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

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.