Showing papers in "Archives of Otolaryngology-head & Neck Surgery in 1977"
TL;DR: In this paper, the authors provide an account of current trends in auditory research on a level not too technical for the novice, by relating psychological and perceptual aspects of sound to the underlying physiological mechanisms of hearing in a way that the material can be used as a text to accompany an advanced undergraduate or graduate level course in auditory perception.
Abstract: The author's stated general approach is to relate the psychological and perceptual aspects of sound to the underlying physiological mechanisms of hearing in a way that the material can be used as a text to accompany an advanced undergraduate- or graduate-level course in auditory perception. The attempt is to provide an account of current trends in auditory research on a level not too technical for the novice. Psychoacoustic studies on humans and physiological studies on animals serve as the primary bases for subject matter presentation, and many practical applications are offered. Among the chapters are the following: the nature of sound and the structure of the auditory system; loudness, adaptation, and fatigue; frequency analysis, masking, and critical bands; pitch perception and auditory pattern perception; space perception; and speech perception. Within these chapter headings special attention is given to a number of topics, including signal detection theory, monaural and binaural hearing,
1,956 citations
TL;DR: Acoustic tumor size can be estimated from the amount of latency delay, which was 0.4 msec or greater for 35 acoustic tumor cases and for seven of ten other temporal bone tumors.
Abstract: • Tumors that press on the auditory nerve can cause a latency increase that is detectable from the scalp by electric response audiometry (BERA). The response delay is best seen by comparing the Jewett wave V, or P5, latencies for the two ears. This interaural latency difference is normally less than 0.2 msec, but was 0.4 msec or greater for 35 acoustic tumor cases and for seven of ten other temporal bone tumors. Acoustic tumor size can be estimated from the amount of latency delay. (Arch Otolaryngol103:181-187, 1977)
359 citations
TL;DR: CBA/J mice deprived of airborne sound stimulation during postnatal development have smaller globular cells in the ventral cochlear nucleus and smaller neurons in the medial nucleus of the trapezoid body than do normal control mice.
Abstract: • CBA/J mice deprived of airborne sound stimulation during postnatal development have smaller globular cells in the ventral cochlear nucleus and smaller neurons in the medial nucleus of the trapezoid body than do normal control mice. The sound deprivation in these mice is similar to that experienced by persons with pure congenital conductive hearing losses. Even more profound central neural changes were found in auditory nuclei in the brain stem of a congenitally sensorineural deaf human. ( Arch Otolaryngol 103:392-396, 1977)
271 citations
TL;DR: Ears with retrocochlear deficits in the subjects in the study were detected reliably by prolonged N1 to V interval and increased BSER peak V latency, and the reliability of these retro cochlear signs was further increased by allowing for the effects of audiogram shape.
Abstract: • Simultaneously recorded auditory nerve action potentials (APs) and brain stem auditory-evoked responses (BSERs) were correlated with audiogram shape and with location of pathologic condition. High frequency (4 to 8 kHz) hearing loss (1) prolongs AP and BSER latency, (2) shortens the interval between the first AP peak (N1) and the fifth BSER peak (V), and (3) creates relatively large latency differences between condensation and rarefaction responses (thus bringing into question the common practice of combining condensation and rarefaction responses). Ears with retrocochlear deficits in the subjects in the study were detected reliably by prolonged N1to V interval and increased BSER peak V latency. The reliability of these retrocochlear signs was further increased by allowing for the effects of audiogram shape. Another retrocochlear sign, termed "inappropriate AP preservation," was positive in 40% to 50% of the retrocochlear ears. (Arch Otolaryngol103:605-622, 1977)
266 citations
TL;DR: Maturational descent of the epiglottis, found to occur between 4 and 6 months of age, is verified by cineradiography, and represents a discrete developmental event manifesting the potential for oral tidal respiration from a pattern of obligate nasal breathing.
Abstract: The function of the epiglottis in adult man is unclear. However, during early infancy the epiglottic cartilage appears to play an important role in separating the upper respiratory tract from the upper digestive tract. This separation is accomplished by approximation of the epiglottis to the palate, providing a continuous airway from the nose through the larynx into the trachea. This structural arrangement, however, is uniquely lost in man during postnatal development. Maturational descent of the epiglottis, found to occur between 4 and 6 months of age, is verified by cineradiography. This structural change, requiring a reorganization of respiratory function, represents a discrete developmental event manifesting the potential for oral tidal respiration from a pattern of obligate nasal breathing. This period, four to six months postnatally, interestingly coincides with the peak incidence of sudden infant death syndrome (crib death), which similarly occurs at 3 to 5 months of age.
