What question did this study set out to answer?

To quantitatively evaluate the risk of otitis media with effusion (OME) following radiotherapy in nasopharyngeal carcinoma (NPC) patients.

April 3, 2026Open Access

Radiotherapy‐Induced Otitis Media With Effusion in Nasopharyngeal Carcinoma: A Meta‐Analysis

Key Points

To quantitatively evaluate the risk of otitis media with effusion (OME) following radiotherapy in nasopharyngeal carcinoma (NPC) patients.
Conducted a meta-analysis of observational studies reporting OME after radiotherapy in NPC patients.
Searched databases including PubMed, Embase, and Cochrane Library for relevant articles.
Used random-effects modeling with risk difference (RD) as the effect measure and Hartung-Knapp adjustment for analysis.
Evaluated study quality using the Newcastle-Ottawa Scale.
Included eight studies with 10 cohorts totaling 582 patients.
Overall risk difference for OME was 0.08 (95% CI: 0.01–0.15, p = 0.0078) in NPC patients post-radiotherapy.
OME-naïve patients had a relative risk of 0.18 (95% CI: −0.06 to 0.42, p < 0.0001) of developing OME post-treatment.
Technique-specific risks for OME were: 2D-RT at 0.18, 3D-CRT at 0.18, and IMRT at 0.19.

Abstract

ABSTRACT Objective Nasopharyngeal carcinoma carries a significant health burden in Asia, with incidence reaching up to 25 per 100,000. Post‐radiotherapy otitis media with effusion develops in 32.4% of NPC patients, representing the most frequent otologic toxicity. This meta‐analysis provides the first quantitative synthesis of post‐radiotherapy OME risk in NPC patients with technique‐specific estimates for clinical decision‐making. Data Sources PubMed, Embase, and Cochrane Library were searched from inception through April 23, 2025, using controlled vocabulary terms related to nasopharyngeal carcinoma, radiotherapy modalities, and otitis media with effusion. Additional articles were identified through reference screening. Review Methods Observational studies published as full‐length English articles reporting OME development in NPC patients following radiotherapy were included. The Newcastle‐Ottawa Scale assessed bias. Random‐effects modeling with risk difference (RD) as the effect measure was used, with Hartung‐Knapp adjustment applied to mitigate small‐study effects. Findings were reported per PRISMA guidelines. Results Eight studies comprising 10 cohorts (582 patients, mean age 50.4 years) were included. Among all NPC patients undergoing radiotherapy ( n = 962), the overall RD was 0.08 (95% CI: 0.01–0.15, p = 0.0078). For OME‐naïve patients, the relative risk of acquiring OME post‐RT was 0.18 (95% CI: −0.06 to 0.42, p < 0.0001). Technique‐specific analysis revealed conventional two‐dimensional radiotherapy (2D‐RT) risk of 0.18 (95% CI: −0.24 to 0.60), three‐dimensional conformal radiotherapy (3D‐CRT) risk of 0.18 (95% CI: −0.13 to 0.49), and intensity‐modulated radiotherapy (IMRT) risk of 0.19 (95% CI: 0.01–0.27). Chemotherapy exposure and NPC stage showed no significant association. Conclusion Radiotherapy significantly increases OME risk in NPC patients with marked technique‐specific variation, enabling personalized counseling and evidence‐based surveillance protocol development. Trial Registration: CRD420251012963

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