Case report: Eosinophilic Otitis media – targeted biologic therapy as an add-on-therapy to surgery?

Eosinophilic otitis media (EOM) is a difficult-to-treat disease characterized by persistent efflusion and eosinophilic cell infiltration. Asthma and chronic rhinosinusitis with nasal polyps (cRSwNP) are frequently associated with EOM. Treatment approaches with local and systemic corticosteroids as well as surgical therapy are mostly ineffective [1]. We present the case of a 49-year-old male with a first manifestation of seizures. MRI scans showed infiltration of the left mastoid with destruction of the skull base expanding intracranially. Ear microscopy showed polypoid granulation on both sides. The patient had a known hearing impairment and a history of sinus surgery with septoplasty and paracentesis with tube insertion. A mastoidectomy with tympanoplasty on the left side as well as the resection through craniectomy with coverage of the skull base defect was performed. Histology showed a chronic granulomatous infection. Few weeks after the operation recurrent granulation could be detected in the ear canal on both sides. As the patient also had an uncontrolled cRSwNP and asthma we started a targeted biologic therapy with dupilumab. Ten months after initiation the patient showed an excellent treatment response with increased quality of life and smelling as well as decreased nasal polyps and a near to complete reduction of granulation in the ear canal. This case report highlights the benefit of targeted biologic therapy in addition to surgical approaches when comorbid cRSwNP is present in EOM.

 

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• References

• 1 De Corso E. et al. "Efficacy of biologics on refractory eosinophilic otitis media associated with bronchial asthma or severe uncontrolled CRSwNP.". Journal of Clinical Medicine 2022; 11 (04) 926

Publication History

Article published online:
19 April 2024