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Written By:  Sakina N. Bharani, M.D.



            The most common ear problem seen in patients with allergies is fluid in the ear or middle ear effusion.  Allergic reactions have been proposed as being responsible for some cases of hearing loss and fluid in the middle portion of the ear.

  Most of the middle ear effusions occur under two years of age and the incidence continues to decrease by the age of ten years.  There seems to be an increased incidence during the winter and spring months, apparently related to an increase in respiratory tract infections.

             The fluid in the middle ear may be clear and watery; this is usually seen following respiratory infections and flare up of allergic nasal congestion.  In “glue ear,” the effusion consists of thick and cloudy fluid.  These “gluey” secretions are more prone to recurrent infections if they persist on a long term basis.

             The middle ear and nasal-oral cavity are connected by tubes called the Eustachian tubes (commonly called the ear tubes).  In infants and young children, the ear tube is wide, short, and horizontal.  This structural position predisposes to aspiration of the secretions from the throat to the middle ear cavity.  As the child gets older, the tube narrows, elongates, and becomes relatively vertical, preventing the aspiration.  This explains the decreased frequency of fluid in the ear in older children.  Normally when the Eustachian tube is open, the air passes from the nasal cavity to the middle ear and equalizes the pressure on both sides of the ear drum.  When the ear is blocked by nasal congestion, as in nasal allergies, enlarged adenoids, and severe colds, there is increased negative pressure in the middle ear causing fluid collection.

             Children with fluid in the ear often complain of being “stopped up” or having “popping ears.”  The older child and young adult may complain of having a hearing loss and of a feeling of fullness in the ear.  The fluid in the middle ear is the most prevalent cause of hearing loss in school age children.  These children are often described by teachers and parents as being inattentive, loud talkers, and slow learners.  When middle ear effusion is present for a long period of time, there may be a delay in language development and learning resulting in poor school performance.  Some of the children are prone to frequent ear infections with high fever and earaches.

             The child with fluid in the middle ear should be evaluated by examination of the ear drums and specific hearing tests.  Allergy evaluation is indicated when middle ear effusion is associated with symptoms of allergic rhinitis, sinusitis and asthma.  Family history of allergy is an indication towards an allergic cause of the problem.

             Middle ear fluid can be treated symptomatically by the daily use of antihistamine/decongestant combinations.  In some patients, this may not relieve the symptoms completely.  Corticosteroid nasal sprays and cromolyn sodium spray may be effective.  In patients with “allergies” (allergic rhinitis), allergy avoidance procedures (environmental control) and desensitization may be helpful.  Antibiotics should be used when infection is suspected.  Insertion of tubes in the middle ear is indicated in patients who fail to respond to medical treatment.  When adenoids are markedly enlarged and cause obstruction of the ear tubes, adenoidectomy is indicated.




            The trees will be blooming soon in the Midwest, starting from April through May.  Pollen from the tree causes symptoms of allergic rhinitis, such as nasal congestion, post-nasal drainage with sneezing and runny nose.  Allergic conjunctivitis with red, itchy watery eyes and mucoid drainage is fairly common.  The trees produce lightweight pollen in sufficient quantities to produce symptoms in susceptible individuals.

            The pollination season is constant in a given area.  Hot, dry, windy air releases more pollen, causing a flare up of symptoms.  When it rains and is damp, one experiences relief because pollen clears from the air.

             Some of the common trees in the Midwest which cause allergy symptoms are Elm, Oak, White Ash, Maple and Cottonwood.

             Most garden flowers do not cause allergic symptoms, unless the patient is in close contact with the plant such as when smelling flowers or gardening.

            Patients should not avoid outdoor environments during high pollen counts but should take appropriate measures to lessen their exposure.  It is advisable not to freshen the wash by hanging it outside to dry because damp clothing is a sure trap for airborne pollens.  Clothes should be changed and the person should shower after coming indoors.

             Patients with severe symptoms can be controlled by logical environment controls, appropriate medications and/or desensitization.

PLEASE NOTE: The information in this “News and Notes” represents general guidance in the field of Allergy.

Nothing herein stated shall be construed as a specific or implied treatment for an ailment.







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Last modified: 03/01/16