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DOI: 10.1055/s-0045-1805045
Hearing Loss and Middle Ear Effusion in Nasopharyngeal Carcinoma Following Radiotherapy: Dose–Response Relationship and Normal Tissue Complication Probability Modeling[*]
Funding The authors declare that they did not receive funding from agencies in the public, private, or non-profit sectors to conduct the present study.

Abstract
Introduction Radiotherapy is the primary treatment for nasopharyngeal carcinoma. Radiation exposure to the cochlea and middle ear can cause hearing loss.
Objective To develop a multivariable normal tissue complication probability (NTCP) model to predict the risk of hearing impairment in nasopharyngeal cancer patients based on clinical and radiation dosimetry features and to identify the key factors associated with hearing loss.
Methods A retrospective review of 229 patients was conducted. We recorded the audiometry and presence of middle ear effusion (MEE) and compared findings before and after therapy. The factors included age, gender, signs and symptoms at presentation, tumor staging, prescribed dose at the tumor and high-risk nodal region, cochlea, and concurrent chemotherapy treatment. The model was formulated using multivariate logistic regression.
Results Age of more than 50 years, high primary staging, and dose at the cochlea > 43 Gy were major risk factors for sensorineural hearing loss. The final NTCP model for hearing loss comprised age and cochlea dose with an area under the curve (AUC) of 0.644; the predicted risk ranged from 15.84 to 44.52%. Locally advanced disease and cochlea dose greater than 44 Gy were risk factors for MEE; the predicted risk ranged from 20.42 to 51.99%.
Conclusion Age over 50, T stages 3 and 4, and > 43 Gy dose to the cochlea were significantly associated with an increased risk of sensorineural hearing loss and MEE. The developed NTCP model provides information to predict these risks, aiding in treatment planning and decision-making to avoid complications.
Keywords
nasopharyngeal neoplasms - hearing loss - radiotherapy - proton - otitis media with effusionData Availability Statement
Data is available upon request from the corresponding authors.
Ethics Approval Statement
The present study was approved by the Institutional Review Board.
Patient Consent Statement
The need for informed consent was waived by the institutional review board.
* The present manuscript was accepted for poster presentation at the 9th World Congress of the International Academy of Oral Oncology, Seoul, Republic of Korea, November 2023.
Publication History
Received: 12 February 2024
Accepted: 08 January 2025
Article published online:
03 July 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil
Prem Wungcharoen, Anussara Prayongrat, Napadon Tangjaturonrasme. Hearing Loss and Middle Ear Effusion in Nasopharyngeal Carcinoma Following Radiotherapy: Dose–Response Relationship and Normal Tissue Complication Probability Modeling[*] . Int Arch Otorhinolaryngol 2025; 29: s00451805045.
DOI: 10.1055/s-0045-1805045
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