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Otitis MediaPhase 3NCT07189572

Intranasal Corticosteroid Spray for Preventing Otitis Media With Effusion After Radiotherapy in Nasopharyngeal Carcinoma

A Phase 3 study testing Triamcinolone Acetonide in people with Otitis Media and Otitis Media With Effusion After Nasopharyngeal Carcinoma, run by Union Hospital, Tongji Medical College, Huazhong University of Science and Technology.

Not yet recruiting

Opening soon. The study is approved but enrolment has not started yet. Sites may already take enquiries.

Official record
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Trial summary

This study focuses on a common side effect experienced by many patients after radiation therapy for nasopharyngeal cancer, which is a type of head and neck cancer. This side effect is called secretory otitis media (fluid buildup in the middle ear). It can cause a feeling of fullness in the ear and hearing loss. Read more about this study

Who is it for?
Ages 18 to 75 years
What is being tested?
Triamcinolone Acetonide
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
168 participants
Where
No sites listed yet
Study dates
Oct 2025to Oct 2027
Phase
Phase 3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 75 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Pathologically confirmed nasopharyngeal carcinoma scheduled for curative intensity-modulated radiation therapy (IMRT), with or without concurrent chemotherapy.
  • Age between 18 and 75 years.
  • No previous history of head and neck radiotherapy.
  • Intact tympanic membranes bilaterally at baseline, with no history of middle ear surgery (including tympanostomy tube placement).
  • Willing to comply with all study procedures, including nasal spray use, audiological examinations, and follow-up visits.
  • No use of systemic or topical corticosteroids, antihistamines, or decongestants within 14 days prior to randomization.
  • All inclusion criteria must be met for participation

Who cannot join

  • Diagnosed with complete conductive hearing loss or ossicular chain fixation.
  • Scheduled to undergo tympanostomy tube placement, tympanotomy, or other middle ear surgery prior to randomization.
  • Unlikely to complete the 12-month follow-up (e.g., planned relocation, poor compliance).
  • Presence of respiratory conditions requiring treatment with nasal corticosteroids.
  • Known allergy or hypersensitivity to nasal corticosteroids (especially triamcinolone acetonide or its excipients).
  • History of severe mental illness, cognitive impairment, or substance abuse that may affect compliance.
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  • Pregnant or lactating women, or women of childbearing potential unwilling to use effective contraception.
  • Participation in other investigational drug clinical trials within the past 3 months.
  • Deemed unsuitable for the trial by the investigator (e.g., severe septal deviation, chronic rhinosinusitis requiring systemic treatment, or poorly controlled diabetes).
  • Any subject who meets any of the above exclusion criteria at baseline will be excluded from the study.

About this study

Official title: Efficacy of Intranasal Corticosteroid Spray in Preventing Otitis Media With Effusion After Radiotherapy for Nasopharyngeal Carcinoma: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Phase III Clinical Trial

This study focuses on a common side effect experienced by many patients after radiation therapy for nasopharyngeal cancer, which is a type of head and neck cancer. This side effect is called secretory otitis media (fluid buildup in the middle ear). It can cause a feeling of fullness in the ear and hearing loss. While procedures like ear tube placement can help, they can also lead to other problems like ear infections and drainage.

Radiation treatment is thought to cause inflammation that disrupts the normal function of the tube connecting the ear to the throat (Eustachian tube), leading to this fluid buildup. A nasal spray containing a steroid medicine (triamcinolone acetonide) is already known to be safe and effective at reducing inflammation in the ear fluid of both children and adults. We believe that using this spray may also help prevent and improve this condition in nasopharyngeal cancer patients after radiation therapy.

The main goal of this study is to explore whether this nasal spray can effectively prevent or reduce fluid buildup in the ear following radiation therapy. We hope this non-invasive treatment will provide a new option to improve the quality of life for these patients.

Read the detailed description

Background and Rationale:

Nasopharyngeal carcinoma (NPC) is endemic in Southern China. While radiotherapy has significantly improved survival rates, radiation-induced complications severely impact quality of life. Otitis media with effusion (OME) is a highly prevalent complication, with an acute phase (during radiotherapy up to 3 months post-treatment) incidence of 30%-70%. Notably, 20%-40% of these cases progress to chronic OME, and 10%-30% require invasive procedures like tympanostomy tube insertion due to persistent symptoms and hearing loss (often >30 dB).

