Neurotologic Symptoms as the Initial Presentation of Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma is a rare malignant neoplasm that arises from nasopharyngeal epithelium. Although globally rare, is endemic in Southeast Asia particularly south China. One fifth of these patients develop cranial nerve dysfunction and headache. Neurotologic symptoms are inadequately diagnosed since only 20% develop these symptoms at diagnosis. Tinnitus, serous otitis media and hearing loss are the most frequent neurotologic symptoms. Cranial nerve palsies are rare and most frequently affect V and VI nerves. Patients face referral and diagnostic problems due to a myriad of symptoms, requiring high suspicion by the medical team. Furthermore, otolaryngology referral and endoscopic visualization are paramount for diagnosis. We report a case that developed right nasal obstruction, epistaxis, otitis media, headache, neck pain and diplopia. The patient was referred due to nasal symptoms and erosion of sphenoid sinus as an incidental finding on CT scan. We highlight the clinical symptoms at presentation, particularly neurotologic symptoms.