English

Abstract

BACKGROUND: Radiotherapy-induced ear toxicities remain under-evaluated and under-reported. These reactions may affect all structures of the hearing organ, and can result in conductive hearing loss (CHL) due to development of otitis media. The field of radiation for head and neck malignancies ranges from skull base to thoracic inlet in order to include both the primary tumour and neck nodes. The temporal bone thus becomes a part of the irradiated field. However, the dose of radiation varies depending on the site of primary tumour. Up to 40% of patients have acute middle ear side effects during radical irradiation leading to significant morbidity. AIM: To find out the incidence of otitis media with effusion in patients who received concurrent chemo-radiation for head and neck malignancies. SETTINGS AND DESIGN: Prospective study conducted in the Department of ENT in a tertiary care centre during a time period from Jan 2014 to June 2014. A total of 50 patients suffering from head and neck malignancies (histologically proven) who were admitted under the departments of ENT or Radiation Oncology were included in the study. METHODS AND MATERIAL: 100 ears in 50 radiotherapy - treated patients suffering from head and neck malignancies were assessed. Radiotherapy dose varied between a total of 66 - 70 Gy given as 2Gy/day at five fractions/week and chemotherapy dose of cisplatin 35mg/m2 weekly for 6 weeks. CHL was identified by pure tone audiometry and impedance audiometry conducted at regular intervals. The presence of pre-existing and tumour induced hearing loss was taken into consideration. RESULTS: Pre- therapy 11(11%) ears were found to have pre-existing OME. On assessment at the end of therapy, 48(48%) ears were found to have OME and 9(18%) of patients had bilateral OME. None of the cases had chronic otitis media. All ears showed CHL and the ones with pre-existing CHL showed further threshold deterioration. CONCLUSION: Short term OME following concurrent chemo- radiation (CTRT) in unilateral or bilateral ears leads to CHL. This can contribute significantly to decreased hearing in the patients and lead to further morbidity.