A Study of 10 Cases of Eosinophilic Otitis Media Treated with Biologics

Introduction: We report on 10 patients with eosinophilic otitis media (EOM) who received a biologic agent (omalizumab, benralizumab, mepolizumab, or dupilumab) for the treatment of comorbid bronchial asthma or eosinophilic sinusitis (ECRS) from 2013 to 2021.In each of the 10 patients, EOM severity score, hearing changes, changes in oral or intratympanic steroid use, and nasal polyp score were evaluated before and after the use of the biologic.

Methods: Ten patients (20 ears) with eosinophilic otitis media who were started on omalizumab, benralizumab, mepolizumab, or dupilumab for comorbid bronchial asthma or eosinophilic sinusitis from 2013 to 2021 and followed up for at least 12 months.
In cases of suspected allergy to the biologics or failure to improve clinical symptoms after use of the biologics, the biologics were changed.
The changes in EOM severity score, hearing in pure tone audiometry (1000, 2000, 4000 Hz), the use of systemic steroids, nasal polyps score, and the peripheral blood eosinophil counts were examined.

Results: EOM severity scores at 20 ears improved from a mean of 4.5 ± 1.7 before biologic use to 0.5 ± 1.2 after use of biologics （p < 0.01）, and also there was statistical improvement in nasal polyp scores before and after biologic use ( p< 0.01, Wilcoxon signed rank test).
The pure tone hearing average in 20 ears before the use of the biologic agent was 40.8 ± 20.6 dB improved to 33.5 ± 25.6 dB after the use of the biologics.A significant improvement in threshold was observed at the 125-8000 Hz air conduction, and bone conductance thresholds also improved at 1000 Hz and 2000 Hz (P < 0.01, p< 0.001). There was little change before and after the use of biologics in those patients whose hearing thresholds were already highly elevated.

Conclusions: The use of biologics for eosinophilic otitis media is expected to improve both the eosinophilic otitis media severity score and the pure tone threshold.
In the chronic otitis media type with granulation, the granulation improved, but there was little improvement in severity score and hearing level.