Nasopharyngeal Carcinoma with Eustachian Tube Extension

Epidemiology

Nasopharyngeal carcinoma (NPC) usually originates in the lateral pharyngeal recess (fossa of Rosenmüller). The tumor can easily invade the opening of the eustachian tube, which is located immediately anterior and inferior to the fossa of Rosenmüller. Patients in the high-risk group who present with tinnitus or serous otitis media should be carefully evaluated. Risk factors include several factors: age (> 30 years), sex (male > female), ethnic group (especially ethnic Chinese), and a family history of NPC in a first-degree relative.

Clinical Findings

The most common ear symptom is unilateral hearing loss. This symptom is related to tumor obstructing the eustachian tube resulting in serous otitis media. Eustachian tube dysfunction can also be caused by tumor infiltration of the muscles of deglutination. In the absence of any infection or allergic nasal symptoms, a nasopharyngeal biopsy is indicated in all high-risk patients with unilateral serous otitis media. Epstein-Barr virus (EBV) serology may provide further useful information, especially in patients with a clinically occult primary.