TNF and otitis media: Furthermore, in an in vitro model of otitis media (OM), trophoblast-derived extracellular vesicles (TB-EVs) suppressed LPS-induced inflammation in human middle ear epithelial cells (HMEECs) in a concentration-dependent manner, reducing the levels of TNF-α, COX-2, and NF-κB [118], supporting the potential of EV-based therapies for mitigating middle ear inflammation.