FIG 12.

A 52-year-old man with secondary otalgia caused by nasopharyngeal carcinoma (NPC). Axial T2-weighted fat-saturated MR imaging shows an intermediate signal intensity nasopharyngeal mass (white arrow) consistent with a cellular tumor, which extends laterally into the parapharyngeal space. Note the additional metastatic retropharyngeal adenopathy (white arrowhead) and left mastoid effusion. NPC may present with primary and secondary otalgia caused by mastoid–middle ear effusion (primary otalgia) and referred pain along CN IX (secondary otalgia).