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INJURIES of the larynx do not comprise the most frequent source of war casualties, but they do constitute one of the most serious forms of battle injury. This is true not only as to the immediate prognosis in regard to the loss of life but as to the future rehabilitation of the patient after the immediate crisis is past. The threatened advent of gas warfare would have sent the incidence of laryngeal injuries soaring, as the effect of poisonous gas on the larynx is well known and has been demonstrated not only from the experience of World War I but from accidents or improper handling of poisonous gases in World War II. As the battle casualties have mounted there has been a proportionate rise in laryngeal injuries, although the exact number will never be known as many of them have been recorded as injuries of the neck. Laryngeal and tracheal

The following case of carcinoma of the nasopharynx presents several features interesting not only to the otolaryngologist but also to the neurologist, the ophthalmologist, the roentgenologist and the pathologist. It is presented because of its value to both the clinician and the pathologist in that an attempt has been made to explain clinical symptoms from a complete study at autopsy. Of further interest was the intracranial extension of the tumor with marked destruction of bone, metastasis to the liver and an apparent implantation of tumor cells by contact from the growth in the nasopharynx to an ulcer on the nasal surface of the soft palate. This ulcer approximated and was irritated by the tumor in the nasopharynx on phonation and swallowing. That malignant tumors of the nasopharynx are not uncommon is evidenced by the abundance of literature on the subject, many authors reporting fairly large series of cases. It was

The ancients were well aware of the presence of nasal polyps and of the problems which they presented, and they devised ingenious methods for their removal. The evaluation of the present knowledge of the etiology and treatment of nasal polyps must be viewed with a degree of skepticism engendered by a lack of unanimity of opinion. We do not now know the etiology of polyps. Polyps do not occur solely as the result of allergy; many allergic patients (with seasonal and perennial allergy) do not have them. Polyps represent a hyperplastic change of one portion or all of the nasal or sinal mucosa. Clinicians fail to distinguish between polyps that occur in one person and those that occur in another. This might explain why the same management or procedure is ineffective in one patient and effective in another. A patient with nasal polyps must be distinguished by an additional factor, possibly an inherited structural deficiency of connective tissue. Atopic patients with seasonal and perennial rhinitis associated with extensive nasal polyps may undergo surgery of the nose and/or sinuses. Nonatopic persons, however, are best approached with surgical reluctance, since bronchial asthma develops rapidly in this group. Dissatisfaction with present methods of management arises from failure to control the regrowth of polyps. This applies to those patients whose rate of recurrence of polyps has been prolific and rampant. Attention is directed to the fact that polyps may be a presenting part of underlying tumors, thereby clouding the true nature of the growth pattern. Furthermore, the proliferative nature of polyps may indicate a type of pathologic entity termed "inverting papilloma," erroneously considered to be "merely polyps." An integrated study by the allergist and the rhinologist should be encouraged if the problem is to be solved.

Although many observations have been carried out on the results of section of the trigeminal nerve in man for tic douloureux, little attention has heretofore been paid to its effect on the nose and the nasal mucosa. This is rather astonishing, as the present day conception of nasal pathology attributes many of its factors to reactions which can only be explained basically as a result of a disturbance of the nerve equilibrium, maintained in the nasal mucosa by its sensory and autonomic innervation. Especially, the wide range of so-called allergic reactions encountered daily with pathologic conditions of the nose should make advisable a morphologic study of noses which have been deprived of their first line of defense, their reaction to pain and irritation. Much of this pathologic change is attributable to mechanical irritation, and it is to be expected that the presence of such irritation, unnoticed by the patient, would

The development of tumors as a result of reaction to metabolic disturbances, chronic septic states or local changes in the tissues often presents a perplexing clinical and pathologic problem. Lederer, Fabricant and Milles 1 recently described an unusual cellular response to chronic infection. Another unusual type of cellular reaction, lipoid cell granuloma, prompts this report. Attention has been directed by a number of authors to the aural manifestations of this disease, but the American otologic literature is devoid of any reference to this entity. It is, therefore, not unreasonable to suppose that many cases have been overlooked. CLASSIFICATION The recent articles of Rowland 2 have done much to clarify the conception of the various clinical manifestations of disturbed lipoid metabolism. While the major interest has been in the Schuller-Christian syndrome, a number of less generalized forms of xanthomatosis have been described, which differ somewhat in

