Multimodal Integration of Real-time Middle Ear Optical Coherence Tomography Imaging and Dynamic Eosinophil Activation Profiling for Enhanced Diagnosis and Management of Eosinophilic Otitis Media

Abstract Background: Eosinophilic otitis media (EOM) is a recalcitrant inflammatory disease characterised by eosinophil-rich middle ear effusion and mucosal infiltration, often leading to progressive sensorineural hearing loss. Conventional diagnostic methods provide limited immediate findings and do not correlate systemic immune activity with local pathology. Objective: This study aims to develop a multimodal diagnostic instrument that integrates microscale imaging and systemic eosinophil profiling for early, precise and personalised management of EOM. Methods: We combined high-resolution optical coherence tomography (OCT) with dynamic eosinophil activation profiling. OCT provided uncoloured, microscale imaging of the middle ear membrane and mucosa, quantifying parameters such as mucous membrane thickness and scattering coefficients. Functional eosinophil activation was assessed in peripheral blood using flow cytometry and transcriptomics, evaluating surface marker expression, mitochondrial activity and the release of granule proteins. A time-series analysis linked systemic eosinophil activity with local structural changes, revealing a predictive 7-day lag between functional and structural measures. Results: This study demonstrated that mucosal thickness was significantly higher in EOM patients during flares (1.24 ± 0.18 mm) compared to remission (0.87 ± 0.12 mm, P < 0.001) and controls (0.68 ± 0.09 mm, P < 0.001). Similarly, the eosinophil activation score was elevated during flares (0.83 ± 0.11) versus remission (0.52 ± 0.09, P < 0.001). Time-series analysis revealed a 7-day lag between systemic eosinophil activation and local inflammation. Conclusion: This multimodal diagnostic approach offers a novel, precision-guided framework for EOM management and may be applicable to other eosinophilic-mediated diseases, representing a step towards personalised otologic care.