Postirradiation Otitis Media With Effusion in Nasopharyngeal Carcinoma: A Comprehensive Review of Pathogenesis, Management, and Prevention.

Abstract

In recent years, multimodal treatment approaches have significantly improved survival outcomes for patients with nasopharyngeal carcinoma, drawing increased clinical attention to treatment-related complications. One particularly prevalent and debilitating complication is postirradiation otitis media with effusion (OME), which severely impacts the quality of life in nasopharyngeal carcinoma survivors. This review comprehensively examines the pathogenesis of postirradiation OME, emphasizing the roles of radiation-induced Eustachian tube dysfunction, direct tumor invasion, as well as infectious and immunological factors. Emerging evidence on biomarkers demonstrates potential in the early detection and prediction of radiation-induced toxicity. Current therapeutic strategies, including conservative medical management, physical therapies, and surgical interventions, have demonstrated transient symptomatic relief and are limited in achieving long-term efficacy. Although novel treatment modalities show potential in addressing these challenges, their effectiveness requires further validation. Consequently, there is an urgent need to develop prevention-oriented strategies. Radiation therapy de-escalation and personalized target delineation are discussed as potential approaches to minimize ototoxicity while maintaining effective tumor control. By synthesizing recent literature, this review aims to provide valuable clinical insights and highlight future research directions for the management of postirradiation OME.