148 citations
TL;DR: The results of this investigation in general confirm previous studies, although percentage figures for positive tests differed in the large series.
Abstract: • Auditory test results in the first 53 cases of this series of 500 acoustic neuromas were reported in 1964. Subsequent studies involving larger numbers of patients detailed new results based on these additional cases. Five hundred cases of surgically confirmed acoustic neuromas were analyzed. Pure-tone loss configurations, speech discrimination, auditory adaptation as measured by the modified tone decay test, Bekesy audiometry, short increment sensitivity index test, and alternate binaural loudness balance test data were evaluated. The results of this investigation in general confirm previous studies, although percentage figures for positive tests differed in the large series. Acoustic reflex results were reported for those patients evaluated more recently. Slightly more than half of the cases had inconsistent audiometric results in one or more aspects. Inconsistencies to the tests were examined in detail. Consistent responses to the tests appear to be related to the size of the lesion. The full battery of audiologic tests is of importance in the differential diagnosis of acoustic neuromas. (Arch Otolaryngol103:152-158, 1977)
125 citations
TL;DR: It is concluded that partial glossectomy is effective treatment for control of localized disease and more aggressive prophylactic treatment in the form of neck dissection or radiotherapy is indicated for lesions larger than 2 cm.
Abstract: • One hundred fifty patients with squamous cell carcinoma of the oral tongue (anterior two thirds) treated initially by surgery alone were analyzed and factors influencing survival were evaluated. Thirteen patients who died without evidence of disease in less than five years were excluded, leaving 137 determinate cases for review. The overall survival was 67.9%. The presence or absence of cervical node metastases appeared to be the most important determining factor in this series. The size of the primary lesion in itself did not play a substantial role in local control. However, overall survival was affected because the larger the primary lesion the higher the incidence of cervical metastases, and therefore, the lower the survival. It is concluded that partial glossectomy is effective treatment for control of localized disease (92.7%). Since cervical node metastases lowered the survival figure to 31%, it appears that more aggressive prophylactic treatment in the form of neck dissection or radiotherapy is indicated for lesions larger than 2 cm. (Arch Otolaryngol103:212-215, 1977)
118 citations
TL;DR: Comparison of performance vs intensity functions for both phonemically balanced words and synthetic sentence identification yields patters useful in differentiating among peripheral and central sites of auditory disorder.
Abstract: • The scope of speech audiometry can be expanded to provide useful diagnostic information. Comparison of performance vs intensity (PI) functions for both phonemically balanced (PB) words and synthetic sentence identification (SSI) yields patterns useful in differentiating among peripheral and central sites of auditory disorder. (Arch Otolaryngol103:216-222, 1977)
108 citations
TL;DR: The findings support the idea of the primary soft-tissue spread of cholesteatoma in children, and Cavity obliteration with canal wall down technique proved safe, even in the cases of the most extensive and active cholESTeatoma.
Abstract: • The 65 cholesteatomas operated on in children showed a more expansive and rapid growth than those in adults. In one fifth of the cases cholesteatoma filled the whole air-cell area, which was wide in half of the children. Fifty-two ears of these children had an attic or a posterosuperior perforation. One case was complicated by a fistula in the horizontal semicircular canal, and the ossicular chain was unbroken in 23 cases (35%). Thus, the findings support the idea of the primary soft-tissue spread of cholesteatoma in children. Five ears (8%) discharged postoperatively, and three ears (5%) were reoperated on and showed residual tympanal cholesteatoma. Cavity obliteration with canal wall down technique proved safe, even in the cases of the most extensive and active cholesteatoma. ( Arch Otolaryngol 103:74-77, 1977)
106 citations
TL;DR: None of the patienqs had developed pulmonary hypertension, cor pulmonale, or other reported complications of prolonged upper airway obstruction, all of which may have been averted by early diagnosis and treatment.
