Kevin Chow1, Maura K Cosetti2. 1. McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas. 2. Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.
Abstract
OBJECTIVE: We report a case of recurrent eosinophilic otitis media (EOM) successfully treated with the novel monoclonal IL-5 inhibitor benralizumab. We also review literature relevant to EOM diagnosis and potential for biologic treatment. PATIENT: A 24-year-old woman with bilateral otitis media with effusion unresponsive to standard treatment. INTERVENTION(S): Multidisciplinary treatment using subcutaneous benralizumab after diagnosis of EOM. MAIN OUTCOME MEASURE(S): Behavioral audiometry, peripheral serology, otomicroscopy, and eosinophilic otitis media symptom severity. RESULTS: Recalcitrant otitis media with effusion (OME) in the setting of nasal polyposis and asthma prompted clinical suspicion for EOM, which was confirmed by pathologic examination of middle ear effusion and soft tissue biopsy. Treatment with benralizumab was initiated by pulmonology and well-tolerated. Within 2 months of treatment onset there was a cessation of EOM symptoms, a reduction of peripheral eosinophil levels, and an improvement in conductive hearing loss. CONCLUSIONS: Monoclonal antibodies such as benralizumab may be an effective treatment option for EOM. A high level of clinical suspicion in patients with bronchial asthma, nasal polyposis, and recalcitrant OME may allow early diagnosis of EOM. Awareness of emerging biologic treatment options is important in the management of this challenging entity and may prevent long-term sequelae.
OBJECTIVE: We report a case of recurrent eosinophilic otitis media (EOM) successfully treated with the novel monoclonal IL-5 inhibitor benralizumab. We also review literature relevant to EOM diagnosis and potential for biologic treatment. PATIENT: A 24-year-old woman with bilateral otitis media with effusion unresponsive to standard treatment. INTERVENTION(S): Multidisciplinary treatment using subcutaneous benralizumab after diagnosis of EOM. MAIN OUTCOME MEASURE(S): Behavioral audiometry, peripheral serology, otomicroscopy, and eosinophilic otitis media symptom severity. RESULTS: Recalcitrant otitis media with effusion (OME) in the setting of nasal polyposis and asthma prompted clinical suspicion for EOM, which was confirmed by pathologic examination of middle ear effusion and soft tissue biopsy. Treatment with benralizumab was initiated by pulmonology and well-tolerated. Within 2 months of treatment onset there was a cessation of EOM symptoms, a reduction of peripheral eosinophil levels, and an improvement in conductive hearing loss. CONCLUSIONS: Monoclonal antibodies such as benralizumab may be an effective treatment option for EOM. A high level of clinical suspicion in patients with bronchial asthma, nasal polyposis, and recalcitrant OME may allow early diagnosis of EOM. Awareness of emerging biologic treatment options is important in the management of this challenging entity and may prevent long-term sequelae.