Suitability of near-total laryngopharyngectomy in piriform carcinoma.

The surgical specimens from total laryngectomy and partial pharyngectomy in 20 consecutive cases of piriform sinus carcinoma were studied by whole-organ serial sectioning in the horizontal plane. There had been gross clinical involvement or fixation of the vocal cord in 19 of these cases. Histopathologic evidence of cartilage invasion or piriform apex involvement was found in 17 specimens. In 13 cases, it appeared, retrospectively, that the cancer could have been adequately encompassed without resecting the entire contralateral side of the larynx. When this element is spared, a sphincteric speaking shunt can be made. Careful preoperative assessment would have correctly predicted the suitability or danger of this approach in 18 of the 20 cases; the two indeterminate cases would have required intraoperative quick section. These findings have meaningful implications regarding the scope of conservation surgery in piriform carcinoma.

Blastomycosis of the larynx.

Blastomycosis is a chronic fungal disease with a constellation of signs and symptoms and a variable course. It primarily affects the lower respiratory tract, although extrapulmonary manifestations are common. We describe 6 patients with blastomycosis of the larynx who represent 5.6% of 107 patients with blastomycosis seen at the Mayo Clinic from 1950 through 1981. When involvement of the larynx occurs, both gross and histopathologic findings of the lesion usually resemble the features of well-differentiated squamous cell carcinoma and often lead to misdiagnosis and inappropriate, overly aggressive, surgical or radiation therapy. So that this unnecessarily aggressive treatment of the diseased larynx can be avoided, we discuss the clinical features, histopathologic findings, diagnosis, and current forms of treatment of blastomycosis.

Cochlear function in chronic otitis media.

Otologic symptoms, audiometric data, and operative findings were reviewed in 200 consecutive patients who had surgically treated unilateral chronic otitis media. Bone conduction thresholds were analyzed in relation to extent of perforation, frequency of otorrhea, duration of disease, and extent of pathologic change. Median bone conduction threshold differences between diseased and uninvolved ears were within 5 dB at all frequencies. The mean speech discrimination score between affected and unaffected ears was equal. Patients with prolonged disease and more extensive pathologic alterations were more likely to experience cochlear changes and hence sensorineural hearing loss, though not to the extent others have described. Our findings indicate that chronic otitis media has little effect on cochlear function in the majority of patients.