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Osteoradionecrosis of the Temporal Bone: A Case Series

Sharon, Jeffrey D.*; Khwaja, Shariq S.; Drescher, Andrew*; Gay, Hiram; Chole, Richard A.*

doi: 10.1097/MAO.0000000000000321
Middle Ear and Mastoid Disease

Objective: To study osteoradionecrosis (ORN) of the temporal bone.

Study Design: Retrospective case review.

Setting: Academic medical center.

Patients: Patients were included who had previously undergone radiation to the head and neck and then developed exposed necrotic bone within the ear canal that persisted at least 3 months.

Interventions: Patients were treated with a variety of modalities, including conservative therapy with antibiotic ear drops and in-office debridements, hyperbaric oxygen therapy, and surgery.

Main Outcome Measures: To describe the presentation and management of patients with temporal bone osteoradionecrosis.

Results: Thirty-three patients with temporal bone osteoradionecrosis were included. The most common site of primary tumor was the parotid gland (n = 11), followed by the nasopharynx (n = 7). The time to development of ORN varied between 1 and 22 years, with mean of 7.9 years. The mean radiation dose was 62.6 Gy to the primary tumor, 53.1 Gy to the affected temporal bone, and 65.2 Gy to the affected tympanic bone. The most common symptoms of ORN were otorrhea (n = 15), hearing loss (n = 13), and otalgia (n = 12). Fifteen patients had bacterial superinfection, most commonly Staphylococcus aureus (n = 9). Conservative therapy was successful at managing symptoms but not in eradicating exposed bone in most patients. Surgery was used for recalcitrant pain, infection, cholesteatoma, cranial neuropathies, and intracranial complications.

Conclusion: Osteoradionecrosis is a rare complication of radiation to the temporal bone. Management should be aimed at relief of symptoms, eradication of superinfection, and treatment of other commonly present radiation effects like cholesteatoma and hearing loss.

*Department of Otolaryngology, and †Department of Radiation Oncology, Washington University in St. Louis, Missouri, U.S.A.

Address correspondence and reprint requests to Richard A. Chole, M.D., Ph.D., Washington University School of Medicine, Department of Otolaryngology, 660 S. Euclid, Campus Box 8115, St Louis, MO 63110; E-mail: CholeR@ent.wustl.edu

The authors disclose no conflicts of interest.

This study was supported by grants from the National Institutes of Health: R01-DC000263-25 (RAC) P30-DC004665-13 (RAC) and T32 DC00022-28

Copyright © 2014 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company