Upload
aldhi-tri-budhi
View
219
Download
0
Embed Size (px)
Citation preview
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
1/23
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*
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
2/23
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.
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
3/23
Results: $i'e patients !e'eale Ps (ou! nonke!atiniin* /a!/inoas an one suaous /ell
/a!/inoa). OM2 was eee to ha'e !esulte
!o :uppe! !espi!ato!y ine/tion in "0 patients ("7.0)
/h!oni/ pa!anasal sinusitis in 1; patients (1#.7)
alle!*i/ !hinitis in 16 patients (18.4)
P in ; patients (;.#)'a!ious othe! known etiolo*ies in 11 patients (1".6)
unknown etiolo*ies in "0 patients ("7.0).
he in/ien/e o P aon* aults sue!in* !o
OM2 -ut eatu!in* no othe! syptos an si*ns
su**esti'e o P was ;.# (; o 8# patients).
Su/h a i*u!e appea!e to -e *!eate! than that in
soe othe! !epo!ts -e/ause P tens to eatu!e
a *!eate! p!e'alen/e in aiwan.
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
4/23
he!eo!e -iopsy o the postnasal spa/e o!
aults who appea! to eatu!e only OM2 when
P is st!on*ly suspe/te is ne/essa!y o! the
ea!ly ia*nosis o P.
Conclusions: We /on/lue that aiwaneseaination an -iopsy
o the nasopha!yn> to e>/lue P.
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
5/23
OME Otitis eia with eusion (OM2) is usually
!e*a!e as a /hilhoo isease howe'e! whe!easault
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
6/23
he in/ien/e an e/haniss o
OM2 /ause -y P appea! to ha'e
-een wiely es/!i-e. o the -esto ou! knowle*e the!e appea! to
-e ew pu-lishe !epo!ts /on/e!nin*
the in/ien/e o P in aults withOM2 -ut with appa!ently no othe!
suspi/ious si*ns su**esti'e o P.
We a!e inte!este in the possi-ility
that P ay -e ia*nose only
!o ault
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
7/23
As we know, the common presenting
symptoms and signs are typically
related to the locoregional problemsproduced by NPC, such as neck mass,
epistaxis, cranial nerve palsy, and OM
!erein, when the above symptoms or
signs accompany OM, we strongly
suspect NPC" #$ 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"
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
8/23
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.
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
9/23
$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.
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
10/23
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
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
11/23
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.
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
12/23
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 ""
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
13/23
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 $$usion /n 0 %(1
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
14/23
,ll patients une!went a -iopsy o the nasopha!yn>G i'e
patients with unilate!al OM2 !e'eale -iopsy
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
15/23
Patient Age(yr)
Sex nilateralityof !"E
Pat#ology Sy$%to$ &uration($o)
1 ) 2emale 3ight N4C !earing loss, tinnitus 5
' ' Male 3ight N4C !earing loss, ear $ullness *
( 2emale 6e$t N4C !earing loss, ear $ullness *
) Male 6e$t 7CC !earing loss, ear $ullness *
* &* Male 3ight N4C !earing loss, ear $ullness 5
Table '.
Clinical 8ata o$ 9iopsy.Proven Nasopharyngeal Carcinoma /n 0 &1
N4C 0 non keratini:ing carcinoma; 7CC 0 s
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
16/23
Cause Cases %
Allergi+ r#initis *) *%"Sinusitis *& *("-
%%er res%iratory tra+t
infe+tion
5+ 5-"+
,aso%#aryngeal
+ar+ino$a
& &"(
!t#er etiologies ** *5")nknown etiologies 5+ 5-"+
Table . Causes o$ Adult.Onset Otitis Media with $$usion /n 0 %(1
=One case o$ s
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
17/23
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
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
18/23
+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@?
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
19/23
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#).
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
20/23
+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.
7/23/2019 Early Recognition of Nasopharyngeal Cancer in Adults With
23/23
THANK
YOU