Otologic Characteristics and Outcomes in Aspirin-Exacerbated Respiratory Disease

Introduction: Otologic findings in aspirin-exacerbated respiratory disease (AERD) are common; however, quantifiable otologic data, including imaging, audiometry, and evidence of eustachian tube dysfunction remain limited in the literature. In this study, we sought to better quantify otologic disease in this subset of patients to better understand optimal management.

Methods: Single institution retrospective chart review of patients with AERD. Charts were reviewed for pre- and post-treatment otologic history, temporal bone computed tomography (CT), audiometry, tympanometry, Eustachian Tube Dysfunction Questionnaire (ETDQ-7) scores, and Sino-Nasal Outcome Test (SNOT-22) scores.

Results: Of 97 patients with AERD, 25 (25.8%) had subjective or objective evidence of otologic disease at baseline. 57 patients had a pre-treatment CT: 23 (20.2%) mastoids and 12 (10.5%) middle ears were at least partially opacified. Of 24 patients with pre-treatment ETDQ-7 scores, 16 (66.7%) had clinically significant ETD, with a mean score of 21.1±12.1. 21 (21.6%) patients had audiometric evidence of hearing loss, with an average air-bone gap of 7.88±3.36 dB. Abnormal tympanometry was found in 25 (43%) ears – 10 (17.2%) type B and 15 (25.9%) type C. Endoscopic sinus surgery (ESS) significantly improved SNOT-22 scores (n=50, p< 0.001), but not ETDQ-7 scores (n=10, p=0.08) after one year. 10 patients received otologic treatment (2 eustachian tube dilations, 6 tympanostomy tube placements, 2 tympanomastoidectomies) with mixed efficacy – 4 had resolution with otologic treatment. Notably, 2 patients requiring recurrent tympanostomy tubes had resolution with dupilumab therapy.

Conclusions: Patients with AERD may have significant otologic disease. The utility of ESS and otologic surgery for management of these otologic symptoms is mixed.