lous and leukemic
adenitides are sometimes favorably influenced by the same agents.
Surgery will relieve the compression of struma and benign neoplasms,
and may be indicated in certain neoplasms of malignant origin. The
possible coexistence of laryngeal paralysis with tracheal compression
is frequently overlooked by the surgeon. Monolateral or bilateral
paralysis of the larynx is by no means an uncommon postoperative
sequel to thyroidectomy, even though the recurrent nerves have been in
no way injured at operation. Probably a localized neuritis, a
cicatricial traction, or inclusion of a nerve trunk accounts for most
of these cases.

_Hyperplastic and cicatricial chronic stenoses_ preventing
decannulation may be classified etiologically as follows:
1. Tuberculosis
2. Lues
3. Scleroma
4. Acute infectious diseases
(a) Diphtheria
(b) Typhoid fever
(c) Scarlet fever
(d) Measles
(e) Pertussis
5. Decubitus
(a) Cannular
(b) Tubal
6. Trauma
(a) Tracheotomic
(b) Intubational
(c) Operative
(d) Suicidal and homicidal
(e) Accidental (by foreign bodies, external violence, bullets,
etc.)

Most of the organic stenoses, other than the paralytic and neoplastic
forms, are the result of inflammation, often with ulceration and
secondary changes in the cartilages or the soft tissues.

[304] _Tuberculosis_.--In the non-cicatricial forms, galvanocaustic
puncture applied through the direct laryngoscope will usually reduce
the infiltrations sufficiently to provide a free airway. Should the
pulmonary and laryngeal tuberculosis be fortunately cured, leaving,
however, a cicatricial stenosis of the larynx, decannulation may be
accomplished by laryngostomy.

_Lues_.--Active and persistent antiluetic medication must precede and
accompany any local treatment of luetic laryngeal stenosis. Prolonged
stretching with oversized intubation tubes following excision or
cauterization may sometimes be successful, but laryngostomy is usually
required to combat the vicious contraction of luetic cicatrices.

_Scleroma_ is rarely encountered in America. Radiotherapy has been
advocated and good results have been reported from the intravenous
injection of salvarsan. Radium may be tried, and its application is
readily made through the direct laryngoscope.

_Diphtheria_.--Chronic postdiphtheritic stenosis may be of the panic,
spasmodic or, rarely, the paralytic types; but more often it is of