Laryngeal Polypoid Growths Following Endotracheal Anæsthesia

SINCE the introduction of endotracheal anaesthesia eight cases were reported where this procedure was followed, after some weeks, by the formation of polypoid growths in the larynx. Chevalier Jackson had examined eighty cases by direct laryngoscopy after endotracheal anaesthesia. He found no reaction except that due to the open ether anaesthesia. So it was believed that the formation of such growths was either due to the use of a hard tube ; force against closed cords ; retching after the operation while the tube was still present, or a fault of technique during the introduction of the tube. The first case was reported by Clausen in 10,32. A patient operated upon under gas and O2 endotracheal anaesthesia developed a small granuloma of the posterior end of the larynx below the right vocal cord about five months after the procedure. This was coughed spontaneously by the patient and biopsy revealed blood clots with very little early organization. The second case was reported by Gould (1935)A patient had loss of voice and attacks of choking four months after an operation where endotracheal anaesthesia, gas, O2 and ether was used. At first the attacks remained for a few minutes, after which respiration was regained but the loss of voice remained. The attacks of choking became more prolonged and examination of the larynx showed a subglottic granuloma. This was removed and the patient recovered. Microscopic examination of the growth showed granulation tissue undergoing degeneration. There were no giant cells and no epithelial cells. The third case was reported by Cohen i_5338A patient had an operation under endotracheal anaesthesia where a medium-sized Magill's tube was inserted by the blind nasal route after repeated attempts. She felt some changes of voice and something going up and down in her throat during talking, about nine weeks after the operation. Examination showed a small tumour at the base of the right vocal cord. Biopsy showed fibrous tissue and numerous capillaries lined with large endothelial cells. There was, also, infiltration with lymphocytes and plasma cells. The fourth case, reported by Smiley in 1340, was a patient with a small polypoid swelling in the left side of the larynx about two weeks after endotracheal anaesthesia. Examination two weeks later revealed a large pedunculated swelling below the left vocal cord rising between the cords on phonation. When removed it was about i | x 1 cm., and the pathological examination showed granulation tissue with acute and chronic inflammatory changes. In 1946 the fifth case was reported by Kearney following an operation