Clinical effects of dupilumab therapy on eosinophilic otitis media in patients with severe nasal polyposis and aspirin hypersensitivity

Introduction Aspirin intolerance (AI) is associated with severe chronic rhinosinusitis with nasal polyposis (CRSwNP) and asthma. The frequency of otogenic involvement in AI patients is largely unknown. Eosinophilic otitis media (EOM) is defined by intractable otitis media with persistent middle ear effusion or polyps. Aim of study: Examination of patients with severe CRSwNP and aspirin intolerance for the presence of EOM and clinical effects of dupilumab therapy (anti-IL-4Rα) on EOM. Methods: Patients ≥ 18 y, severe CRSwNP/aspirin intolerance, dupilumab therapy 300 mg every 2 weeks s.c., examination of rhinological, pneumological and otological clinical parameters and RSOM-31. Results: Of 55 patients (20f, 35m, MV 50y) with severe CRSwNP, asthma and hypersensitivity to aspirin (MV 3 NNH surgery, total IgE Ø 315 kU / l, eosinophils in the blood Ø 2.2 / nl and FEV1 Ø 82 %.), EOM was detected in 5 of the cases (9 %). After at least 12 weeks of dupilumab therapy, NP was significantly reduced (p=0.001). The subanalysis of EOM patients showed diminished middle ear secretion, an improvement of hearing loss in their audiograms and a decrease of ear complaints measured by RSOM-31. In two EOM cases the middle ear polyps decreased and one of these patients with severe sensorineural and conductive hearing loss received successfully a cochlear implant. Conclusions: In case of a severe CRSwNP and hypersensitivity to aspirin the diagnosis of EOM should be considered. The data of this follow-up indicates a good response of dupilumab therapy to nasal polyps and eosinophilic otitis media in patients with aspirin intolerance.

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Publication History

Article published online:
13 May 2021