Medical Student University of Michigan Medical School
Objective: To compare the responses of eosinophilic otitis media to treatment with or without a targeted biologic therapy against IL-4, IL-5, or IL-13 signaling
Study Design: Retrospective review
Setting: Tertiary referral center
Patients: Subjects with Type 2 chronic rhinosinusitis with nasal polyposis (CRSwNP) and eosinophilic otitis media who underwent treatment between 2005 and 2021
Intervention: Treatment with targeted biologic therapy
Main Outcome Measures: Pre- and post-treatment nasal endoscopy, ear examination, and audiologic evaluation
Results: Four hundred seventy-seven subjects were identified with Type 2 CRSwNP treated between 2005 and 2021. Sixtytwo had symptomatic otitis media with pre- and post-treatment evaluation. Retrospective chart review assessed pre- and post-treatment exam findings, nasal endoscopy findings, and audiologic measures (hearing loss, tympanometry). During treatment nineteen subjects received a targeted biologic therapy, while forty-three did not. Exam, endoscopy, and audiometric findings were graded on a 3-point scale and compared pre- and post-treatment to generate a differential score (a larger value indicates improvement). Nasal endoscopy scores improved with biologic therapy relative to the control group, though not statistically significant (control 1.04, biologic 1.36, p 0.22). Subjective ear exam and audiometric findings were significantly improved with biologic therapy (control 0.05, biologic 0.84, p 9.3 x10-5; control -0.1, biologic 0.62, p 0.0002).
Conclusions: Biological therapies targeting IL‐4, IL‐5, and IL-13 signaling have changed treatment strategies for eosinophilic conditions such as Type 2 CRSwNP. This is the largest study to date demonstrating improvement in ear symptoms in subjects with eosinophilic otitis media in response to targeted biologic therapy, and immune modulation represents a novel treatment strategy for this challenging condition. Professional Practice Gap & Educational Need: Current treatment strategies for otologic symptoms in eosinophilic disease are not tremendously effective or durable, resulting in a need for improved treatment
Learning Objective: To determine if targeted biologic therapy, often used for eosinophilic asthma and Type 2 chronic rhinosinusitis with nasal polyposis, improves coexistent eosinophilic otitis media
Desired Result: Treatment of eosinophilic otitis media with targeted biologic therapy will result in improvement of otologic symptoms with a durable response compared to current treatment options