Brief Answer: As below: Detailed Answer: Hi, Thank you for your query. 1. Due to its location and spread, Nasopharyngeal Carcinoma is the only nasal tumor which may involve all the Cranial Nerves. It originates behind the eustachain tube (Fossa of Rosenmuller) and can block the ear. It may spread to the neck and jaw, causing trismus (pain on moving the jaw). It may ulcerate (or get infected), bleed and cause nasal regurgitation (by paralysis of the palate). It may spread into the cranium. All these conditions are known to cause excruciating pain. 2. If you can upload the images of a CECT (Contrast enhanced CT) Scan or an MRI Scan, clinical notes of the nasal, ear and throat examination, it may be possible to predict the source of the pain. 3. Check if the pain is a headache, one sided, ear, nose or throat pain, jaw or neck pain. Check whether it is sharp, burning or dull aching. 4. You may request for a Duragesic (fentanyl) transdermal patch. This requires monitoring. Combinations of regular, injectable (such as tramadol) and nerve painkillers (such as amitriptyline, carbamazepine, gabapentin and pregabalin) will help. 5. If there is ear blockage, procedures such a myringotomy with grommet insertion may help. 6. There is also likely more pain to be expected during and after the chemotherapy and radiation. Steroids may help provided they do not flare up any infection (bacterial or fungal). I hope that I have answered your query. If you have any further questions, I will be available to answer them. Regards.

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