Quantitative Multiple Factors Analysis On Middle Ear Function In Primarily Diagnosed Patients With Nasopharyngeal Carcinoma

Background and objectivesNasopharyngeal carcinoma is occurred in the epithelial tissue of nasopharyngeal cancer, is one of the head and neck malignant tumor in the South China region especially multiple common in Guangdong. Nasopharyngeal carcinoma has a close relation with middle ear disease because it occurs in the nasopharynx of pharyngeal recess and posterior parietal wall. Although the hearing loss, tinnitus, aural fullness, etc ear symptoms unlike the nasopharyngeal carcinoma has such big influence on the survival in patients, they affected the quality of life of patients and treatment. Hence, paying attention to the middle ear function of patients with nasopharyngeal carcinoma, is of great significance to improve the quality of survival in patients with nasopharyngeal carcinoma. A comprehensive understanding of the relevant factors affecting the middle ear function of patients with nasopharyngeal carcinoma is very important for the subsequent treatment.Regarding the Pathogenesis of the middle ear dysfunction in patients who are preliminary diagnosed as nasopharyngeal carcinoma, early thought believed nasopharyngeal mechanical obstruction is the major cause of nasopharyngeal carcinoma complicated with secretory otitis media. The influence mechanism mainly including:direct compression of tumor obstruction, characterized by blocking eustachian tube dysfunction. In addition nasopharyngeal lesions caused by obstruction of inflammatory mediators can cause lumen surface active material to reduce, increase the surface tension, active open eustachian tube function is impaired, show the insufficiency type of eustachian tube dysfunction. Tensor veli palatini muscle, levator veli palatini, Eustachian tube involvement is one of thepathogenic mechanisms of the current consensus. Tumor invasion of the eustachian tube or invasion of the tensor veli palatini or corresponding nerve and lead to the paralysis, make the eustachian tube opening disorder, can cause the secretory otitis media. But there are still a few scholars study the influential factors of the middle ear dysfunction in patients who are preliminary diagnosed as nasopharyngeal carcinoma from the angle of clinical thinking, the growth of the primary lesion of nasopharyngeal carcinoma, the eustachian tube function, and the eustachian tube swallow mouth.At present, there are a lot of disputes on the pathogenesis, assessment and treatment of the middle ear dysfunction in patients who are preliminary diagnosed as nasopharyngeal carcinoma. The related research on relevant influential factors of the middle ear dysfunction in patients who are preliminary diagnosed as nasopharyngeal carcinoma is still lack of depth, and t an objective and comprehensive quantitative evaluation method. This study is based on the data summarized from the patients who are preliminary diagnosed as nasopharyngeal carcinoma, it is the first attempt to adopt the method of multiple factors and quantities to analyze middle ear function in patients who are preliminary diagnosed as nasopharyngeal carcinoma with system analysis of potential factors may affect middle ear function in patients who are preliminary diagnosed as nasopharyngeal carcinoma, striving to more comprehensively, objectively and quantitatively evaluate middle ear function in patients who are preliminary diagnosed as nasopharyngeal carcinoma trying best to provided the clinical basis for early diagnose and prevention of nasopharyngeal carcinoma patients with middle ear dysfunction, so as to further improve the quality of life of patients.Subjects and methods1. Subjects320ears from320patients of nasopharyngeal carcinoma with complete clinical data were collected from Jan.2009to Nov.2012, and they were from Nanfang Hospital, Guangzhou and People’s Hospital of Shiyan, Baoan District, Shenzhen. The patients were examinated with electric otoscope, and took acoustic immittance examination, pure tone threshold test, middle ear and nasopharynx CT or MRI scanning, eustachian tube function test and electronic nasopharyngoscope.2.uipments Electric otoscope, acoustic immittance measurement(Madsen ZODIAC-901), pure tone audiometry(GSI16), nasopharynx and middle ear CT(Lightspeed16, United States General Company) or MRI (GE Signal.5T) scanning,eustachian tube function examination, electronic nasopharyngoscope (Olympus, Japan).3. Methods of scoringThe following findings were scoring quantitatively. The higher scores obtained, the middle ear function was more severely affected.