diff --git a/packages/node/src/integrations/tracing/koa.ts b/packages/node/src/integrations/tracing/koa.ts
index e2a2a52264ae..43b901afebee 100644
--- a/packages/node/src/integrations/tracing/koa.ts
+++ b/packages/node/src/integrations/tracing/koa.ts
@@ -1,6 +1,7 @@
+import type { KoaInstrumentationConfig, KoaLayerType } from '@opentelemetry/instrumentation-koa';
 import { KoaInstrumentation } from '@opentelemetry/instrumentation-koa';
 import { ATTR_HTTP_ROUTE } from '@opentelemetry/semantic-conventions';
-import type { IntegrationFn, Span } from '@sentry/core';
+import type { IntegrationFn } from '@sentry/core';
 import {
   captureException,
   defineIntegration,
@@ -8,27 +9,51 @@ import {
   getIsolationScope,
   logger,
   SEMANTIC_ATTRIBUTE_SENTRY_OP,
-  SEMANTIC_ATTRIBUTE_SENTRY_ORIGIN,
   spanToJSON,
 } from '@sentry/core';
 import { DEBUG_BUILD } from '../../debug-build';
 import { generateInstrumentOnce } from '../../otel/instrument';
+import { addOriginToSpan } from '../../utils/addOriginToSpan';
 import { ensureIsWrapped } from '../../utils/ensureIsWrapped';
 
+interface KoaOptions {
+  /**
+   * Ignore layers of specified types
+   */
+  ignoreLayersType?: Array<'middleware' | 'router'>;
+}
+
 const INTEGRATION_NAME = 'Koa';
 
 export const instrumentKoa = generateInstrumentOnce(
   INTEGRATION_NAME,
-  () =>
-    new KoaInstrumentation({
+  KoaInstrumentation,
+  (options: KoaOptions = {}) => {
+    return {
+      ignoreLayersType: options.ignoreLayersType as KoaLayerType[],
       requestHook(span, info) {
-        addKoaSpanAttributes(span);
+        addOriginToSpan(span, 'auto.http.otel.koa');
+
+        const attributes = spanToJSON(span).data;
+
+        // this is one of: middleware, router
+        const type = attributes['koa.type'];
+        if (type) {
+          span.setAttribute(SEMANTIC_ATTRIBUTE_SENTRY_OP, `${type}.koa`);
+        }
+
+        // Also update the name
+        const name = attributes['koa.name'];
+        if (typeof name === 'string') {
+          // Somehow, name is sometimes `''` for middleware spans
+          // See: https://github.com/open-telemetry/opentelemetry-js-contrib/issues/2220
+          span.updateName(name || '< unknown >');
+        }
 
         if (getIsolationScope() === getDefaultIsolationScope()) {
           DEBUG_BUILD && logger.warn('Isolation scope is default isolation scope - skipping setting transactionName');
           return;
         }
-        const attributes = spanToJSON(span).data;
         const route = attributes[ATTR_HTTP_ROUTE];
         // eslint-disable-next-line @typescript-eslint/no-unsafe-member-access
         const method = info.context?.request?.method?.toUpperCase() || 'GET';
@@ -36,14 +61,15 @@ export const instrumentKoa = generateInstrumentOnce(
           getIsolationScope().setTransactionName(`${method} ${route}`);
         }
       },
-    }),
+    } satisfies KoaInstrumentationConfig;
+  },
 );
 
-const _koaIntegration = (() => {
+const _koaIntegration = ((options: KoaOptions = {}) => {
   return {
     name: INTEGRATION_NAME,
     setupOnce() {
-      instrumentKoa();
+      instrumentKoa(options);
     },
   };
 }) satisfies IntegrationFn;
@@ -55,6 +81,8 @@ const _koaIntegration = (() => {
  *
  * For more information, see the [koa documentation](https://docs.sentry.io/platforms/javascript/guides/koa/).
  *
+ * @param {KoaOptions} options Configuration options for the Koa integration.
+ *
  * @example
  * ```javascript
  * const Sentry = require('@sentry/node');
@@ -63,6 +91,20 @@ const _koaIntegration = (() => {
  *   integrations: [Sentry.koaIntegration()],
  * })
  * ```
+ *
+ * @example
+ * ```javascript
+ * // To ignore middleware spans
+ * const Sentry = require('@sentry/node');
+ *
+ * Sentry.init({
+ *   integrations: [
+ *     Sentry.koaIntegration({
+ *       ignoreLayersType: ['middleware']
+ *     })
+ *   ],
+ * })
+ * ```
  */
 export const koaIntegration = defineIntegration(_koaIntegration);
 
