From the Research
Trotter's triad is a clinical symptom complex characterized by conductive hearing loss, ipsilateral temporoparietal neuralgia, and palatal paralysis, which suggests the presence of nasopharyngeal cancer, particularly when a tumor in the nasopharynx extends to involve the Eustachian tube, soft palate, and branches of the trigeminal nerve. This combination of symptoms is named after Sir Wilfred Trotter, a British surgeon who first described it in the early 20th century. The symptoms of Trotter's triad can be caused by malignant tumors involving the lateral pharyngeal recess (Rosenmüller's fossa) 1.
Key Components of Trotter's Triad
- Unilateral conductive hearing loss
- Ipsilateral temporoparietal neuralgia
- Palatal paralysis
When a patient presents with these three symptoms, especially if they are middle-aged or older with risk factors like smoking or Epstein-Barr virus exposure, prompt referral for nasopharyngeal examination, imaging studies (MRI or CT scan), and possible biopsy is essential for early diagnosis. Early detection of nasopharyngeal cancer significantly improves treatment outcomes, as advanced disease has a much poorer prognosis 2, 3. The presence of even one or two components of the triad should raise suspicion in high-risk individuals.
Importance of Imaging Studies
Imaging studies, particularly MRI, play a crucial role in the diagnosis and staging of nasopharyngeal cancer. MRI is superior to CT in demonstrating lesions in the retropharyngeal node, skull base, intracranial area, carotid space, longus colli muscle, and levator palatini muscle 2. The combined use of MRI and FDG PET/CT can provide more accurate information for tumor restaging than either modality used alone 4.
Clinical Implications
In clinical practice, it is essential to be aware of Trotter's triad and its association with nasopharyngeal cancer. A high index of suspicion and prompt referral for further evaluation can significantly improve treatment outcomes. The presence of conductive hearing loss, ipsilateral temporoparietal neuralgia, and palatal paralysis should prompt further investigation, including imaging studies and possible biopsy, to rule out nasopharyngeal cancer.