Management of eosinophilic otitis media in the era of biological therapy: systematic review and proportion meta-analysis

Background: Eosinophilic otitis media (EOM) is a recently recognised type 2 inflammatory disease, strongly associated with asthma and chronic rhinosinusitis with nasal polyps. Known as a difficult-to-treat condition, EOM is often refractory to traditional therapies for (chronic) otitis media. This review aims to assess the success rates of the different interventions for patients with EOM including newly available biological therapy. Methodology: In March 2024 we systematically searched PubMed, Embase, Scopus and Web of Science for studies on >5 EOM patients undergoing any medical or surgical intervention with a reported success rate. Proportion meta-analysis on a random ef fect model was used to synthesize results effectively. Risk of bias was assessed through the Risk Of Bias In Non randomized Studies of Interventions tool (ROBINS-I). Results: From 1103 potential articles, 14 studies with 361 patients were included. 62% were females and 85% had bilateral presentation. Otorrhoea was present in 68% of patients, tympanic membrane perforation in 50%. The overall success rate was 61.3%. However, interventions comprising biological agents targeting type 2 inflammatory cascade showed higher success rates compared to non-biological treatments. Conclusions: A shift towards biologic-based therapies could be beneficial for managing the challenging condition EOM.