Article record

中国关于鼻咽癌患者放射性听力损失管理的德尔菲共识建议

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

指南共识耳科IF 9.1Q1

文献信息

PMID	42972536
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Xin Zhang 查看其他 26 位作者 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
作者单位	Radiation Oncology Center, College of Medicine, Chongqing University Cancer Hospital, Chongqing University, Chongqing, China. 查看其他 23 条单位信息 Department of Otolaryngology, Chongqing General Hospital, Chongqing, China.；Fujian Cancer Hospital, Fujian Key Laboratory of Translational Cancer Medicine, Clinical Oncology School of Fujian Medical University, Fuzhou, China.；Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.；Department of Radiation Oncology, Sichuan Cancer Center, Sichuan Cancer Hospital & Institute, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.；Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.；Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China.；Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, China.；Department of Head and Neck Surgery, Sichuan Cancer Center, Sichuan Cancer Hospital & Institute, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.；Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.；Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.；Department of Otorhinolaryngology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.；Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.；Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.；Department of Radiation Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.；Department of Radiology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, China.；Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.；ENT Institute and Department of Otorhinolaryngology, EYE & ENT Hospital, Fudan University, Shanghai, China.；Department of thyroid and breast surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.；Hubei Key Laboratory of Precision Radiation Oncology, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.；Department of Oncology and Hematology, Zhongxian People's Hospital, Chongqing, China.；Department of Otolaryngology, Chongqing General Hospital, Chongqing, China. weiyuan175@sina.com.；Radiation Oncology Center, College of Medicine, Chongqing University Cancer Hospital, Chongqing University, Chongqing, China. wangy123@cqu.edu.cn.；Radiation Oncology Center, College of Medicine, Chongqing University Cancer Hospital, Chongqing University, Chongqing, China. jiangdong.sui@cqu.edu.cn.
期刊	BMC medicine
SCI 分区	Q1
IF	9.1
研究类型	指南共识 · 临床
所属专科	耳科

中文摘要

背景： 旨在建立关于放射性听力损失（RIHL）临床评估和管理的共识建议与标准化方案，RIHL是接受放疗的鼻咽癌（NPC）患者常见但可能严重的并发症，目前有效治疗仍有限。
方法： 开展了两轮德尔菲调查，参与者为19名来自不同专业的中国专家，包括放射肿瘤学、肿瘤内科学、放射学和耳鼻咽喉科学。利用一份涵盖RIHL诊断、预防和治疗方面的详细条目问卷，专家组制定了共识建议。此外，最终建议基于德尔菲调查结果，并结合使用GRADE系统评价的证据制定。
结果： 在放疗计划制定过程中，强调对关键听觉结构——即鼓室腔、内听道和耳蜗——实施剂量约束，以保护听觉功能。建议诊断评估包括全面评估，如纯音和言语测听、鼓室压测量、耳声发射、听觉诱发电位、耳镜检查以及CT/MRI成像，并根据2021年WHO分型和严重程度分级标准进行分类。治疗方法应根据疾病分期和潜在病因进行个体化定制，纳入咽鼓管功能恢复、分泌性中耳炎管理和量身定制的听觉康复等策略。然而，由于证据不足或存在矛盾，对大多数干预措施适用性的共识有限，凸显了进一步研究的必要性。
结论： 该共识提供了一个结构化框架，以标准化RIHL的临床评估和管理，同时为未来旨在优化患者结局的研究奠定基础。

英文摘要

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.