ENT Issues: Navigating Nasopharyngeal Cancer Concerns

Inquiry about Ear, Nose, and Throat Issues (Nasopharyngeal Carcinoma)

Hello Dr.
Zheng, I would like to ask about my symptoms and how to communicate with outpatient doctors for further treatment.
I have a long history of nasal allergies, which cause severe nasal congestion on both sides during flare-ups, but most of the time, I experience unilateral nasal congestion that alternates between sides.
Doctors have previously mentioned that I have a deviated septum.
About three weeks ago, during a cold and humid period, my allergies worsened, leading to complete nasal blockage on both sides.
After forcefully blowing my nose, I suddenly felt a sharp pain in my left ear.
A couple of days later, the pain persisted, so on March 1, 2016, I visited the ENT department at Linkou Chang Gung Memorial Hospital.
The doctor examined my ears externally and my throat, stating everything appeared normal.
I inquired about the possibility of a ruptured eardrum or symptoms of middle or inner ear inflammation, and the doctor confirmed there were none.
He prescribed medication for my nasal allergies (Nasal Mometasone and Ipratropium for seven days).
However, after a week, my symptoms remained unchanged, so I returned for another visit.
During this time, I discussed with my family and learned about the possibility of a nasal endoscopy for a preliminary examination, so I requested the doctor to perform one.
The doctor examined my outer ear and throat again, stating everything looked fine, but he did not have the necessary equipment for the endoscopy and referred me to another specialist.
That weekend, I had other commitments, and since the doctor said everything appeared normal and I only had mild ear pain, I decided to observe my condition.
Unfortunately, the discomfort persisted (not the initial sharp pain, but a dull, continuous pain in my ear) and was accompanied by unilateral headaches and throat pain.
On March 17, I consulted another physician who performed a nasal endoscopy (a thin black tube inserted into my nose).
The doctor noted that everything looked smooth with no tumors.
Based on my description, he expressed concern about nasopharyngeal cancer and palpated my neck for any lumps, stating that since he found none, there was no need for excessive worry.
He prescribed the same medications (Nasal Mometasone and Ipratropium) along with an antibiotic: Cefadroxil monohydrate for a week, indicating that I had Eustachian tube dysfunction and that recovery might take some time.
However, the day after the examination and today (March 18 and 19), I noticed dark red streaks and small blood clots in my nasal mucus and throat phlegm, which has caused me great concern.
I am unsure how to communicate with my doctor to ensure a thorough examination, as it seems they believe there is nothing wrong and do not perform further tests.
I am not a medical professional and do not know what tests should be "done." I found online that a biopsy could be performed, but if, as the doctor stated, there are no suspicious areas in the nasal cavity, would a biopsy be meaningful? I would greatly appreciate any advice you could provide, thank you.

Mr. Zheng, 30~39 year old female. Ask Date: 2016/03/19

Dr. Zheng Jueyi reply Otolaryngology

Hello! If an endoscopic examination has been performed and no suspected tumors were found in the nasopharynx, the significance of a biopsy is minimal.
The bleeding may be related to microvascular rupture.
You may continue medication and return for follow-up.
Wishing you health and happiness! Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2016/03/19

More Info

Navigating concerns related to nasopharyngeal cancer, especially when symptoms are present, can be quite challenging. It’s understandable to feel anxious, particularly when experiencing persistent symptoms like nasal congestion, ear pain, and the presence of blood in nasal discharge. Here’s a comprehensive overview of your situation, along with some recommendations on how to communicate effectively with your healthcare provider.

Understanding Your Symptoms
1. Nasal Congestion and Allergies: Chronic nasal congestion, especially with a history of allergies, can often lead to complications such as sinusitis or eustachian tube dysfunction. The fact that you experience alternating nasal blockage could indeed be related to a deviated septum, which is common and can exacerbate allergic reactions.

2. Ear Pain and Headaches: The ear pain you describe, coupled with headaches, may suggest that the eustachian tube is not functioning properly, leading to pressure changes in the ear. This can happen when nasal passages are blocked, affecting the drainage of the middle ear.

3. Blood in Nasal Discharge: The presence of blood, especially if it’s recurrent, should be taken seriously. It can be a sign of various conditions ranging from minor issues like nasal irritation to more serious concerns such as tumors or significant infections.

Communicating with Your Healthcare Provider
Given your ongoing symptoms and concerns about nasopharyngeal cancer, here are some strategies for effectively communicating with your ENT specialist:
1. Be Clear and Specific: When discussing your symptoms, be as specific as possible. Describe the frequency, duration, and intensity of your symptoms. For instance, mention how long you’ve had the nasal congestion, the nature of the ear pain, and any changes in your symptoms over time.

2. Express Your Concerns: Clearly articulate your worries about nasopharyngeal cancer. It’s important for your doctor to understand that you are concerned about this possibility, especially given your symptoms and family history (if applicable).

3. Request Specific Tests: If you feel that your concerns are not being addressed, don’t hesitate to ask for specific tests. For instance, you might request a nasal endoscopy if it hasn’t been done yet, or inquire about imaging studies like a CT scan of the sinuses or nasopharynx. Mention that you would like to rule out any serious conditions, including malignancies.

4. Ask About Follow-Up: If your symptoms persist or worsen, ask about the timeline for follow-up appointments or additional evaluations. It’s reasonable to request a re-evaluation if your symptoms do not improve with the current treatment.

5. Seek a Second Opinion: If you feel that your concerns are not being adequately addressed, it’s perfectly acceptable to seek a second opinion from another ENT specialist. Different doctors may have varying approaches to diagnosis and treatment.

Additional Considerations
- Allergy Management: Since you have a history of nasal allergies, managing these effectively may help alleviate some of your symptoms. Discuss with your doctor about potential allergy testing or treatments that could help.

- Monitoring Symptoms: Keep a detailed log of your symptoms, noting any changes, triggers, or patterns. This information can be invaluable during your consultations.

- Educate Yourself: While it’s essential to avoid self-diagnosing, educating yourself about potential conditions related to your symptoms can empower you during discussions with your healthcare provider.

Conclusion
Navigating health concerns, particularly those related to potential malignancies, can be daunting. It’s crucial to maintain open lines of communication with your healthcare provider, ensuring that your concerns are heard and addressed. By being proactive about your health and advocating for yourself, you can work towards obtaining the answers and care you need. Remember, your health is a priority, and seeking clarity and reassurance is a vital part of the process.

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