Low W K, Fong K W
Department of Otolaryngology, Singapore General Hospital, Singapore.
Auris Nasus Larynx. 1998 Sep;25(3):319-21. doi: 10.1016/s0385-8146(98)00035-2.
This study aimed to find out if there were factors which influenced the development of long-term middle ear effusion (MEE) in patients irradiated for nasopharyngeal carcinoma. Thirty-five patients (70 ears) were studied for 2-8 years (mean 5.5 years) post-radiotherapy. The factors studied were (a) sex (b) age (c) tumour size and (d) presence of pre-radiotherapy MEE. Only the presence of pre-radiotherapy MEE was found to be statistically significant (P = 0.004, Fisher's exact test). Stepwise multiple regression analysis showed the presence of pre-radiotherapy MEE was a predictor of post-radiotherapy MEE with an odds ratio of 0.67. It is postulated that irreversible Eustachian tube dysfunction occurs when the tube which has been damaged by tumour is further damaged by irradiation. This may explain the frequent persistent otorrhea when ventilation tubes are used to treat post-radiotherapy MEE in patients with nasopharyngeal carcinoma. In conclusion, an ear with pre-irradiation MEE was almost seven times more likely to have long-term post-irradiation MEE than an ear without pre-irradiation MEE.
本研究旨在确定是否存在影响鼻咽癌放疗患者长期中耳积液（MEE）发生发展的因素。对35例患者（70耳）进行了放疗后2至8年（平均5.5年）的研究。研究的因素包括：（a）性别；（b）年龄；（c）肿瘤大小；（d）放疗前MEE的存在情况。结果发现，仅放疗前MEE的存在具有统计学意义（P = 0.004，Fisher精确检验）。逐步多元回归分析显示，放疗前MEE的存在是放疗后MEE的一个预测因素，优势比为0.67。据推测，当已被肿瘤损伤的咽鼓管因放疗进一步受损时，会发生不可逆的咽鼓管功能障碍。这或许可以解释为何在使用通气管治疗鼻咽癌患者放疗后MEE时，持续性耳漏较为常见。总之，放疗前有MEE的耳朵发生放疗后长期MEE的可能性几乎是放疗前无MEE耳朵的7倍。
