A Delphi consensus recommendations from China for the management of radiation-induced hearing loss in patients with nasopharyngeal carcinoma.
24 affiliations
- 1Radiation Oncology Center, College of Medicine, Chongqing University Cancer Hospital, Chongqing University, Chongqing, China.
- 2Department of Otolaryngology, Chongqing General Hospital, Chongqing, China.
- 3Fujian Cancer Hospital, Fujian Key Laboratory of Translational Cancer Medicine, Clinical Oncology School of Fujian Medical University, Fuzhou, China.
- 4Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China.
- 5Department of Radiation Oncology, Sichuan Cancer Center, Sichuan Cancer Hospital & Institute, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
- 6Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
- 7Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China.
- 8Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, China.
- 9Department of Head and Neck Surgery, Sichuan Cancer Center, Sichuan Cancer Hospital & Institute, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
- 10Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- 11Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China.
- 12Department of Otorhinolaryngology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- 13Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
- 14Department 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.
- 15Department of Radiation Oncology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
- 16Department of Radiology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, China.
- 17Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
- 18ENT Institute and Department of Otorhinolaryngology, EYE & ENT Hospital, Fudan University, Shanghai, China.
- 19Department of thyroid and breast surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
- 20Hubei Key Laboratory of Precision Radiation Oncology, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
- 21Department of Oncology and Hematology, Zhongxian People's Hospital, Chongqing, China.
- 22Department of Otolaryngology, Chongqing General Hospital, Chongqing, China. [email protected].
- 23Radiation Oncology Center, College of Medicine, Chongqing University Cancer Hospital, Chongqing University, Chongqing, China. [email protected].
- 24Radiation Oncology Center, College of Medicine, Chongqing University Cancer Hospital, Chongqing University, Chongqing, China. [email protected].
Abstract
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.
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BibTeX
@article{zhang2026delphi,
title = {{A Delphi consensus recommendations from China for the management of radiation-induced hearing loss in patients with nasopharyngeal carcinoma.}},
author = {Xin Zhang and Si-Qi Cai and Hong-Jiang Chen and Shao-Jun Lin and Man Hu and Shi-Chuan Zhang and Xue-Guan Lu and Xiao-Shen Wang and Yong-Sheng Li and Yong-Guo Chen and Yu Sun and Hou-Yu Zhao and Hou-Yong Kang and Sui-Jun Chen and Jun-Lin Yi and Jin-Sheng Hong and Ye Zhang and Jiu-Quan Zhang and Fei-Yun Wu and Yun-Feng Wang and Cheng-Yao Zhang and Zhi-Yun Liao and Xue-Lian Wang and Zhen Zhang and Wei Yuan and Ying Wang and Jiang-Dong Sui},
journal = {BMC medicine},
year = {2026},
month = jul,
doi = {10.1186/s12916-026-05062-w},
url = {https://europepmc.org/article/MED/42972536},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - A Delphi consensus recommendations from China for the management of radiation-induced hearing loss in patients with nasopharyngeal carcinoma.
AU - Xin Zhang
AU - Si-Qi Cai
AU - Hong-Jiang Chen
AU - Shao-Jun Lin
AU - Man Hu
AU - Shi-Chuan Zhang
AU - Xue-Guan Lu
AU - Xiao-Shen Wang
AU - Yong-Sheng Li
AU - Yong-Guo Chen
AU - Yu Sun
AU - Hou-Yu Zhao
AU - Hou-Yong Kang
AU - Sui-Jun Chen
AU - Jun-Lin Yi
AU - Jin-Sheng Hong
AU - Ye Zhang
AU - Jiu-Quan Zhang
AU - Fei-Yun Wu
AU - Yun-Feng Wang
AU - Cheng-Yao Zhang
AU - Zhi-Yun Liao
AU - Xue-Lian Wang
AU - Zhen Zhang
AU - Wei Yuan
AU - Ying Wang
AU - Jiang-Dong Sui
PY - 2026
DA - 2026/07/31
JO - BMC medicine
DO - 10.1186/s12916-026-05062-w
UR - https://europepmc.org/article/MED/42972536
AB - 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.
SN - 1741-7015
ER -