Early Recognition of Nasopharyngeal Cancer in Adults With

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    EARLY RECOGNITION OF

    NASOPHARYNGEAL CANCER IN ADULTS

    WITH ONLY OTITIS MEDIA WITHEFFUSION

    Oleh :

    Willyani Setiawan (406.091.008)Poppy Meisalina (406.091.010)

    Rika Wulana!i (01."04.48#4)

    $akultas %eokte!an

    &ni'e!sitas a!uana*a!a

    &ni'e!sitas +sla Sultan ,*un*

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    ABSTRACT Objective: o assess the p!o-a-ility o

    nasopha!yn*eal /a!/inoa (P) -ein* p!esentaon* aults who appea!e to sue! only !o

    otitis eia with eusion (OM2).

    Design and Setting: he /lini/al eatu!es o 8#aults sue!in* !o OM2 -ut who

    eonst!ate no othe! appa!ent syptos an

    si*ns su**esti'e o P at the 3epa!tent o

    Oto!hinola!yn*olo*y %aohsiun* Mei/al&ni'e!sity 5ospital -etween anua!y "007 an

    3e/e-e! "004 we!e analye. , !outine

    nasopha!yn*eal -iopsy was pe!o!e.

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    Results: $i'e patients !e'eale Ps (ou! nonke!atiniin* /a!/inoas an one suaous /ell

    /a!/inoa). OM2 was eee to ha'e !esulte

    !o :uppe! !espi!ato!y ine/tion in "0 patients ("7.0)

    /h!oni/ pa!anasal sinusitis in 1; patients (1#.7)

    alle!*i/ !hinitis in 16 patients (18.4)

    P in ; patients (;.#)'a!ious othe! known etiolo*ies in 11 patients (1".6)

    unknown etiolo*ies in "0 patients ("7.0).

    he in/ien/e o P aon* aults sue!in* !o

    OM2 -ut eatu!in* no othe! syptos an si*ns

    su**esti'e o P was ;.# (; o 8# patients).

    Su/h a i*u!e appea!e to -e *!eate! than that in

    soe othe! !epo!ts -e/ause P tens to eatu!e

    a *!eate! p!e'alen/e in aiwan.

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    he!eo!e -iopsy o the postnasal spa/e o!

    aults who appea! to eatu!e only OM2 when

    P is st!on*ly suspe/te is ne/essa!y o! the

    ea!ly ia*nosis o P.

    Conclusions: We /on/lue that aiwaneseaination an -iopsy

    o the nasopha!yn> to e>/lue P.

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    OME Otitis eia with eusion (OM2) is usually

    !e*a!e as a /hilhoo isease howe'e! whe!easault

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    he in/ien/e an e/haniss o

    OM2 /ause -y P appea! to ha'e

    -een wiely es/!i-e. o the -esto ou! knowle*e the!e appea! to

    -e ew pu-lishe !epo!ts /on/e!nin*

    the in/ien/e o P in aults withOM2 -ut with appa!ently no othe!

    suspi/ious si*ns su**esti'e o P.

    We a!e inte!este in the possi-ility

    that P ay -e ia*nose only

    !o ault

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    As we know, the common presenting

    symptoms and signs are typically

    related to the locoregional problemsproduced by NPC, such as neck mass,

    epistaxis, cranial nerve palsy, and OM

    !erein, when the above symptoms or

    signs accompany OM, we strongly

    suspect NPC" #$ adults have su$$ered

    only $rom OM but no other symptoms

    and signs suggestive o$ NPC, the

    possibility that these patients are also

    su$$ering $rom NPC is usually neglected"

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    hus this -e*s the uestion ?What is the in/ien/e

    o P aon* aiwanese aults eatu!in* only OM2@A

    Bu>o! an Sheehy wo!kin* with a Bos ,n*eles

    population in 198" ete/te ; P /ases aon* 781aults une!*oin* *!oet inse!tionCan in/ien/e

    o 1.7.

