Should nasopharyngeal biopsy be mandatory in adult unilateral glue ear?

Lee, W. C.; Weiner, Gregory M.; Campbell, Jeffrey B.

doi:10.1017/s0022215100132736

Cited by 8 publications

(7 citation statements)

References 11 publications

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“…It is accepted that nasopharyngeal tumours may spread submucosally and that the nasopharynx may appear normal on flexible nasendoscopy. 5,6 However, in our study, no patient with a normal-looking nasopharynx proved to have a nasopharyngeal tumour on initial biopsy or at six month follow up.…”

Section: Discussioncontrasting

confidence: 62%

Routine nasopharyngeal biopsy in adults presenting with isolated serous otitis media: is it justified?

et al. 2006

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Nasopharyngeal malignancy accounts for less than 2 per cent of all head and neck cancers. Serous otitis media (SOM) causing deafness is a recognized indicator of nasopharyngeal obstruction and the possibility of a nasopharyngeal malignancy must be considered in all adults. Examination under anaesthesia (EUA) and biopsy of the nasopharynx is routinely undertaken in many centres to rule out nasopharyngeal malignancy in adults with SOM. The purpose of this 10-year retrospective study was to evaluate the case records of all adult cases of SOM, including their presentation, clinical findings, management and nasopharyngeal biopsy results. Eighty-five patients were included in the study. Fifty-nine presented with unilateral SOM and 26 with bilateral SOM. The primary presenting complaint in all cases was hearing loss. A nasopharyngeal mass was documented in 55 patients (69 per cent). Four nasopharyngeal masses were noted to have irregular or exophytic mucosa on flexible nasendoscopy. All patients underwent a EUA of the ears and a nasopharyngeal biopsy. The four patients with suspicious-looking masses were all found to have malignancies (two squamous cell carcinomas, one B-cell non-Hodgkin lymphoma and one adenocarcinoma). Three of these patients presented with unilateral SOM and one with bilateral SOM. All other patients with masses were found to have benign lymphoid hyperplasia. In total, 4.7 per cent of the adults with conductive hearing loss secondary to SOM were found to have a malignancy on nasopharyngeal biopsy. We would advocate a high index of suspicion of a nasopharyngeal tumour in adults presenting with SOM. If a mass is found in the nasopharynx then it should be biopsied. If no mass is found then it is not necessary to biopsy; however, close follow up, with repeat fibre-optic nasendoscopy, is advised.

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Section: Discussioncontrasting

confidence: 62%

Routine nasopharyngeal biopsy in adults presenting with isolated serous otitis media: is it justified?

et al. 2006

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“…To date, two cases of NPC have been reported that were identified after the biopsy of a normal-looking nasopharynx in patients with isolated serous otitis media. 17 Furthermore, in three studies of 72, 275 and 169 patients presenting with serous otitis media, some of whom also had other symptoms, a tumour was identified in one patient with normal nasendoscopy findings in each study, with no other suspicious signs or symptoms in each study, representing 1.4 per cent, 0.4 per cent and 0.6 per cent incidence rates, respectively. 6,9,18 Conversely, in two studies of 85 and 57 patients with isolated serous otitis media, no tumours were identified in patients with normal nasendoscopy findings.…”

Section: Discussionmentioning

confidence: 95%

Should adults with isolated serous otitis media be undergoing routine biopsies of the post-nasal space?

2020

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Background Serous otitis media is a recognised presentation of Eustachian tube dysfunction secondary to post-nasal space pathology. Post-nasal space biopsies are commonly taken in patients with isolated serous otitis media, despite normal nasendoscopy findings, without robust evidence for doing so. This study examined cases of unilateral serous otitis media with effusion in adults. It is the largest known retrospective study to investigate whether post-nasal space biopsies are indicated in non-endemic regions. Methods A retrospective analysis was performed of 119 patients who underwent post-nasal space biopsy because of isolated serous otitis media, in a tertiary referral centre, from 2007 to 2017. Endoscopic examination and final histological report findings were reviewed. Results Of the 119 patients identified, 6 (5.0 per cent) were found to have abnormal histology. In all six cases, suspicious clinical findings had been noted on nasendoscopic examination prior to biopsy. Conclusion Suspicious findings pre-operatively predict sinister pathology. Biopsies are not recommended in cases of adult serous otitis media with normal nasendoscopy findings if no other risk factors exist. A UK-wide retrospective study or prospective study over the next 10 years will help provide the evidence necessary to support this guidance.

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“…It is well accepted that it is not possible to exclude NPC by macroscopic examination of the nasopharynx alone, since nasopharyngeal tumours may spread submucosally, and that the nasopharynx may appear normal on flexible nasopharyngoscopy (31,32) . Therefore, if the clinical suspicion for nasopharyngeal malignancy is high, even if the suspected tumour cannot be visualized on endoscopic examination, other non-invasive techniques, such as MRI, should be used.…”

Section: Discussionmentioning

confidence: 99%

Nasopharyngeal biopsy in adults: a large-scale study in a non endemic area

Abu‐Ghanem¹,

Carmel²,

Horowitz³

et al. 2015

Rhin

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Should nasopharyngeal biopsy be mandatory in adult unilateral glue ear?

Abstract: Unilateral secretory otitis media is a recognized presenting feature of nasopharyngeal neoplasia. In the two cases presented, biopsy from the nasopharynx revealed an unsuspected underlying adenocarcinoma. The need to biopsy the normal looking post-nasal space is highlighted.

Cited by 8 publications

References 11 publications

Routine nasopharyngeal biopsy in adults presenting with isolated serous otitis media: is it justified?

Routine nasopharyngeal biopsy in adults presenting with isolated serous otitis media: is it justified?

Should adults with isolated serous otitis media be undergoing routine biopsies of the post-nasal space?

Nasopharyngeal biopsy in adults: a large-scale study in a non endemic area

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