Objective To explore the effect of otoscopic resection of external auditory canal osteoradionecrosis with free

flap repair on patients' clinical symptoms and quality of life. Methods Sixty patients diagnosed with radiation-induced

osteonecrosis of the external auditory canal from December 2021 to December 2023 were selected. The patients' previous medical history， otoendoscopy and pathological examination all supported the clinical diagnosis of radiation-induced osteonecrosis of the external auditory canal after radiotherapy for nasopharyngeal carcinoma. Moreover， CT examination indicated that the lesion was limited to the external auditory canal， and soft tissue shadows could be seen in the ear canal. In cases where free dead bone forms in the ear canal， there is a skin defect in the necrotic bone area. All the included patients underwent otoscopic resection of external auditory canal osteoradionecrosis with free flap repair， and the effects of the surgical treatment on the clinical symptoms and quality of life of the patients were observed. Results All 60 patients included in the study successfully completed the surgery. Postoperative follow-up ranged from 3 to 9 months. The clinical cure rate was 86.67% （52/60）. Specifically， patients with clinical stage I had a cure rate of 93.33% （42/45）， while those with clinical stage Ⅱ had a cure rate of 66.67% （10/15）. Comparison of clinical efficacy between different clinical stages revealed a statistically significant difference （P=0.019）. The main clinical symptoms such as recurrent pus， ear pain， restricted mouth opening， and hearing loss were significantly improved after otoscopic resection of external auditory canal osteoradionecrosis  and free flap repair （P<0.05）. The improvement of postoperative clinical symptoms in patients with clinical stage Ⅰ was better than that in patients with clinical stage Ⅱ， but the difference was not statistically significant （P>0.05）. The patients’ quality of life showed a significant improvement trend after otoscopic resection of external auditory canal osteoradionecrosis with free flap repair （P<0.05）， and no significant difference was seen between the patients with clinical staging type Ⅰ and type Ⅱ（P>0.05）. Conclusion Clinical efficacy of otoscopic radiolucent excision of necrotic bone in the external auditory canal with free flap repair can alleviate patients' clinical symptoms and improve their quality of life.

Nasopharyngeal carcinoma, Radioactive osteonecrosis, External auditory canal, Free flap repair,