The pathophysiology of radiation-related OME is distinct from generic OME. It involves mucosal injury in the Eustachian tube region (especially at radiation doses ≥60 Gy), leading to ciliary dysfunction, local immune dysregulation, and mechanical obstruction. Post-radiation changes also include mucosal structure alteration, local immunosuppression, and impaired mucociliary clearance, creating a persistent inflammatory environment conducive to effusion formation.

Current management, primarily adapted from conventional OME protocols (e.g., tympanostomy), offers short-term symptom relief but is associated with significant long-term complications, including chronic otorrhea (15%-20%) and persistent tympanic membrane perforation (5%-10%). This highlights the critical need for preventive and non-invasive strategies targeting the underlying inflammatory etiology.

Topical intranasal corticosteroids, such as triamcinolone acetonide, offer a mechanistically grounded prophylactic approach. They exert potent local anti-inflammatory and immunomodulatory effects by targeting and inhibiting the NF-κB pathway. This action can potentially mitigate mucosal inflammation, restore ciliary function, and rebalance local immunity in the nasopharynx and Eustachian tube orifice during and after radiotherapy, thereby preventing the initiation of the effusion process. Evidence supports their efficacy and safety in managing OME in other populations, with randomized controlled trials (e.g., by El-Anwar et al.) showing non-inferiority to systemic steroids with a significantly improved adverse effect profile (60%-70% reduction in systemic adverse events), making them suitable for long-term use in this patient population.

Study Objective and Design:

This study is a phase III, multicenter, randomized, double-blind, placebo-controlled trial designed to evaluate the efficacy of prophylactic intranasal triamcinolone acetonide in reducing the incidence and severity of radiation-related OME in patients with NPC.

The intervention will be initiated concurrently with radiotherapy. Participants will be randomly assigned to receive either triamcinolone acetonide nasal spray or an identical placebo spray. The primary outcome is the incidence of clinically significant OME requiring intervention within a specified post-radiation period. Key secondary endpoints include objective measures of hearing function (pure-tone audiometry to assess hearing threshold shifts), tympanometric changes, the need for invasive procedures (tympanocentesis or tube placement), and patient-reported quality of life measures assessed using validated questionnaires.

This study aims to provide high-level evidence for a novel, preventive strategy targeting the inflammatory pathogenesis of radiation-induced OME, ultimately aiming to improve long-term otological outcomes and quality of life for NPC survivors.

Being tested
Triamcinolone Acetonide, Placebo
Medical subject headings
Otitis Media, Radiation Injuries, Otitis Media with Effusion

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Triamcinolone AcetonideDrug

    Triamcinolone acetonide is a medium-potency synthetic corticosteroid. This intervention is administered via a commercially available, metered-dose nasal spray that delivers 55 μg of the active drug per spray. It exerts potent local anti-inflammatory and immunomodulatory effects in the nasal mucosa and Eustachian tube orifice. In this study, it is investigated for the prevention of radiotherapy-induced otitis media with effusion in patients with nasopharyngeal carcinoma.

  • PlaceboDrug

    The placebo nasal spray is specifically formulated to be indistinguishable from the active triamcinolone acetonide nasal spray. It is identical in all physical properties including appearance, scent, taste, packaging, and administration procedure. It contains the same inactive excipients (e.g., preservatives, suspending agents) but does not contain any triamcinolone acetonide or other active pharmaceutical ingredient.

Study groups in NCT07189572
Study groupRoleWhat they receive
Triamcinolone Acetonide Nasal SprayExperimentalParticipants will receive triamcinolone acetonide nasal spray (55 μg/spray) in addition to concurrent cisplatin-based chemoradiation. The intervention is initiated on day 1 of radiotherapy. The dosing regimen is 2 sprays per nostril (total daily dose of 220 μg) administered each morning for 12 weeks, covering the entire radiotherapy course and the acute inflammatory phase. All patients will also perform daily nasal irrigation with normal saline, timed at least 30 minutes apart from the drug administration.
Receives: Drug: Triamcinolone Acetonide
Placebo Nasal SprayPlacebo comparatorParticipants will receive a matching placebo nasal spray, which is identical in appearance and usage to the active drug, in addition to concurrent cisplatin-based chemoradiation. The intervention is initiated on day 1 of radiotherapy. The dosing regimen is 2 sprays per nostril administered each morning for 12 weeks. All patients will also perform daily nasal irrigation with normal saline, timed at least 30 minutes apart from the placebo administration.
Receives: Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of Otitis Media with Effusion (OME) within 12 months after radiotherapy

    The occurrence of OME is determined by a combination of: 1) Presence of relevant symptoms (e.g., ear fullness, hearing loss); AND 2) Confirmatory physical examination findings on otoscopy (e.g., tympanic membrane retraction, air-fluid levels, bubbles); AND 3) Objective evidence from tympanometry (Type B or Type C curve, indicating middle ear effusion or significant negative pressure). A case of OME is only confirmed if all three criteria are met. The incidence is calculated as the proportion of participants in each group who develop confirmed OME at any point during the 12-month follow-up period after the completion of radiotherapy.

