--- title: 58-year-old male with ear pain description: It's Quiz Time with Med-Challenger! image: https://challengercme.com/hubfs/image%20(10).png --- [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com/) - [SHOP EXAM PREP & CME ](https://challengercme.com/blog/58-year-old-male-with-ear-pain#) ### [EMERGENCY MEDICINE](https://challengercme.com/emergency-medicine-exam-review-cme-course) [ABEM exam prep](https://challengercme.com/emergency-medicine-exam-review-cme-course), [MyEMCert](https://challengercme.com/emergency-medicine-myemcert-exam-review-course), etc. ### [FAMILY MEDICINE](https://challengercme.com/family-medicine-exam-review-cme-course) [ABFM exam prep](https://challengercme.com/family-medicine-exam-review-cme-course), [ABFM KSA](https://challengercme.com/family-medicine-moc-ksa-course), etc. ### [INTERNAL MEDICINE ABIM exam prep, MOC points, etc.](https://challengercme.com/internal-medicine-exam-review-cme-course) ### [OBGYN ABOG exam prep, CREOG, etc.](https://challengercme.com/obgyn-exam-review-cme-course) ### [PEDIATRICS ABP exam prep, MOCA-PEDS, etc.](https://challengercme.com/pediatric-medicine-exam-review-cme-course) ### [PEDIATRIC EM](https://challengercme.com/pediatric-emergency-medicine-3rd-edition) [ABP/ABEM exam prep Ed.3](https://challengercme.com/pediatric-emergency-medicine-3rd-edition), [Ed.2](https://challengercme.com/pediatric-emergency-medicine-pack2), etc. ### [SPECIAL PURPOSE / SPEX FSMB exam prep, etc.](https://challengercme.com/special-purpose-exam-review-spex-exam-preparation-course) ### [PHYSICIAN ASSISTANT](https://challengercme.com/physician-assistant-exam-review-cme-course) [PANCE / PANRE](https://challengercme.com/physician-assistant-exam-review-cme-course), [CAQ-EM](https://challengercme.com/pa-caq-em-review-course), etc ### [NURSE PRACTITIONER](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course) [FNP](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course), [ENP](https://challengercme.com/emergency-nurse-practitioner-exam-review-cne-course), [AGNP](https://challengercme.com/adult-gerontology-nurse-practitioner-exam-review-cne-course), [PNCB/CPNP](https://challengercme.com/pediatric-nurse-practitioner-exam-review-cne-course), etc. ### [NURSING / NCLEX NCLEX, CNE, etc.](https://challengercme.com/nursing-certification-nclex-exam-review-cne-courses) ### [STATE-REQUIRED CME / CE State CME requirements, etc.](https://challengercme.com/state-required-cme) ### [JOINT COMMISSION CME](https://challengercme.com/stroke-center-ce-review-course) [Stroke](https://challengercme.com/stroke-center-ce-review-course), [Cardiac](https://challengercme.com/cardiac-center-ce-review-course), [Trauma](https://challengercme.com/trauma-center-ce-review-course), [ALS](https://challengercme.com/advanced-life-support-and-resuscitation-center-ce-review-course), etc. ### [PROFESSIONALISM CME Professionalism review with CME](https://challengercme.com/professionalism-review-course) ### [DERMATOLOGY CME Dermatology review with CME](https://challengercme.com/dermatology-review-course) ### [USMLE STEP 2CK / STEP 3 USMLE exam prep, etc.](https://challengercme.com/usmle-certification-exam-review-clerkship-exams-shelf-exam-review) - [INSTITUTIONS ](https://challengercme.com/atlas-pro-inst) - [BLOG ](https://challengercme.com/blog) - [SUPPORT ](https://support.challengercme.com/knowledge) [SIGN IN ](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) emergency medicine # 58-year-old male with ear pain It's Quiz Time with Med-Challenger! [ Med-Challenger ](https://challengercme.com/blog/author/med-challenger) Oct 28, 2024 [emergency medicine](https://challengercme.com/blog/tag/emergency-medicine) [Personal Education](https://challengercme.com/blog/tag/personal-education) [Question of the Week](https://challengercme.com/blog/tag/question-of-the-week) [quick quiz](https://challengercme.com/blog/tag/quick-quiz) ### < [All Posts](https://challengercme.com/blog) ABEM Exam Prep + CME Med-Challenger Emergency Medicine Pass-guaranteed ABEM exam review with CME built-in. Try it for free. On sale now. [START EM REVIEW](https://fuse.challengercme.com/fulltrial/184) --- ### Share this article [mailto:?subject=Check%20out%20https://challengercme.com/blog/58-year-old-male-with-ear-pain&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/58-year-old-male-with-ear-pain&utm_medium=social&utm_source=email](mailto:?subject=Check%20out%20https://challengercme.com/blog/58-year-old-male-with-ear-pain&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/58-year-old-male-with-ear-pain&utm_medium=social&utm_source=email) ### Subscribe ### Subscribe ![37 Week Gestation with Hypertension](https://challengercme.com/hubfs/image%20(10).png) A 58-year-old male presents in the middle of the night complaining of a constant pain in his left ear that is now interfering with his ability to sleep. The patient’s ear exam is benign, but a lateral neck mass is noted (see image). ![image (10)](https://challengercme.com/hs-fs/hubfs/image%20(10).png?width=480&height=432&name=image%20(10).png) Which of the following statements is correct? - In general, 30% of non-thyroid neck masses in adults are neoplasms - A lateral neck mass such as the one in the image with referred pain to the ear should prompt questioning about tuberculosis - Unilateral, referred ear pain in an adult is a retropharyngeal neoplasm until proven otherwise - The chart should reflect a cranial nerve exam, together with questioning about hoarseness, odynophagia, dysphagia, stridor, globus phenomena, and speech changes - This patient’s presentation is most consistent with a chronic pharyngeal infection from an odontogenic source The correct answer is: The chart should reflect a cranial nerve exam, together with questioning about hoarseness, odynophagia, dysphagia, stridor, globus phenomena, and speech changes.   This patient was suffering from a nasopharyngeal carcinoma that had metastasized to the lymph nodes in the sternocleidomastoid area. In general, unilateral referred otalgia or persistent serous otitis media in an adult is a nasopharyngeal cancer (not a retropharyngeal cancer) until proven otherwise. Other rules of thumb with regards to neck masses are: 1. Lateral neck masses are more likely to be malignant. 2. 80% of non-thyroid neck masses in adults are neoplasms, of which 80% are malignant (80-80 rule). The undiagnosed cancer patient will often not connect pertinent symptoms of a neoplasm together. Thus the clinician should perform and document a more general exam (beyond the patient's immediately symptomatic area) and review of systems when confronted with a mass that may be a tumor. A minimum HEENT review would include a cranial nerve exam and questioning about otalgia, hoarseness, odynophagia, dysphagia, stridor, globus phenomena, and new speech problems. The status of neck lymphnodes should also be remarked upon. The level at which an abnormal node occurs is in and of itself a clue to the location of the primary tumor. Hoarseness in particular is an easily ignored complaint that may be the only presenting sign of a laryngeal or tracheal malignancy. Any hoarseness that has lasted for more than two weeks requires investigating or referral. Pearls: - **Globus phenomenon** refers to the sensation of a mass in the throat. - **Referred Otalgia:** Unexplained ear pain in adults should raise suspicion for nasopharyngeal carcinoma. - **80-80 Rule:** 80% of non-thyroid neck masses are neoplasms; 80% of those are malignant. - **Cranial Nerve Exam:** Check cranial nerves and ask about hoarseness, dysphagia, and stridor when a neck mass is found. - **Lateral Neck Masses:** Lateral neck masses in adults are more likely to be malignant. - **Early Referral:** Early identification and referral for neck masses may improve outcomes. References: Marx: Rosen's Emergency Medicine, Concepts and Clinical Practice, 6th ed., 2006 Robert Dolan, MD, Associate Professor, Department of Otolaryngology, Boston University Medical Center, Case Study. Additional Literature: Molecular Biology of Head and Neck Cancer: Risks and Pathways. 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All rights reserved [Privacy Policy](https://support.challengercme.com/knowledge/what-are-your-terms-of-service-privacy-policy-user-agreement) ```json { "@context" : "https://schema.org", "@id" : "https://challengercme.com/blog#webpage", "@type" : "WebPage", "description" : "The Challenger Medical Education Blog offers informative patient cases, medical certification exam preparation courses and board exam review tips.", "inLanguage" : "en", "isPartOf" : { "@type" : "WebSite", "name" : "Med-Challenger", "url" : "https://challengercme.com/" }, "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog", "@type" : "WebPage" }, "name" : "Challenger Medical Education