Literacy and laryngectomy: how should one treat head and neck cancer in patients who cannot read or write? The entire population of otolaryngologists and radiation oncologists (N = 192) in active practice in the state of North Carolina were surveyed to assess their level of awareness of illiteracy among adults in the United States and to determine whether these physicians consider illiteracy in the treatment decision process for patients with head and neck cancer. Excluding respondents who did not treat patients with head and neck cancer and physicians practicing outside of the state of North Carolina, the response rate was 115 of 182, or 63%. Only 26% of respondents were able to estimate correctly the prevalence of illiteracy in the US adult population. Forty-one percent of respondents, however, stated that they did consider their patient's ability to read and/or write before making treatment recommendations for head and neck cancer. This survey and accompanying literature review suggest that physicians perceive illiteracy as a problem that may have a significant impact on patients with head and neck cancer, but lack the data needed to enable them to quantify the effect of illiteracy on treatment outcome. The study reported is the first step in examining ways in which illiteracy might negatively affect patient outcomes. 