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Managing Effects of Radiation: Conservative Treatment Proves Most Effective

Management of Radiation Effects on the Ear and Temporal Bone

  • 7:30 – 8:30 am
  • Monday
  • Room N133

Radiation therapy for head and neck cancers can create problems for the ear. However, there is not much evidence available for dealing with those problems. Paul W. Gidley, MD, professor of otology-neurotology at the Department of Head and Neck Surgery at the University of Texas MD Anderson Cancer Center, will provide options for counteracting the side effects of radiation.

“There is not a lot of evidence or literature that has been written about osteoradionecrosis and radiation effects of the ear,” Dr. Gidley said. “For the ear, in my mind, I have a standard way I think about it and how I manage those patients. I am at a big cancer hospital and all that I do is take care of patients with ear problems, so I see all of these complications. I have had a good experience with managing them.”

Because of its central location, the ear is in the radiation fields for nasopharyngeal, parotid, and some oropharynx cancers, as well as some brain tumors, he said. The thin layer of skin over the ear canal and its poor blood supply make it vulnerable to the radiation therapy.

Using case studies, Dr. Gidley will explain how he manages problems to the outer, middle, and inner ear.

“The problem we have is the changes from radiation are slow in onset and so they are slow in resolving,” Dr. Gidley said. “Some are permanent problems. For example, sensorineural hearing loss that comes from radiation therapy is a permanent problem. Other problems like infections are things we can manage, and in some cases, completely resolve.”

However, some problems require more aggressive treatment, including surgical management. Patients who develop osteoradionecrossis that spreads beyond a local problem often require surgery. Another issue Dr. Gidley will examine is myringotomy, which can become a complex issue following radiation therapy.

MD Anderson has had success when its radiation therapists take a proactive approach to reduce the radiation dose to the inner ear, he said.

“On the other hand, if a tumor is close to the inner ear, the radiotherapist needs to deliver an adequate treatment dose even if that means the cochlea will get a much higher dose than what you would prefer to give it,” Dr. Gidley said.

“The take-away is that physicians need to recognize these problems as complications of radiation therapy, and they need to consider conservative management over surgical management when they can,” he said.

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