    3epste! an Sipson !epo!tin* on a Dlas*ow

    population in 1988 ete/te a nasopha!yn*ealtuou! in only 1 /ase !o a population o #" aults

    sue!in* only !o OM2C an in/ien/e o 0.4.

    he in/ien/e o P as es/!i-e in these !epo!ts

    woul thus appea! to -e low. hese autho!s

    su**este that the 'e!y natu!e o su/h !outine

    in'esti*ations has -een /hallen*e wa!!antin* a

    u!the! uestion ?,!e these /on/lusions applie@? +n

    aiwan P has a !athe! hi*h in/ien/e.

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    $u!the! uestions that ne/essa!ily a!ise in/lue

    ?What a!e the ie!en/es in the in/ien/e o P

    aon* aults eatu!in* only OM2 when /opa!in*

    aiwan with othe! !e*ional populations@? an ?+sthe!e a weak o! a st!on* asso/iation -etween P

    an OM2@?

    o /la!iy the asso/iation -etween these two

    /onitions an to e'aluate the ne/essity onasopha!yn*eal -iopsy o! aiwanese aults

    p!esentin* appa!ently with only OM2the /lini/al

    eatu!es o patients with known OM2 we!e analye

    an the in/ien/e o P aon* aults appa!entlysue!in* only !o OM2 was assesse.

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    MATERIALS AND METHODS ,ll patients o'e! the a*e o "0 yea!s who ha

    'isite the 3epa!tent o Otola!yn*olo*y at

    %aohsiun* Mei/al &ni'e!sity 5ospital

    %aohsiun* aiwan an who ha une!*one

    typano/entesis o! typano*!aphy /oni!in*

    OM2 -etween anua!y "007 an 3e/e-e! "004

    in/lusi'ely we!e ientiie.

    hose patients whose OM2 was eee to ha'e

    a!isen as a /onseuen/e o P post !aiothe!apy

    o! -y the p!esen/e o a ne/k ass we!e e>/lue!o this stuy. 2i*hty

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    he p!esentin* /oplaints we!e !e/o!e an

    the /auses o ile ea! eusions we!e

    analye. $o! ea/h patient p!esentin*syptos we!e note an the /lini/al inin*s

    !o a se!ies o in'esti*ations in/luin*

    otos/opy i-!eainations o the

    nasopha!yn> hea!in* tests an typano*!as.

    , !outine -iopsy o the nasopha!yn> was

    pe!o!e to assess the possi-ility o P. he

    patients with P who owne the /ha!a/te!isti/

    o a tiny un*atin* ass o'e! the nasopha!yn>

    !e/ei'e tuou! -iopsy une! enos/opieassistan/e. Othe!s without o-'ious P !e/ei'e

    nasopha!yn*eal -iopsy o'e! RosenElle! ossa

    an !oo o the lesion site sepa!ately.

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    RESULTS he 8# patients (;6 ale 71 eale) p!esentin* with

    OM2 -ut no othe! suspi/ious si*ns we!e ientiie at ou!institution. he ean a*e at p!esentation was 4#.7 yea!s

    (!an*e ""

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    Symptom Cases %

    Hearing loss %& '("(

    Ear fullness )* (+"*

    Tinnitus - '"

    Running water-

    like sound in ear

    & &"(

    Table 1.Clinical Presentations in Patients with

    #nitial Adult.Onset Otitis Media with $$usion /n 0 %(1

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    ,ll patients une!went a -iopsy o the nasopha!yn>G i'e

    patients with unilate!al OM2 !e'eale -iopsy

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    Patient Age(yr)

    Sex nilateralityof !"E

    Pat#ology Sy$%to$ &uration($o)

    1 ) 2emale 3ight N4C !earing loss, tinnitus 5

    ' ' Male 3ight N4C !earing loss, ear $ullness *

    ( 2emale 6e$t N4C !earing loss, ear $ullness *

    ) Male 6e$t 7CC !earing loss, ear $ullness *

    * &* Male 3ight N4C !earing loss, ear $ullness 5

    Table '.

