**6.1 Medial extension**

From sphenopalatine foramen, it extends into the nasopharynx and grows submucosally. It can occupy the entire nasopharynx to produce bilateral nasal obstruction and nasal intonation of voice (rhinolalia clausa). Recurrent epistaxis often starts at this stage only. The tumor mass may depress the soft palate or hang in the oropharynx. Blockage of eustachian tube(s) results in conductive hearing loss (otitis media with effusion).
