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Effect of Mepolizumab on Middle Ear Disease and Hearing Outcomes in CRSwNP

Anne-Sophie Homøe1, Jens Tidemandsen2, Kasper Aanæs1

  • 1Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

The Laryngoscope
|February 3, 2026
PubMed
Abstract

Insights

Mepolizumab treatment showed a trend toward reduced otitis media with effusion (OME) and improved hearing symptoms in severe Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) patients. This suggests a link between airway inflammation and ear conditions.

Area of Science:

  • Otolaryngology
  • Immunology
  • Respiratory Medicine

Background:

  • Otitis media with effusion (OME) is common in severe Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) but often overlooked.
  • Both conditions are debilitating and may share underlying type 2 inflammatory pathways.
  • Understanding the relationship between CRSwNP and OME is crucial for comprehensive patient management.

Purpose of the Study:

  • To determine the prevalence of OME in severe CRSwNP patients using tympanometry.
  • To evaluate the impact of mepolizumab, with or without Functional Endoscopic Sinus Surgery (FESS), on hearing and otologic symptoms in CRSwNP.
  • To explore the role of biologic therapy in managing comorbid ear conditions in CRSwNP.

Main Methods:

  • Secondary analysis of a randomized controlled trial (RCT) involving 58 severe CRSwNP patients.
  • Comparison of mepolizumab alone versus mepolizumab combined with FESS.
  • Assessment of tympanometry, audiometry, and patient-reported outcomes (SNOT-22, COMOT-15) at baseline and 6 months.

Main Results:

  • Baseline OME prevalence was 22.8% (13/57) via tympanometry.
  • After 6 months, OME prevalence decreased to 14% (p=0.07), with no significant change in pure tone averages (PTA).
  • Significant improvements were noted in self-reported otologic symptoms (COMOT-15, SNOT-22 scores, p<0.05), irrespective of OME status.

Conclusions:

  • Mepolizumab treatment demonstrated a trend towards reduced middle ear symptoms in CRSwNP patients.
  • Significant improvement in patient-reported otologic symptoms was observed with mepolizumab.
  • Findings support the concept of systemic type 2 inflammation and highlight the importance of evaluating ear health in CRSwNP management.
Keywords:
CRSwNPOMEbiologicsmepolizumabmiddle ear diseasemiddle ear symptomsmonoclonal antibodies

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