Radiation-Induced Necrosis of the Temporal Bone: Diagnosis and Management.
OBJECTIVE
To document our experience with osteoradionecrosis (ORN) of the temporal bone.


METHODS
Retrospective case review.


METHODS
Tertiary care medical center.


METHODS
Patients who developed exposed necrotic bone of the external auditory canal after radiation therapy to the head and neck.


METHODS
Temporal bone ORN was managed conservatively in all patients with a combination of systemic antibiotics, antibiotic ear drops, and in-office debridement. Three patients required surgery, two of which were for a cholesteatoma.


METHODS
The need for surgical intervention in the management of ORN.


RESULTS
Twenty-three patients with ORN of the temporal bone comprise the study group. The average age of patients at the time of diagnosis was 58 years (range, 34-75 yr). The parotid gland was the most common primary tumor site (n = 10). The mean lag time from completion of radiotherapy to diagnosis of ORN was 11 years (range, 2-48 yr). The most common presenting symptom was hearing loss (n = 18), followed by tinnitus (n = 13) and otorrhea (n = 13). All 23 patients were managed conservatively with antibiotic therapy and in-office debridement of necrotic bone. None of the patients required temporal bone resection and/or free-flap reconstruction.


CONCLUSIONS
ORN of the temporal bone is a rare adverse event that can occur after radiotherapy for a variety of neoplasms of the head, neck, and central nervous system. Conservative management, which includes directed antibiotic therapy and regular in-office debridement of necrotic bone, can adequately control the disease process and symptomatology, thus avoiding more invasive surgical interventions.
*Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York; and †Department of Otolaryngology-Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A.
David J
DJ
Phillips
Innocent U
IU
Njoku
Kevin D
KD
Brown
Samuel H
SH
Selesnick
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001299:Audiometry; D018424:Cholesteatoma, Middle Ear / Q000601:surgery; D003646:Debridement; D004424:Ear Canal / Q000473:pathology / Q000528:radiation effects; D005260:Female; D034381:Hearing Loss / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000532:radiotherapy; D010025:Osteoradionecrosis / Q000382:microbiology / Q000473:pathology* / Q000601:surgery; D013506:Otologic Surgical Procedures / Q000379:methods; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D013701:Temporal Bone / Q000473:pathology* / Q000528:radiation effects* / Q000601:surgery; D014012:Tinnitus / Q000209:etiology; D057832:Watchful Waiting
D000900:Anti-Bacterial Agents