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

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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:

Last edited 03/2019 and last reviewed 07/2021

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