Abstract: The authors examined four children with substantial adenotonsillar enlargement that caused intermittent severe upper airway obstructive episodes, documented by all-night polygraphic monitoring of sleep and respirations. Previously unreported complications of severe adenotonsillar enlargement that were demonstrated included prolonged obstructive apneic episodes and disturbed sleep patterns. The children also exhibited daytime hypersomnolence. Polygraphic sleep studies after adenotonsillectomy confirmed improved sleep patterns and relief of the obstructive episodes. None of our patienqs had developed pulmonary hypertension, cor pulmonale, or other reported complications of prolonged upper airway obstruction, all of which may have been averted by early diagnosis and treatment.
106 citations
TL;DR: The records of 508 patients who had undergone radical neck dissection were reviewed and 28 patients were found to have tumor attached to the carotide arterial system, with the mean survival time being 16.9 months.
Abstract: • The records of 508 patients who had undergone radical neck dissection were reviewed. Twenty-eight of these patients (5.5%) were found to have tumor attached to the carotid arterial system. Twenty-four patients (86%) died with tumor, the mean survival time being 16.9 months. Local recurrence of tumor in the neck occurred in 46% of the patients and distant metastases in 67%. Eighteen percent of those who developed local recurrence did so in the absence of distant metastases and might have benefited from a more aggressive approach toward the tumor. ( Arch Otolaryngol 103:70-73, 1977)
TL;DR: The case reports of 88 patients who received endotracheal intubation for airway problems are reviewed and the complication rate is evaluated as it correlates to the various contributing factors of duration ofintubation, size of endotrachesal tube, frequency of intubations, concomitant infections, and age of patient.
Abstract: • Different opinions have developed on the use of endotracheal intubation in newborns and neonates for airway distress syndrome. The ensuing complications of the prolonged use of these airway tubes are drawing increased interest. This article reviews the case reports of 88 patients who received endotracheal intubation for airway problems and evaluates the complication rate as it correlates to the various contributing factors of duration of intubation, size of endotracheal tube, frequency of intubation, concomitant infections, and age of patient, which all lead to the complication rate. ( Arch Otolaryngol 103:329-335, 1977)
TL;DR: The recognition of anerobic middle ear infections may be clinically significant because the susceptibilities of the organisms to antimicrobial agents and to air are characteristically different from those of aerobic or facultative bacteria.
Abstract: The bacteriology of 70 consecutive cases of active chronic otitis media was studied. Using appropriate technology, anaerobic bacteria were recovered in 33%, Bacteroides species accounting for one half of them. They were always found in mixed infections involving the average of 3.8 bacteria, 1.9 anaerobic, and 1.9 facultative species. The bacteriology was relatively stable from one ear to the other in the ten bilateral cases studied. The results were alike in the groups differing with respect to local antimicrobial therapy or appearance of the middle ear discharge. The cases with chronic otitis in spite of previous radical surgery presented more often with anaerobic infection than the unoperated ones, and none of them yielded sterile cultures. The recognition of anerobic middle ear infections may be clinically significant because the susceptibilities of the organisms to antimicrobial agents and to air are characteristically different from those of aerobic or facultative bacteria.
TL;DR: The BER test proved to be a highly reliable diagnostic tool when used in assessing "difficult-to-test" patients and identified new patients with peripheral auditory abnormality who subsequently received confirming conventional audiological tests.
Abstract: Evaluation of the peripheral auditory system was attempted in 81 infants and children using an electrophysiological response, the brain stem auditory evoked response (BER). These measurements, which were successfully made in all cases, were supplemented with impedance measures in some subjects. Results were compared with previous and follow-up audiograms whenever possible. The BER test proved to be a highly reliable diagnostic tool when used in assessing "difficult-to-test" patients. It also identified new patients with peripheral auditory abnormality who subsequently received confirming conventional audiological tests. The BER test results correlated well with the impedance measurements, but some rare instances of important discrepancies require further study.
TL;DR: A positive Hennebert's sign was found in 24 of 81 (30%) of ears with Meniere's disease and in none of 22 cases of vestibular schwannoma or 100 normal controls, providing corroborative evidence for a cochlear site of hearing impairment with hydrops and vestibulofibrosis are the underlying pathophysiologic condition.
Abstract: A positive Hennebert's sign was found in 24 of 81 (30%) of ears with Meniere's disease and in none of 22 cases of vestibular schwannoma or 100 normal controls. Negative pressure applied to the external auditory canal was the required stimulus in 14 of 24 (58%) ears. The character of induced eye motion was variable, although horizontal nystagmus was found in 22 of 24 (92%) ears. A positive Hennebert's sign is seen in a variety of labyrinthine lesions and gives corroborative evidence for a cochlear site of hearing impairment with hydrops and vestibulofibrosis are the underlying pathophysiologic condition.
