Sinusitis and Nasopharyngeal Cancer: Symptoms and Diagnosis

Q: Sinusitis and Nasopharyngeal Cancer: Symptoms and Diagnosis

Hello： (1) If a CT scan and endoscopy have already been arranged and no significant abnormalities are found, the likelihood of nasopharyngeal carcinoma is low. <br>If there are abnormalities or concerns, physicians will often proceed with a biopsy. <br>(2) Since a CT scan has bee

Sinusitis and nasopharyngeal cancer examination?

Dear Dr.
Zheng,
I am currently in the United States and have been troubled by persistent left-sided nasal congestion and occasional left-sided tinnitus for the past month and a half.
I feel as though there is a foreign body between my oral maxilla and the left nasal cavity, and I occasionally experience discomfort and pain in the left nasal cavity while breathing.
At times, I also have a prickling and numb sensation around my left eye and a sore throat.
There is a single painful lymph node behind my ear measuring less than 5mm, but there is no lymphadenopathy in my neck.
My primary care physician initially diagnosed me with sinusitis and prescribed Flonase nasal spray, but there was no significant improvement.
Three weeks ago, I was referred to an ENT specialist at a medical center, who also diagnosed me with sinusitis and prescribed antibiotics and anti-inflammatory medication for treatment.
After two weeks of treatment, my nasal congestion symptoms have improved, but the tinnitus seems to have become more frequent.
During my follow-up visit, due to concerns about nasopharyngeal carcinoma, I underwent EBV serology testing, a CT scan, and a nasal endoscopy this week.
The serology results were negative, the CT scan showed fluid accumulation in the sinuses near the orbits, and the doctor stated that there were no abnormalities found in the nasopharynx during the endoscopy.
I would like to ask: (1) Does this mean that the possibility of nasopharyngeal carcinoma can be completely ruled out? Given that cases of nasopharyngeal carcinoma are rare in the United States, is there a high likelihood of misdiagnosis with the CT scan and endoscopy? Should I consider getting an MRI or a biopsy for further confirmation? (2) After more than a month of treatment, while my nasal congestion has improved, it has not been completely resolved, and the tinnitus and pain still occur intermittently, disrupting my normal life.
I would like to understand if there could be other potential head and neck pathologies involved.
Thank you for taking the time to respond.

David, 40~49 year old female. Ask Date: 2018/10/05

Dr. Zheng Jueyi reply Otolaryngology

Hello: (1) If a CT scan and endoscopy have already been arranged and no significant abnormalities are found, the likelihood of nasopharyngeal carcinoma is low.
If there are abnormalities or concerns, physicians will often proceed with a biopsy.
(2) Since a CT scan has been arranged, the possibility of head and neck lesions should be very low.
If the persistent pain has improved with sinusitis treatment, it may be necessary to consider issues such as migraines or tension-type headaches.
Wishing you peace and health.
Sincerely, Dr.
Jue-Yi Cheng, Head of ENT Department, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2018/10/05

More Info

When it comes to differentiating between sinusitis and nasopharyngeal cancer, it is essential to understand the symptoms, diagnostic methods, and the underlying conditions that may lead to similar presentations. Your concerns regarding persistent left-sided nasal congestion, occasional ear ringing, and discomfort in the oral cavity and throat are valid, especially given your recent medical history and the tests you've undergone.

Understanding the Symptoms
Sinusitis is an inflammation of the sinus cavities, which can lead to symptoms such as nasal congestion, facial pain or pressure, reduced sense of smell, and sometimes ear discomfort due to pressure changes. The presence of a small lymph node in the neck, especially if it is less than 5mm and not progressively enlarging, is often not a cause for concern and can be a normal response to inflammation or infection.

On the other hand, nasopharyngeal cancer may present with symptoms that overlap with sinusitis, such as nasal obstruction, ear ringing (tinnitus), and throat discomfort. However, additional symptoms may include persistent nasal bleeding, a lump in the neck (due to enlarged lymph nodes), and unexplained weight loss.

Diagnostic Approaches
You have already undergone several diagnostic tests, including a CT scan and nasal endoscopy, which are crucial in evaluating the nasal passages and surrounding structures. The fact that your CT scan showed fluid accumulation in the sinuses but no abnormalities in the nasopharyngeal area is reassuring. Additionally, a negative EBV (Epstein-Barr Virus) serology test is also a good sign, as EBV is often associated with nasopharyngeal carcinoma.

1. Can Nasopharyngeal Cancer Be Ruled Out?
- While no test can provide a 100% guarantee, the combination of a negative EBV test, normal findings on nasal endoscopy, and the CT scan results significantly lowers the likelihood of nasopharyngeal cancer. However, if your symptoms persist or worsen, further investigation may be warranted.
2. Should You Consider MRI or a Biopsy?
- An MRI can provide more detailed images of soft tissues and may be useful if there are concerns about other head and neck pathologies. A biopsy is typically reserved for cases where there is a palpable mass or abnormality that needs histological examination. If your symptoms do not improve with conservative treatment, discussing the possibility of an MRI or biopsy with your healthcare provider may be appropriate.

Other Potential Conditions
Given that your symptoms have not fully resolved, it is essential to consider other potential conditions that could be causing your symptoms. Conditions such as allergic rhinitis, chronic rhinosinusitis, or even other forms of head and neck pathology could be contributing to your ongoing discomfort.
- Chronic Rhinosinusitis: This condition can persist despite treatment and may require a more aggressive approach, including possibly surgery to improve sinus drainage.

- Allergic Rhinitis: If allergies are a factor, they can exacerbate sinusitis symptoms and lead to persistent nasal congestion and ear issues.

- Other Head and Neck Issues: Conditions such as temporomandibular joint (TMJ) disorders can also cause ear pain and discomfort in the jaw and throat.

Conclusion
In summary, while your current diagnostic tests provide a reassuring picture regarding nasopharyngeal cancer, it is crucial to continue monitoring your symptoms. If they persist or worsen, further imaging or even a biopsy may be necessary to rule out other conditions. Always communicate openly with your healthcare provider about your concerns and symptoms, as they can guide you in making informed decisions about your health. Your well-being is paramount, and addressing these issues comprehensively will help you find relief and clarity.

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