title: New therapeutic strategy for treating otitis media with effusion in postirradiated nasopharyngeal carcinoma patients.
abstract: BACKGROUND
  Postirradiation otitis media with effusion (OME) is the most common radiotherapy-associated otologic complication associated with nasopharyngeal carcinoma (NPC). This study's aim was to evaluate the efficacy of laser myringotomy followed by intratympanic steroid injection (LMIS) for treating OME in postirradiated NPC patients.
  
  
  METHODS
  From August 2002 to January 2006, 27 newly diagnosed NPC patients who developed OME after a full course of radiotherapy were enrolled. Laser myringotomy was performed followed by once-weekly administration of steroids (0.5mL dexamethasone at a concentration of 5.0mg/mL) into the middle ear for 3 consecutive weeks. The success rate of dry eardrum perforation and the prognostic factors associated with OME resolution were analyzed.
  
  
  RESULTS
  The procedure was performed on 44 ears of 27 patients. The mean follow-up period was 37 weeks. Of the 44 ears, 23 (52.3%) developed persistent eardrum perforation, 18 (40.9%) developed recurrent OME, and three (6.8%) were disease-free on follow-up. Of the 23 ears with persistent eardrum perforation, 18 (78.3%) were diagnosed as dry perforation. The absence of pretreatment mastoiditis was an independent factor associated with OME resolution (p<0.001).
  
  
  CONCLUSIONS
  LMIS is a quick, minimally invasive, office-based technique that can be repeatedly performed to treat highly recurrent postirradiation OME, and it results in relatively slight pain to NPC patients. Long-lasting dry eardrum perforation allows for adequate middle ear ventilation and drainage and guarantees sustained relief from symptoms. The absence of preoperative mastoiditis is a favorable prognostic factor associated with OME resolution.
authors: Department of Otorhinolaryngology - Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors: Chin-Lung
authors: CL
authors: Kuo
authors: Mao-Che
authors: MC
authors: Wang
authors: Chia-Huei
authors: CH
authors: Chu
authors: An-Suey
authors: AS
authors: Shiao
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D010034:Otitis Media with Effusion / Q000628:therapy*; D011878:Radiotherapy / Q000009:adverse effects; D014432:Tympanic Membrane / Q000601:surgery
chemical_list: D003907:Dexamethasone