(Bear with me, this does relate to audio)
Last November, I noticed a lump on the left side of my neck, just below the jawline. It was about one inch in diameter and protruded one quarter inch or so. This was a swollen lymph node, usually a sign of infection or inflammation nearby. It was soft and there was no pain or other sensation associated with it, but I knew I should get it checked by my doctor.
A CT scan was ordered, which proved inconclusive. Next up was a visit to an ear, nose, and throat doctor (ENT) for another examination and a needle biopsy. Fluid was drained and cellular material was collected. The initial report on the fluid found no evidence of cancer, leading to unwarranted optimism, but subsequent tests on the other material came back with “HPV-related squamous cell carcinoma.” Just what one doesn’t want to hear – a cancer diagnosis.
Nearly everyone has been exposed to HPV, which is spread through intimate contact. Exposure to HPV is not necessarily a precursor to cancer. There is currently an effective vaccine available, but it must be administered between the ages of 11 and 45 for men. It was too late for me. My particular cancer is unrelated to smoking (which results in a less desirable form of throat cancer). It is also not a metastasization of my previous cancer. In men, it shows up at the base of the tongue or back of the throat. Did you know there are tonsils at the base of the tongue (lingual tonsils) that are separate from the ones on the sides (palatine tonsils) that are sometimes removed? In women, this particular cancer is found in the cervix, vagina, or vulva. Recommended ages for the vaccine for women match the men.
A PET scan revealed that my cancer origin was indeed at the lingual tonsils. This was confirmed by a scope inspection which showed a BB-sized divot. I was told that this is one of the most common cancers for men these days (it’s what Michael Douglas had). My own oncologist actually referred to it as “our bread and butter,” an unfortunate description, given the location. My healthcare provider is Kaiser, and their cancer board meets regularly to review cases and determine the course of treatment. In most cases, unless it has progressed, surgery is not recommended and a regimen of chemotherapy and radiation results in a very favorable outcome. That’s what I was looking at – seven weeks of concurrent treatment (IV chemo on Mondays and radiation Monday through Friday, with a blood draw on Saturdays to make certain I was healthy enough for the next round of chemo). The chemo infusion included hydration and anti-nausea drugs delivered over a few hours. The radiation only took less than five minutes each time, during which I had to lie down with my head resting in a cradle and a custom mask locking my head into place. I was told that, should the treatment be unsuccessful, a rather unpleasant surgery would be required.
I tend to be an odd mix of optimist and pessimist/realist. At no time was I concerned about survival, but there was something about the treatment that disturbed me. I had been through chemo and radiation ten years ago for breast cancer, which I found myself while showering. For that, the two therapies were administered sequentially, with radiation following chemo. I got through that quite well, but getting them concurrently was a different thing. My oncologist said the chemical this time would be Cisplatin, a particularly powerful anti-cancer drug with the potential to affect my hearing. I asked if there was an alternative because listening to music on my sound system is one of my biggest joys in life (see my article in Issue 171). She said “yes, but this is what works best.”
Right and left ear hearing test audiogram printouts. The dark lines represent the current state of my hearing, with the fainter lines indicating the previous conditions.
I was given a baseline hearing test before treatment began. It showed that although high frequencies were a little down, I was nowhere near requiring hearing aids. Partway through the seven weeks, I noticed the highs being more subdued, and another test revealed further loss. Additionally, I was getting distortion on certain upper midrange frequencies. My system’s beautiful sound became simultaneously dull and edgy. The edginess abated as long as I wasn’t listening at my normal level. Needless to say, my worst fears were coming true. The doctors say there is no guarantee that I will recover the highs. It could take months or not happen at all.
I have a theory about the distortion that I plan to run by the ENT. Once treatment began, I noticed that my ears were not producing any wax, resulting in a smoother, harder ear canal surface. I think this could be causing reflection and resonance, which might explain the distortion. I won’t know if this is a valid conclusion for a month or more when wax production should resume.
Other common potential side effects of my treatment included nausea, mouth sores, and difficulty swallowing. I’m happy to say that none of those happened with me, leading my optimistic side to think, “Yay!” but then the pessimistic side countered with, “Is the treatment working?” I won’t know for certain until a PET scan is performed in June.
My sense of taste was affected to the point where almost nothing tasted good, even water! Flavors ranged from nonexistent to unpleasant, and most solid food felt like mush. Two-thirds of the way through the seven weeks, I was reduced to drinking Ensure Plus and protein shakes through a straw. I was told that if I lost more than 10 percent of my weight, they would put in a feeding tube. Again, I avoided that scenario. It wasn’t until a week after all the treatments had ended that my taste started improving. Most food is now close to tasting like it should. All things considered, my doctors said that I was doing much better than average.
But the hearing issues remain. If the distortion goes away, I guess I can live with the lack of highs. Of course, my equipment doesn’t have tone controls. If it did, I would be afraid to turn the treble up much, for fear of blowing the tweeters. I’m counting on my brain to compensate and adjust for the changes. If not, I might have to give hearing aids a try.
The point of this article is to warn people not to ignore a lump on one’s neck. Go to your doctor and have it checked out. If you see someone with a neck lump, suggest that they do the same.
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