Nasopharyngeal Carcinoma: A Case of Delayed Diagnosis with Favourable Outcome

Nasopharyngeal Carcinoma (NPC) often presents with subtle, non-specific otological or neurological symptoms that can mimic common benign conditions, leading to significant diagnostic delay. This case report describes a 50-year-old male who presented with a six-month history of right-sided headache and two-month progressive hearing loss, and was repeatedly managed as otomastoiditis and trigeminal neuralgia at multiple clinics. Despite various imaging findings suggestive of middle ear pathology, persistent unilateral symptoms prompted a diagnostic nasal endoscopy at the presenting hospital, which revealed a suspicious nasopharyngeal lesion. Histopathology confirmed non-keratinising undifferentiated NPC (T2bN0M0, Stage II). The patient underwent coblation-assisted biopsy, grommet insertion, and subsequently received definitive chemoradiotherapy with excellent therapeutic response on follow-up. This case highlights the clinical challenge of diagnosing NPC in non-endemic settings and underscores the importance of early nasopharyngeal evaluation in patients with unexplained unilateral otitis media with effusion, cranial nerve symptoms, or atypical headache. Prompt recognition and multidisciplinary management can significantly improve outcomes even in cases with delayed diagnosis.