In a prospective study of 271 new patients with nasopharyngeal carcinoma, 36 (13.3%) were found to have cranial nerve involvement. Serous otitis media (SOM) was found in 98 (41.4%) of 237 patients who had undergone complete otologic assessment. The local control of tumor and actuarial survival of three subgroups of patients, namely, 80 patients with SOM only, 11 patients with cranial nerve palsy only, and 18 patients with both SOM and cranial nerve palsy, were analyzed. The local control of tumor was better in patients with SOM alone than in those with cranial nerve palsy alone; those patients with both SOM and cranial nerve involvement had worse local control as well as survival. As SOM is not uncommon in the diagnosis of nasopharyngeal carcinoma, and adult-onset SOM is otherwise distinctly uncommon, this provides a good opportunity for early recognition and, perhaps, better control of nasopharyngeal carcinoma.