The osseous structures of the head are capable of undergoing pathologic changes which are of interest to the otolaryngologist. The bony labyrinth of the ear, for example, may be affected by such diseases as fragilitas ossium, osteitis deformans, osteoarthritis, osteogenesis imperfecta, osteomalacia, osteopsathyrosis, rickets, Paget's disease, senile osteoporosis, chondrodystrophy and athyreopituitary dwarfism. Many of these may affect any and all parts of the skull. There is a group of idiopathic hyperostoses of the skull, which have long been considered rare, viz., osteitis deformans, or Paget's disease, and craniosclerosis, or leontiasis ossea. Recently Coppo,1in connection with a description of a patient with the latter condition, reviewed the literature extensively and found the cases recorded not numerous. Virchow2proposed the term "leontiasis ossea" for a particular form of hyperostosis of the skull. The name was suggested by the appearance which the face of the patient came to assume, due to enlargement

The larynx of old persons has frequently been examined. However, a perusal of the literature reveals that no two physicians agree in their findings as far as the muscles of this organ are concerned. Kofler 1 mentioned slight atrophy of the muscles, without giving further details, and Imhofer 2 found that the lipoid pigment usually situated around the nuclei of the sarcolemma increased in amount in old persons. Segre 3 found simple atrophy of the adductor and the abductor muscles, characterized by an increase of the nuclei of the sarcolemma and an increase in both the collagenous and the elastic fibers. This atrophy was least marked in the interarytenoid and the vocal muscles. In contrast, Imhofer 4 did not observe an increase in elastic fibers. The cricothyroid muscles showed hypertrophy in the cases of Segre, 3 which was considered compensatory, because of the atrophy of the adductor muscles. Carnevale Ricci 5 described essentially the same conditions

Esophageal foreign bodies, particularly when they are pointed and embedded against the plane of removal, present almost unsurmountable difficulties to the operator. Even the greatest skill in these cases results in some degree of esophageal laceration, which is usually a superimposed extension of the preexistent perforation. It is not our purpose to report a great number of cases over a period of years with tabulations of percentages, although we do not deny that statistics serve their purpose. It must be remembered that often these may be applicable for the reporter, but with another geographic site and certain changes in personalities, not only of the surgeons but also of the patients, statistical compilation unrecognizably alters the moral. The following brief reports typify this natural consequence: In China,1foreign bodies are more frequently found in the esophagus than in the respiratory tract. An article from Los Angeles2records as a

The histologic examination of tumor-like formations in the external auditory canal, frequently observed in association with chronic suppurative otitis media, may yield information of diagnostic, prognostic and corroborative clinical importance. It is well recognized that neoplastic formations such as carcinoma, specific granulomas associated with tuberculosis and syphilis, and manifestations of metabolic disorders may be combined with chronic suppuration of the middle ear. These groups will be discussed briefly with emphasis on certain points of clinicopathologic interest. The main purpose of this communication is to encourage a renewal of interest in the benign neoplastic formations and perhaps a new interpretation of their clinical significance. CARCINOMA Malignant neoplasms affecting the middle ear are relatively frequent. The literature shows a paucity of material on the subject, and even any reference there to "primary" carcinoma of the middle ear requires explanation. Proof of the occurrence of such a neoplasm is most difficult. Notably do

Crowe (1) called attention to the fact that lymphoid tissue in the nasopharynx, especially the lateral parts, could, as the result of hypertrophy and hyperplasia, cause intermittent or constant blockage of the nasopharyngeal orifices of the eustachian tubes. He noted that such blockage interfered with the normal ventilation of the middle ear cavity and was reflected, most often in children, in decreased hearing. The examination of the ear drums revealed retraction of the tympanic membrane and a reddish blush from the edematous mucosa of the medial wall of the tympanic cavity. Examination with an electric nasopharyngoscope showed actual encroachment of the lymphoid elements on the mouth of the eustachian tube. It was evident that surgical extirpation of the oral and nasopharyngeal lymphoid structures, no matter how complete, could not reach the laterally placed portions in the fossae of Rosenmuller and about the lips of the tubal orifice without causing serious damage to the mucosa and nearby anatomic part...

To appreciate the protean manifestations of neurologic, and the frequently related emotional, disorders affecting the head and neck areas, is to realize the morphological complexity of the human mechanism and its susceptibility to a wide range of disturbing experiences. Since these anatomical areas house all of the special senses, emotional and physical factors may interact in a number of interesting but puzzling ways. Few persons are ever entirely spared the sensation of pain or the malfunction of one or some of the cranial nerves, the cervical nerves, the brain, or the sympathetic nervous system. This discussion will concern itself with the symptomatologic approach. The symptoms which develop from neurologic disease, from trauma, or from complications of conditions encountered in the course of diseases of the ear, nose, or throat may be the earliest indicators of serious disorders. The majority of these may be listed under their broad, all-inclusive, generic