In adults, a new unilateral otitis media with effusion, with no recent upper respiratory infection or flight, can be the first sign of a nasopharyngeal tumour blocking the Eustachian tube. This matters in India, where nasopharyngeal carcinoma is common in the north-east.
Examine the postnasal space endoscopically in every adult with persistent unilateral effusion, and feel the neck for nodes. Inserting a grommet without looking first risks delaying the diagnosis.
- Perform nasoendoscopy in every adult with unexplained unilateral middle ear effusion
- Palpate the neck for upper deep cervical nodes
- Ask about nasal obstruction, epistaxis and cranial nerve symptoms
- Do not insert a grommet before the nasopharynx has been examined
Why it matters
Unilateral effusion can be the earliest presentation of nasopharyngeal carcinoma.
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