Cancer and Chemodectoma in the Middle Ear and Mastoid

Cancer in the middle ear is a paradoxical and frustrating sort of malignant disease. Favorably situated to give early warning and to allow easy diagnosis, slow to spread to well-lateralized and surgically convenient lymphatics, and rarely metastasizing to distant organs, it is nevertheless a relentless killer not readily subdued by tried methods of attack. What is the reason for the paradox? How can changing concepts and new techniques be applied to the problem? To answer these questions the natural history of these tumors has been restudied, the methods of treatment reexamined, and the record of achievement, which must be bettered, established. Since the last review of cases at the Mayo Clinic by one of us (F.A.F.) and Hempstead in 1943,1a carotidbody-like tumor of the middle ear has been identified and classed as chemodectoma.2This tumor, which has a relatively favorable prognosis, had been included previously among the