Extension of nasopharyngeal carcinoma and otitis media with effusion

Anatomic Eponyms in Neuroradiology: Head and Neck

In medicine, an eponym is a word-typically referring to an anatomic structure, disease, or syndrome-that is derived from a person's name. Medical eponyms are ubiquitous and numerous. They are also at times controversial. Eponyms reflect medicine's rich and colorful history and can be useful for concisely conveying complex concepts. Familiarity with eponyms facilitates correct usage and accurate communication. In this article, 22 eponyms used to describe anatomic structures of the head and neck are discussed. For each structure, the author first provides a biographical account of the individual for whom the structure is named. An anatomic description and brief discussion of the structure's clinical relevance follow.

Middle ear effusion in patients with sinonasal cancer treated by surgery with or without radiotherapy

OBJECTIVE

To identify the prevalence and risk factors of eustachian tube dysfunction after surgery for sinonasal cancer by observing the occurrence of middle ear effusion.

STUDY DESIGN

Historical cohort study.

SETTING

Academic university hospital.

SUBJECTS AND METHODS

Clinical records of 112 patients surgically treated for sinonasal cancer over a 16-year period were evaluated. Initial bivariate analysis was followed by a multivariate logistic regression model.

RESULTS

The best model included 2 variables: posterior extension of surgical resection (nasopharynx, soft palate, eustachian tube, pterygomaxillary fossa, parapharyngeal space) with an odds ratio of 5.662 (95% confidence interval [CI], 1.877-9.447) and postoperative radiotherapy with an odds ratio of 8.691 (95% CI, 4.187-13.194).

CONCLUSION

Despite the limited number of patients, the study gives a prediction of middle ear effusion based on 2 well-defined factors: surgical resection of anatomic structures involved in tubal function and adjuvant radiotherapy.

Nasopharyngeal cancer mimicking otitic barotrauma in a resource-challenged center: a case report

INTRODUCTION

Nasopharyngeal cancer commonly manifests with cervical lymphadenopathy, recurrent epistaxis and progressive nasal obstruction. Neuro-ophthalmic and otologic manifestations can also occur. Isolated otologic presentations of nasopharyngeal cancer are rare and the diagnosis of nasopharyngeal cancer may not be foremost in the list of differentials.

CASE PRESENTATION

We present the case of a 29-year-old Nigerian woman with bilateral conductive hearing loss and tinnitus after air travel. There were no other symptoms. The persistence of the symptoms after adequate treatment for otitic barotrauma necessitated re-evaluation, which led to a diagnosis of nasopharyngeal cancer.

CONCLUSION

Isolated otologic manifestations of nasopharyngeal cancer are rare in regions with low incidence of the disease. There is a need for it to be considered as a possible differential in patients presenting with bilateral serous otitis media.

Patulous eustachian tube in long-term survivors of nasopharyngeal carcinoma

This article reports on 21 long-term (10 years) survivors of nasopharyngeal carcinoma, divided into 2 groups: those subjected to an inflation-deflation test and a clearance function test in a longitudinal study, and those receiving sonotubometry in a cross-sectional study. On the inflation-deflation test, 12 (55%) out of 22 ears had a patulous eustachian tube, and on sonotubometry, 10 (50%) out of 20 ears also revealed a patulous eustachian tube. Except for 4 ears with chronic otitis media, the ears had resolved to a normal eardrum appearance at 10 years postirradiation. The phenomenon might be attributed to both restoration of the impaired tubal function and the development of a patulous tube.

Nasopharyngeal carcinoma presenting as an intracranial abscess

BACKGROUND

There are many conditions related to brain abscess. Brain abscesses resulting from nasopharyngeal carcinoma is rare. It is unusual for an intracranial abscess to appear as the initial clinical presentation of nasopharyngeal carcinoma.

CASE REPORT

A 43-year-old male patient suffering from nasopharyngeal carcinoma with the initial manifestation of an intracranial abscess without symptoms and signs suggestive of the primary nasopharyngeal carcinoma is reported. The diagnosis was particularly elusive and was not made until the third admission.

