What is the relationship between Allergic Rhinitis and Otitis Media with Effusion? (OME)

Otitis media is a condition in which the middle ear becomes inflamed. The middle ear space contains fluid that is susceptible to infection, and an infection of the middle ear is referred to as otitis media with effusion. The majority of allergic rhinitis patients develop chronic OME (otitis media with effusion) as a result of IgE-mediated allergies. IgE-mediated allergy occurs when an IgE antibody (a type of white blood cell) interacts with a mast cell. When a foreign substance from the outside of the body enters the blood via the nasal mucosal surface, the plasma cell produces IgE antibody. Once the IgE antibody binds to the mast cell surrounding the nose, this cell secretes histamine, which is the primary chemical responsible for the itching and hypersensitivity of the nose. According to a group of scentists, 50% of children with chronic OME also have nasal allergy [Acta Otolaryngol (Stockh) 1988;458(suppl):41-7]. A few groups of medical scientists have studied the effects of seasonal allergic rhinitis on Eustachian tube function and middle ear pressure. According to one study, the percentage of pollen allergic patients with obstructed Eustachian tubes increases from 15% to 60% from the start to the peak of pollen exposure. [J Allergy Asthma 1990;65:206–10]. In one study, ragweed pollen was exposed to a group of people. Ragweed pollen is a seasonal pollen. It was discovered that it triggers immune responses in the Eustachian tube and nose [Am J Rhinol 1988;2:155-61.]. Apart from this study, another reported that the house dust mite, a perennial allergen, also obstructed the Eustachian tube [ ArchOtolaryngol Head Neck Surg 1986;112:840-]. In the same study, they discovered that 55% of adults with nasal allergies developed Eustachian tube dysfunction after being exposed to house dust mites. In the subsequent study, it was discovered that Eustachian tube obstruction occurred more frequently in patients with allergic rhinitis. [Journal of Allergy and Clinical Immunology 1987;79:27–31]. Scientists discovered that nasal obstruction typically occurs prior to the development of Eustachian tube obstruction in allergen provocation studies. Individuals who participated in the allergen provocation study were exposed to allergens to elicit their nasal allergy symptom. Additionally, researchers discovered that a variety of inflammatory mediators, including histamine, were detected in the middle ear effusions of children with OME. [American Journal of Otolaryngology-Head and Neck Surgery 1988;114:1131-3]. If an obstruction in the Eustachian tube caused by persistent exposure to an allergen such as a house dust mite is left untreated for an extended period of time, it can develop into middle ear disease, particularly when the priming phenomenon occurs in the Eustachian tube. The priming effect occurs when the organ’s mucosa responds to repeated exposure to low doses of allergen. Allergic rhinitis may also exhibit priming, in which the mucosa of the nasal passage responds to a small amount of allergen inhaled through the nostril. The physiologic hyperresponsiveness of the Eustachian tube obstruction caused by seasonal exposure to allergens such as ragweed pollen may extend beyond the ragweed season.

According to studies, half of newly diagnosed otitis media are diagnosed immediately after the patient has been infected with a viral URTI (virus that causes flu and common cold). It is extremely rare for viruses to be isolated from middle ear effusions in patients with otitis media using conventional culture techniques. However, using a newly developed PCR-based molecular analysis, viruses in middle ear effusions were detected, and it was discovered that 53% of middle ear effusions are virus-positive [J Infect Dis 1995;172:1348-51]. Infection of real humans with rhinovirus-39 was used in an experiment at Children’s Hospital of Pittsburgh to determine the virus’s effect on middle ear pressure and the Eustachian tube. The results of this experiment revealed a significant increase in Eustachian tube dysfunction and also abnormal middle ear development in approximately 30% of those infected in this study. However, all of these individuals who were infected with this virus had a decreased risk of developing otitis media disease. In another study, where influenza A virus was administered intranasally to a group of people, 59 percent of those inoculated developed middle ear pressure and only 25% developed otitis media [J Infect Dis 1995;172:1348-51]. One of the participants in this study developed middle ear pressure followed by purulent otitis media. The middle ear effusion of this patient was sent for PCR analysis, which revealed positive results for influenza A and Streptococcus Pneumoniae. Streptococcus Pneumoniae is a Gram-positive, alpha-hemolytic spherical bacterium that belongs to the genus Streptococcus. Eighty percent of those inoculated with this virus developed Eustachian tube dysfunction, and eighty percent developed middle ear pressure [Ann Otol Rhinol Laryngol 1994;103:59-69]. Five of the infected individuals developed OME on the fourth day following viral exposure. One of the patients experienced dizziness and vertigo, which is primarily caused by an inner ear malfunction. All of these studies support the URTI virus as a cause of otitis media, as well as the development of Eustachian tube obstruction and abnormal middle ear pressure as a cause of otitis media. The investigator of a recent publication on a group of children with acute otitis media isolated microorganisms from the children’s middle ear fluids. They discovered that 65% of the fluid samples collected contained bacteria and viruses. These findings demonstrate that virus infection of the middle ear creates an environment conducive to bacterial growth. [New England Journal of Medicine 1999;340:260-4].

On the basis of information gathered from a few recent publications on the relationship between allergic rhinitis and OME (otitis media with effusion), we can conclude that allergic rhinitis or the common cold/flu will result in Eustachian tube obstruction and middle ear pressure. When the situation becomes out of control, otitis media with effusion develops, which may result in permanent hearing loss. As a result, allergic rhinitis and the common cold/flu should be treated immediately. This is because these common illnesses can progress to chronic sinusitis and otitis media with effusions, both of which are extremely difficult to treat.