Targeting Eustachian Tube Microenvironment: Probiotic Surfactant Utilization for Antimicrobial Peptide Secretion to Prevent Otitis Media.

Otitis media prevention remains challenging due to antibiotic resistance and frequent recurrence. This review proposes a novel strategy based on probiotic modulation of the Eustachian tube microenvironment. The approach leverages a dual-mechanism whereby probiotics secrete biosurfactants that contribute to the restoration of physiological surface tension and mucus flow, while simultaneously producing antimicrobial peptides that directly eliminate pathogens and suppress inflammatory responses. This synergistic action may not only facilitates sustainable colonization by beneficial bacteria but also disrupts the cycle of biofilm formation and functional impairment in the Eustachian tube. Experimental evidence and clinical observations indicate that this probiotic-based intervention correlates with significantly reduced incidence of otitis media and decreased recurrence rates. Future translation into clinical practice will require further development of optimized strain-specific formulations and effective delivery systems to fully realize this therapeutic approach. This review aims to critically evaluate current evidence supporting probiotic-mediated modulation of the Eustachian tube microenvironment, with particular emphasis on the complementary roles of biosurfactants and antimicrobial peptides in preventing otitis media, while highlighting the current limitations and future translational challenges. These findings highlight the potential of probiotic-mediated modulation of the Eustachian tube environment as a promising preventive strategy.