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Pilot study: Clinical effects of dupilumab therapy on eosinophilic otitis media in patients with severe nasal polyposis
Introduction Eosinophilic otitis media (EOM) is defined by intractable otitis media with persistent middle ear effusion or polyps. It is associated with chronic rhinosinusitis with nasal polyposis (CRSwNP) and asthma. However, EOM is still largely unknown to clinicians. Aim of study: Examination of patients with severe CRSwNP for the presence of EOM and clinical effects of dupilumab therapy (anti-IL-4Rα) on EOM.
Methods Patients ≥ 18 y, severe CRSwNP, dupilumab therapy 300 mg every 2 weeks s.c., examination of rhinological, allergological, pneumological and otological clinical parameters and RSOM-31.
Results Of 10 patients (6f, 4m, MV 50y, min 19y, max 74y) with severe CRSwNP (MV 6 sinus surgeries, asthma (100 %) and hypersensitivity to aspirin (50 %), sensitivity to aeroallergens 80 % in CAP test, total IgE MV 315 kU / l, eosinophilia in the blood MV 1.6 / nl and FEV1 MV 88 %), who received dupilumab therapy, EOM was detected in 5 cases. These patients showed a hearing impairment in their audiograms. After 4 weeks of dupilumab therapy, 4 patients with EOM showed diminished middle ear secretion and a decrease of ear complaints-score measured by RSOM-31. One patient with middle ear polyps showed no response to the therapy.
Conclusions In case of a severe CRSwNP the diagnosis of EOM should be considered. The data of this short-term follow-up indicates a good response of EOM on dupilumab therapy.
Article published online:
10 June 2020
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