Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Korea.
J Int Adv Otol. 2024 Jul 29;20(4):331-338. doi: 10.5152/iao.2024.231374.
Eosinophilic otitis media, first reported in Japan, is a viscous, intractable otitis media often linked to bronchial asthma and chronic rhinosinusitis, characterized by highly viscous middle ear effusion. Its pathological mechanism remains unclear and the condition occasionally does not respond to steroids. It is now recognized as a rare type 2 inflammatory disease and should be treated specifically to enhance quality of life. This systematic review and meta-analysis evaluated the efficacies of biologic treatments. We searched PubMed, SCOPUS, Embase, Web of Science, and Cochrane databases up to September 2023. We retrieved ear examination findings, otitis media-related and symptom scores, air-bone gaps and hearing thresholds, serum eosinophil, and immunoglobulin E (IgE) levels before and after biologic treatments. Biologics treatment significantly improved subjective otitis media-related scores, compared with control group (standard mean difference (SMD) -1.62; 95% confidence interval (CI) [-2.24; -1.01], I2=54%). Additionally, the serum eosinophil counts and IgE levels significantly decreased (SMD -1.40; 95% CI [-1.99; -0.81], I 2=0%) after 6-12 months of biologic treatments, but the hearing thresholds did not significantly change. There were no significant differences between groups treated with dupilumab and groups treated with other biologics. Biologics treatment for eosinophilic otitis media significantly improved subjective otitis media-related scores and decreased serum eosinophil and IgE levels, but no significant changes in hearing threshold. More randomized cohort studies are needed to confirm the efficacies of biologics in patients with refractory eosinophilic otitis media.
变应性中耳炎，首次在日本报道，是一种粘性的、难治性中耳炎，常与支气管哮喘和慢性鼻-鼻窦炎有关，其特征是中耳有高度粘性的渗出物。其病理机制仍不清楚，并且这种情况偶尔对类固醇没有反应。现在它被认为是一种罕见的 2 型炎症性疾病，应该专门治疗，以提高生活质量。本系统评价和荟萃分析评估了生物制剂治疗的疗效。我们检索了 PubMed、SCOPUS、Embase、Web of Science 和 Cochrane 数据库，截至 2023 年 9 月。我们检索了耳检查结果、中耳炎相关和症状评分、气骨间隙和听力阈值、血清嗜酸性粒细胞和免疫球蛋白 E（IgE）水平，在生物制剂治疗前后。与对照组相比，生物制剂治疗显著改善了主观中耳炎相关评分（标准均数差（SMD）-1.62；95%置信区间（CI）[-2.24；-1.01]，I2=54%）。此外，在接受生物制剂治疗 6-12 个月后，血清嗜酸性粒细胞计数和 IgE 水平显著降低（SMD-1.40；95%CI[-1.99；-0.81]，I2=0%），但听力阈值没有显著变化。接受度普利尤单抗治疗的组和接受其他生物制剂治疗的组之间没有显著差异。生物制剂治疗变应性中耳炎显著改善了主观中耳炎相关评分，并降低了血清嗜酸性粒细胞和 IgE 水平，但听力阈值没有显著变化。需要更多的随机队列研究来证实生物制剂在难治性变应性中耳炎患者中的疗效。
