Objective: To explore the relevant treatment strategies and the influence of relevant factors on prognosis by retrospectively analyzing cases of osteoradionecrosis of the skull base in nasopharyngeal carcinoma. Methods: The clinical data of 60 patients with osteoradionecrosis of the skull base in nasopharyngeal carcinoma who visited the Department of Otorhinolaryngology Head and Neck Surgery of the People's Hospital of Guangxi Zhuang Autonomous Region from June 2018 to June 2024 with follow-up imaging data were summarized. Among them, there were 21 cases in the non - surgical treatment group and 39 cases in the surgical treatment group. Binary logistic regression analysis was used to analyze the influence of multiple factors on prognosis, and the Mann - Whitney U test was used to analyze the influence of surgical intervention on healing and headache symptoms. Results: Results of binary logistic regression analysis showed that for each increase in the stage of osteoradionecrosis of the skull base and the T stage of initial diagnosis, the probability of acceptable healing was 0.37 times (OR = 0.37, P = 0.021) and 0.172 times (OR = 0.172, P = 0.003) that of poor healing respectively. In the case of headache, the probability of acceptable healing was 0.085 times (OR = 0.085, P = 0.017) that of poor healing. For those who underwent surgery, the probability of acceptable healing was 12.965 times (OR = 12.965, P = 0.006) that of poor healing. In addition, results of the Mann-Whitney U test analysis showed that compared with the non-surgical group, the surgical group had better healing (W = 255, P = 0.011). The surgical group could better improve the imaging score(W=601.5, P=0.001) and the headache symptoms of patients (W = 621.5, P ＜ 0.001). Conclusion: Headache, whether to undergo surgery, the stage of osteoradionecrosis of the skull base, and the T stage of initial diagnosis are four independent factors affecting prognosis. Among them, surgery is a protective factor, and the others are risk factors. Endoscopic nasal surgery is the preferred treatment option for osteoradionecrosis of the skull base in nasopharyngeal carcinoma. Implementing individualized and early intervention strategies for patients helps to improve the prognosis and quality of life of patients.