TL;DR: A combined craniofacial approach is described for resection of tumors that involve the ethmoid sinuses and adjacent base of the skull in the frontal fossa, which provides a more thorough en bloc excision than by conventional methods with reasonable safety.
Abstract: • A combined craniofacial approach is described for resection of tumors that involve the ethmoid sinuses and adjacent base of the skull in the frontal fossa. This operation provides a more thorough en bloc excision than by conventional methods with reasonable safety since both the neurosurgeon and the head and neck surgeon are guided by each other during the mobilization of the specimen, and adequate repair of dural defects can be accomplished. Reconstruction of the bony defect in the skull base is performed with a pedicled periosteal flap from the scalp and a skin graft.
TL;DR: Intranasal dermoplasty and estrogen therapy have been shown to be the most effective means of managing epistaxis in patients with hereditary hemorrhagic telangiectasia.
Abstract: • Intranasal dermoplasty and estrogen therapy have been shown to be the most effective means of managing epistaxis in patients with hereditary hemorrhagic telangiectasia. In a series of 80 patients studied, the most effective treatment was by intranasal dermoplasty; of 22 patients so treated, 14 had improvement for more than six months after surgery and six had improvement for one to six months. Regrafting for recurrent epistaxis was successful in four of five patients (improvement for more than six months). Estrogen was administered for systemic effect to 16 patients and produced improvement of more than six months' duration in eight and of one to six months' duration in three. Other forms of management were less effective for the prolonged control of epistaxis. ( Arch Otolaryngol 103:627-630, 1977)
TL;DR: In Meniere disease there is, with increassing duration of diseases, a decrease in the periaqueductal and opercular air cell pneumatization, with a concomitant shorter and straighter VA, which correlates with a decreased ELS luminal patency, and a more inferiorly positioned ELS.
Abstract: • The endolymphatic sac (ELS) and vestibular aqueduct (VA), which play a notable role in the pathogenesis of endolymphatic hydrops and Meniere disease, were identified in all anatomic and tomographic materials. More than 100 temporal bones were used for microdissection, tomography, and plastic molds. Normal subjects and Meniere disease patients were studied tomographically (N = 63) and observed during ELS surgery (N = 49). In Meniere disease there is, with increasing duration of disease, a decrease in the periaqueductal and opercular air cell pneumatization, with a concomitant shorter and straighter VA. This correlates with a decreased ELS luminal patency, and a more inferiorly positioned ELS. These factors help to explain both the difficulties of visualizing the VA by tomography in Meniere disease as well as the occasional difficulties reported by others in satisfactorily identifying the ELS at sac surgery. All observations are made from the surgeon's viewpoint to enhance clinical identification of the ELS. ( Arch Otolaryngol 103:1-11, 1977)
TL;DR: A curved lateral osteotomy is described, as described here, cuts bone posteriorly only where aesthetic narrowing is required in rhinoplasty.
Abstract: • Lateral osteotomies performed posteriorly enough to avoid step-like prominences at the sides of the nose may allow medial displacement of bone to impinge on the airways. This obstruction near the floor of the nasal passageway is prevented by leaving a triangular piece of bone at the pyriform aperture intact just superior to the level of the inferior turbinate. A curved lateral osteotomy, as described here, cuts bone posteriorly only where aesthetic narrowing is required in rhinoplasty. Techniques providing the recommended curved or angulated lateral osteotomies with osteotomes are demonstrated in the cadaver and in patients. ( Arch Otolaryngol 103:454-458, 1977)
TL;DR: The retroactive analysis of the documents from every case that was treated at the Ear, Nose, and Throat Clinic of the Aristotelian University from 1970 to 1975, as well as the comparative statistical study, show common characteristics shared by all 90 cases under consideration.
