Routine nasopharyngeal biopsy in adult secretory otitis media

Abstract

This study was to determine whether routine examination under anaesthesia and nasopharyngeal biopsy in adults presenting with deafness due to secretory otitis media (SOM) is necessary for detection of nasopharyngeal malignancy. Two patient groups were studied. The first comprised 72 adults with SOM. Of these patients, 3 had nasopharyngeal tumours, 2 of whom also had cervical lymphadenopathy. The prevalence of malignancy in patients with SOM but no other suspicious signs was 1/72 (1.4%). The second group comprised 66 patients receiving treatment for nasopharyngeal neoplasms. In this group, 8 patients had SOM at presentation, 7 of whom had other features suspicious of malignancy. SOM as the sole presenting feature of nasopharyngeal malignancy was 1/66 (1.5%). EUA and biopsy of the nasopharynx is a cost effective investigation which continues to be indicated in adults presenting with deafness due to SOM.

Nasopharyngeal biopsy in adults presenting with serous otitis media: Cross‐sectional study

“…Middle ear effusion had been reported to be unilateral in a range of 68%‐96.6% of patients undergoing nasopharyngeal biopsy . In our study, SOM/CHL was unilateral at a rate of 71.8%, which is in accordance with these values.…”

“…Adult‐onset SOM and CHL are associated with common medical conditions, such as upper respiratory tract infection, sinusitis, allergic rhinitis, and adenoidal hypertrophy . They may also be presenting features of NPC and, unlike other clinical features, such as cervical lymphadenopathy or cranial nerve palsies, they were suggested as early‐stage disease manifestations when the tumor is still confined to the nasopharynx . Therefore, an adult patient who presents with SOM/CHL should be thoroughly assessed for further clinical manifestations of NPC.…”

“…However, the uncertainty involved in the nasopharyngoscopic examination and the concern of missing a cancer diagnosis results in a referral of patients with SOM/CHL to fiber‐optic‐guided nasopharyngeal biopsy in many cases, regardless of the nasopharyngoscopic findings or the presence of additional clinical manifestations other than SOM/CHL. A routine nasopharyngeal biopsy in those patients is a common practice carried out in many centers, although there are no clear indications and guidelines for when it should be performed . Moreover, although SOM/CHL are considered as being well‐known features of NPC, surprisingly, based on our extensive literature review, the evidence regarding this association of SOM/CHL as an isolated presentation and NPC is limited in both high‐endemic and low‐endemic areas …”

“…A routine nasopharyngeal biopsy in those patients is a common practice carried out in many centers, although there are no clear indications and guidelines for when it should be performed . Moreover, although SOM/CHL are considered as being well‐known features of NPC, surprisingly, based on our extensive literature review, the evidence regarding this association of SOM/CHL as an isolated presentation and NPC is limited in both high‐endemic and low‐endemic areas …”

“…10 They may also be presenting features of NPC and, unlike other clinical features, such as cervical lymphadenopathy or cranial nerve palsies, they were suggested as early-stage disease manifestations when the tumor is still confined to the nasopharynx. 11,12 Therefore, an adult patient who presents with SOM/CHL should be thoroughly assessed for further clinical manifestations of NPC. Fiberoptic nasopharyngoscopy is an essential part of this workup.…”