Risk of nasopharyngeal cancer if hearing loss (deafness) and unilateral middle ear effusion in adult of Chinese or South-East Asian family origin

Referral criteria for deafness (1):

Hearing loss with specifific additional symptoms or signs

• for adults of Chinese or south-east Asian family origin who have hearing loss and a middle ear effusion not associated with an upper respiratory tract infection (see notes)
  • consider an urgent referral (to be seen within 2 weeks) to an ear, nose and throat service (1)
    
    

Notes:

• unilateral persistent middle ear effusion not associated with upper respiratory tract infection in people of Chinese and South-East Asian family origin (1)
  • there is a high incidence of nasopharyngeal carcinoma in people of Chinese and South-East Asian family origin and presentation is often a middle ear effusion not associated with, or not resolving after, an upper respiratory tract infection (1)
  • in most parts of the world, nasopharyngeal carcinoma (NPC) occurs at an annual incidence rate of <1/100,000, yet in South East Asia and Southern China, it is endemic (2)
    • NPC appears to be most widespread in central of Guangdong province, where the city of Sihui, for instance, shows incidence rates of 30.94/100,000 in males and 13.00/100,000 in females (2)
  • this condition is also more common in other racial groups such as those from North Africa and Eskimos but is generally rare in people of European family origin (1)
  • NICE assessed this scenario as likely to be associated with a positive predictive value of 3% or above for nasopharyngeal carcinoma and should prompt the clinician to consider urgent referral (1)

Reference:

• NICE (June 2018). Hearing loss in adults: assessment and management
• Hong-Lian R et al. Developing Genetic Epidemiological Models to Predict Risk for Nasopharyngeal Carcinoma in High-Risk Population of China. PLoS One. 2013; 8(2): e56128.