Given the rarity of nasopharyngeal cancer in general, I would say that most ringing in the ears is probably not cancer. However, some of the signs of nasopharyngeal cancer can include a lump in the neck, a sore throat, difficulty breathing or speaking, difficulty hearing, frequent nosebleeds, headaches, and pain or ringing in the ear. Other risk factors for nasopharyngeal cancer include Chinese ancestry and exposure to Epstein-Barr virus. The nasopharynx is located at the back of the nose and connects the nose to the back of your throat (pharynx). Examination of this area can detect any growths or masses and further diagnosis may require a biopsy. Sometimes a flexible endoscopic camera is inserted into the nose to better visualize the nasopharynx. Additional CT or MRI scans may also be necessary. If you feel that you are at risk for nasopharyngeal cancer or have symptoms you are concerned about, you should consult your doctor in order to have this area evaluated. Q2. My mom is going to an ear, nose and throat specialist so they can check out something in her ear canal. It looks like a small, round, red, flat lesion. She’s using antibiotic drops now. She had no symptoms. If it’s squamous cell, then that means total ear canal and eardrum removal, radiation, and still a poor prognosis. What can you tell me about treatment for this type of cancer? Treatment for cancers of the ear canal depends on the stage of the cancer. Early cancers that are limited to the canal skin and not the eardrum can often be surgically excised, leaving the ear drum intact. More extensive cancers will require additional removal of the bone around the ear canal, which is called a mastoidectomy. In advanced cases, surgery will involve removing the ear drum and the bones of the middle ear (ossicles). Radiation therapy is often given after surgery to treat any microscopic residual cancer that may be left behind. Prognosis depends on the stage of the cancer, whether or not surgery can completely remove the cancer, and the spread of cancer into adjacent structures such as the facial nerve and skull base. CT scans and MRI are used to assess the extent of cancer prior to surgery. Both head and neck cancer surgeons and neuro-otologists (surgeons specializing in the ear) treat this type of cancer. Q3. I have hearing loss that is worse in my right ear than left. It started rather fast. I have been a heavy smoker for 40 years. My ear, nose and throat doctor is blaming the aging process as I am 63. He has not done any tests except a hearing test. I am worried because I think a CT or MRI should be done to be sure it is the aging process and not something more serious before I purchase a hearing aid. What do you think? I think that any longtime smoker like yourself should be thoroughly examined because your risks of cancer are greater than someone who has never smoked. Not everyone who has hearing loss needs imaging tests like a CT scan or an MRI for cancer. A good head and neck exam, coupled with a good hearing test, can be a thorough screening for hearing loss even in a heavy smoker. Unless you have other symptoms to make you suspect that your hearing loss is something more serious, further testing may not be necessary. If you have concerns, I would discuss them with your doctor. In cases where you and your doctor do not see eye to eye, you can always request a second opinion. Q4. I hear the sound of crickets constantly in my ears — I’m serious. No one else hears them, and I’m wondering if the problem is just in my ears or if I’m going crazy. What could cause this? — Carol, Missouri The sounds you are describing are called tinnitus. Tinnitus is not a disease in itself but rather a reflection of something else that is going on in the hearing system or the brain. Even though nobody else can hear the clicking or ringing, what you are hearing is real. The most common cause of tinnitus is probably hearing loss. Through either the normal aging process or as a result of trauma to the ear, the portion of the ear that allows us to hear, the cochlea, becomes damaged. One theory suggests that because the cochlea can no longer send normal signals to the brain, the brain becomes confused and creates its own noise to compensate. Besides physical trauma caused by loud noises, certain powerful antibiotic drugs or too much aspirin can also cause tinnitus. Another possible cause of tinnitus is related to the increased blood flow that often accompanies conditions such as anemia, an overactive thyroid, and even temporomandibular joint (TMJ) problems. Meniere’s disease also causes tinnitus, along with hearing loss and dizziness. Rarely, a brain tumor can cause tinnitus as well. A thorough examination by a physician trained in the diagnosis and treatment of tinnitus, such as a neurologist or an otolaryngologist, is in order. Specialized tests can determine the cause of the ringing in your ears. Treatment can include medication, biofeedback, masking devices, counseling, and even cochlear implants. If the problem is related to TMJ problems, fixing the joint could relieve the ringing. You are not going crazy, and the good news is that there is a very good chance the bothersome noises can be minimized or eliminated. Learn more in the Everyday Health Oral, Head, and Neck Cancer Center.
