arm Ph ac f ov l o i a g n il r a n u c Huong et al., J Pharmacovigil 2018,S4 o e J Journal of Pharmacovigilance DOI: 10.4172/2329-6887.1000S4-002 ISSN: 2329-6887 Research Article Article OpenOpen Access Access Secondary Middle-ear Damages in Patients with Head and Neck Cancer after Radiotherapy Huong LD1, Nguyen LP1* and Nguyen HX2 1Department of Otorhinolaryngology, Military Medical 103 Hospital, Le Huu Trac Medical Pharmaceutical University, Vietnam 2Department of Pharmaceutical Sciences, College of Pharmacy, Mercer University, Atlanta, USA Abstract Objective: This study aimed to evaluate the relationship between radiotherapy and Eustachian tube dysfunction, and to investigate the efficacy of treatments by tympanostomy and grommet insertion. Methods: Patients with head and neck cancer (148 patients) were treated by three–dimensional radiotherapy in the Center of Oncology and Nuclear Medicine, Military Medical 103 Hospital from February 2014 to April 2016. All patients underwent an ear examination (otoscopy), audiometry, and tympanometry test. Those who developed otitis media with effusion and tympanosclerosis were then treated by tympanostomy or myringotomy. Results: The most common complication after the radiotherapy was found to be Eustachian tube dysfunction, especially otitis media with effusion and tympanosclerosis. Thus, carefully examining and closely monitoring need to be performed to detect patients with secondary middle-ear damages, to successfully cure post-radiotherapy otitis media with effusion, and to minimize possible injury to the middle ear and Eustachian tube. Also, tympanostomy and myringotomy were reported to be the preferable treatments due to their simplicity, high quality, and patients’ compliance. Conclusion: Eustachian tube dysfunction after radiotherapy treatment was the cause for otitis media with effusion and tympanosclerosis. Furthermore, tympanostomy and grommet insertion were convenient, efficient, and desirable treatments for secondary middle-ear damages in patients with head and neck cancer. Keywords: Oncology; Nuclear medicine; Myringotomy; Neck cancer Head and Neck Cancer and treated by 3D conformal radiotherapy at the Center Of Oncology and Nuclear Medicine, Military Hospital 103 from Abbreviations: HNC: Head and Neck Cancer; OME: Otitis Media February 2014 to April 2016. The patients were reported with no middle with Effusion; 3D: Three-Dimensional; PTA: Pure Tone Audiometry; ear injury prior to the radiotherapy, however, suffered from the injury after RT: Radiotherapy the treatment. Introduction Methods Head and Neck Cancer (HNC) is one of the most popular and Descriptive study with clinical intervention serious malignancies over the world for which radiotherapy (RT) is the mainstay of treatment. Radiotherapy including the definitive In this study, we examined all Head and Neck Cancer patients before and postoperative adjuvant treatment has been favorably offered to and after radiotherapy, thus found that 148 patients have suffered from approximately 75% HNC patients. Radiotherapy-associated toxicities middle-ear damage post-treatment. These patients were then divided into and complications have been known to substantially reduce the quality two groups: Group A included those with OME or tympanosclerosis who of life of the patients, making them intolerant and unable to complete later undergo myringotomy and tympanotomy, and group B consists of the treatment plan. those with Eustachian dysfunction who did not require any intervened Otitis media with effusion (OME) has been known as a treatment. The patients in those two groups were examined and monitored radiotherapy-related complication that leads to a reduced function for one month after the radiotherapy using otoscopy, audiometry, and of the Eustachian tube [1]. As reported in multiple otolaryngology tympanometry test. literatures, post–irradiation eustachian dysfunction causes hearing loss at all frequencies. If not being timely detected and properly managed, Results this complication may progress to OME or tympanosclerosis [2]. At the In this study, we reported the average age of 148 HNC patients to Center of Oncology and Nuclear Medicine, Military Hospital 103, we have been operating three-dimensional (3D) conformal radiotherapy since 2013. This treatment has been recognized for its superiority in lowering the needed dose for conformal radiation, and targeted delivery *Corresponding author: Nguyen LP, Department of Otorhinolaryngology, Military Medical 103 Hospital, Le Huu Trac Medical Pharmaceutical University, Vietnam, into the diseased tissue without causing damages to the healthy vicinity Tel: (+84) 932 681; E-mail: [email protected] 486 [3,4]. In this study, we aimed to evaluate the relationship between radiotherapy and Eustachian tube dysfunction and to assess the efficacy Received: October 10, 2018; Accepted: November 01, 2018; Published: November 11, 2018 of the treatments using tympanostosmy and grommet