Treatment of otitis media after radiotherapy for nasopharyngeal carcinoma

Nasopharyngeal carcinoma is mainly poorly differentiated squamous cell carcinoma. The nasopharynx is adjacent to important blood vessels and nerves, making surgical exposure difficult. Therefore, radiotherapy is the main treatment for nasopharyngeal carcinoma. However, no matter how the radiotherapy plan is optimized, most of the structures of the middle ear are within the radiation field. The resulting ear side effects will plague patients for a long time. Radiation-induced secretory otitis media is one of the most common ear side effects. Patients experience persistent tinnitus, stuffy ears, and progressive hearing impairment.

Systemic treatment of radiation-induced secretory otitis media mainly includes neurotrophic and vasodilator agents, and the use of broad-spectrum antibiotics. Local treatment mainly includes tympanic membrane tube placement and tympanic membrane puncture and fluid extraction under ear endoscopy. Tympanic membrane puncture and fluid extraction can effectively relieve the patient's symptoms of ear congestion and tinnitus, but the relief lasts less than one month, and repeated tympanic membrane puncture and fluid extraction can cause permanent perforation of the tympanic membrane; tympanic membrane tube placement can significantly improve the patient's hearing impairment, reduce symptoms such as tinnitus, ear congestion, and headache, and the maintenance time is also longer, up to more than half a year, but tympanic membrane tube placement connects the middle ear cavity to the outside world, increasing the chance of middle ear infection and the risk of complications such as suppurative otitis media, tympanosclerosis, and conductive deafness.

In addition, partial tympanectomy and fiberoptic nasopharyngeal endoscopic Eustachian tube dilation and injection can also be used to treat secretory otitis media after radiotherapy for nasopharyngeal carcinoma. However, partial tympanectomy also carries the risk of complications such as otorrhea and residual tympanic membrane perforation. Although fiberoptic nasopharyngeal endoscopic Eustachian tube dilation and injection can avoid tympanic membrane perforation or infection, repeated Eustachian tube dilation can aggravate damage to the Eustachian tube and lead to restenosis. For patients with severe hearing impairment, relief can be obtained by using hearing aids, but the negative pressure of middle ear effusion is not relieved, and the patient's headache, tinnitus, and ear stuffiness symptoms cannot be relieved, and the patient's quality of life cannot be effectively improved.