Clinical efficacy of mepolizumab and dupilumab for eosinophilic otitis media: Analysis of patient clinical characteristic.

Abstract

Background: Eosinophilic otitis media (EOM) is characterized by eosinophilic infiltration of the middle ear; it is frequently associated with bronchial asthma and chronic rhinosinusitis with nasal polyposis. Although biologics have been used to treat EOM, their efficacy based on clinical characteristics remains unclear. In this study, we evaluated the effectiveness of biologics and analyzed the clinical factors that influenced outcomes.

Methods: We retrospectively studied 29 patients with EOM treated with either mepolizumab or dupilumab as an adjunct to standard therapy, which included intratympanic instillation of triamcinolone. Clinical efficacy was assessed by severity scores, temporal bone computed tomography scores, and pure-tone audiometry. The control group comprised 15 patients with EOM who did not receive biologics. We also analyzed the correlations between changes in severity score from baseline and clinical factors for each patient.

Results: Both biologics groups had significantly lower severity scores at 6 months, with sustained effects until 12 months. The patients with severe middle ear mucosal changes and high baseline severity scores experienced significant improvement with the use of dupilumab; mepolizumab was more effective in elderly patients. Temporal bone computed tomography scores improved in both biologics groups, indicating inflammation resolution in the whole temporal bone. No deterioration of bone-conduction hearing levels was observed in any group.

Conclusions: Mepolizumab and dupilumab showed efficacy for EOM, with therapeutic effects evident within 6 months. Dupilumab is preferable for patients with severe mucosal changes, whereas mepolizumab may benefit elderly patients. Further studies are needed to refine treatment strategies.