# ENT Pathology > FMGE Pathology notes on ENT pathology: nasopharyngeal carcinoma and EBV, juvenile angiofibroma, laryngeal cancer, cholesteatoma and otosclerosis. - Canonical URL: https://prepelephant.com/topics/fmge/pathology/ent-pathology - Exam / course: FMGE · Subject: Pathology - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "ENT Pathology", PrepElephant, https://prepelephant.com/topics/fmge/pathology/ent-pathology ## Direct answer Recurrent epistaxis in an adolescent boy, a neck node in an adult from an endemic region, hoarseness in a smoker — ENT pathology for FMGE clusters around a handful of recurring entities: nasopharyngeal carcinoma, an EBV-associated non-keratinising tumour that presents as a cervical node mass; juvenile nasopharyngeal angiofibroma, the bleeding tumour of adolescent boys in which biopsy is contraindicated; laryngeal carcinoma, where the glottic site presents earliest through hoarseness; cholesteatoma, a keratinising epidermoid cyst of the middle ear that erodes bone; and otosclerosis, the stapes-fixing bone disease of young adults. Squamous cell carcinoma underlies most head-and-neck malignancy, and tobacco, alcohol and betel quid remain its drivers in Indian patients. ## What you must remember - **Nasopharyngeal carcinoma:** WHO non-keratinising (undifferentiated) type is EBV-associated, presents with a neck node, nasal obstruction or epistaxis and otitis media from Eustachian blockage; it is radiosensitive, and serum EBV DNA tracks disease. - **Juvenile nasopharyngeal angiofibroma:** adolescent males, posterior nasal mass with recurrent epistaxis and obstruction; biopsy is contraindicated because of haemorrhage — diagnosis is angiographic and treatment embolisation plus surgical excision. - **Sinonasal neighbours:** inverted (Schneiderian) papilloma is unilateral, locally recurrent and carries malignant potential; occupational wood-dust exposure links to intestinal-type sinonasal adenocarcinoma. - **Laryngeal carcinoma:** glottic cancers present early with persistent hoarseness and metastasise late (sparse lymphatics); supraglottic and subglottic sites present later with node disease; smoking is the driver. - **Vocal cord lesions:** singer's nodules are bilateral, at the junction of the anterior and middle thirds, from voice abuse; a polyp is usually unilateral and haemorrhagic. - **Middle ear disease:** cholesteatoma is keratinising stratified squamous epithelium in the middle ear — bone erosion threatens facial nerve and labyrinth, and chronic suppurative otitis media is the substrate; malignant otitis externa is Pseudomonas osteomyelitis of the skull base in elderly diabetics. - **Otosclerosis:** abnormal bone around the oval window fixing the stapes footplate, conductive deafness in young adults with a positive family history; no history of otorrhoea — the point that separates it from chronic otitis media. ## A teenager who will not stop bleeding A 15-year-old boy attends the emergency department for the third time in two months with brisk epistaxis and increasing nasal obstruction; anterior rhinoscopy suggests a mass in the posterior nasal cavity. The correct next step is imaging, not biopsy: contrast CT and MRI with angiography show a vascular tumour extending through the sphenopalatine foramen — juvenile nasopharyngeal angiofibroma. Biopsy here is famously contraindicated because these tumours can bleed catastrophically; the pathway is preoperative embolisation followed by endoscopic excision, with recurrence risk related to residual invasion. Contrast the adult with painless unilateral nasal obstruction and a fleshy mass: that lesion should be biopsied, because inverted papilloma and carcinoma enter precisely there. Same anatomical corridor, opposite rules about tissue diagnosis — the ENT question most reliably tested. ## Where students slip The site-deafness logic of laryngeal cancer is inverted by candidates: hoarseness appears early in glottic cancer (vocal cord mobility is disturbed early) while supraglottic disease whispers until a neck node appears. Cholesteatoma gets dismissed as a tumour or as "chronic discharge" — it is a keratinising epidermoid in situ whose bone erosion causes the feared complications, which is why scanty, foul, persistent discharge with hearing loss demands examination. Finally, otosclerosis presents with conductive loss and a family history but no discharge; mixing it up with otitis media wastes the discriminating clue. ## Frequently asked questions ### Why is biopsy contraindicated in juvenile nasopharyngeal angiofibroma? Because these vascular tumours can bleed torrentially; diagnosis rests on imaging and angiography, with embolisation-assisted excision as treatment. ### What is the association of nasopharyngeal carcinoma? Epstein-Barr virus with the non-keratinising WHO type, typically presenting as a cervical lymph node in an adult from an endemic region. ### Which laryngeal cancer presents earliest and why? Glottic carcinoma, because even a small cord lesion disturbs vibration and phonation, producing persistent hoarseness while curative options remain wide. ### What is a cholesteatoma? A keratinising stratified squamous epidermoid within the middle ear, erosive toward ossicles, facial nerve and labyrinth, arising on chronic otitis media. ### What causes conductive deafness in otosclerosis? Fusion of the stapes footplate by otospongiotic bone at the oval window, in a young adult with a positive family history and no history of otorrhoea.