Human Metapneumovirus and Its Association With Otorhinolaryngological Manifestations: A Systematic Review With Descriptive Synthesis

ABSTRACT Human metapneumovirus (HMPV) is a respiratory virus that predominantly affects the pediatric population. Its role as an infective agent in ear, nose, and throat (ENT) diseases is not yet well understood. To systematically review the available literature on the association between HMPV and ENT manifestations, following PRISMA guidelines, a detailed search was conducted on PubMed/Medline from January 1, 2000 to May 25, 2025. Studies reporting ENT conditions associated with laboratory confirmed HMPV infection were included. Data were synthesized descriptively due to heterogeneity in study designs, populations, diagnostic methods, and reported outcomes, which precluded formal meta‐analysis. Twelve studies were included in the final analysis out of 1345 initially identified records. All percentages represent study‐level proportions unless otherwise specified. Quality assessment was performed using the Joanna Briggs Institute checklist and Newcastle‐Ottawa Scale. Twelve studies including a total of 2302 patients were identified, the majority of whom were pediatric (88.3%). The USA contributed half of the studies. Acute otitis media was reported in 50.0% of included studies, followed by upper respiratory tract infections in 25.0%. The most frequently used test to confirm infection was RT‐PCR (41.67% of studies). Antibiotic use was reported in all included studies (100.0% of studies), regardless of confirmed bacterial infection. Outcomes were inconsistently reported with 33.3% of studies lacking follow‐up data. This systematic review highlights a possible association between HMPV and ENT manifestations; however, due to limited and heterogeneous evidence, no causal relationship can be established, and further well‐designed studies are required.