ve methods. (Proceedings American Laryngological
Association, 1921.)

[203] CHAPTER XXII--BENIGN GROWTHS IN THE LARYNX (Continued)

PAPILLOMATA OF THE LARYNX IN CHILDREN

Of all benign growths in the larynx papilloma is the most frequent. It
may occur at any age of childhood and may even be congenital. The
outstanding fact which necessarily influences our treatment is the
tendency to recurrences, followed eventually in practically all cases
by a tendency to disappearance. In the author's opinion multiple
papillomata constitute a benign, self-limited disease. There are two
classes of cases. 1. Those in which the growth gets well
spontaneously, or with slight treatment, surgically or otherwise; and,
2, those not readily amenable to any form of treatment, recurrences
appearing persistently at the old sites, and in entirely new
locations. In the author's opinion these two classes of case represent
not two different kinds of growths, but stages in the disease. Those
that get well after a single removal are near the end of the disease.
Papillomata are of inflammatory origin and are not true neoplasms in
the strictest sense.

_Methods of Treatment_.--Irritating applications probably provoke
recurrences, because the growths are of inflammatory origin. Formerly
laryngostomy was recommended as a last resort when all other means had
failed. The excellent results from the method described in the
foregoing paragraph has relegated laryngostomy to those cases that
come in with a severe cicatricial stenosis from an injudicious
laryngofissure; and even in these cases cure of the stenosis as well
as the papillomata can usually be obtained by endoscopic methods
alone, using superficial scalping off of the papillomata with
subsequent laryngoscopic bouginage for the stenosis. Thyrotomy for
papillomata is mentioned only to be condemned. Fulguration has been
satisfactory in the hands of some, disappointing to others. It is
easily and accurately applied through the direct laryngoscope, but
damage to normal tissues must be avoided. Radium, mesothorium, and the
roentgenray are reported to have had in certain isolated cases a
seemingly beneficial action. In my experience, however, I have never
seen a cure of papillomata which could be attributed to the radiation.
I have seen cases in which no effect on the growths or recurrence was
apparent, and in some cases the growths seemed to have been stimulated
to more rapid repullulations. In oth