Epithelial hyperplasia of the larynx may assume all gradations from simple diffuse thickening in chronic inflammation to localized keratosis, papillomatous masses which fill the larynx or carcinomatous ulceration with extensive invasion. As a result, difficult problems in diagnosis are encountered. Localized areas of thickening of the epithelium which appear as single or multiple chalky white elevations on the upper surface and edge of one or both vocal cords usually with involvement of the membranous portion are not uncommon. These have been designated as keratosis, hyperkeratosis, leukoplakia, pachydermia laryngis or by other terms by laryngologists and pathologists, and by some these terms appear to be used synonymously; others consider them as distinct and different entities. Pachydermia laryngis as described by Virchow referred to thickening of the posterior wall of the larynx and the posterior half of the vocal cords. It was observed in alcoholic addicts or excessive voice users, as street