumor process. Against the background of low expression of LRP1 mRNA, the relationship between cofilin 1 and profilin 1 expression became stronger (r=0.08; p=0.05) and a correlation between cofilin 1 and esrin expression (r=0.7; p=0.05) appeared. Studies on a larger patient cohort are required to make a definite conclusion on the role of LRP1 in the development of laryngeal and laryngopharyngeal squamous cell carcinoma.

Хронический гиперпластический ларингит у профессионалов голоса

The aim of the study was to improve the efficiency of diagnosis of various forms of chronic hyperplastic laryngitis, which is referred to as precancerous conditions of the larynx, video laryngostroboscopy was performed in 249 patients. All patients have occupational hazards: increased voice load, smoking, working capacity in a hospital state during acute respiratory viral infections, laryngitis, bronchitis. In case of detection of areas of dyskeratosis of mucous membrane of vocal folds (leukoplacia, hyperkeratosis) biopsy followed by histological examination was carried out. The results of a histological study of leukoplakia showed the presence of metaplasia of stratified squamous epithelium in 100% of the examined. Among patients with vocal fold hyperkeratosis, metaplasia of stratified squamous epithelium was detected in 20,8%, grade II and III dysplasia – 15,1% of observations. 64,1% of patients were diagnosed with laryngeal cancer. The video laryngostroboscopic picture of the larynx in various forms of chronic hyperplastic laryngitis was studied. According to the results of the study, pathological changes in the mucosa of the vocal folds with possible malignation include hyperkeratosis. During video laryngostroboscopy, asymmetric, irregular, mucous waves oscillate in the hyperkeratosis area in 60,4% of patients, and in 39,6% of patients the absence of vibrations of the vocal fold in the area of hyperkeratosis is diagnosed.

Современный подход к диагностике хронического ларингита

The timely detection and treatment of chronic hypertrophic laryngitis is a task of particular importance, it is the main link in the prevention of malignant diseases of the larynx. The traditional diagnostic methods do not always provide proper assessment of the state of the larynx in chronic laryngitis and the dynamics of recovery processes during therapeutic activities. Therefore, the combined use of modern methods of examination of the larynx condition is getting more and more important. Based on examination of 15 men and 5 women aged from 24 to 72 years previously treated for chronic hypertrophic laryngitis, it has been shown that video stroboscopy, autofluorescence diagnostics, NBI endoscopy, and cytological examination of swabs from the affected vocal fold areas are methods of early diagnostics of chronic hyperplastic laryngitis, they can complement each other not only in the event of diagnostic difficulties, but in the assessment of efficacy of treatment and rehabilitation measures aimed at restoration of laryngeal functions and prevention of the development of tumors. The data obtained made it possible to clarify the nature of the hypertrophic changes in the mucous membrane of the vocal folds and thereby confidently interpret the clinical picture of the disease in the examined patients as a manifestation of chronic hyperplastic laryngitis with leukokeratosis and leukoplakia.

Molecular features of head and neck squamous cell carcinoma

Relevance.To identify new markers of early diagnosis and prognosis of head and neck squamous cell carcinoma (HNSCC) it is necessary to study the molecular features of this disease.Purpose.The aim of the study was to analyze blood serum protein spectrum in patients with HNSCC and in healthy volunteers using the methods of mass spectrometry and to evaluate the selected serum protein markers as candidates for early detection of HNSCC.Materials and Methods: The blood serum of HNSCC patients before therapy with metastases, without metastases and healthy volunteers was studied by proteomic methods. Validation of the results of proteomic analysis was carried out by ELISA in serum of 52 patients with HNSCC (T1-4N0-3M0), 10 patients with chronic hyperplastic laryngitis, dysplasia DII-DIII and 10 healthy volunteers. The statistical analysis was carried out using Statistica 6.0. Software package.Results.Blood serum proteome of HNSCC patients with metastases, without metastases and healthy volunteers are different and contain proteins of different classes. Adenylyl cyclase-associated protein 1 (CAP1) and protein phosphatase 1B (PPM1B) were selected to validate the obtained results. It was shown that the serum level of CAP1 and PPM1B differed in control and dysplasia groups and dysplasia and cancer groups (p ≤ 0,05). In patients with HNSCC (T1N0M0) the serum CAP1 and PPM1B levels were higher than in patients with dysplasia and healthy individuals (p ≤ 0,05). It was noted the positive correlation of the CAP1 level in the serum with the presence of metastases and the PPM1B level.Conclusion.Candidates for serum markers of HNSCC prognosis were identified. The difference in serum levels of CAP1 and PPM1B depending on the prevalence of primary tumors and the difference in serum level of CAP1 depending on the presence of regional metastases was shown. Determination of CAP1 level in the serum can be useful for early diagnosis and prognosis of HNSCC.

