. A manual of diseases of the nose and throat. eir accustomed freedom, and very fre-quently the bulging subglottic tissue projects betweenthe edges of the vocal cords, thereby making it impossi-ble for proper approximation and vibration in the pro-duction of sound. Differential Diagnosis. This disease is to be differen-tiated from rhinoscleroma of the larynx, in which theappearance may be very similar to that just described. 438 DISEASES OF THE LARYNX. Rhinoscleroma, however, is a very rare disease in thiscountry, and is almost invariably accompanied byrhinoscleroma of the nose, where the char
. A manual of diseases of the nose and throat. eir accustomed freedom, and very fre-quently the bulging subglottic tissue projects betweenthe edges of the vocal cords, thereby making it impossi-ble for proper approximation and vibration in the pro-duction of sound. Differential Diagnosis. This disease is to be differen-tiated from rhinoscleroma of the larynx, in which theappearance may be very similar to that just described. 438 DISEASES OF THE LARYNX. Rhinoscleroma, however, is a very rare disease in thiscountry, and is almost invariably accompanied byrhinoscleroma of the nose, where the characteristicsof the disease can well be determined. If the larynxbe cocainized and the swelling touched with a laryngealprobe, that of subglottic laryngitis will be found com-paratively soft and easily indented, while that of rhino-scleroma will be hard, cartilaginous, and scarcely ifat all indented. Where doubt still exists removea portion of the growth by means of the punch forceps(Fig. 106), which is used with the Schroetter handle Fig. Punch forceps for removing laryngeal growths. (Fig. 25). Sections made and stained by Gramsmethod will determine not only the character of thegrowth, but will reveal also the presence of the bacilliof rhinoscleroma. Prognosis. The prognosis in this disease is far moregrave than in diffuse hypertrophic laryngitis. Wherethe swelling is of large size the voice seldom returns tonormal and on account of the dyspnea the patient mayhave to be tracheotomized and wear a canula for therest of his life. Treatment. The internal administration of 10 grainsof potassium iodide, three times a day, may assist in CHRONIC HYPERTROPHIC LARYNGITIS. 439 the retrograde changes and absorption of the newly formed tissue. Caustics, such as nitrate of silver ancNttc^j^* trichloracetic acid, and even the galvano-cautery, have **-* h~dK been employed to reduce the size of this tissue. Theintroduction of caustics into the larynx to remove anovergrowth of tissue in thi
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