Nasopharyngeal carcinoma misdiagnosed as otitis media

Mr. Chen, 53 years old, was admitted to the hospital due to "left tinnitus and hearing loss for half a year".

Medical history

The patient had left tinnitus and hearing loss without obvious causes six months ago, and the symptoms were chronic and progressive. There was no tinnitus or nasal congestion, no feeling of blockage in the ears, no respiration of blood in the nose, no diplopia, no limb numbness, and no aggravation of pain at night. In the past two months, he had sought medical treatment in many places, all of which diagnosed him with exudative otitis media and gave him corresponding treatment, but his condition did not improve.

Physical examination

The lymph nodes in the neck and before and after the ears were not palpable, and there were no obvious abnormalities in the heart and lungs. The left tympanic membrane was retracted, with a fluid level and enlarged lymph nodes in the left neck.

Testing

The results of fiberoptic nasal endoscopy showed that the left pharyngeal recess was full and rough with purulent secretions. Two pieces of hyperplastic tissue were taken from the tumor and sent to pathology, which showed undifferentiated squamous cell carcinoma of the nasopharynx.

Diagnosis and treatment

The patient had visited the doctor many times before, and was treated for otitis media in the past two months. He was given local antibiotics and ear canal irrigation, but his condition did not change significantly, and occasionally improved. He was then given a fiberoptic nasal endoscopy and a biopsy of the hyperplastic tumor. The pathological results confirmed that it was undifferentiated nasopharyngeal carcinoma and radiotherapy was recommended.

After 20 days of regular radiotherapy, the patient's symptoms of tinnitus and hearing loss were significantly alleviated. He was then discharged from the hospital after treatment with Chinese medicine for nourishing yin and increasing fluid. There was no recurrence during follow-up one year after discharge.

This is a misdiagnosed case. The patient sought medical treatment many times and was always treated for otitis media. The early symptoms of nasopharyngeal cancer are mild, and the patient is generally in good condition, so doctors are easily careless and miss the diagnosis.