Ear, nose and throat signs in IBD: what a 2026 systematic review actually documents

Ulcerative colitis and Crohn's disease — the two main forms of inflammatory bowel disease — are long-term conditions where parts of the digestive system become inflamed [1][2]. People who have lived with either one for a while tend to learn fast that the disease doesn't only stay in the gut. Joints. Eyes. Skin. Mouth ulcers. These are the extraintestinal manifestations clinicians and patient communities talk about most often.

There is a quieter group that gets talked about less, and a 2026 systematic review in Medicina spends some time with it: the ear, nose and throat end of the body. A persistent runny nose that no antibiotic seems to settle. A hoarse voice that won't come back. A sudden change in hearing on one side. The paper pulls the relevant literature together and asks — modestly — what we can and can't say about how often this happens and what it looks like [3].

What the review actually did

It is a systematic review, conducted according to the PRISMA 2020 methodology, of English-language human studies published between 2015 and 2026 that reported ENT manifestations in ulcerative colitis or Crohn's disease. The authors searched PubMed and Scopus, screened records against inclusion criteria, and ended up with 23 included studies in the qualitative synthesis [3].

A note on what kind of evidence those 23 papers represent. Most of them are case reports and small observational series, not large comparative trials [4]. That matters more than it might sound. A case report — even a careful one — is one person, written up because the finding was striking. A small observational series might be ten or twenty. Adding many such reports together inside a systematic review gives you a fuller map of what has been seen; it does not give you the percentages, the rates, or the risk numbers you could read off a large population study. The authors of this review are clear about that ceiling, and any honest summary has to be clear about it too.

What it found

Sorting through the 23 studies, the review groups what showed up by anatomical region.

Ears. Sensorineural hearing loss — the kind that comes from the inner ear or the auditory nerve rather than from a blockage — was the most frequently reported ENT manifestation, in both adult and paediatric populations. The reviewed evidence points toward immune-mediated mechanisms and a variable response to corticosteroids; some people in the included cases improved on systemic steroids, others did not [5].

Nose. Reported nasal involvement included pyoderma gangrenosum, pyoderma vegetans and aseptic nasal septal abscess. In a small number of severe cases, the inflammation went on long enough to cause structural damage — including saddle-nose deformity, where the bridge of the nose collapses [6]. These are the dramatic case reports; they are rare, but they exist in the literature.

Throat and airway. Laryngeal and airway involvement reported across the included studies included dysphonia (voice changes), tracheitis and, rarely, more serious inflammatory airway disease. The review also notes associations between IBD and chronic rhinosinusitis — long- running, treatment-resistant sinus inflammation [7].

The throughline across all three regions, as the authors describe it: diagnosis depended on standard ENT tools — audiometry for hearing, imaging and endoscopy for the nose and airway, histopathology where a biopsy made sense — and systemic corticosteroids were frequently effective when started early. Delayed recognition, on the other hand, is named in the paper as a risk for irreversible sequelae [8].

Why the careful framing matters

A systematic review summarises the studies it can find. When the field has not produced large comparative trials yet, the review can describe the pattern and the severity ceiling — but it cannot tell you how common any of this is in the average IBD population, who is most at risk, or which symptoms reliably point to ENT-IBD versus something else.

So the load-bearing sentence from this paper isn't "IBD causes hearing loss" or "IBD causes nasal collapse". It is something quieter: ENT manifestations in IBD are a clinically heterogeneous but important group of extraintestinal complications, and the authors argue that increased awareness may support earlier diagnosis and multidisciplinary management, potentially reducing irreversible complications [8]. The modal evidence behind that sentence is case-level. That is exactly the moment to take a finding seriously without overreading it.

What this might mean in everyday life

A few useful, non-alarmist things to take from a paper like this.

First, persistent ENT symptoms in someone with IBD are worth naming during a routine review. A months-long blocked or runny nose that antibiotics don't clear. A new and lasting change in hearing on one or both sides. A voice that has gone hoarse and stayed hoarse. None of these by themselves point to IBD-related ENT involvement — most of the time the explanation is the ordinary one — but they are not a separate universe from your IBD either, and the IBD team and your GP are the people who can decide whether an ENT referral is the right next step.

Second, most of what this review describes is rare. Saddle-nose deformity and life-threatening airway inflammation in IBD exist in the literature because they are striking; they are not the everyday experience of most people living with ulcerative colitis or Crohn's disease. Reading a case-series-heavy review without that context can make a quiet symptom feel like an emergency. Better to mention it calmly and let your clinician place it on the map.

Third, earlier is better than later when something does turn out to be involved. The paper's most actionable observation — that timely systemic corticosteroids were often effective and that delayed recognition risked irreversible damage — depends on someone bringing the symptom up in the first place [8]. That part is on the patient and the clinician together; the literature can't do it for either of you.

This is the part where, as a curator, we step back. The honest takeaway from a 2026 systematic review of 23 case-heavy studies is not a slogan. It is a sentence with two careful clauses: the ENT side of IBD is under-recognised, mostly uncommon, sometimes severe, and worth asking about rather than diagnosing from a screen. We can make the research legible; only your IBD team and ENT clinician can interpret it against the rest of you.