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Radiation-Induced Necrosis of the Temporal Bone

Diagnosis and Management

Phillips, David J.*; Njoku, Innocent U.*; Brown, Kevin D.; Selesnick, Samuel H.*

doi: 10.1097/MAO.0000000000000812
Middle Ear and Mastoid Disease

Objective To document our experience with osteoradionecrosis (ORN) of the temporal bone.

Study Design Retrospective case review.

Setting Tertiary care medical center.

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

Interventions 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.

Main Outcome Measure 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.

Conclusion 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.

Address correspondence and reprint requests to Samuel H. Selesnick, M.D., F.A.C.S., Vice Chairman, Department of Otolaryngology–Head and Neck Surgery, Weill Cornell Medical College, 1305 York Ave, 5th Floor, New York, NY 10021, U.S.A.; E-mail:

The authors disclose no conflicts of interest.

Copyright © 2015 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company