such as vocal rest,
various vocal exercises, etcetera have failed may require surgical
excision. This may be done with the laryngeal tissue forceps or with
the author's vocal nodule forceps. Sessile vocal nodules may be cured
by touching them with a fine galvanocautery point, but all work on the
vocal cords must be done with extreme caution and nicety. It is
exceedingly easy to ruin a fine voice.

_Fibromata_, often of inflammatory genesis, are best removed with the
laryngeal grasping forceps, though the small laryngeal punch or tissue
forceps may be used. If very large, they may be amputated with the
snare, the base being treated with galvanocautery though this is
seldom advisable. Strong traction should be avoided as likely to do
irreparable injury to the laryngeal motility.

_Cystomata_ may get well after simple excision or galvanopuncture of a
part of the wall of the sac, but complete extirpation of the sac is
often required for cure. The same is true of _adenomata._

[202] Angiomata, if extensive and deeply seated, may require deep
excision, but usually cure results from superficial removal. Usually
no cauterization of the vessels at the base is necessary, either to
arrest hemorrhage or to lessen the tendency to recurrence. A diffuse
telangiectasis, should it require treatment, may be gently touched
with a needle-pointed galvanocaustic electrode at a number of
sittings. The galvanonocautery is a dangerous method to use in the
larynx. Radium offers the best results in this latter form of angioma,
applied either internally or to the neck.

_Lymphoma, enchondroma and osteoma_, if not too extensively involving
the laryngeal walls, may be excised with basket punch forceps, but
lymphoma is probably better treated by radium.* _True myxomata and
lipomata_ are very rare. _Amyloid tumors_ are occasionally met with,
and are very resistant to treatment. _Aberrant thyroid tumors_ do not
require very radical excision of normal base, but should be removed as
completely as possible.

In a general way, it may be stated that with benign growths in the
larynx the best functional results are obtained by superficial rather
than radical, deep extirpation, remembering that it is easier to
remove tissue than to replace it, and that cicatrices impair or ruin
the voice and may cause stenosis.

* In a case reported by Delavan a complete cure with perfect
restoration of voice resulted from radium after I had failed to cure
by operati