Abstract: • Despite the progress made in the fields of endoscopy and anesthesia for children, as well as the accumulated experience, the inhalation of foreign bodies remains a serious and often dramatic problem. Every case varies to some extent, and only general conclusions may be drawn. The retroactive analysis of the documents from every case that was treated at the Ear, Nose, and Throat Clinic of the Aristotelian University from 1970 to 1975, as well as the comparative statistical study, show common characteristics shared by all 90 cases under consideration. In these cases, the foreign body was of organic origin (mainly seeds and dry fruits) and particularly pumpkin seeds (25% of all cases). Half of the patients sought hospitalization, with a delay varying from two days to four months, while localization varied (larynx, 11 cases; trachea, 10; bronchus, 69). Localization in the left bronchus was more frequent than in the right one, especially in children. The diagnosis was based on the case history, clinical examination, and radiologic findings, while in the majority of the cases, the treatment involved bronchoscopy, the removal of the foreign body, and treatment of lung problems in delayed cases. ( Arch Otolaryngol 103:570-573, 1977)
TL;DR: Results establish irradiated homologous costal cartilage as a valid implant material for facial contour restoration in a variety of anatomic sites and demonstrate that this implant is not easily infected.
Abstract: • This study represents a retrospective evaluation of 145 implants of irradiated homologous costal cartilage used over a three-year period for facial contour restoration in a variety of anatomic sites. In this series, the immediate complication rate was 5.5%, the late complication rate was 2.1%, and the partial resorption rate was 1.4%. The infection rate for the implants inserted intraorally onto the face of the maxilla did not have a statistically significant difference from the infection rate for the entire series, thus demonstrating that this implant is not easily infected. These results establish irradiated homologous costal cartilage as a valid implant material. ( Arch Otolaryngol 103:12-15, 1977)
TL;DR: The vital composite hyoid bone-muscle graft interposition technique offers a promising method for the solution of difficult cases of glottic, subglottics, and tracheal stenosis.
Abstract: • Successful results were achieved in three of four human cases of glottic, subglottic, and tracheal stenosis by using composite hyoid bone-muscle pedicle. A technique is used to create and interposition the grafts to widen the lumen and to provide structural support. The vital composite hyoid bone-muscle graft interposition technique offers a promising method for the solution of difficult cases of glottic, subglottic, and tracheal stenosis. Abandonment of previous long-term dilations is recommended in favor of early surgical restoration of a widened airway.
TL;DR: Four cases are presented that illustrate the difficulties in diagnosis; treatment consists of meticulous dissection of the thin-walled sac in continuity with the excision of the sublingual glands that are the origin of these lesions.
Abstract: • The term "ranula" is poorly understood and is frequently applied to a variety of cystic structures in the head and neck. Ranulas classically are cysts of salivary gland origin, usually the sublingual glands, of which two varieties are described: a simple, epithelial lined cyst resulting from ductal obstruction, and a pseudocyst without epithelial lining resulting from extravasation of saliva that dissects through the tissue planes of the neck and may appear as a neck mass. Four cases are presented that illustrate the difficulties in diagnosis; treatment consists of meticulous dissection of the thin-walled sac in continuity with the excision of the sublingual glands that are the origin of these lesions. (Arch Otolaryngol103:397-400, 1977)
TL;DR: Comparison of crossed and uncrossed reflex thresholds provided an important diagnostic tool for differentiating the eighth nerve from the brain stem site.
Abstract: • Acoustic reflexes to crossed (sound in one ear; probe in opposite ear) and uncrossed (sound and probe in the same ear) stimulation were obtained from 17 patients with eighth nerve or brain stem disorders and 20 normal control subjects. Comparison of crossed and uncrossed reflex thresholds provided an important diagnostic tool for differentiating the eighth nerve from the brain stem site. Eighth nerve disorders were usually characterized by diagonal reflex patterns. In contrast, brain stem disorders were usually characterized by horizontal reflex patterns. Detailed evaluation of the reflex time course in two selected patients with intra-axial brain stem disorder showed unusual abnormalities in the crossed acoustic reflex. (Arch Otolaryngol103:445-453, 1977)
TL;DR: The results of these experiments suggest that the auditory nerve can withstand surgical implantation and the long-term interface with scala tympani electrodes and can be discretely excited with bipolar stimulation, having important implications for the application of multielectrode prosthetic devices to the profoundly deaf.
Abstract: A series of neurophysiological and anatomical experiments have been performed on cats implanted on a long-term basis with scala tympani electrodes. Auditory nerve survival was assessed for both neomycin sulfate-deafened and previously normal-hearing cats three weeks to 30 months after electrode implantation. Acute neurophysiological experiments were performed on nearly all of the cats and the spatial response to electrical stimulation was determined. The results of these experiments suggest that the auditory nerve can withstand surgical implantation and the long-term interface with scala tympani electrodes. In addition, restricted portions of the auditory nerve can be discretely excited with bipolar stimulation. Monopolar stimulation produced a very broad excitation pattern. These findings have important implications for the application of multielectrode prosthetic devices to the profoundly deaf.
