Title: A Prospective Study of Auditory Alterations Following Radiotherapy in Patients with Head and Neck Malignancy
Authors: Soutrik Kumar, Pradipta Ghosh, Swapan Kr Ghosh, Subhrodev Biswas, Bijan Basak, Kaustuv Das Biswas, Sourav Roy, Ankit Choudhary, Sauravmoy Banerjee
DOI: https://dx.doi.org/10.18535/jmscr/v7i6.35
Abstract
Introduction: Head and neck cancers are most commonly of the squamous cell carcinoma type. In 2015, head and neck cancers globally affected more than 5.5 million people, and it has caused over 379,000 deaths. The head and neck malignancies constitute 5% of all the cancers worldwide. In India, the most common H and N cancers are those of oral cavity and pharynx.
As both the ears and Eustachian tubes are included in the radiation field, in case of cancers of H and N, the otological complications are quite common following RT.
This study focuses on finding out the type of auditory alteration that occurs after radiotherapy so that the disease can be identified early and different methods of prevention and cure can be used promptly, thereby reducing the number of people suffering from unwanted post-RT auditory changes.
Materials & Methods: Over a period of 1year 50 Patient who attended the OPD & indoor with Head and neck malignancy and were waiting to undergo Radiotherapy were included in this study and then subjected to ENT examination, Pure Tone Audiometry & Impedance Audiometry during RT, 1month after RT completion & 3months after RT completion. Patients with abnormal findings before Radiotherapy were excluded.
Results and Analysis: Out of 50 patients the study shows that 70-88% patients had no conductive hearing loss & 74-82% had no sensorineural hearing loss in PTA done during RT but 24-62% patients had >25 dB conductive hearing loss & 38-54% patients had >25dB sensorineural hearing loss in PTA done after completion of RT.
Discussion: Studies done so far show that as radiation field descends down from nasopharynx to Neck, the effect on otological structures decreases and auditory alterations occur soon after radiotherapy especially when subjected to doses greater than 60Gy.
Conclusions: Radiotherapy in Head & Neck cancer patients adversely affects the hearing apparatus causing varying degrees of conductive &/or sensorineural hearing loss with higher incidence of auditory alteration seen in cancers of regions higher up such as Nasopharynx due to its proximity to the Temporal bone which falls in the radiation field and also may be due to Eustachian tube blockage due to the disease process which is further aggravated due to RT.
There is scope of future study on reducing radiation to adjacent sites with the help of newer methods such as Intensity modulated Radiotherapy/ Proton Radiotherapy, and comparing the auditory alterations in these patients with those receiving Conventional RT.
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