Blog", "primaryImageOfPage" : { "@type" : "ImageObject", "url" : "https://challengercme.com/hubfs/Webpage%20Featured%20Images/Medical%20Education%20Blog%20-%20Free%20CME%20resources%2c%20certification%20exam%20tips%2c%20clinical%20challenge%20questions%20and%20more.png" }, "publisher" : { "@type" : "Organization", "name" : "Challenger Corporation", "url" : "https://challengercme.com/" }, "url" : "https://challengercme.com/blog" } ``` ```json { "@context" : "https://schema.org", "@type" : "Article", "about" : [ "lateral neck mass", "referred otalgia", "nasopharyngeal carcinoma", "head and neck cancer", "serous otitis media", "cranial nerve examination", "hoarseness", "dysphagia", "globus phenomenon", "neck lymph nodes", "medical education", "exam preparation" ], "articleSection" : "Emergency Medicine", "author" : { "@type" : "Organization", "name" : "Challenger Corporation" }, "dateModified" : "2024-11-08T21:35:44.986Z", "datePublished" : "2024-10-28T16:15:06.000Z", "description" : "It's Quiz Time with Med-Challenger!", "headline" : "58-year-old male with ear pain", "image" : [ { "@type" : "ImageObject", "description" : "Challenger Corporation logo", "url" : "https://challengercme.com/logo.png" } ], "inLanguage" : "en-US", "keywords" : [ "referred otalgia", "nasopharyngeal carcinoma", "lateral neck mass", "80-80 rule", "cranial nerve exam", "hoarseness", "neck lymph nodes", "serous otitis media", "emergency medicine", "Med-Challenger", "exam prep" ], "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog/58-year-old-male-with-ear-pain", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://challengercme.com/logo.png" }, "name" : "Challenger Corporation" } } ``` ```json { "@context" : "https://schema.org", "@type" : "QAPage", "mainEntity" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "The correct answer is: The chart should reflect a cranial nerve exam, together with questioning about hoarseness, odynophagia, dysphagia, stridor, globus phenomena, and speech changes. The case described was nasopharyngeal carcinoma with nodal metastasis to the sternocleidomastoid area. In adults, unilateral referred otalgia or persistent serous otitis media should raise suspicion for nasopharyngeal cancer until proven otherwise. Clinicians should perform and document a broader HEENT exam (including cranial nerve testing) and review of systems, and remark on neck lymph nodes." }, "name" : "Which statement is correct regarding a lateral neck mass with referred ear pain?", "text" : "A 58-year-old male presents in the middle of the night complaining of a constant pain in his left ear that is now interfering with his ability to sleep. The patient’s ear exam is benign, but a lateral neck mass is noted. Which of the following statements is correct?\n\n- In general, 30% of non-thyroid neck masses in adults are neoplasms\n- A lateral neck mass such as the one in the image with referred pain to the ear should prompt questioning about tuberculosis\n- Unilateral, referred ear pain in an adult is a retropharyngeal neoplasm until proven otherwise\n- The chart should reflect a cranial nerve exam, together with questioning about hoarseness, odynophagia, dysphagia, stridor, globus phenomena, and speech changes\n- This patient’s presentation is most consistent with a chronic pharyngeal infection from an odontogenic source" } } ``` ```json { "@context" : "https://schema.org", "@type" : "ItemList", "description" : "Exam-style review questions based on this article’s teaching points.", "itemListElement" : [ { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "The chart should reflect a cranial nerve exam and inquiry about hoarseness, odynophagia, dysphagia, stridor, globus phenomena, and speech changes; unilateral referred otalgia or persistent serous otitis media in an adult should raise suspicion for nasopharyngeal carcinoma." }, "name" : "Which statement is correct for this patient with a lateral neck mass and referred ear pain?" }, "position" : 1 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "80% of non-thyroid neck masses in adults are neoplasms, and 80% of those neoplasms are malignant (the '80-80' rule)." }, "name" : "What is the '80-80 rule' regarding non-thyroid neck masses in adults?" }, "position" : 2 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Hoarseness that has lasted for more than two weeks requires investigation or referral." }, "name" : "Which symptom lasting more than two weeks requires investigation or referral?" }, "position" : 3 } ], "name" : "Practice Questions", "numberOfItems" : 3 } ```