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Background <p>To establish consensus recommendations and standardized protocols for the clinical assessment and management of radiation-induced hearing loss (RIHL), a common yet potentially serious complication in nasopharyngeal carcinoma (NPC) patients receiving radiotherapy, for which effective treatments remain limited.</p> Methods <p>A two-round Delphi survey was conducted with 19 Chinese experts from diverse specialties, including radiation oncology, medical oncology, radiology, and otorhinolaryngology. Utilizing a detailed items questionnaire that addressed diagnosis, prevention, and treatment aspects of RIHL, the panel formulated consensus recommendations. Additionally, the final recommendations were formulated based on the findings of the Delphi survey, in conjunction with evidence appraised using the GRADE system.</p> Results <p>During radiotherapy planning, the implementation of dose constraints for key auditory structures—namely the tympanic cavity, internal auditory canal and cochlea—was emphasized to preserve auditory function. Diagnostic evaluations were advised to comprise comprehensive assessments such as pure tone and speech audiometry, tympanometry, otoacoustic emissions, auditory evoked potentials, otoscopic examination, and CT/MRI imaging, with classification guided by the 2021 WHO grading criteria for type and severity. Therapeutic approaches should be customized based on disease stage and underlying etiology, incorporating strategies like Eustachian tube function restoration, management of otitis media with effusion, and tailored auditory rehabilitation. However, consensus on the applicability of most interventions was limited due to insufficient or conflicting evidence, underscoring the need for further research.</p> Conclusions <p>This consensus provides a structured framework to standardize clinical assessment and management of RIHL, while laying a groundwork for future studies focused on optimizing patient outcomes.</p>

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A Delphi consensus recommendations from China for the management of radiation-induced hearing loss in patients with nasopharyngeal carcinoma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月31日

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  • Xin Zhang,
  • Si-Qi Cai,
  • Hong-Jiang Chen,
  • Shao-Jun Lin,
  • Man Hu,
  • Shi-Chuan Zhang,
  • Xue-Guan Lu,
  • Xiao-Shen Wang,
  • Yong-Sheng Li,
  • Yong-Guo Chen,
  • Yu Sun,
  • Hou-Yu Zhao,
  • Hou-Yong Kang,
  • Sui-Jun Chen,
  • Jun-Lin Yi,
  • Jin-Sheng Hong,
  • Ye Zhang,
  • Jiu-Quan Zhang,
  • Fei-Yun Wu,
  • Yun-Feng Wang,
  • Cheng-Yao Zhang,
  • Zhi-Yun Liao,
  • Xue-Lian Wang,
  • Zhen Zhang,
  • Wei Yuan,
  • Ying Wang,
  • Jiang-Dong Sui

摘要

Background

To establish consensus recommendations and standardized protocols for the clinical assessment and management of radiation-induced hearing loss (RIHL), a common yet potentially serious complication in nasopharyngeal carcinoma (NPC) patients receiving radiotherapy, for which effective treatments remain limited.

Methods

A two-round Delphi survey was conducted with 19 Chinese experts from diverse specialties, including radiation oncology, medical oncology, radiology, and otorhinolaryngology. Utilizing a detailed items questionnaire that addressed diagnosis, prevention, and treatment aspects of RIHL, the panel formulated consensus recommendations. Additionally, the final recommendations were formulated based on the findings of the Delphi survey, in conjunction with evidence appraised using the GRADE system.

Results

During radiotherapy planning, the implementation of dose constraints for key auditory structures—namely the tympanic cavity, internal auditory canal and cochlea—was emphasized to preserve auditory function. Diagnostic evaluations were advised to comprise comprehensive assessments such as pure tone and speech audiometry, tympanometry, otoacoustic emissions, auditory evoked potentials, otoscopic examination, and CT/MRI imaging, with classification guided by the 2021 WHO grading criteria for type and severity. Therapeutic approaches should be customized based on disease stage and underlying etiology, incorporating strategies like Eustachian tube function restoration, management of otitis media with effusion, and tailored auditory rehabilitation. However, consensus on the applicability of most interventions was limited due to insufficient or conflicting evidence, underscoring the need for further research.

Conclusions

This consensus provides a structured framework to standardize clinical assessment and management of RIHL, while laying a groundwork for future studies focused on optimizing patient outcomes.