Hormone Replacement Therapy is Associated With Reduced Rates of Otologic Surgery in Postmenopausal Women

To evaluate the association between hormone replacement therapy (HRT) use and the likelihood of undergoing otologic surgery in postmenopausal women with otitis media.

Retrospective cohort study.

TriNetX Global Collaborative Network, aggregating electronic health records from multiple health care settings.

Women aged 55 years or older with a diagnosis of otitis media and no prior ear surgery were included. After 1:1 propensity score matching by age and race, 2 cohorts were generated: HRT users (n=23,614) and nonusers (n=23,614).

Exposure to HRT.

Incidence of otologic procedures (tympanostomy, myringotomy, tympanoplasty, and mastoidectomy) and a composite surgical outcome over a 5-year period.

HRT use was significantly associated with reduced risk of all assessed otologic procedures. The incidence of composite ear surgery was 1.3% in the HRT group versus 2.8% in the non-HRT group [absolute risk reduction (ARR) 1.5%, odds ratio (OR) 0.467; 95% CI: 0.408-0.535; P <0.001]. ORs for specific procedures were similarly reduced in the HRT group (all P <0.001): tympanostomy (ARR: 1.0%, OR: 0.466), myringotomy (ARR: 0.3%, OR: 0.478), tympanoplasty (ARR: 0.3%, OR: 0.502), and mastoidectomy (ARR: 0.2%, OR: 0.494).

Among postmenopausal women with otitis media, HRT use was associated with a 50%-55% reduction in the odds of undergoing ear surgery over 5 years. This study is the first to demonstrate a potential protective effect of HRT on the need for surgical intervention in otologic disease. Further investigation is warranted to explore underlying mechanisms and clinical implications.