Malignancy

Background: Sinonasal and ear cancers are rare. The associated clinical features include progressive or new unilateral nasal obstruction in association with one or more of proptosis, epistaxis, dental pain or loosening dentures, cranial nerve palsy or nasal (not facial) pain. However, sinus and nasal symptoms are common presenting features in primary care and are frequently benign (e.g. rhinosinusitis or benign nasal polyps). If there is concern that there is a nasal or paranasal cancer a USC referral should be made to the Head and Neck Service.

How to assess:

Examine the nose with a light / otoscope

Examine the neck for lymphadenopathy

Check cranial nerves especially visual acuity, eye movements and trigeminal nerve sensation

Referral guidance:

Refer to ENT as urgent suspicion of cancer

Consider discussing with ENT on call if patient unwell or requiring inpatient symptom control e.g. pain