Ventilation tubes in middle ear effusion post-nasopharyngeal carcinoma radiation: To insert or not?

BACKGROUND Postirradiation otitis media with effusion (OME) due to transient edema and dysfunction of the eustachian tube is the most common radiotherapy-associated otologic complication in nasopharyngeal cancer (NPC) patients. However, it can be seen in other head and neck cancers whose field of radiation includes the nasopharynx. Whether to insert ventilation tubes in these patients remains controversial. On one hand, ventilation tube insertion may lead to persistent otorrhea and permanent ear drum perforation; on the other hand, patients left with their serous otitis may experience hearing loss, aural fullness, tinnitus and dizziness. What is the best practice when dealing with middle ear serous effusion post radiotherapy? This review focuses on NPC (Table I), as this is the population in which radiation and ventilation tube insertion has been studied, but we feel the findings have widespread applicability in head and neck cancer.