CONCLUSION

Although it is rare, intracranial abscess should be considered as one of the possible manifestations of nasopharyngeal carcinoma.

Preservation of tubal function in patients with nasopharyngeal carcinoma, post-irradiation

Nineteen nasopharyngeal carcinoma (NPC) patients were subjected to eustachian tube function testing before and 5 years after irradiation. Tubal patency and clearance function of the eustachian tube showed deterioration if maximum irradiation dosage was more than 70 Gy, whereas dynamic function of the eustachian tube was preserved. Development of middle ear complications in NPC patients post-irradiation was caused by both tubal and inflammatory factors. To preserve tubal function, maximum irradiation dosage to NPC should be limited to 70 Gy. To decrease the inflammatory reaction, firstly, middle ear effusion should be drained by repeated myringotomies instead of grommet insertion, and secondly, sinusitis should be evaluated and treated, because sinusitis can aggravate otitis media with effusion.

Eustachian tube function of patients with nasopharyngeal carcinoma

Prolonged observations of the eustachian tube (ET) function were made on 40 ears of 20 patients with nasopharyngeal carcinoma (NPC) who survived more than 5 years after radiotherapy in a state of remission. The ET function tests included passive opening, inflation-deflation, and clearance, and were performed before, at 6 months, and at 5 years after radiotherapy. The test results were found to be worst at 6 months after radiotherapy and improved at 5 years after radiotherapy. Tubal obstruction and inflammation are the main causes of the ET malfunction that results in otitis media with effusion (OME) in NPC patients after radiotherapy. Insertion of a ventilation tube into the ear with OME can relieve tubal obstruction but can aggravate inflammation. Thus, myringotomy and aspiration of effusion and local treatment may be preferable to insertion of a ventilation tube in NPC patients with OME. When hearing improvement in prolonged survival of NPC patients with OME is needed, the use of amplification is recommended.

The nasopharynx, eustachian tube and otitis media

It has been classically hypothesized that a mass in the nasopharynx causes an obstacle to air flow through the eustachian tube, thereby creating a negative pressure in the middle ear followed by an effusion. However, examination of the relevant data concerning the supposed obstruction of the eustachian tube by nasopharyngeal carcinomas, choanal polyps and adenoids does not seem to support this cause and effect relationship. Evidence points to other more sophisticated mechanisms which cause negative pressure and an effusion in pathological middle ear conditions. While the hypothesis of a nasopharyngeal mass as the usual obstructive cause of middle ear effusion is hard to maintain, evidence does exist to support the origin of middle ear infection, as seen in acute and secretory otitis media, as being associated, at times, with an ascending infection from the nasopharynx.

The otological status of patients with nasopharyngeal carcinoma after megavoltage radiotherapy

A middle ear effusion is a common complication of nasopharyngeal carcinoma both before and after radiotherapy. An effusion was found in 38 per cent of patients before radiotherapy and 9 per cent developed an effusion after the start of radiotherapy. Surgical treatment by myringotomy with or without grommet insertion was associated with a high incidence of otorrhoea (26 per cent) which was often refractory to treatment. In view of the frequency of this complication and the fact that a middle ear effusion may not be of concern to an adult patient with nasopharyngeal carcinoma, a 'wait and see' policy may be appropriate in the management of a middle ear effusion in these patients.

Serous otitis media and paranasopharyngeal extension of nasopharyngeal carcinoma

Two hundred thirty-two patients with nasopharyngeal carcinoma were evaluated for serous otitis media (SOM) at diagnosis. The diagnosis of SOM required the detection of effusion behind the tympanic membrane in association of air-bone gap of 10 dB or more in pure tone audiogram. These patients were also evaluated by computed tomography for the degree of tumor extension. By stepwise logistic regression analysis, the degree of paranasopharyngeal extension of tumor, erosion of petrous temporal bone, and the obliteration of pharyngeal recess were significantly related to the development of SOM, but sex and age were not. The findings of computed tomography may influence the plan of management for SOM in patients with nasopharyngeal carcinoma at diagnosis.