PROTEIN PHOSPHATASE 1В IN THE PATHOGENESIS OF LARYNGEAL AND HYPOPHARYNGEAL CANCER

To predict the development and clinical course of squamous cell head and neck carcinoma (SCHNC), we studied the level of protein phosphatase 1B (РРМ1В) using the proteomic analysis. Verification of the results of proteomic analysis by ELISA showed that the level of РРМ1В in blood serum of patients with SCHNC depended on the disease stage. The level of РРМ1В in the blood serum of patients with stage T1N0M0 cancer was higher than that observed in the control group and in patients with chronic hyperplastic laryngitis. In tumor tissue, the level of РРМ1В was associated with the size of the primary tumor and the presence of metastases. In tumor tissue, the level of РРМ1В was also higher in patients with stage T1N0M0 than in patients with chronic hyperplastic laryngitis. The data obtained indicate that the level of РРМ1В can be used for early detection and prediction of the clinical course of SCHNC. Further studies with larger cohorts of patients are required to evaluate the prognostic significance of the РРМ1В level.

САР1 AS A SERUM MARKER FOR EARLY DETECTION OF LARYNGEAL AND HYPOPHARYNGEAL CANCERS

Squamous cell carcinoma of head and neck (SCCHN) is often asymptomatic until it reaches the advanced stage. Currently, there are no available markers that can accurately predict the risk of progression of epithelial dysplasia to squamous cell carcinoma. The purpose of the study was to evaluate the feasibility of using the level of adenylyl cyclase-associated protein 1 (CAP-1) in the blood serum to identify groups of increased risk of cancer in patients with chronic laryngeal and hypopharyngeal hyperplasia associated with epithelial dysplasia. Material and methods. The blood serums from 45 patients with SCCHN ( T 1–4 N 0–3 M 0 ), 12 patients with chronic inflammatory laryngeal and hypopharyngeal diseases and 15 heath subjects were examined. The blood analysis was performed using the CAP1 ELISA kit (Cusabio) on the Biochrom Anthos 2020 Microplate IEA Reader. Results . The serum level of САР 1 was higher by 75 % in patients with SCCHN ( Т 1 N 0 M 0 ) than in patients with chronic hyperplastic laryngitis. Moreover, differences in the serum level of САР 1 were observed between healthy subjects and patients with chronic laryngeal hyperplasia. In SCCHN patients with regional metastases, CAP1 concentration in the blood serum was 2 times higher compared to that observed in SCCHN patients without regional metastases (p≤0.01). Conclusion . The study results showed the feasibility of using the level of CAP1 for distinguishing patients with chronic hyperplastic laryngitis from those with laryngeal cancer, as well as for early detection of SCCHN and the development of new method for prediction of disease.

Endoscopic diagnosis of premalignant diseases and laryngeal cancer in the phoniatric practice

Laryngeal cancer still occupies the leading position among malignant neoplasms of the upper respiratory tract. The detection of laryngeal cancer in situ occurs only in 2.3–6% of cases. It is explained by the complexity of differential diagnosis between dyskeratosis and cancer in situ of the vocal folds. The objective of the study was to identify pathognomonic differential-diagnostic signs of videoendostroboscopic and auto-fluorescent larynx picture in the patients with premalignant diseases and early stages of the vocal folds cancer. The study included 110 patients with premalignant diseases and suspected for early stage of laryngeal cancer. All the patients underwent biopsy of mucosa areas that caused oncological alertness. As a result, squamous cell carcinomas in situ and T1 have been detected in 58 (52.7%) patients, chronic hyperplastic laryngitis with stage 2-3 mucosa dysplasia – in 32 (29.1%), chronic hyperplastic laryngitis with metaplasia sections – 12 (10.9%) patients, benign neoplasms– 4 (3.6%), tumor-like diseases – 4 (3.6%) patients. According to videoendostroboscopy results, most of 58 patients with cancer, 46 (79.3%) people, had no vocal fold vibrations and mucotic waves. Less frequently they were preserved, but had reduced amplitude and were irregular. During auto-fluorescent endoscopy the decrease in fluorescence intensity was observed in almost all cases – in 57 (98.3%) patients. In 32 patients with stage 2–3 dysplasia videoendostroboscopy showed lower amplitude of the vocal folds vibration, they were irregular in 30 (93.7%) observations, mucosal wave stopped at the lesion site in 27 (84.4%) observations. Vocal folds vibrations were absent in 2 (6.3) patients. In auto-fluorescent endoscopy, the increase in fluorescence intensity was observed in most cases – in 25 (78.1%) patients. Timely performed videoendostroboscopy in combination with auto-fluorescent larynx endoscopy provides the increase of efficacy of diagnostics of premalignant changes and early vocal folds cancer.

DIAGNOSTICS AND TREATMENT OF PATIENTS WITH PAPILLOMATOSIS OF LARYNX AND VARIOUS FORMS OF CHRONIC HYPERPLASTIC LARYNGITIS

In the article the questions of diagnostics and treatment of patients with recurrent papillomatosis of larynx, singular papillomas and various forms of chronic hyperplastic laryngitis from the present-day view-points have been presented. The most optimal schemes of treatment for recurrent papillomatosis of larynx were suggested.

