- Design
- Systematic review with pooled proportions
- Population
- 69 ears implanted after radiotherapy for nasopharyngeal carcinoma, 12 studies
- Primary outcome
- Complications and audiometric improvement
- Effect
- Improvement in 91.3% (73.1–98.8); no postoperative complications in 96.5%
This systematic review gathered 12 studies covering 69 ears implanted for profound hearing loss after radiotherapy for nasopharyngeal carcinoma. Most used a standard mastoidectomy and posterior tympanotomy approach.
About 80% had no intraoperative complication and 96.5% no postoperative complication. Hearing improved in about 91% (95% CI 73% to 99%), with gains in speech perception and patient-reported outcomes. Patients had lived with profound loss for a mean of 6.5 years before implantation.
Radiation-damaged temporal bone has been a reason for hesitancy, and this evidence base is small. But it suggests implantation is reasonable in these patients, and the long delay before referral is the clearest gap. Nasopharyngeal cancer is common in parts of North-East India, where this is directly relevant.
- Consider cochlear implant referral for profound hearing loss after nasopharyngeal radiotherapy.
- Do not treat previous radiotherapy as an automatic contraindication.
- Image the temporal bone for osteoradionecrosis and middle ear disease before surgery.
- Arrange audiology review well before hearing becomes profound.
Why it matters
Patients waited more than six years on average, though implantation generally worked.
Don't overread it
Twelve small studies of 69 ears — the true complication rate in irradiated bone may be higher than reported.
The statistics, in plain English
With only 69 ears, the confidence intervals are wide — 'no intraoperative complication' could truly be anywhere from 55% to 97%. Small case series also tend to report successes more readily than failures.
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