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Osteoradionecrosis of the Temporal Bone

An Evidence-Based Approach

Yuhan, Brian T.*; Nguyen, Brandon K.*; Svider, Peter F.*; Raza, Syed N.*,†; Hotaling, Jeffrey*,†; Chan, Eleanor*,‡; Hong, Robert S.*,‡

doi: 10.1097/MAO.0000000000001925

Objectives: To perform a systematic review evaluating etiologies, associated complications, and management of osteoradionecrosis of the temporal bone (ORNTB).

Methods: The authors searched the PubMed, Embase, and Cochrane Library databases for relevant literature. Patient demographics, etiologies, treatments, and other clinical characteristics were obtained. Treatment success was defined as resolution of symptoms at last follow-up. Results were reported using the preferred reporting systems for systematic reviews and meta-analysis (PRISMA) guidelines.

Results: Thirty-eight studies encompassing 364 patients with ORNTB were identified. The most common etiologies necessitating radiotherapy included: nasopharyngeal carcinoma (n = 133 [36.8%]), parotid tumors (n = 73 [20.2%]), and external auditory canal pathology (n = 59 [16.3%]). The mean dose of radiation was 58.0 Gy. The mean lag time between radiotherapy and osteoradionecrosis (ORN) symptoms was 7.9 years. The most common presenting symptoms were purulent otorrhea (33.3%), hearing loss (29.1%), and otalgia (17%). ORNTB complications included tympanic membrane perforation (n = 102 [63.8%]) and chronic otitis media (n = 16 [10%]). Treatments included lateral temporal bone resection (n = 99 [28.3%]), conservative treatment (n = 92 [26.3%]), and mastoidectomy (n = 82 [23.5%]) with 90.9, 89.13, and 59.76% considered successful, respectively.

Conclusions: ORNTB is a rare complication of radiotherapy that may present years after initial radiation exposure. Management should be aimed at relief of presenting symptoms and treatment of ORNTB associated complications. Both conservative and surgical measures may adequately control the disease process and symptomatology; however, randomized controlled studies comparing treatments would serve to further corroborate these findings.

*Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine

Barbara Ann Karmanos Cancer Institute, Detroit

Michigan Ear Institute, Farmington Hills, Michigan

Address correspondence and reprint requests to Peter F. Svider, M.D., Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, St. Antoine, 5E-UHC, Detroit, MI 48201; E-mail:

Financial Disclosures: None declared.

The authors disclose no conflicts of interest.

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