Diagnosis and management of eosinophilic otitis media: a systematic review

Chen, Tiffany; Ashman, Peter; Bojrab, Dennis I.; Johnson, Andrew P.; Hong, Robert S.; Benson, Brian; Svider, Peter F.

doi:10.1080/00016489.2021.1901985

Cited by 14 publications

(14 citation statements)

References 19 publications

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“…Although omalizumab safety was generally considered tolerable, as reported in clinical trials [ 15 , 16 ], a RCT [ 16 ] and a report [ 18 ] demonstrated the onset of ear disorders after omalizumab use in patients with asthma. This study found symptoms of EOM, such as deafness, otorrhea, and tympanic membrane perforation, in omalizumab AE reports, consistent with previous studies [ 20 , 21 , 33 , 34 ]. In addition, increased eosinophil effects were detected following omalizumab treatment.…”

Section: Discussionsupporting

confidence: 92%

Is Omalizumab Related to Ear and Labyrinth Disorders? A Disproportionality Analysis Based on a Global Pharmacovigilance Database

Park

Jung

et al. 2022

Diagnostics

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Introduction: Asthma is a chronic disease, characterized by reversible airway obstruction, hypersensitivity reactions, and inflammation. Oral corticosteroids are an important treatment option for patients with severe or steroid-resistant asthma. Biologics for asthma are recommended in patients with severe asthma, owing to their steroid-sparing effect as well as their ability to reduce the severity and aggravation of uncontrolled asthma. Most clinical trials of omalizumab in patients with asthma have suggested its tolerability and safety. However, some studies reported eosinophilic comorbidities in the ear, nose, and throat during omalizumab treatment, particularly eosinophilic otitis media. This study examined the relationship between ear disorders and omalizumab compared with that of other biologics for asthma using a large real-world database. Materials and Methods: Individual case safety reports from the Uppsala Monitoring Centre Vigibase of biologics for asthma (omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab) up to December 29, 2019, were used. A disproportionality analysis was performed using the proportional reporting ratio (PRR), reporting odds ratio (ROR), and information components (IC). A hierarchy analysis used the Medical Dictionary for Regulatory Activities Terminology. A tree map was generated using R studio version 4.2. Results: In 32,618 omalizumab reports, 714 adverse events (AEs) were detected as signals. Among the 714 signals, seventeen AEs were detected as signals of omalizumab-related ear and labyrinth disorders in 394 reports. Only three AEs (ear pain, ear disorder, and ear discomfort) were detected from mepolizumab. No signal was detected from reslizumab, benralizumab, and dupilumab. Conclusions: Careful monitoring of ear disorders is recommended when omalizumab treatment is started, with decreased oral corticosteroid use in patients with severe asthma. Further studies are necessary to confirm the omalizumab-related signals.

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Section: Discussionsupporting

confidence: 92%

Is Omalizumab Related to Ear and Labyrinth Disorders? A Disproportionality Analysis Based on a Global Pharmacovigilance Database

Park

Jung

et al. 2022

Diagnostics

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“…When identified early, topical or systemic steroids can be helpful, but diagnosis is often delayed as patient presentation is similar to other forms of otitis media. A recent meta-analysis (1) has identified numerous treatment options used across a myriad of smaller studies of this condition, including topical and oral antibiotics, topical, intratympanic, and oral steroids, aspirin desensitization, immunotherapy, inhaled corticosteroids, surgery, and biologic therapies. In that study, biologic therapy with omalizumab (directed against IgE) and intratympanic steroids were the most effective treatments, with success rates of 47% and 58%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The role of surgery in the treatment of this disease appears to be limited. No surgical treatment has demonstrated consistent improvement, but removal of granulation tissue may provide symptomatic relief and make topical treatments more effective (1,24). Curiously, a corollary measure of eosinophilia, objective nasal endoscopy findings, also did not improve significantly with biologic therapy relative to the control group.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Eosinophilic otitis media is a relatively new and likely underdiagnosed entity notable for eosinophil-predominant effusion or inflammation in the middle ear. Diagnostic criteria laid out by Iino et al (1) require otitis media with eosinophil-predominant effusion or chronic otitis media with predominantly eosinophils, with minor diagnostic criteria of viscous middle ear fluid, resistance to treatment, bronchial asthma, and nasal polyposis. With early diagnosis, the disease responds well to steroids, but some patients fail treatment or have protracted disease requiring multiple interventions, many of which are not successful (1).…”

