Uncommon otological manifestations of nasopharyngeal carcinoma

Nasopharyngeal carcinoma (NPC) is significant for the otologist although the nasopharynx is located outside the anatomical confines of the ear. Middle-ear effusion resulting from NPC is well-known. There are however, other less common ear symptoms of NPC that many physicians are not sufficiently aware of. A personal series of patients with NPC presenting with uncommon symptoms relating to the ear is presented. These include NPC presenting as a) haemotympanum b) a peri-auricular mass c) referred sensation to the ear d) blocked ear e) barotrauma f) an ear polyp g) sudden sensorineural hearing loss. These symptoms may pose diagnostic difficulties, resulting in the diagnosis of NPC being delayed. It was concluded that a high index of suspicion for NPC is warranted in high risk patients presenting with unexplained otological symptoms.