Effect of Mepolizumab on Middle Ear Disease and Hearing Outcomes in CRSwNP

OBJECTIVE: Otitis media with effusion (OME) is frequently observed in patients with severe Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)-yet it remains underrecognized. Both conditions are debilitating and may share type 2 inflammatory mechanisms. This study investigates the prevalence of OME (measured by tympanometry) in patients with CRSwNP and evaluates the effect of biologic treatment with mepolizumab, with or without combined FESS, on hearing outcomes as well as otologic symptoms. METHODS: Secondary analysis of a randomized controlled trial (RCT) (n = 58) comparing FESS and mepolizumab versus mepolizumab alone in patients suffering from severe CRSwNP. Tympanometry, audiometry, and patient-reported outcomes (SNOT-22 and COMOT-15) were assessed at baseline and after 6 months. RESULTS: At baseline, 22.8% (13/57) of patients had pathological tympanometry (OME), consistent with previous prevalence estimates. After 6 months, the proportion decreased to 14% (p = 0.07). No significant changes were observed in pure tone averages (PTA). In contrast, self-reported outcomes improved significantly, with reductions in both COMOT-15 and SNOT-22 scores (p < 0.05), independent of baseline tympanometry status. CONCLUSION: Mepolizumab treatment was associated with a trend toward reduced middle ear symptoms and significant improvement in self-reported otologic symptoms, supporting the concept of global type 2 airway inflammation and the clinical relevance of assessing ear disease in CRSwNP.