Corticosteroid Burden and Hearing Outcomes in Eosinophilic Otitis Media With and Without Biologic Therapy: A Pilot...

Eosinophilic otitis media (EOM) is a refractory, type 2-driven form of otitis media that often requires repeated local and/or systemic corticosteroid therapy. Biologic agents prescribed for comorbid type 2 airway disease may improve EOM outcomes; however, comparative real-world data remain limited. Therefore, we aimed to evaluate changes in EOM severity, air-conduction pure-tone average (PTA), and corticosteroid treatment burden in patients with EOM treated with and without biologic therapy in a single-center retrospective cohort.

We retrospectively reviewed consecutive patients with EOM treated at a single tertiary center. The index date was defined as initiation of biologic therapy (dupilumab or mepolizumab) in the biologics group and initiation of EOM-directed corticosteroid therapy (systemic and/or intratympanic) in the non-biologics group. Post-index outcomes were assessed within a prespecified 10-14-month window, selecting the visit closest to 12 months. The primary analysis was conducted at the patient level, averaging bilateral ear outcomes when applicable. Primary outcomes were the EOM severity score (0-10) and air-conduction PTA (0.5/1/2/4 kHz).

Fourteen patients (24 ears) were included (mean age: 57.3±9.3 years; three men/11 women), with seven patients per group. Follow-up timing was standardized (median: 12.5 months; interquartile range [IQR]: 12.0-13.0). Baseline severity score and air-conduction PTA differed between groups (4.9±1.7 vs. 5.7±1.1; 39.6±19.0 vs. 55.0±19.0 dB, respectively). Severity improved in both groups; however, the between-group difference in change did not reach statistical significance (p=0.077). Air-conduction PTA improved within the biologics group (p=0.031); however, the between-group difference in PTA change was not significant (p=0.249). Systemic corticosteroids were discontinued in the biologics group (0.00±0.00 mg/day) but remained required in the non-biologics group (1.35±1.55 mg/day; p=0.011).

In this pilot real-world cohort, biologic therapy used for comorbid type 2 airway disease was associated with a reduced corticosteroid burden and lower post-index EOM severity. Air-conduction PTA improved within the biologics group; however, the between-group difference in PTA change was not statistically significant, and the hearing findings should therefore be considered exploratory. These preliminary findings should be interpreted cautiously and may help inform adequately powered future studies.