Involvement of the larynx and trachea by lymphoma is an uncommon problem that can cause life-threatening airway obstruction. High grade obstruction, involvement of the soft tissue of the neck, and tracheal deviation can make intubation and tracheotomy hazardous, if not impossible. Tracheotomy can be ineffective with obstruction of the distal trachea. The clinical presentation and treatment of eight patients with lymphoma involving the larynx or trachea are presented with emphasis on airway management. Dramatic tumor response with relief of airway symptoms was achieved with a regimen of radiotherapy, chemotherapy, corticosteroids, helium-oxygen mixtures, humidity, and intensive care unit monitoring. Direct airway intervention, including tracheotomy, was usually successfully and safely avoided.