Despite their particular functional consequences, radiotherapy-induced ear injuries remain under-evaluated and under-reported. These reactions may have acute or late character, may affect all structures of the hearing organ, and result in conductive, sensorineural or mixed hearing loss. Up to 40% of patients have acute middle ear side effects during radical irradiation including acoustic structures and about one-third of patients develop late sensorineural hearing loss (SNHL). Total radiotherapy dose and tumour site seem to be among the most important factors associated with the risk of hearing impairment. Thus, reduction in radiation dose to the auditory structures should be attempted whenever possible. New radiotherapy techniques (3-dimensional conformal irradiation, intensity modulated radiotherapy, proton therapy) allow better dose distribution with lower dose to the non-target organs. Treatment of acute and late external otitis is mainly conservative and includes the anti-inflammatory agents (applied topically and systematically). Post-radiation chronic otitis media and the eustachian tube pathology may be managed with tympanic membrane incision with insertion of a tympanostomy tube (grommet), although the benefit of such approach is controversial and some authors advocate a more conservative approach. In these patients the functional deficit can be alleviated by application of bone conduction hearing aids such as, e.g., the bone anchored hearing aid (BAHA). There is no standard therapy for post-irradiation sudden or progressive SNHL yet corticosteroid therapy, rheologic medications, hyperbaric oxygen or carbogen therapy are usually employed (as for idiopathic SNHL), although controversial data on the efficacy of these treatment modalities have been published. In selected cases with bilateral profound hearing loss or total deafness, cochlear implants may prove effective. Further improvements in radiotherapy techniques and progress in otologic diagnostics and therapy may allow better prevention and management of radiation-related acoustic injury.

中文翻译：

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放射疗法引起的耳朵毒性。

尽管有特殊的功能后果，但放疗引起的耳部损伤仍被低估和报告不足。这些反应可能具有急性或晚期特征，可能影响听力器官的所有结构，并导致传导性，感觉神经性或混合性听力损失。多达40％的患者在根治性辐射期间会出现急性中耳副作用，包括声学结构，约三分之一的患者会出现晚期感音神经性听力损失（SNHL）。总放疗剂量和肿瘤部位似乎是与听力障碍风险相关的最重要因素。因此，应尽可能减小对听觉结构的辐射剂量。新的放射疗法技术（3D保形放射，强度调制放射疗法，质子疗法）可实现更好的剂量分布，并降低对非靶器官的剂量。急性和晚期外耳道炎的治疗主要是保守的，包括抗炎药（局部和系统地应用）。放射治疗后的慢性中耳炎和咽鼓管病理可以通过鼓膜切开并插入鼓膜造口管（索环）来解决，尽管这种方法的好处尚有争议，有些作者主张采用更为保守的方法。在这些患者中，可以通过应用骨传导助听器例如骨锚式助听器（BAHA）来减轻功能障碍。目前尚无针对放射后突然或进行性SNHL的标准疗法，但皮质类固醇疗法，流变药物，尽管已发表了有关这些治疗方式疗效的争议性数据，但通常采用高压氧或碳原疗法（对于特发性SNHL）。在某些双侧严重听力丧失或完全性耳聋的病例中，人工耳蜗可能有效。放射治疗技术的进一步改进以及耳科诊断和治疗的进展可以更好地预防和管理与辐射有关的声损伤。