①Basing on the tympanic membrane signs:1point was recorded when it was normal. When the tympanic membrane was retracted and no liquid level was saw,2points were recorded. When bubbles or liquid levels were saw on the tympanic,3points were recorded. ②Basing on the results of pure tone audiometry:When the hearing was normal (<25dBHL),1point was recorded. When the hearing was mild deafness (26-40dBHL),2points was recorded. When the hearing was moderate deafness (41-55dBHL),3points were recorded. When the hearing was moderate to severe deafness (56-70dBHL),4points were recorded. When the hearing was severe hearing loss (71-90dBHL),5points were recorded. When the hearing was profound deafness (>91dBHL),6points were recorded.③Basing on the tympanogram:When the type was A,1point was recorded.2points were recorded when the type was C. When the type was B,3points were recorded.④Basing on the stapedius reflex:When it was leaded from the ipsilateral ear or healthy ears on side,1point was recorded, otherwise2points were recorded.⑤Valsalva maneuver was used to check the function of eustachian tube:When it wasnormal,1point was recorded, when it was dysfunctional,2points were recorded.⑥Based on the form of the pharyngeal ostium of eustachian tube:When it was oval shape,1point was recorded. When it was trumpet shape,2points were recorded. When it was triangle,3points were recorded, and when it was slit shape,4points were recorded.⑦Based on whether complicated with tympanic cavity effusion:no effusion sign recorded1point, otherwise2points were recorded. Discriminant criterion was tympanic membrane puncture, MRI or CT imaging evidence.⑧Basing on the imaging is complicated with sinusitis without nasal sinusitis, when there is no nasal sinusitis, recorded1point, otherwise2points were recorded.⑨Basis on the MRI or CT, whether it is complicating mastoiditis. When there was no mastoiditis,1point was recorded, otherwise2points were recorded. ⑩Basing on the time of ear symptoms appear:When it was asymptomatic,1point was recorded. When there was no ear symptoms, but the symptoms lasted≤6months,2points were recorded. And when there was ear symptoms which lasting>6months,3points were recorded.4. Statistical AnalysisSPSS13.0software was used for statistical analysis. Initially, associations between the independent variable and the outcome variables were assessed by t-tests and t-tests were also carried out to analyze the relationships between the controlling variables and the outcome variables. Those controlling variables with a p-value of0.50or lower were included in the multiple logistic regression analysis. Secondly, multiple logistic regression analysis was performed to examine the relative significance of the effects of the independent variable and the controlling variables on the outcome variables. The level of significance for all statistical tests was set at0.05.Results1. Results of single factor analysisResults of univariate analysis showed that there were no significant differences between the middle ear function and sex, age, N stage, M stage, pathological type, while significant differences were found between the T staging, clinical staging, pharyngeal ostium of eustachian tube, the function of eustachian tube, tumor morphology, tumor type, tumor position diffusion morphology, imaging (nasal skull base invasion,, pharyngeal recess, parapharyngeal space, tensor veli palatini muscle, levator veli palatini) invasion.①T stagingMiddle ear function score of T1,T2, T3, T4were13.25±3.22,18.52±6.24,21.29±3.42,24.37±3.35, respectively. With T stage developing, the middle ear function got worse, and the score was higher. When the four groups were compared in pairwise comparison, no statistically significant differences were found (P<0.05).②Clinical stageMiddle ear function scores of Ⅰ, Ⅱ, Ⅲ, IV groups were12.54±1.70,16.73±5.67,20.18±4.96,23.65±4.39, respectively. When the four groups were compared in pairwise comparison, there were no statistically significant differences (P<0.05).③Local tumor siteMiddle ear function scores of Pharyngeal recess, posterior parietal wall of were23.47±4.69,15.64±4.34, respectively. When did paired comparison of them were no statistically significant difference was found between the two groups (P<0.05).④The local mass diffusion typeMiddle ear function scores of localized, ascending, descending type, mixed type were14.10±3.99,22.45±2.84,16.13±5.78,24.22±3.62, when did paired comparison of them were statistically significant difference (P<0.05).⑤Local tumor morphologyLocalized, isolated mass type, infiltrative middle ear scores were:14.94±4.27,18.03±4.39,25.56±2.11, respectively., when did paired comparison of them were statistically significant difference (P<0.05).⑥Pharyngeal ostium of eustachian tube typeMiddle ear function scores of oval, trumpet shaped, triangle, slit shaped were13.20±2.81,20.58±3.46,23.31±4.02,25.00±4.12, respectively. The results between the pharyngeal ostium of eustachian tube of each type were statistically different (P<0.05).