Section: Introductionmentioning

confidence: 99%

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Improvement of Suspected Eosinophilic Otitis Media with Targeted Biologic Therapy

2023

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ObjectiveTo compare the responses of suspected eosinophilic otitis media to treatment with or without a targeted biologic therapy against interleukin-4 (IL-4), IL-5, or IL-13 signaling.Study DesignRetrospective review.SettingTertiary referral center.PatientsSubjects with type 2 chronic rhinosinusitis with nasal polyposis (CRSwNP), asthma, and otitis media who underwent treatment between 2005 and 2021.InterventionTreatment with targeted biologic therapy.Main Outcome MeasuresPre- and posttreatment nasal endoscopy, ear examination, and audiologic evaluation.ResultsFour hundred seventy-seven subjects with type 2 CRSwNP were treated between 2005 and 2021. Sixty-two had otitis media with pre- and posttreatment evaluation. Retrospective chart review assessed pre- and posttreatment exam findings, nasal endoscopy, audiometry, and tympanometry. Nineteen subjects received a biologic therapy, whereas 43 did not. Exam, endoscopy, and tympanometry were graded for severity and compared pre- and posttreatment. Subjective ear exam and tympanometry were significantly improved with biologic therapy (control = 0.05, biologic = 0.84, p = 9.3 × 10−5; control = −0.1, biologic = 0.62, p = 0.0002). Conductive hearing loss as assessed by air–bone gaps did not change between groups (control = 1.2 dB better, biologic = 1.2 dB worse, p = 0.32). Nasal endoscopy findings improved with biologic therapy relative to the control group, although not statistically significant (control = 1.04, biologic = 1.36, p = 0.22).ConclusionsBiologic therapies targeting interleukin-4 (IL-4), IL-5, and IL-13 signaling are potential new treatments for eosinophilic otitis media. This is the largest study demonstrating improvement in subjects with suspected eosinophilic otitis media in response to biologic therapy, and immune modulation represents a novel treatment strategy for this challenging condition.Professional Practice Gap and Educational NeedCurrent treatment strategies for otologic symptoms in eosinophilic disease are not tremendously effective or durable, resulting in a need for improved treatment options.Learning ObjectiveTo determine if targeted biologic therapy, often used for eosinophilic asthma and type 2 chronic rhinosinusitis with nasal polyposis, improves coexistent suspected eosinophilic otitis media.Desired ResultTreatment of suspected eosinophilic otitis media with targeted biologic therapy will result in improvement of otologic symptoms with a durable response compared with current treatment options.Level of EvidenceLevel IV.Indicate IRB or IACUCExempt. HUM00182703.

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Dupilumab improves eosinophilic otitis media associated with eosinophilic chronic rhinosinusitis

Nakashima¹,

Minagawa²,

Adachi³

et al. 2023

Allergology International

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Diagnosis and management of eosinophilic otitis media: a systematic review

Cited by 14 publications

References 19 publications

Is Omalizumab Related to Ear and Labyrinth Disorders? A Disproportionality Analysis Based on a Global Pharmacovigilance Database

Is Omalizumab Related to Ear and Labyrinth Disorders? A Disproportionality Analysis Based on a Global Pharmacovigilance Database

Improvement of Suspected Eosinophilic Otitis Media with Targeted Biologic Therapy

Dupilumab improves eosinophilic otitis media associated with eosinophilic chronic rhinosinusitis

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