Carcinoid tumor of the larynx.

Primary carcinoid of the larynx is an unusual neoplasm. Only one case could be traced in the literature so far. Another case, a 55-year-old male patient, is presented and discussed. The tumor proved to be malignant, showing histological, histochemical and electron microscopical characteristics of a carcinoid. Initially there was a striking discrepancy between the scanty findings in the larynx and the wide metastatic spread of the tumor into the cervical lymph nodes along the internal jugular vein, and the progression of the process was markedly slower than that of laryngeal carcinoma. Despite the massive dose of radiotherapy that had been administered after radical neck dissection in an attempt to preserve the larynx, the tumor continued to expand, infiltrating the laryngeal tissues and causing stenosis that necessitated total laryngectomy, thus again proving that the treatment of choice in laryngeal carcinoid should be wide surgical excision.

Primary presentation of malignant lymphoma in middle ear cleft.

An unusual case of histiocytic type malignant lymphoma with primary presentation in the middle ear cleft in a 32-year-old female patient is reported. Despite combined surgical, radiological and chemotherapeutic treatment, the patient expired from a fulminant spread of the lymphoma 14 months after the first clinical manifestation of the disease in the right ear.

Chronic tympanomastoiditis with formation of calculi.

Numerous calculi of varying sizes and shapes were discovered in the mastoid, antrum, and attic during mastoid surgery for persistent chronic suppurative inflammation of the middle ear cleft with retroauricular and external meatal fistulas in an 8-year-old boy. Light microscopic and scanning electron microscopic examinations and x-ray microanalysis revealed the calculi to consist of masses of crystals containing calcium-oxalate and calcium- and magnesium-phosphate. No signs of tuberculosis were found. Since the patient had multiple dysplasias, including ipsilateral macrotia, in addition to chronic otitis media and mastoiditis, it is suggested that the formation of the calculi may have been due to congenital predisposition.

Synovial sarcoma of the hypopharynx.

Primary synovial sarcoma of the hypopharynx is an extremely rare neoplasm. Only 16 cases could be traced in the literature so far. An additional case, in a 29-year-old male patient, is presented. Progressive disturbance of deglutition and speech, chocking sensation, and mild respiratory distress were his original complaints. Our case differs from those previously reported in that a) the tumor was pedunculated, and the site of its attachment could be very well-defined, and b) unusual intratumoral destructive hemorrhage turned the case into an emergency. The pedicle was radically excised together with part of the grossly uninvolved underlying tissue, and the tumor was removed in toto. The histological findings are described. The patient is under observation. No recurrence has been noticed 11 months after surgery, and there are no signs of metastasis. The origin of the tumor and its treatment are discussed.

Early repair of blast ruptures of the tympanic membrane.

A method and results of early repair of blast rupture of the tympanic membrane in 24 selected cases, where flaps and/or free edges of the torn eardrum could be detected by examination with the operating microscope, are presented. By reversion of the flaps and approximation of the edges, the perforation was closed or significantly diminished. This ensured the healing of the tympanic membrane in all cases within days instead of months. No complications were noted during a subsequent two to three-years' follow-up. The improved hearing was stable.

The incidence of otosclerosis in the general population.

The incidence of clinical otosclerosis in the general population of Lithuania (USSR) was recorded from December 1961 to May 1970. A total of 974 otosclerotic individuals were found during this period, 27.2% of whom were males and 72.8%, females. In the majority of these patients, the clinical diagnosis of otosclerosis was confirmed at operation. The incidence of clinical otosclerosis in the population was found to be about 0.1%. The ratio of incidence of clinical:histological otosclerosis in the population investigated is assumed to be 1:4. The age period at risk for clinical otosclerosis is between 16 and 50 years, the greatest age period at risk being 20 to 40 years.

The genetics of Otosclerosis. I. Distorted sex ratio.

The offspring of 214 otosclerotic x normal couples were investigated, and within these sibships, the segregation of otosclerosis is compatible with autosomal dominant inheritance. However, the overall sex ratio is approximately 0.73, with otosclerosis being approximately 1.8 times more frequent in female offspring. These observations are interpreted as the consequence of selection against males carrying the otosclerosis gene. Elimination of such males occurs only in certain sibships. The remaining families demonstrate a sex ratio approximating unity with similar rates of otosclerosis in both sexes. This selection operates mainly, and possibly only, prenatally.

Auditory nerve and brainstem-evoked responses before and after middle ear corrective surgery.

Auditory brainstem response (ABR) recordings were made in two groups of middle ear pathology--middle ear effusion and otospongiosis before and after rehabilitation surgery. The ability of ABR recordings to quantify the hearing improvement (threshold and latency) after insertion of ventilating tubes and after stapedioplasty is demonstrated.