Middle Ear Morbidity after Head and Neck Chemoradiation

Abstract

Objective: Radiation therapy (RT) for head and neck cancers (HNC) has been associated with middle ear mobidity (MEM). The goal of this study is to evaluate the post-RT incidence of middle ear morbidity in HNCa patients receiving RT ± chemotherapy (chemo) and associated patient and treatment related factors. Method: Pre- and post-RT records of HNC patients were retrospectively assessed to estimate the incidence of chronic otitis media with effusion (OME), chronic suppurative otitis media (CSOM), tympanosclerosis, persistent tympanic membrane perforation (TMP), mastoiditis, dysgeusia, and corresponding radiation doses to the middle ear. Results: A total of 375 patients (750 ears) were evaluated. The rate of MEM included OME (31.5), CSOM (8.0), TMP with (7.0) and without (8.5) tympanostomy, tympanosclerosis (20.5), mastoiditis (5.5), middle ear fibrosis (6.0), dysgeusia (7.5). With a range of 0.25 to 6.5 years, the median times for detection of MEM varied from 0.95 to 2.3 years. Univariate and multivariate analyses indicated that dose to middle ear was significant for all MEM, but age (>60 years), gender, and race were not. Significance of dose fractionation (daily/twice daily) for OME was marginal ( P = .0498). Adjuvant chemotherapy was significant for incidence of OME, TMP ( P < .05). Conclusion: Incidence of post-RT MEM is proportional to the radiation dose received by middle ear. Adjuvant chemotherapy is associated with MEM, but further investigation into this risk factor is needed.