    Measured: From initiation of study intervention (radiotherapy start) until 12 months after completion of radiotherapy.

Secondary outcomes (4)
  1. Time to onset of Otitis Media with Effusion (OME)

    This measures the time from the start of radiotherapy (baseline) to the first diagnosis of OME. Diagnosis requires the concurrent presence of: 1) relevant symptoms (e.g., ear fullness, hearing loss); 2) confirmatory findings on otoscopy; and 3) a Type B or C tympanogram. The time-to-event data will be analyzed using methods such as Kaplan-Meier curves and Cox proportional hazards models to compare the difference between study arms. Additionally, the proportion of participants with early-onset OME (within 1 month post-radiotherapy) and late-onset OME (after 3 months post-radiotherapy) will be compared between groups using chi-square tests.

    Measured: From the start of radiotherapy until the first occurrence of OME, assessed up to 12 months after radiotherapy completion.

  2. Change in pure-tone average hearing threshold

    Hearing function is assessed by pure-tone audiometry. The pure-tone average (PTA) will be calculated for low frequencies (500 Hz), medium frequencies (1000, 2000 Hz), and high frequencies (4000 Hz). Change from baseline (pre-radiotherapy) in PTA at each post-treatment timepoint will be calculated and compared between groups. The incidence of clinically significant hearing loss, defined as a threshold shift of ≥15 dB HL at the affected frequencies, will also be compared. The severity of hearing loss will be categorized based on PTA as mild (26-40 dB HL), moderate (41-60 dB HL), or severe (>60 dB HL).

    Measured: Baseline (pre-radiotherapy), and at 3 month, 6 months, and 12 months after completion of radiotherapy.

  3. Tympanometry results

    Middle ear function is assessed by tympanometry. Results will be categorized according to standard Jerger classification: Type A (normal), Type B (flat, suggesting effusion), and Type C (negative pressure, suggesting Eustachian tube dysfunction). The distribution of tympanogram types, actual tympanometric peak pressure values (in daPa), and static acoustic compliance values (in mL) will be compared between groups at each timepoint. The primary focus is on the incidence of abnormal tympanograms (Type B or C). Additionally, the conversion rate from an abnormal tympanogram to a normal Type A tympanogram will be analyzed as a measure of recovery.

    Measured: Baseline (pre-radiotherapy), and at 3 month, 6 months, and 12 months after completion of radiotherapy.

  4. Change in disease-specific quality of life scores

    Description [*] The impact on quality of life is assessed using two validated patient-reported outcome measures: the EORTC QLQ-H\&N35 module (specific to head and neck cancer patients) and the ETDQ-7 questionnaire (specific to Eustachian tube dysfunction). The QLQ-H\&N35 assesses symptoms and social function, while the ETDQ-7 focuses on ear-related symptoms. Change scores from baseline for each questionnaire will be calculated. A decrease in the score represents an improvement in symptoms and quality of life. The mean change in scores at each post-radiotherapy timepoint will be compared between the two study arms.

    Measured: Baseline (pre-radiotherapy), and at 3 months, 6 months, and 12 months after completion of radiotherapy.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Sep 2025
  2. Study startOct 2025 (estimated)
  3. Primary completionAug 2027 (estimated)
  4. Study completionOct 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
168 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07189572
Sponsor's protocol ID
UHCT250873
Status last verified
Sep 2025
First submitted
16 Sep 2025
Last updated
29 Sep 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Triamcinolone Acetonide in people with Otitis Media and Otitis Media With Effusion After Nasopharyngeal Carcinoma, run by Union Hospital, Tongji Medical College, Huazhong University of Science and Technology.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: opening soon, as of the sponsor's last update on 29 Sep 2025. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of Otitis Media with Effusion (OME) within 12 months after radiotherapy (time frame: From initiation of study intervention (radiotherapy start) until 12 months after completion of radiotherapy.). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Sep 2025.

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