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DISEASES OF THE NASOPHARYNX                     135

tissue with a rich supply of blood vessels, some of which may be greatly
dilated.

SYMPTOMS. The most common early symptom is nasal obstruction with
consequent nasal speech. Excessive nose bleeding may occur from time to
time, especially if surface ulceration is present. This may also give rise to a
foetid nasal discharge. The growth may extend into the nasal cavities and
present as a fleshy polypus. Broadening of the nasal bones may take place in
advanced cases. Proptosis may occur from invasion of the ethmoidal cells and
orbit. The tumour can often be seen protruding below the soft palate.
Deafness and middle ear effusions result from occlusion of the auditory tubes.
In later stages severe pain may be complained of due to involvement of
branches of the trigeminal nerve. Invasion of the base of the skull may give rise
to meningitis. In untreated cases death may occur from haemorrhage or from
intracranial complications.

CLINICAL FEATURES. On examination of the pharynx a bulging of the soft
palate may be observed. In other cases the tumour may appear below the soft
palate as a dark red fleshy mass. In less advanced cases the postnasal mirror
may be needed to visualize the tumour. Examination of the nasal cavities may
reveal an extension of the growth. A firm mass can be felt on palpation of the
nasopharynx.

DIAGNOSIS. This is not difficult hi typical cases although the condition has to
be differentiated from a naso-antral polypus. This, however, is much paler and
less firm in consistency. Biopsy of the tumour will confirm the diagnosis.
Even this simple procedure may initiate an alarming haemorrhage necessitat-
ing control by packing and often by blood transfusion.

TREATMENT. Treatment is by a combination of radiotherapy and surgical
removal via a transpalatal approach, and close co-operation between the
surgeon and radiotherapist is essential. Intensive follow-up is necessary for
some years.

PROGNOSIS. Prognosis is always guarded. Spontaneous remission may occur
but the tendency is for the tumour to progress and spread, although this is less
likely after the age of 25 years.

SIMPLE TUMOURS

Enchondroma, exostosis, adenoma, angioma and many other tumours may be
found in the nasopharynx, but they require no special description.

MALIGNANT TUMOURS

Neoplasms of the nasopharynx, while not common, are by no means rare, and
are prevalent in south China. They may occur at any age and are found at a
relatively younger age than other tumours. Both sarcoma and carcinoma are
found although an undifferentiated squamous epithelioma is probably the
most frequent, with reticulum cell sarcoma only a little less common. The
tumour arises from the roof and lateral wall of the nasopharynx, commonly
just behind the opening of the auditory tube. Lateral spread to the jugular
foramen leads to involvement of the IXth, Xth, Xlth and Xllth cranial nerves,
either singly or in combination. Upward extension through the base of the
skull causes meningitis and involvement of intracranial nerves. Invasion of the