Long-term post-irradiation middle ear effusion in nasopharyngeal carcinoma

This study aimed to find out if there were factors which influenced the development of long-term middle ear effusion (MEE) in patients irradiated for nasopharyngeal carcinoma. Thirty-five patients (70 ears) were studied for 2-8 years (mean 5.5 years) post-radiotherapy. The factors studied were (a) sex (b) age (c) tumour size and (d) presence of pre-radiotherapy MEE. Only the presence of pre-radiotherapy MEE was found to be statistically significant (P = 0.004, Fisher's exact test). Stepwise multiple regression analysis showed the presence of pre-radiotherapy MEE was a predictor of post-radiotherapy MEE with an odds ratio of 0.67. It is postulated that irreversible Eustachian tube dysfunction occurs when the tube which has been damaged by tumour is further damaged by irradiation. This may explain the frequent persistent otorrhea when ventilation tubes are used to treat post-radiotherapy MEE in patients with nasopharyngeal carcinoma. In conclusion, an ear with pre-irradiation MEE was almost seven times more likely to have long-term post-irradiation MEE than an ear without pre-irradiation MEE.