When does middle ear effusion signify nasopharyngeal cancer?
OBJECTIVE
To analyse the presenting symptoms of patients with nasopharyngeal carcinoma seen in Auckland, New Zealand, with emphasis on the significance of otological symptoms.


METHODS
The records of 85 patients with nasopharyngeal carcinoma seen in the department between 1980-93 were reviewed.


RESULTS
Twenty eight of patients were Pacific Island Polynesian, 21 caucasian, and 18 Chinese. The youngest patient was 11 years old. The most prominent symptoms were neck mass (53), deafness/otalgia (45), nasal obstruction (35) and epistaxis (30). The ear symptoms, representing middle ear effusion were evident for more than 9 months, on average, before a diagnosis was made. Most patients presented with multiple symptoms: 95% of patients had one or more of the above four cardinal symptoms. Only two patients presented with middle ear effusion alone: 95 of the patients with middle ear effusion had another, accompanying, cardinal symptom. Nineteen patients had cranial nerve involvement.


CONCLUSIONS
Neck mass, deafness/otalgia, progressive nasal obstruction and epistaxis are the cardinal symptoms of nasopharyngeal carcinoma. A persisting middle ear effusion in people over 10 years of age must be examined for nasopharyngeal carcinoma, if an accompanying cardinal symptom is also present, or develops.
Department of Otolaryngology/Head & Neck Surgery, Green Lane Hospital, Auckland.
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AC
Woollons
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RP
Morton
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology; D002648:Child; D003389:Cranial Nerve Diseases / Q000209:etiology; D004844:Epistaxis / Q000209:etiology; D005260:Female; D034381:Hearing Loss / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000209:etiology; D009303:Nasopharyngeal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000208:ethnology; D009520:New Zealand; D010034:Otitis Media with Effusion / Q000209:etiology*; D044465:White People