Rhinology A9


Red flag nasal symptoms

Nasopharyngeal carcinoma is rare. Risk factors for nasopharyngeal carcinoma include Chinese ethnicity, male, diets with high salt intake, cured meats and fish (common in parts of Asia), EBV infection, family history, tobacco smoking and alcohol. 

Nasopharyngeal carcinoma can present with symptoms of eustachian tube obstruction (hearing loss, tinnitus, otalgia and/or sensation of aural fullness), nasal obstruction (blocked nose, facial pain), blood-stained nasal discharge and persistent epistaxis. The patient may develop a glue ear. Symptoms are usually unilateral.

In patients with high suspicion of nasopharyngeal carcinoma (or any head and neck cancer), a full ENT examination is warranted, and you must inspect the post nasal space with flexible nasoendoscopy to identify/rule out a mass. In a primary care setting, the patient must be referred to ENT urgently.

If there is a mass, biopsy is required, and depending on the biopsy result, further imaging and histology for staging and grading of the cancer will be necessary. Treatment options include chemotherapy, radiotherapy and surgery, and the case will be discussed in the multidisciplinary team meeting to decide on the best management plan.

Correct Answer: