Chi Fan-Hsiang, Young Yi-Ho
Department of Otolaryngology, National Taiwan University Hospital, Yun-Lin Branch, Dou-Liou.
Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.
Laryngoscope. 2015 Nov;125(11):2565-71. doi: 10.1002/lary.25329. Epub 2015 May 6.
OBJECTIVES/HYPOTHESIS: Despite the advancement of concurrent chemoradiotherapy, inner ear symptoms such as hearing loss, tinnitus, or vertigo/dizziness are still experienced in irradiated nasopharyngeal carcinoma (NPC) survivors. This study utilized an inner ear test battery to assess the causes and sequence of inner ear deficits in irradiated NPC survivors with a mean interval of 10 years after radiotherapy.
Retrospective study.
Thirty-six irradiated NPC survivors were enrolled. Otoscopy and an inner ear test battery comprising audiometry were performed, as well as ocular vestibular-evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and caloric tests.
Otoscopic examination revealed middle ear complications in 37 ears (51%), including radiation-induced otitis media in 32 ears and otitis media with effusion in five ears. Percentages of abnormal cVEMP test, oVEMP test, bone-conducted mean hearing level, and caloric test were 91%, 75%, 67%, and 39%, respectively, exhibiting a significantly declining sequence in inner ear deficits. Most (67%) NPC survivors had inner ear deficit originated from peripheral vestibular lesion, mainly due to sequela of otitis media. In contrast, 33% of them had inner ear deficit caused by central vestibular disorder.
A significant sequential decline in inner ear function of irradiated NPC survivors was observed from the saccule to the utricle, cochlea, and semicircular canals. Most of them were due to sequela of otitis media, followed by central vestibular disorder.
目的/假设：尽管同步放化疗技术有所进步，但接受放疗的鼻咽癌（NPC）幸存者仍会出现内耳症状，如听力损失、耳鸣或眩晕/头晕。本研究采用一套内耳测试方法，评估放疗后平均间隔10年的NPC幸存者内耳功能缺陷的原因及顺序。
回顾性研究。
招募36名接受过放疗的NPC幸存者。进行耳镜检查以及包括听力测定在内的一套内耳测试，还有眼前庭诱发肌源性电位（oVEMP）、颈肌前庭诱发肌源性电位（cVEMP）和冷热试验。
耳镜检查发现37只耳朵（51%）有中耳并发症，其中32只耳朵为放射性中耳炎，5只耳朵为渗出性中耳炎。cVEMP测试、oVEMP测试、骨导平均听力水平和冷热试验异常的百分比分别为91%、75%、67%和39%，内耳功能缺陷呈明显下降顺序。大多数（67%）NPC幸存者的内耳功能缺陷源于外周前庭病变，主要是中耳炎后遗症。相比之下，33%的患者内耳功能缺陷由中枢前庭障碍引起。
观察到接受放疗的NPC幸存者内耳功能从球囊到椭圆囊、耳蜗和半规管有明显的顺序性下降。大多数是由中耳炎后遗症引起，其次是中枢前庭障碍。
4级。
