Sinonasal Intervention Reduces the Need for Pressure Equalization Tube Placement in Atopic Adults

ABSTRACT Objectives To determine the impact of management of upper airway atopic disease on middle ear and eustachian tube function in adults. Methods The TriNetX Research Network was queried to construct cohorts of adult patients with atopic disorders of the upper airway (defined by ICD‐10 codes for asthma, allergic rhinitis, and chronic rhinosinusitis with nasal polyposis) with concurrent eustachian tube dysfunction (ETD) undergoing medical or surgical intervention for their atopic disease, including monoclonal antibody (mAb) therapy (e.g., dupilumab, mepolizumab, omalizumab), topical nasal steroid spray (fluticasone propionate), functional endoscopic sinus surgery (FESS), septoplasty with inferior turbinate submucosal resection (BITSMR), and allergy immunotherapy. The primary measured outcome was the difference in the rate of pressure equalization tube (PET) placement before and after each intervention. Results FESS demonstrated an absolute risk reduction (ARR) of 10.0% ( p < 0.05, 95% confidence interval [CI] 8.9%–11.1%), septoplasty/BITSMR 7.5% ( p < 0.05, 95% CI 6.3%–8.7%), mAb 5.5% ( p < 0.05, 95% CI 4.1%–6.8%), nasal steroid spray (fluticasone proprionate) 0.9% ( p < 0.05, 95% CI 0.8%–1.0%), and allergy immunotherapy 2.4% ( p < 0.05, 95% CI 1.5%–3.2%). Individually, the three mAb—dupilumab, mepolizumab, and omalizumab—exhibited ARR of 6.5% ( p < 0.05%, 95% CI 4.8%–8.3%), 6.8% ( p < 0.05, 95% CI 2.6%–11.0%), and 3.4% ( p < 0.05, 95% CI 1.4%–5.4%), respectively, without significant differences in rates of PET placement among the three ( p = 0.18). Conclusion Management of upper airway atopic disorders via both medical and surgical intervention is associated with improvement in middle function as measured by the need for PET placement. Level of Evidence 3.