⑦The function of eustachian tubeMiddle ear function scores of normal eustachian tube eustachian tube, disorder were14.84±4.05,23.37±4.18, respectively. And the scores were statistically different between two groups of (P<0.05).⑧Imaging of6sub variablesMiddle ear scores of6imaging variables (nasal, skull base, pharyngeal recess, parapharyngeal space, tensor veli palatini muscle, levator veli palatini) with invasion and without invasion differed statistically (P<0.05).2. Multiple factor analysisControl variables with relation to the outcomes in the single factor analysis were clinical staging, T staging, tumor location, tumor type, tumor morphology of diffusion of eustachian tube dysfunction, pharyngeal ostium of eustachian tube morphology, and6imaging range (nasal, skull base, pharyngeal recess, parapharyngeal space, tensor veli palatini muscle, levator veli palatini), and they were included in the multiple logistic regression analysis. After multiple logistic regression analysis, T stage, tumor location, the function of eustachian tube, tensor veli palatini muscle invasion, skull base invasion groups were showed associated with middle ear function (P<0.05), suggesting that these factors were independent factors affecting the middle ear function in primitively diagnosed patients with nasopharyngeal carcinoma.Conclusions1.From the study we know that T stage, clinical stage, tumor location, tumor type, tumor morphology, proliferation of eustachian tube dysfunction, pharyngeal ostium of eustachian tube morphology, imaging extensions (nasal, skull base, pharyngeal recess, parapharyngeal space, tensor veli palatini muscle, levator veli palatini) were related to the middle ear function of patients with primitively diagnosed nasopharyngeal carcinoma in the single factor analysis, while gender, age, pathological type, N staging, M staging showed no connection with the middle ear function of patients with primitively diagnosed nasopharyngeal carcinoma. The results of multiple factor analysis showed that T stage, tumor location, the function of eustachian tube, tensor veli palatini muscle invasion, skull base invasion were independent prognostic factors on the middle ear function of patients with primitively diagnosed nasopharyngeal carcinoma.2. T stage, the delay of clinical stage, growth in the pharyngeal recess, ascending type and mixed type, eustachian tube dysfunction, pharyngeal ostium of eustachian tube as the fracture type, imaging extensions in nasal, skull base, pharyngeal recess, parapharyngeal space, tensor veli palatini muscle, levator veli palatini and other organizations, as well as with sinusitis, inflammation of dairy process, all of these can aggravate the dysfunction of the middle ear.3. Through the comprehensive and quantitative examinations of electric otoscopy, pure tone audiometry, tympanometry detection, nasopharyngeal imaging and eustachian tube function test, as well as electronic nasopharyngoscopy, we can know well about the anatomy and function of the tympanic membrane, otitis media, tympanometry, tumor infiltration, the function of eustachian tube, the eustachian tube opening and so on. Thus, we can comprehensively, objectively assess the function of the middle ear in patients with nasopharyngeal carcinoma, and can also accurately understand the degree of lesion in the middle ear. The comprehensive evaluation of middle ear function in primitively diagnosed patients with nasopharyngeal carcinoma can provide us with clinical diagnostic basis, and it is conducive to the prevention and treatment of patients with dysfunction of eustachian tube and middle ear diseases. Therefore, we can further improve the quality of life of patients4.According to the results of this study, combined with the middle ear diseases and symptoms that can be diagnosed, the function of middle ear in patients with nasopharyngeal carcinoma can be divided into:<11, with no tinnitus and hearing loss, as normal function;11-15, maybe with slight tinnitus and hearing loss which has a little influence on life, as slightly abnormal function;16-23, many with tinnitus, hearing loss and maybe the ear choking sense, as moderate abnormal function;24points or more, often with tinnitus, hearing loss and choking sense which has obvious influence on life, as severe abnormal function.5.The results of this study are to be enriched and perfected by more clinical data. There are still a lot to be researched, especially in the evaluating factors and the rationality of the score proportion, in providing proper treatment for patients according to the quantization score of middle ear disorders, and in the correspondingly dynamic and further middle ear function evaluation.