A case of eosinophilic otitis media successfully treated by tympanoplasty with use of dupilumab

Eosinophilic otitis media (EOM) is an intractable otitis media that is mostly associated with bronchial asthma. Middle ear effusion is highly viscous and contains many eosinophils. Surgical interventions, such as tympanoplasty and mastoidectomy, are usually contraindicated for patients with EOM because of the high incidence of deafness and relapse of EOM after the operation. We report here a patient who was successfully treated with tympanoplasty with the use of dupilumab therapy. The patient was a 50-year-old woman with the granulation type of EOM who had a poor response to treatments for EOM, including systemic and topical use of corticosteroids and other biological drugs. After switching to add-on dupilumab therapy, the granulation tissue from the mesotympanum gradually decreased and no middle ear effusion was found. The severity score of EOM and temporal bone computed tomographic findings were dramatically improved after dupilumab therapy. Tympanoplasty was then performed 13 months after the initiation of dupilumab therapy. The postoperative course was excellent without deterioration of the bone conduction hearing level or relapse of EOM for 1 year. Tympanoplasty/mastoidectomy for EOM is currently indicated if patients show a good response to biological drugs for a long time.