In an area with low risk of nasopharyngeal carcinoma, is it necessary to perform nasopharyngoscopy in adults who present with isolated otitis media with effusion?
Adult-onset otitis media with effusion (AO-OME) is associated with common medical conditions such as upper respiratory tract infection (URI), sinusitis, allergic rhinitis, and adenoidal hypertrophy. It can also be a presenting feature of nasopharyngeal carcinoma (NPC). While NPC is endemic in China and Southeast Asia, it is a very rare disease (less than 1 per 100,000) in the United States. Despite this, it is common for American otolaryngologists to recommend nasopharyngoscopy in patients with AO-OME in order to rule out NPC. With such a rare disease, one must ask if nasopharyngoscopy is essential in adults who present with isolated AO-OME.
There is a lack of prospective randomized controlled trials addressing the role of nasopharyngoscopy in patients who present with isolated OME. Nasopharyngoscopy in patients who have OME in combination with other signs and symptoms suggestive of NPC appears to be a well-supported diagnostic measure. The available evidence would suggest that nasopharyngeal evaluation with biopsy could be expected to yield a diagnosis of neoplasia in 0.4% to 7.4% of all adults presenting with isolated OME, depending on the ethnicity of the patient population. Whether routine nasopharyngoscopy alone (as opposed to routine biopsy) would effectively diagnose nasopharyngeal neoplasia in all such patients remains unclear. It is clear, however, that the routine use of nasopharyngoscopy in adults presenting with isolated OME frequently reveals contributory, benign nasopharyngeal pathology of varying severity in a significant proportion of patients. Given the limitations of the existing data on the use of nasopharyngoscopy in the workup of adults with isolated OME, the clinician should use clinical judgment and the presence of any additional signs and symptoms of nasopharyngeal pathology to guide the decision whether endoscopic examination of the nasopharynx in such patients is necessary. Read the full article in The Laryngoscope.