The histology revealed an undifferentiated carcinoma of the nasopharynx (World Health Organization type III). She underwent examination of the nasopharynx under general anesthesia and a biopsy of the lesion was performed. Nasopharyngoscopy, which would have been pivotal in reaching a diagnosis, was not done before the CT scan because nasopharyngeal cancer had not been in our list of differentials. A computerized tomographic (CT) scan of her paranasal sinuses was done, which revealed isodense lesions in both fossae of Rosenmüller with complete occlusion of the openings of the Eustachian tubes bilaterally (Figure 2). This necessitated a re-evaluation during examination her tympanic membranes were now hyperemic and bulging. However, her symptoms still persisted after two weeks. She was treated with nasal decongestants, prophylactic antibiotics and asked to perform the Vasalva maneuver frequently. Impedance audiometry showed type B curves bilaterally.Ī diagnosis of bilateral otitic barotrauma was made. Examination of her other systems did not reveal any abnormalities.Ī pure tone audiogram confirmed the bilateral conductive hearing loss (Figure 1A). Her cranial nerves and both eyes were grossly normal. Indirect laryngoscopy findings appeared normal. A nasal and oropharyngeal examination revealed essentially normal findings. No evidence of spontaneous nystagmus was noted. The tuning fork test showed evidence of bilateral conductive hearing loss. Both tympanic membranes were dull with a loss of light reflex. She had received treatment at peripheral hospitals for barotrauma before presenting to our hospital due to persistence of the symptoms.Įxamination revealed a young woman with a nevus on the lobule of her right pinna. There was no history suggestive of exposure to carcinogens. There were no throat or neuro-ophthalmic symptoms. She did not have any nasal blockage, nasal discharge, epistaxis or postnasal drip. There was associated tinnitus but no otalgia, no ear discharge and no sensation of disequilibrium or vertiginous spells. She erstwhile had experienced repeated episodes of this symptom, which occurred each time she flew, but there was always complete resolution after a few days following treatment from an outside health facility. Hence, we report an unexpected presentation of nasopharyngeal cancer, with isolated otologic symptoms, which was initially managed as otitic barotrauma.Ī 29-year-old Nigerian woman, who frequently travels by air, presented with a six-month history of persistent bilateral hearing impairment following a flight. A high index of suspicion is required to evaluate the patient for nasopharyngeal cancer as a differential diagnosis. When they do occur, other more common benign ear diseases that present with similar symptoms are usually considered. It is quite uncommon for nasopharyngeal cancer patients to present with only isolated otologic symptoms, especially in regions where the incidence of this disease is low. However, these presentations are not pathognomonic of nasopharyngeal cancer. The otological manifestations of this disease entity are commonly unilateral Eustachian tube dysfunction, fluid accumulation within the middle ear, conductive hearing loss, otalgia and tinnitus. The clinical morphology of the lesion may be infiltrative, ulcerative or exophytic. They may include cervical lymphadenopathy, nasal blockage, epistaxis, hyponasal speech and otologic and neuro-ophthalmic manifestations. They are usually related to the local, regional and distant spread or metastasis of the lesion. J Acute Dis 2019 8:204.The clinical presentations of nasopharyngeal cancer may sometimes be insidious and nonspecific. Acute otitis media with facial nerve palsy: Our experiences at a tertiary care teachinghospital of eastern India. The effect of compression rate and slope on the incidence of symptomatic eustachian tube dysfunction leading to middle ear barotraumas: A phase I prospective study. Varughese L, O Neill OJ, Marker J, Smykowski E, Dayya D. Postoperative facial baroparesis while flying: A rare complication of decompressing a facial nerve schwannoma. Facial baroparesis secondary to middle‑ear over‑pressure: A rare complication of scuba diving. Hyams AF, Toynton SC, Jaramillo M, Stone LR, Bryson PJ. Transient facial paralysis during ascent to altitude. Facial baroparesis caused by scuba diving.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |