Question: Hello, I am 29 yrs old male and of Taiwanese descent. For the past 13 months after a cold, I have been feeling pressure in both of my ears. Not the same as the feeling when flying in a plane but I feel a constant urge of wanting to pop my ears. The doctor who treated my cold said its a natural response after a cold and would subside within weeks but obviously it hasn't. I should note that I am a very allergic person and have rhinitis all my life. My nose is constantly blocked either on one side or both. I have seen several ENTs and they all said my nose and ear looks clear. However, 2 months ago a doctor put a scope inside my nose to check out my nasopharynx area and noticed that my adenoid is swollen. He said it doesn't look like Nasopharynx cancer but since I am having symptoms the only way to find out is to do a biopsy. I also told him I am doing an ongoing treatment for TMJ and my jaws pop very loud. He then said my problem is likely stemming from one of the two. There is also no Nasopharynx cancer in my family history. Couple weeks later I went to another hospital and the ENT also scoped me out. Saying adenoid still inflammed but does not look malignant. Ordered a EB virus blood test. Week after I got the report and I was positive for E-B VCA IgG Ab and E-B VCA IgA (albeit it seems like 99% of Taiwanese population is positive). However she said my readings for IgA ab was 1.45 which was abnormal (and said every hospital has their own standard). She then suggested for a biopsy and now I'm sitting here pondering whether I should have it done. I have been using a night guard when sleeping for TMJ and now my left jaw doesn't click anymore, and simultaneously, the left ear is no unplugged. My right jaw is still clicking and now the pressure is mostly on my right ear. I have no other symptoms of nasopharynx cancer besides this pressure from my ears (which may be associated with TMJ). Please provide some thoughts on where you think the problem may be. Thanks

Hello Dr. Bakshi, Thank you for your response. Actually, to correct my info, the pressure has been troubling for 10 months. And 3-4 months prior to that I noticed a swollen lymph node in the front of my neck. It is roughly 2 cm and throughout the past 13 months, have not changed at all. There is no pain and is not tender. Many (around 5-6) doctors have physically examined the particular node and told me that if its moveable they wouldn't worry about it. So they told me that it may go away and it may not, and even if it doesn't just as long as it doesn't change you are fine. So its still sitting there as we speak. I researched a little and found that the most common swollen node on the neck for NPC would be just under the ear. Is that correct? I have been using Nasonex for a month now without much improvement. It helps with congestion but not the pressure. The TMJ night mouth guard helps I believe. Several questions I hope you can assist me with: 1. What can the CT scan tell us exactly? Can I do a PET or MRI? 2. What are the consequences of having a biopsy done (not factoring monetary cost)? What is holding you back other then it is "unnecessary" 3. I asked the doctor what would nasopharynx cancer look like using the scope and he said "a lot scarier than this". Does this mean that most cases of cancer have a physical tumor that can be spotted right away? What are the % of this. And what % of nasopharynx cancer has tumor where a scope can't detect it? 4. I had a full body checkup in 2008 and back then my E-B VCA IgG Ab was negative. Does this tell us anything? 5. I'm quite worried that if I start to develop symptoms then the cancer would be in its more advanced stages already. As I understand Stage I NPC emits very little, if any, symptoms.

Hello Dr. Bakshi, Thank you for your response. So you would recommend me to do a CT scan instead of a biopsy? If CT scan is clean can we be almost certain there is no malignancy? I read that CT scan cannot detect tumors <3cm So are you saying that most nasopharynx cancer has some sort of visible tumor, whether smooth or not. Does en enlarged adenoid qualifies as a "tumor?" The doctor said that the positive for EB virus isn't significant but more specifically the response to antibody IgA ab is what she is concerned about. As supposedly 90% of NPC patients has an abnormal rate for IgA ab. I am not sure what the % is the other way around. My current thinking is that maybe my Eustachian tube problems are from my TMJ disorder. But maybe I have both problems? Because the doctor feels swollen adenoid + EB virus IgA ab abormally high puts me in more danger of getting cancer and independent from my ear pressures I scheduled the biopsy 2 days from now and if there isn't anything to be worried about other than pain, bleeding, and cost, I am slightly leaning on just sucking it up and getting it done. That way I will know for sure. Otherwise, since I'm such a hypochondriac I will keep thinking I must be the odd person out that actually has cancer and is showing very little symptoms

Hello Dr. Bakshi, Again thank you for your response. I wanted to ask you about if you think there are any other possibilities that is causing this troubled symptom. Could it be Eustachian tube dysfunction? As I recall, I probably have some sort of TMJ problem for couple years now and the symptoms came up suddenly after a cold. If I have had TMJ for years, howcome its only bothering me (in terms of ear problems) for the past 10 months or so? Although I get some improvement from wearing the night guard, the symptoms aren't completely gone. This makes me think perhaps the culprit isn't TMJ and could be nasopharynx cancer. Also, I wanted to know what information was most critical in you dismissing a cancer possibility? Is it a lack of symptoms? length of symptom? or what exactly was the x factor here. To further increase my knowledge, a person with chronic allergic rhinitis would often exhibit signs of enlarged adenoids on a regular basis? Thank you so much again Dr. Bakshi