Nasopharyngeal Cancer Symptoms and Ear Issues

Q: Nasopharyngeal Cancer Symptoms and Ear Issues

Hello, the issues you mentioned could be due to： 1) Eustachian tube dysfunction： This is the most common cause and can occur not only during flying, climbing, or diving, but also when forcefully blowing your nose or bending over. <br>2) Sudden sensorineural hearing loss. <br>3) O

Questions about nasopharyngeal cancer symptoms?

Hello Doctor: After a severe cold at the end of September, I experienced a sharp pain in my eardrum when forcefully blowing my nose.
Since then, I have had a feeling of fullness in my right ear, and I hear a popping sound when I open my mouth.
I visited two clinics, and both indicated that there were no abnormalities in my ear.
Two weeks later, in mid-October, the fullness persisted, so I was referred to a hospital for further examination.
At the hospital, I underwent hearing tests and tympanometry, both of which showed no abnormalities.
The doctor noted that there were bubbles in my right eardrum, possibly indicating middle ear effusion.
After undergoing a myringotomy, the fullness did not improve.
Two weeks later, I visited a nearby Clinic A for another check-up.
The doctor at Clinic A stated that my ears were clean and there were no abnormalities.
Regarding the popping sound, he suggested it might be due to Eustachian tube dysfunction.
However, since I had not undergone a nasopharyngoscopy at the hospital, the doctor at Clinic A performed one and found that my right nasal cavity was somewhat swollen (but he only recommended monitoring it or, if I was very concerned, to consider a biopsy at the hospital).
Unsatisfied, I immediately went to Clinic B the next day and informed the doctor there of Clinic A's findings (the swelling in the right nasal cavity, but Clinic A could not determine the cause) and my right ear fullness.
After examining me with a nasopharyngoscope, the doctor at Clinic B indicated that the swollen area in the right nasal cavity resembled adenoid hypertrophy, likely due to mucus or allergic inflammation (located towards the right side).
If it were nasopharyngeal carcinoma, the tumor would likely be in a slightly left-placed depression and would show signs of erosion (my depression appeared smooth under the endoscope).
The doctor concluded that my ear issue was likely just Eustachian tube dysfunction.
I then asked Dr.
B if a biopsy at the hospital was necessary, and he clearly stated that it was not needed, suggesting a follow-up in six months.
Given my sensitive nature, I would like to ask you: Currently, I have no fullness in my right ear, but I still hear a popping sound when I open my mouth (which improves when lying down).
Could symptoms of nasopharyngeal carcinoma affecting the ear improve due to changes in posture? Since I am quite sensitive about my ear condition, and it has been about two weeks since my last examination, do you think it is necessary to seek a third opinion? Thank you very much!

Niming, 30~39 year old female. Ask Date: 2019/11/09

Dr. Ji Zhaoyun reply Otolaryngology

Hello, the issues you mentioned could be due to: 1) Eustachian tube dysfunction: This is the most common cause and can occur not only during flying, climbing, or diving, but also when forcefully blowing your nose or bending over.
2) Sudden sensorineural hearing loss.
3) Otitis media: a) Acute otitis media: Often occurs alongside upper respiratory infections (like colds) or sinusitis, and in severe cases, the ear may discharge fluid or pus.
b) Chronic otitis media with acute exacerbation: This usually occurs when there is a pre-existing perforation in the eardrum, leading to inflammation due to unclean water or improper ear cleaning.
All of the above conditions can be appropriately treated with medication after consulting a physician.
If you have already undergone pure tone audiometry (which requires headphones in a soundproof room, where sounds prompt you to press a button, rather than just using a tuning fork), and it has been confirmed that you do not have sudden sensorineural hearing loss, then medication may suffice.
However, if you have not had pure tone audiometry, it is advisable to visit a hospital for an examination to rule out sudden hearing loss.
The golden treatment window for sudden sensorineural hearing loss is two weeks, and early treatment yields better results.
Regarding the nasopharyngeal area, if both Dr.
A and Dr.
B have performed endoscopic examinations and found no immediate need for biopsy, regular follow-up may be considered.
If you still have concerns, you may seek further medical evaluation.
Wishing you peace and good health.
Sincerely, Dr.
Chi Chao-Yun, Head of the ENT Department, Taichung Hospital, Ministry of Health and Welfare.

Reply Date: 2019/11/09

More Info

Understanding the symptoms of nasopharyngeal cancer (NPC) and their relationship to ear issues can be quite complex, especially when you are experiencing discomfort and have undergone various examinations. Based on your description, it seems you have been proactive in seeking medical advice, which is commendable.
Firstly, let's address the symptoms you are experiencing. The sensation of ear fullness or "clogging" can often be attributed to dysfunction of the Eustachian tube, which connects the middle ear to the nasopharynx. This dysfunction can occur due to various reasons, including allergies, infections, or inflammation. In your case, the history of a severe cold followed by nasal congestion and the sensation of pressure in the ear suggests that this could be a contributing factor. The "pop" sound you hear when opening your mouth could be related to the movement of the Eustachian tube, which may not be functioning optimally.

The findings from your nasal endoscopy, where the right nasal cavity appeared swollen, could indicate inflammation, possibly due to allergic rhinitis or other forms of sinusitis. It is important to note that while swelling in the nasal cavity can be concerning, it does not automatically indicate cancer. The fact that the area was described as smooth rather than ulcerated is a positive sign. NPC typically presents with more aggressive symptoms, including persistent nasal obstruction, epistaxis (nosebleeds), and possibly a palpable neck mass due to lymph node involvement.

Regarding your concerns about NPC and its potential to cause ear symptoms, it is true that tumors in the nasopharynx can lead to Eustachian tube dysfunction, resulting in ear fullness and discomfort. However, the absence of more severe symptoms, such as significant weight loss, persistent pain, or neurological symptoms, is reassuring. Additionally, the fact that your symptoms have not worsened and that you have received multiple opinions from healthcare providers who have not found malignancy is encouraging.

As for your question about whether the position of your body could influence the symptoms, it is indeed possible. Changes in posture can affect Eustachian tube function and the pressure within the ear. Lying down may help equalize pressure, leading to temporary relief from the sensation of fullness.

In terms of whether you should seek a third opinion, it is always within your rights as a patient to seek further clarification if you feel uncertain about your diagnosis or treatment plan. However, if the healthcare providers you have consulted have provided consistent assessments and recommendations, it may be beneficial to follow their advice and monitor your symptoms over time. If you experience any new or worsening symptoms, such as persistent pain, significant changes in hearing, or other alarming signs, it would be prudent to return for further evaluation.

In conclusion, while your symptoms warrant attention, the current assessments suggest that your issues are likely related to Eustachian tube dysfunction rather than nasopharyngeal cancer. Continue to monitor your symptoms, consider following up as recommended, and do not hesitate to seek further medical advice if your concerns persist. Your health and peace of mind are paramount, and staying informed and engaged in your care is essential.

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