@@ -101,24 +143,3 @@ export const setupKoaErrorHandler = (app: { use: (arg0: (ctx: any, next: any) =>
 
   ensureIsWrapped(app.use, 'koa');
 };
-
-function addKoaSpanAttributes(span: Span): void {
-  span.setAttribute(SEMANTIC_ATTRIBUTE_SENTRY_ORIGIN, 'auto.http.otel.koa');
-
-  const attributes = spanToJSON(span).data;
-
-  // this is one of: middleware, router
-  const type = attributes['koa.type'];
-
-  if (type) {
-    span.setAttribute(SEMANTIC_ATTRIBUTE_SENTRY_OP, `${type}.koa`);
-  }
-
-  // Also update the name
-  const name = attributes['koa.name'];
-  if (typeof name === 'string') {
-    // Somehow, name is sometimes `''` for middleware spans
-    // See: https://github.com/open-telemetry/opentelemetry-js-contrib/issues/2220
-    span.updateName(name || '< unknown >');
-  }
-}
diff --git a/packages/node/test/integrations/tracing/koa.test.ts b/packages/node/test/integrations/tracing/koa.test.ts
new file mode 100644
index 000000000000..9ca221dfba03
--- /dev/null
+++ b/packages/node/test/integrations/tracing/koa.test.ts
@@ -0,0 +1,83 @@
+import { KoaInstrumentation } from '@opentelemetry/instrumentation-koa';
+import { type MockInstance, beforeEach, describe, expect, it, vi } from 'vitest';
+import { instrumentKoa, koaIntegration } from '../../../src/integrations/tracing/koa';
+import { INSTRUMENTED } from '../../../src/otel/instrument';
+
+vi.mock('@opentelemetry/instrumentation-koa');
+
+describe('Koa', () => {
+  beforeEach(() => {
+    vi.clearAllMocks();
+    delete INSTRUMENTED.Koa;
+
+    (KoaInstrumentation as unknown as MockInstance).mockImplementation(() => {
+      return {
+        setTracerProvider: () => undefined,
+        setMeterProvider: () => undefined,
+        getConfig: () => ({}),
+        setConfig: () => ({}),
+        enable: () => undefined,
+      };
+    });
+  });
+
+  it('defaults are correct for instrumentKoa', () => {
+    instrumentKoa({});
+
+    expect(KoaInstrumentation).toHaveBeenCalledTimes(1);
+    expect(KoaInstrumentation).toHaveBeenCalledWith({
+      ignoreLayersType: undefined,
+      requestHook: expect.any(Function),
+    });
+  });
+
+  it('passes ignoreLayersType option to instrumentation', () => {
+    instrumentKoa({ ignoreLayersType: ['middleware'] });
+
+    expect(KoaInstrumentation).toHaveBeenCalledTimes(1);
+    expect(KoaInstrumentation).toHaveBeenCalledWith({
+      ignoreLayersType: ['middleware'],
+      requestHook: expect.any(Function),
+    });
+  });
+
+  it('passes multiple ignoreLayersType values to instrumentation', () => {
+    instrumentKoa({ ignoreLayersType: ['middleware', 'router'] });
+
+    expect(KoaInstrumentation).toHaveBeenCalledTimes(1);
+    expect(KoaInstrumentation).toHaveBeenCalledWith({
+      ignoreLayersType: ['middleware', 'router'],
+      requestHook: expect.any(Function),
+    });
+  });
+
+  it('defaults are correct for koaIntegration', () => {
+    koaIntegration().setupOnce!();
+
+    expect(KoaInstrumentation).toHaveBeenCalledTimes(1);
+    expect(KoaInstrumentation).toHaveBeenCalledWith({
+      ignoreLayersType: undefined,
+      requestHook: expect.any(Function),
+    });
+  });
+
+  it('passes options from koaIntegration to instrumentation', () => {
+    koaIntegration({ ignoreLayersType: ['middleware'] }).setupOnce!();
+
+    expect(KoaInstrumentation).toHaveBeenCalledTimes(1);
+    expect(KoaInstrumentation).toHaveBeenCalledWith({
+      ignoreLayersType: ['middleware'],
+      requestHook: expect.any(Function),
+    });
+  });
+
+  it('passes multiple options from koaIntegration to instrumentation', () => {
+    koaIntegration({ ignoreLayersType: ['router', 'middleware'] }).setupOnce!();
+
+    expect(KoaInstrumentation).toHaveBeenCalledTimes(1);
+    expect(KoaInstrumentation).toHaveBeenCalledWith({
+      ignoreLayersType: ['router', 'middleware'],
+      requestHook: expect.any(Function),
+    });
+  });
+});