Nasopharyngeal carcinoma is one of the most common malignant tumors in southern China, and most of them are mainly low-differentiated squamous carcinomas, while the nasopharynx is adjacent to important blood vessels and nerves, which makes surgical exposure difficult, so the clinical treatment of nasopharyngeal carcinoma is based on radiation therapy with better efficacy, which can significantly improve patients’ survival rate [2]. However, no matter how to optimize the radiotherapy plan, most of the structures of the middle ear are within the radiation field, so while killing the tumor tissue, it will also cause different degrees of damage to the normal tissues in the irradiated field, which may result in ear side effects that will haunt patients for a long time, and one of the most common ear side effects is radioactive secretory otitis media. It is reported that one-third of patients treated with radiotherapy for nasopharyngeal carcinoma suffer from persistent tinnitus, ear congestion, progressive hearing impairment and other symptoms of radiation-secreting otitis media, which is the main cause of the decline in the quality of survival of patients with nasopharyngeal carcinoma. Unlike ordinary otitis media, radioactive otitis media is extremely difficult to treat once it occurs. Therefore, it is an important issue in the field of otolaryngology research to investigate the molecular mechanism of radiation-secreting otitis media caused by radiotherapy for nasopharyngeal carcinoma and to develop drugs to prevent its occurrence, so as to improve the survival quality of nasopharyngeal carcinoma patients. In recent years, the incidence of radiosecretory otitis media has not decreased despite the continuous optimization of radiotherapy methods, and the treatment is very tricky with no effective treatment yet. Systemic treatment mainly includes neurotrophic and vasodilator agents, and broad-spectrum antibiotic application. With the application and popularization of otoscopy and nasal endoscopy, more and more clinical attention has been paid to surgical treatment and local treatment. Endoscopic tympanic tube placement and tympanic membrane puncture and aspiration are the two most important methods for the treatment of post-radiation otitis media complicated by radiation therapy in patients with nasopharyngeal carcinoma, but there are certain problems. Tympanic membrane puncture and aspiration (or incision) can effectively relieve the symptoms of stuffiness and tinnitus, but the improvement time only lasts for 5-30 days, and repeated tympanic membrane incision and aspiration can cause permanent perforation of the tympanic membrane. Tympanic tube placement can significantly improve hearing and reduce tinnitus, stuffiness, and headache, with a natural maintenance time of 3-12 months per tube placement. However, tympanic tube placement opens the middle ear cavity to the outside world, increasing the chance of middle ear infection and complications such as suppurative otitis media, tympanosclerosis, and conductive deafness. Partial tympanic membrane resection for the treatment of secretory otitis media after NPC radiation therapy , moreover, destroys the structural integrity of the tympanic membrane and exchanges the patient’s partial symptom relief with complications such as ear leakage and residual tympanic membrane perforation. The application of fiberoptic nasopharyngoscopic eustachian tube dilation and injection can avoid tympanic membrane perforation or infection, but repeated eustachian tube dilation can aggravate damage to the eustachian tube and lead to restenosis. For patients with persistent hearing loss, hearing aids, especially bone anchored hearing aids, can significantly improve the patient’s hearing, but if the negative pressure of middle ear effusion is not lifted, the patient’s headache, tinnitus, and ear congestion symptoms will continue, and the quality of survival will be greatly reduced. In conclusion, there is no new breakthrough in the treatment of secretory otitis media caused by radiation therapy. Most of the current studies are focused on descriptive studies of the pathological process of radiation-secreting middle ear and retrospective evaluation of the efficacy of therapeutic measures, while few studies have been conducted to explore the mechanism of radiation-secreting otitis media at the molecular level. Only an in-depth study of the molecular mechanism of the occurrence and development of radiosecretory otitis media can provide an opportunity to improve the treatment level of radiosecretory otitis media. We are conducting a study on the molecular mechanism of the pathogenesis of radiosecretory otitis media. This study will provide new ideas for the treatment of radiosecretory otitis media and provide a theoretical basis for the development of drugs targeting epithelial cells TLR4 for the treatment of radiosecretory otitis media.