insertion. Citation: Huong LD, Nguyen LP, Nguyen HX (2018) Secondary Middle- Materials and Methods ear Damages in Patients with Head and Neck Cancer after Radiotherapy. J Pharmacovigil S4: 002. doi:10.4172/2329-6887.1000S4-002 Patients Copyright: © 2018 Huong LD, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted This study was conducted on 148 patients who were diagnosed with use, distribution, and reproduction in any medium, provided the original author and source are credited. J Pharmacovigil Molecular Imaging and Drug Delivery ISSN: 2329-6887 JP, an open access journal Citation: Huong LD, Nguyen LP, Nguyen HX (2018) Secondary Middle-ear Damages in Patients with Head and Neck Cancer after Radiotherapy. J Pharmacovigil S4: 002. doi:10.4172/2329-6887.1000S4-002 Page 2 of 4 be 54.46 years (The youngest was 13 while the oldest was 76 years old). Following the radiotherapy treatment, the patients’ eardrum Of the gender population, 125 were male (84.5%) while 23 were female was progressing toward the pathological pathway of Eustachian tube (15.5%) (Table 1). Among patients (72; 48.65%) who were diagnosed dysfunction. These changes were represented by the color (54.27% with Nasopharyngeal Cancer (NPC), 27 (18.24%) were with larynx- dull grey eardrum), morphology (54.26% thick eardrum), mobility hypopharynx cancer, 36 (24.32%) with oral cavity cancer, 6 (4.05%) (63.48% less mobile eardrum), and light reflection of the eardrums with sino–sinus cancer, and 3 (2.70%) with lympho nodes metastics. (97.95% reduced or lost light reflection) (Table 2). According to the Chemoradiotherapy was employed to treat 134 HNC patients while 14 tympanometry classification of Jeger (1975), Handbook of Clinical patients were treated with radiation alone. The number of patients who Impedance Audiometry. New York: American electromedics Corp), suffered from unilateral and bilateral Eustachian tube dysfunctions we found that the most common was type As tympanometry (59.73%) after the radiotherapy was found to be 11 and 137, respectively. Among while type A was present in only 2.04% patients (Figure 2). Thus, the 286 ears of 148 post-irradiation HNC patients, there were 283 damaged total percentage of the pathological middle ear was 97.96%. After the middle ears (98.95%) in which 39 ears were treated by myringotomy and irradiation, several patients suffered from reduced or lost hearing: 45 ears by tympanostomy (Table 1). After the radiotherapy, the patients 75.43% at 21-40 dB and 22.53% at 41-60 dB. We observed a significant reported that the most common clinical signs were tinnitus (96.59%) and improvement in the pure tone audiometry (PTA) and hearing level of the loss hearing (96.93%), followed by an earache (36.52%) and ear discharge treated patients after myringotomy and tympanostomy. In one month (9.09%) (Figure 1). post-myringotomy, the loss hearing at 41-60 dB was completely cured while the normal hearing increased by 25.64%. Similarly, one month after the tympanostomy treatment, the normal hearing increased by Characteristics Value 42.22%. Furthermore, the loss hearing also decreased from 88.89% to Age (years) 55.55% (Table 3). After the myringotomy with 39 ears, the percentage of Mean 54.46 Range 15-76 Gender (n/%) 300 Tinnitus Male 125 (84.5%) Loss hearing Female 23 (15.5%) s Discharge Tumor (n/%) n g 200 Eareach i s Nasopharyn carcinoma 72 (48.65%) l a c Tosil 3 (2.03%) i n i l 100 Oral cavity 36 (24.32%) C Larynx - Hypopharynx 27 (18.24%) Sino – sinus 6 (4.05%) 0 n % Lympho nodes 4 (2.70%) Groups Chemotherapy (n/%) Figure1: Clinical signs. Yes 134 (90.5%) No 14 (9.5%) Symptoms n % Normal 6 2.04 Eustachian tube dysfunction (n/%) Dull grey 159 54.27 Color Unilateral 11 (7.43%) Yellow 128 43.69 Total 293 100.00 Left 8 (5.41%) Normal 6 2.05 Contracted 12 4.10 Righ 3 (2.02%) Flat 159 54.27 Morphology Bilateral 136 (92.57%) Budging 92 31.40 After radiotherapy (n/%) Reptured 24 8.19 Total 293 100.00 Otitis media with effusion 53 (63.10%) Normal 6 2.05 Less mobile 186 63.48 Tympanocerosis 31 (36.90%) Mobility Immobile 101 34.47 Treatments (n/%) Total 293 100.00 Myringotomy 39 (46.43%) Normal 6 2.05 Light reflection Reduced/lost 287 97.95 Tympanostomy 45 (53.57%) Total 293 100.00 Table 1: Patient characteristics. Table 2: Clinical symptoms. J Pharmacovigil Molecular Imaging and Drug Delivery ISSN: 2329-6887 JP, an open access journal Citation: Huong LD, Nguyen LP, Nguyen HX (2018) Secondary Middle-ear Damages in Patients with Head and Neck Cancer after Radiotherapy. J Pharmacovigil S4: 002. doi:10.4172/2329-6887.1000S4-002 Page 3 of 4 Winnie et al. and Charlie et al. (1 female: 1 to 3 males). This difference r might be explained by the different objects among the studies. In e 200 g Vietnam, males have a higher risk of developing HNCs than their e Type A J female counterparts due to their genes and eating habits (high intake g Type As of sauce and salt). Men in the age range from 46 to 65 years are at the n i 150 Type C highest risk of HNCs.