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GLP-1 Receptor Agonist Induced Eustachian Tube Dysfunction: Database and Systematic Review of Otolaryngologic Adverse
Kaitlynne Y Pak1, Raffaello M Cutri, Wasiq Nadeem
1Cedars-Sinai Medical Center, Division of Otolaryngology-Head and Neck Surgery, Los Angeles, CA.
Introduction:
GLP-1 receptor agonists (GLP-1 RAs) have gained traction in the management of obesity. There is limited literature on the implications of GLP-1 RAs in the field of otolaryngology.
Methods:
We explore the association between GLP-1 RAs with eustachian tube dysfunction (ETD) and patulous ETD (PETD) by review of cases, literature, and the FDA adverse event database (FAERS). We also performed a systematic review using the PRISMA guidelines.
Results:
We present autophony and aural fullness following GLP-1 agonist use. In both cases, nasal endoscopy confirmed significant loss of tissue bulk of the anterior and posterior ET cushions. The total number of adverse events (AEs) with GLP-1 RAs was 97,237. The proportion of otologic AEs was 958 (0.99%): 515 hypoacusis, 203 vertigo, 97 deafness, 93 tinnitus, 22 ear pain, 21 motion sickness, 5 hyperacusis, 2 ear fullness, and 0 autophony. The largest number of potential ETD-related AEs occurred with dulaglutide (417). The greatest proportion of potential ETD-related AEs occurred with exenatide (1.52%) followed by semaglutide (1.17%) and liraglutide (1.16%). The systematic review using PRISMA guidelines yielded 1,490 initial articles, of which 937 were screened and 10 met the inclusion criteria. The top 3 identified otologic side effects included nasopharyngitis, sinusitis, unspecified dizziness.
Discussion:
Ear complaints due to GLP-1 RAs have been reported previously. However, this is the first report of PETD associated with GLP-1 RAs. While literature on GLP-1 RAs and PETD is currently limited, the mechanism is well established as reports of PETD after rapid weight loss, especially in bariatric surgery, are well known. Given the rising use of GLP-1 RAs for weight loss, clinicians should be vigilant in screening for otolaryngologic side effects, especially PET, in this population.
Conclusion:
Otolaryngologists should be aware and monitor for possible otolaryngologic side effects, particularly PETD, with GLP-1 RA use.
Insights
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are linked to patulous eustachian tube dysfunction (PETD). Clinicians should monitor for ear-related side effects in patients using these weight-loss drugs.
Area of Science:
- Otolaryngology
- Endocrinology
- Pharmacology
Background:
- Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for obesity management.
- Limited research exists on the otolaryngologic implications of GLP-1 RA use.
Purpose of the Study:
- To investigate the association between GLP-1 RAs and eustachian tube dysfunction (ETD), specifically patulous ETD (PETD).
- To identify potential otologic adverse events associated with GLP-1 RA therapy.
Main Methods:
- Case review, literature review, and analysis of the FDA Adverse Event Reporting System (FAERS) database.
- Systematic review conducted following PRISMA guidelines to identify relevant studies.
Main Results:
- Cases of autophony and aural fullness were observed post-GLP-1 RA use, with confirmed loss of ET cushion bulk.
- FAERS data revealed 958 otologic adverse events (0.99%) out of 97,237 total events.
- Dulaglutide had the highest number of potential ETD-related AEs (417); exenatide showed the highest proportion (1.52%).
- Systematic review identified 10 studies meeting inclusion criteria; common otologic side effects included nasopharyngitis, sinusitis, and dizziness.
Conclusions:
- This study reports the first association between GLP-1 RAs and PETD.
- The mechanism is consistent with rapid weight loss-induced PETD observed after bariatric surgery.
- Clinicians should be vigilant for otolaryngologic side effects, especially PETD, in patients using GLP-1 RAs for weight loss.
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