    Clinical 8ata o$ 9iopsy.Proven Nasopharyngeal Carcinoma /n 0 &1

    N4C 0 non keratini:ing carcinoma; 7CC 0 s

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    Cause Cases %

    Allergi+ r#initis *) *%"Sinusitis *& *("-

    %%er res%iratory tra+t

    infe+tion

    5+ 5-"+

    ,aso%#aryngeal

    +ar+ino$a

    & &"(

    !t#er etiologies ** *5")nknown etiologies 5+ 5-"+

    Table . Causes o$ Adult.Onset Otitis Media with $$usion /n 0 %(1

    =One case o$ s

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    DISCUSSION OM2 in aulthoo eatu!es a 'a!iety o etiolo*ies. +n a/t it /oul

    -e su**este that OM2 is an ea!ly aniestation o P. +n 198"

    S/hukne/ht an /ollea*ues !epo!te that the onset in aulthooo OM2 ay -e /ause -y one o th!ee patho*eni/ e/haniss: (1) se!ous otitis !esultin* !o -lo/ka*e o the eusta/hian tu-e ainly

    owin* to neoplasti/ iseaseG

    (") ault se!ous eusion o unknown /ause /ha!a/te!ie -y a/ti'e

    se/!etion o se!ous lui !o the u/ous e-!ane linin* o the

    typanoastoi /opa!tentG

    (7) a /e!e-!ospinal lui istula in the typanoastoi /opa!tent.

    +t woul appea! that OM2 a!ises o! patients al!eay sue!in*

    !o P th!ou*h two patho*eni/ e/haniss: (1) the p!esen/e o a spa/e

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    +n 1984 Mye!s an /ollea*ues !epo!te a st!on*

    asso/iation aon* eusta/hian tu-e ysun/tion

    /e!tain hea an ne/k tuou!s an ile ea!eusion. Fetween "6 an 46 patients with

    nasopha!yn*eal tuou!s will also ha'e ile

    ea! eusions at the initial p!esentation. +n

    aiwan au!al syptos su/h as tinnitusullness o the ea! o! hea!in* loss in aition

    to othe! syptos we!e the initial /oplaints

    o "#0 ("8) o 966 P patientsHH this a*ain

    -e**in* the uestion ?What is the in/ien/e oP aon* aults sue!in* !o OM2 -ut

    eatu!in* no othe! suspi/ious si*ns su**esti'e o

    P@?

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    Bu>o! an Sheehy wo!kin* with a Bos

    ,n*eles stuy population ete/te P in ;

    /ases !awn !o 781 aults une!*oin**!oet inse!tionCan in/ien/e o 1.7.

    3epste! an Sipson wo!kin* with a

    Dlas*ow population ete/te a

    nasopha!yn*eal tuou! in only 1 /ase aon*#" aults appa!ently sue!in* only !o OM2

    Can in/ien/e o 0.4.

    Dae an /ollea*ues !epo!te in 199" thatthe in/ien/e o P aon* OM2 sue!e!s

    was 1.4 o! a stuy /onu/te in 2in-u!*h.

    +nte!estin*ly the in/ien/e !o ou! stuy

    was ;.# (; o 8#).

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    +t is hi*he! than othe! !epo!ts -e/ause P is hi*hly

    p!e'alent in aiwan with an in/ien/e o 8.7 pe!

    100.000 o! ales an 7.; pe! 100.000 o! eales

    o! 8.8 pe! 100.000 population a//ountin* o! o!ethan ;# o all hea an ne/k tuou!s. ,ults

    -etween 70 an 60 yea!s o a*e a//ounte o! o!e

    than #0 o the total P /ases.

    his was a stuy o a southe!n aiwanese population

    an su/h /on/lusions /oul -e suita-ly eee to

    apply to a population in whi/h P is enei/.

    he!eo!e the !epo!ts o Bu>o! an Sheeny an

    3epste! an Sipson in/o!po!ate su**estions that

    it shoul -e usual ei/al p!a/ti/e o! /lini/ians to

    e>aine an -iopsy the nasopha!yn> o! all aultaination an -iopsy

    o the nasopha!yn> i ne/essa!y to e>/lue

    the possi-ility o P.

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    THANK

    YOU