ISSUES OF LARYNX PATHOLOGY

The present paper dwells upon larynx pathology and reveals the prevalence of separate nosological forms. It has been defined that chronic hyperplastic laryngitis is an obligate form of pre-cancerous diseases of the larynx and appears mainly in men aged 51-85. By our data, Gomel area of the Gomel region dominates by the number of larynx diseases cases (25%).

Manifestations of gastroesophageal reflux in the otorhinolaryngology tract

Gastroesophageal reflux disease (GERD) is associated with a wide spectrum of otolaryngologic disorders and extraesophageal complications of the upper aerodigestive tract. Previous studies of patients diagnosed with GERD have reported symptoms such as asthma, chronic cough, pneumonia, laryngitis, but also other oral, rhinopharyngeal and laryngeal disorders, e.g. sore throat, globus sensation, and hoarseness. The objective of this study was to determine the incidence of gastroenterologic diseases in patients complaining of upper aerodigestive, pulmonary, laryngeal, pharyngeal, oral, and cervical disorders that are possibly attributable to GERD. This study included 40 patients, who presented to the department of Otolaryngology with chronic complaints of at least one of the following symptoms or disorders during a minimum period of 3 months: dysphagia (n = 28), sensation of globus pharyngeus (n = 28), hoarseness (n = 20), odynophagia (n = 22), heartburn (n = 16), postnasal drip (n = 15), sore throat (n = 22), cough (n = 14), throat clearing (n = 11), laryngospasm (n = 6), and voice fatigue (n = 6). A complete examination of the head and neck was performed. Inflammatory disorders of the nose and the paranasal sinuses could not be confirmed by history, nasal endoscopy and Water's view x-ray or CT-scan of the paranasal sinuses in all patients. The main otorhinolaryngologic findings were laryngeal lesions (n = 38), including posterior laryngitis, erythema and edema of the interarytenoideal region, and chronic hyperplastic laryngitis. All patients were referred for gastroenterologic evaluation, where esophagogastroduodenoscopy was performed with histological examination of biopsy specimens. Different gastroenterologic diseases such as GERD, gastritis and hiatal hernia were confirmed in 30 of 40 cases, and appeared solely or in combination with each other. GERD was the most frequent gastroenterologic disease (48%), followed by hiatal hernia (45%) and Helicobacter pylori positive antrum gastritis (23%). Patients with GERD were treated with medical antireflux therapy, e.g. 20 mg to 40 mg of the proton pump inhibitor omeprazole daily. There was a remarkably good therapeutic outcome, since laryngeal disorders and findings as the result of gastroenterologic diseases resolved in 29 out of 30 patients. To date, these therapeutic results were maintained for the mean follow-up period of 8 months. It is concluded that in many patients, suffering from the above-mentioned otolaryngologic symptoms, occult gastroesophageal diseases are present. However, laryngoscopic findings are subtle and meticulous examination is mandatory. Medical antireflux treatment is effective for relief of symptoms and mucosal healing. Thus, extraesophageal otolaryngologic symptoms and laryngeal manifestations are to be considered as extragastrointestinal manifestations mainly of reflux disease.

Brush cytology and HPV detection in chronic laryngitis and papillomatosis

We investigated the utility of cytologic studies (including follow-up studies) in our specialty in determining the prevalence of human papillomavirus, specifically in the larynx. We utilized Papanicolaou's method of exfoliative cytology and in situ hybridization of the culture (biotin-marked DNA probes). 486 patients with chronic hyperplastic laryngitis and 74 patients with papilloma were enrolled in the study. In 198 typings in 132 patients (59 patients with papilloma, 41 with chronic hyperplastic laryngitis, 17 with cancer, and 15 healthy), we found distributions of the individual types that were independent of the diagnosis. Particularly often, we encountered human papillomavirus types 18 and 31 in the presence of dysplasia, human papillomavirus type 16 in the presence of cancer, and type 11 in general. Cytologic examination and human papillomavirus typing of the culture permit us to define a third risk category in addition to the known risk groups smokers and dysplasia patients. Besides this, cytologic follow-up studies can provide further insight into the behavior of preneoplastic epithelial changes.

Bilateral polypoid granuloma of the larynx following endotracheal anesthesia; report of a case.

THE EXTENSIVE use of endotracheal anesthesia has brought to light some pathological alterations of the vocal cords following injuries which had formerly been observed but which, owing to the limited use of this kind of anesthesia, had not drawn due attention. Recently published works give no description of bilateral polypoid granuloma of the following endotracheal anesthesia, thus not being up-to-date with regard to this clinical its etiology, laryngoscopic picture, and histology. More emphasis must be given to the expression specific clinical feature, since the lesion is a part of the nosological entity simple chronic hyperplastic laryngitis with polypoid elaboration which develops on a substratum of simple chronic laryngitis or follows an operation. This paper concerns exclusively the so-called laryngeal granuloma (of no origin) following endotracheal anesthesia, or inflammatory polypoid granuloma of the larynx following endotracheal anesthesia to which attention was first drawn by R. J. Clausen,