TL;DR: This communication describes the technique of thePalatal island flap and its usefulness in intraoral reconstruction, with a modification for increasing its extension by means of the palatine foramen free-up procedure.
Abstract: • This communication describes the technique of the palatal island flap and its usefulness in intraoral reconstruction, with a modification for increasing its extension by means of the palatine foramen free-up procedure. The other modalities, with their attendant advantages and disadvantages for intra-oral reconstruction, are briefly reviewed. ( Arch Otolaryngol 103:598-599, 1977)
TL;DR: From the results obtained, it was found that if tympanometry alone is used to determine the presence or absence of fluid the best discriminant is a compliance of 0.21 or a gradient of0.04 equivalent volume units.
Abstract: • The findings on paracentesis and aspiration of the middle ear were compared with preoperative tympanometry. From the results obtained, it was found that if tympanometry alone is used to determine the presence or absence of fluid the best discriminant is a compliance of 0.21 or a gradient of 0.04 equivalent volume units. The average failure rate with either of these criteria is 20%. A numerical estimate of the validity of tympanometry may be made for individual cases.
TL;DR: Acute peripheral facial palsy seems to be part of a cranial polyneuropathy and may be caused by a viral infection.
Abstract: • In 14 of 16 consecutive patients with acute peripheral facial palsy, one or more (up to four) other nerves were involved. The nerves affected in addition to the facial nerve were as follows: trigeminal (ten patients), vestibular (eight), cochlear (six), vagus (one), and upper cervical (five). Virus was not isolated from any of the patients. A fourfold increase or decrease in complement-fixing antibody titers was present in eight patients (in four, varicella-zoster; in one, varicella-zoster and mumps; in two, cytomegalovirus; in one, mumps). Further, two of the patients with varicella-zoster antibodies showed clinical signs of herpes zoster oticus. About one fourth of all patients had an increase of ESR and of α 2 -globulins in serum, and two thirds of them had increased γ-globulins in CSF. Acute peripheral facial palsy seems to be part of a cranial polyneuropathy and may be caused by a viral infection. ( Arch Otolaryngol 103:641-644, 1977)
TL;DR: Auditory evoked potentials in the middle component time domain (post-stimulus, 8 to 50 msec) appeared unchanged during the paralyzed state, indicating that they were not of myogenic origin.
Abstract: • Auditory evoked potentials in the middle component time domain (poststimulus, 8 to 50 msec) were recorded in response to 1,000-Hz tone pips in a normal-hearing adult subject Electromyographic (EMG) responses in response to ulnar nerve shocks were recorded from the ipsilateral hypothenar muscles With the assistance of an anesthesiologist, data were collected during a normal resting state, a state of light sedation, and a state of complete skeletal muscle paralysis from succinylcholine administration During the paralyzed state, there was abolition of the normal EMG responses seen in the resting and sedated states The auditory evoked potentials, however, appeared unchanged during the paralyzed state, indicating that they were not of myogenic origin ( Arch Otolaryngol 103:133-137, 1977)
TL;DR: From 1949 to 1974, six patients with solitary extramedullary plasmacytomas of the larynx were seen at the Mayo Clinic; during this period, approximately 3,100 patients with malignant laryngeal neoplasms were examined.
Abstract: • Plasmacytomas, indistinguishable histologically from plasma cell tumors arising in bone marrow, occur almost anywhere in the body—usually independently of multiple myeloma. Thus, they represent an isolated area of plasmacytic dyscrasia but occasionally can be the first evidence of multiple myeloma. From 1949 to 1974, six patients with solitary extramedullary plasmacytomas of the larynx were seen at the Mayo Clinic; during this period, approximately 3,100 patients with malignant laryngeal neoplasms were examined. For these six patients, the median age was 53 years (range, 32 to 63 years). The first symptom in five patients was hoarseness (mean duration, nine months). Excision, electrocoagulation, irradiation, or some combination of these constituted effective therapy. Follow-up ranged from 3 to 25 years. The choice of therapy depends on the size, shape, and location of the tumor. Extensive surgery is rarely necessary. ( Arch Otolaryngol 103:159-161, 1977)