Differentials
Nasopharyngeal cancer
SIGNS / SYMPTOMS
Neck mass - most common presentation of nasopharyngeal cancer (76%).[34]
Presence of risk factors, such as Epstein Barr virus infection, a diet rich in preserved food (in particular salted fish), smoking or other tobacco use, and having a first-degree relative with a history of nasopharyngeal cancer.
Nasal symptoms, such as epistaxis, bloody discharge, or nasal obstruction.[34]
Unilateral polyps should raise suspicion for nasal carcinoma.
Tinnitus or impaired hearing.[34]
Cranial nerve palsy - nerves V and VI are most commonly involved.[35]
Headaches.[34]
Otitis media with effusion.
Diplopia or strabismus
Facial numbness
Fever
Night sweats
Unintentional weight loss
INVESTIGATIONS
Nasopharyngoscopy - lesion observed on endoscopy, most commonly arising from lateral pharyngeal recess (fossa of Rosenmüller).
Tumor biopsy - positive if tumor cells are identified.
MRI of the nasopharynx, skull base, and neck (to clavicles) - identifies suspicious lesions and metastatic disease.
18F-FDG-PET/CT (vertex to mid-thigh) - identifies metastatic disease
Congenital lesions (e.g., encephalocele, concha bullosa)
SIGNS / SYMPTOMS
Concha bullosa is often asymptomatic, but may cause sinus obstruction. Encephalocele symptoms are dependent on size and location.
INVESTIGATIONS
CT and MRI head defines extent and characteristics of the lesion(s).
Foreign body
SIGNS / SYMPTOMS
Usually sudden onset of unilateral symptoms. Epistaxis may feature.
INVESTIGATIONS
Nasendoscopy may allow identification and possible retrieval of foreign body.
CT may identify position, shape, and nature of foreign body.
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