Otitis Media (OM) can be the direct result of H&N malignancy itself or secondary to treatment of malignancy. Both surgery and radiotherapy can cause lasting changes to the physiologic function of the ET, middle ear, tympanic membrane and ear canal. Common treatment options for OM include observation, myringotomy alone and myringotomy with tympanostomy tube insertion (MTT). This US retrospective study identified 70 patients over a seven-year period who had been treated for nasopharyngeal, sinonasal or laryngeal cancer and who had OM. Among these 70 patients, OM was identified in 93 ears, of which 82 (88%) were treated with MTT, five (5%) treated with myringotomy alone and six (7%) observed. Of the 82 ears treated with grommet insertion, 56 (68%) had OM resolution without complication and 26 (32%) developed otorrhea. Of the five ears treated with myringotomy alone, three (60%) had OM resolution, one (20%) developed perforation with otorrhea, and one (20%) developed cholesteatoma. Of the six ears that were observed, four (67%) had OM resolution and two (33%) developed perforation with otorrhea.

The presence of Eustachian tube dysfunction prior to treatment for cancer was associated with a significantly higher complication rate. This study highlights that complication rates following grommet insertion are higher in H&N cancer patients than the general population, with about 10% of those treated for sinonasal / nasopharyngeal cancer developing persistent otorrhea and chronic perforation.

The authors suggest that their data does not support the use of myringotomy alone over grommets as a treatment for OM in this population. The complication rates of OM treatment in nasopharyngeal or sinonasal cancer patients, regardless of whether the intervention occurred before or after radiotherapy, does not differ significantly.

Complications of tympanostomy tubes in head and neck cancer patients.
Shah Jo, Herrera SJ, Roberts DB et al.
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Rohit Verma

North West Deanery, UK.

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