Multidisciplinary Team Role in Cochlear Implantation after Radiotherapy
and Chemotherapy in Nasopharyngeal Carcinoma Patients
Abstract
Objectives: To explore the role of multidisciplinary team (MDT) in
perioperative safety and feasibility evaluation and postoperative effect
prediction of cochlear implantation (CI) in patients with bilateral
profound sensorineural hearing loss (SNHL) after radiotherapy and
chemotherapy for nasopharyngeal carcinoma (NPC). Methods: From 2017 to
2022, 11 patients with bilateral profound SNHL after radiotherapy and
chemotherapy for NPC received CI in our department. MDT formulated
diagnosis and treatment plan for all patients during their perioperative
period. The MDT participants were from the following departments:
otorhinolaryngology, radiology, radiotherapy, neurology, psychiatry,
anesthesiology, and audiology and speech rehabilitation. Several hearing
examinations were tested during the follow-up to dynamically observe the
effectiveness of the hearing and speech rehabilitation in the patients.
Results: Based on the MDT conclusion and decision, five patients
underwent routine CI, two patients underwent simultaneously extended
radical mastoidectomy and CI, and four patients underwent simultaneously
subtotal petrosectomy, external auditory canal elimination, mastoid
cavity obliteration by fat graft or musculoperiosteal flaps and CI. The
pure tone average of all 11 patients was 39.5 ± 5.0 dB and the average
speech discrimination score was 95.0 ± 9.7% postoperatively. One
patient underwent a second surgery for the cochlear electrode prolapsed
postoperatively. Conclusion: To some extent, CI is risky for patients
after chemoradiotherapy for NPC. However, the MDT approach can reduce
the risk fast, predict the auditory effect after implantation early, as
well as predict and prevent the occurrence of postoperative
complications. Therefore, MDT exerts a positive effect on the outcome of
the relatively safe and feasible application of CI in these patients.
Keywords: Multidisciplinary team, nasopharyngeal carcinoma, cochlear
implantation.