Allergy Care - Middle Ear Disease and Allergy

A screaming child with earache in the middle of the night is a familiar scenario to many parents. The cause is usually an acute inflammation in the middle ear known as acute otitis media.

In some people, these acute episodes become recurrent and the diagnosis then becomes chronic otitis media. These recurrent episodes invariably result in the collection of a thick fluid in the middle ear, known as an effusion, which interferes with hearing.

Over the years it has been suggested that allergy might play a significant part in the development of chronic otitis media but there is very little solid evidence one way or the other. This surprising gap in knowledge is significant because if chronic otitis media were shown to be an allergic disease it would be logical to presume that allergic immunotherapy might be useful as a treatment.

Now some light has been thrown on the subject in a recent study by Marseglia* and colleagues. They investigated the allergic status of patients with chronic otitis media with effusion (OME) and whether specific allergy immunotherapy helps relieve the condition.

Eighty nine patients with OME were identified (52 children, 37 adults). All were evaluated for allergy by intradermal skin-testing according to the criteria of the American Academy of Otolaryngic Allergy. A control group of 21 patients who refused therapy was included.

Treatment consisted of immunotherapy for dust, pollen, and moulds. Recurrence or persistence of fluid in the middle ear following 2-8 years of therapy was compared to the patient's pre-treatment status.

All 89 OME patients proved to be atopic, ie have an allergic tendency. Most were allergic to dust (94%), animals (44%), and moulds (88%) while 9% were allergic only to seasonal pollens. Associated allergic diseases included asthma (21%) and allergic rhinitis/sinusitis (63%). Otitis was the sole symptom among 37%. Immunotherapy provided complete resolution of effusion in 85% of the affected ears.

In summary, intradermal testing proved all 89 patients with chronic middle-ear disease in this study to be allergic. Specific allergy immunotherapy completely resolved 85% of chronic otitis media with effusion, in contrast to the controls, none of whom resolved spontaneously. The authors concluded that these results supported the hypothesis that in many people chronic otitis media with effusion is an allergic disease which requires allergy immunotherapy.

Reference
* Marseglia GL, Pagella F, Caimmi D, et al. Increased risk of otitis media with effusion in allergic children presenting with adenoiditis. Otolaryngol Head Neck Surg. 2008;138:572-5.