Case Study

Allergic rhinitis and its effect on middle ear pressure

Ashok Murthy V1.,Meghna P2.-Kuppam (A.P.)
Abstract
Introduction: Allergic rhinitis is one of the diseases of the industrialized nations. It is more prevalent in this modern age than ever
before. With the better understanding of the physiologic mechanism and the pathophysiologic events we are able to discern
various reasons to understand the disease process. With this knowledge, we are able to evaluate and find a suitable remedy to
ongoing disease process. This study analysis the role of allergic rhinitis and its effect it has on the middle ear pressure.
Study design: Descriptive study / Prospective study
Study Centre: Tertiary Centre
Material & Methods: Group A: Sixty eight patients of allergic rhinitis were evaluated on their first visit and impedance
tympanometry was done and noted. On their second visit the process was repeated and results were compared. Group B: This
group consisted of sixty patients of allergic patients. They were evaluated as the previous group.
Results and Conclusion: Group A patients for whose impedance tympanogram showed Type C graph were reverted back to Type
A graph on treating with anti-histamines or steroid nasal spray.
Group B patients who were already on anti-allergy medications exhibited normal middle ear pressure. We conclude that allergic
rhinitis has affected the middle ear pressure but anti-allergy treatment can provide a protective influence on the middle ear.
Key words: Allergic rhinitis, middle ear pressure, impedance tympanogram, otitis media with effusion, anti-histamines, steroid
nasal spray.
Introduction
Allergic Rhinitis is considered to be one of the most common
diseases affecting a wide range of people barring age. With
respect to this disease patients face morbidity issues that can
affect work and family life. Allergic rhinitis as such is
diagnosed with a clinical examination, correlated with
symptoms. The treatment protocol has been varied from time
to time with the discovering newer and safer pharmacologic
anti-allergic agents. Anti-histaminics and steroidal nasal
sprays have been the mainstay in the treatment of allergic
rhinitis. Each have their own merits and demerits.In our study,
we discuss the effect of anti-allergic medications and its effect
on the middle ear pressure.
Aims
1) To show the effect of allergic rhinitis over the middle ear
pressure.2) To prove the protective action of antihistaminics
and steroidal nasal sprays on the middle ear pressure.
Materials and methods
Including Criteria: Patients with allergic rhinitis coming to
Department of ENT, PES IMSR, Kuppam were included
under the study. Excluding Criteria: Ear discharge, ear pain or
any associated ear problems were excluded.During the first
visit, the history was recorded and the patient examined and
evaluated. Intake of anti-histaminics or any other drugs for the
treatment of the same was also noted. Impedance audiometry
was done. Patients who had not taken any medication were

grouped as Group A (n=68) and were prescribed antihistaminics and steroidal spray as per their liking. Patients
who were already on anti-allergy medications were also
considered and grouped as Group B (n=60). Both these
groups underwent the routine examination, evaluation and
impedance tympanometry on their first visit. On their second
visit, after six to eight weeks after anti-allergy medication, the
routine evaluation and impedance tympanometry was carried
out.
Observations
It was noticed that the patients already on anti-allergy
medications (Group B) were having normal middle pressure
on their first and subsequent visits also. Whereas patients in
Group A had Type C curve in 30% of the patients on their first
visit and subsequently on six to eight weeks of anti-allergy
medications the impedance tympanometry showed normal
middle ear pressure.
Results and Conclusions
In Group A patients who have not treated with anti-allergic
medications before showed Type C graph on impedance
tympanogram. These patients were reverted back on
receiving anti-allergic medications and their middle ear
pressure showed normal curve on impedance tympanogram.
Group B patients showed no such variation. They were having
normal pressure on their first visit and also on their
subsequent visit. We conclude that anti-allergic medications
have a protective influence on middle ear pressure.

Professor, 2Resident Department of ENT and HNS,PES Institute of Medical Sciences, Kuppam ( A.P.)

National Journal of Otorhinolaryngology and Head & Neck Surgery, Vol. 1(10) No. 2, August 2013

Discussion
Allergic rhinitis is a chronic condition which affects the nasal
mucosa over a period of time. As nasal mucosa is continuous
with the middle ear mucosa, the changes that can be seen in
the nasal mucosa continue into the ear. Eustachian tube
dysfunction is regarded as the underlying pathophysiologic
event for most cases of chronic otitis media. Allergy and
reflux are the best evidence based explanations for
intermittent nature of Eustachian tube dysfunction. Middle
ear mucosa, which evolves from the same ectoderm as the rest
of the upper respiratory tract epithelium, has been found to
have same active intrinsic immunologic responsiveness to
antigenic stimulus as do the nasal tract, sinuses and
bronchi.1Many otolaryngologist do not accept allergy as an
etiology for otitis media with effusion(OME). This issue
remains controversial. Our study tries to focus on the issue in
bringing some clarity on the topic. There are several large
literature reviews of the relationship of allergy to OME. Ojala
to quote: it would seem that atopy is probably one cause of
persistent therapy-resistant otitis media and it must be taken
into account when considering the treatment of a chronic
ear.2 Sprinkle and Veltri also found solid evidence to consider
allergy a major contributing factor to persistent middle ear
effusion.3Many studies have found allergy to be an
independent risk factor for developing OME.4,5,6,7The use of
antihistaminics and steroidal nasal sprays is the most
commonly used treatment protocol for allergic rhinitis.
Antihistaminics are the first line of treatment for most of the
physicians. Controversy exists about the usage of long term
steroidal nasal sprays.Antihistaminics and steroidal nasal
spray used on the patients with allergic rhinitis do play a
protective role as we have observed in our study. The changes
in the middle ear pressure was measured by impedance
audiometry-a standard method for measuring middle ear
pressure.
References
1. Takeuchi K, Tomemori T, Iriyoshi N, et al. Analysis of T
cell receptor b chain repertoire in middle ear effusions.
Ann OtolRhinolLaryngol 1996; 105:2137.
2. Ojala K, Sipila P, Sorri M, et al. Role of atopic allergy in
chronic otitis media: evaluation based on serum IgE and
nasal/aural cytologic findings in patients withoperated
chronic ears. ActaOtolaryngol 1982; 93:5560.
3. Sprinkle P, Veltri R. Pathophysiology of serous otitis
media. Am J Otol 1986;7:1138.
4. Chantzi FM, Kafetzis DA, Bairamis T, et al. IgE
sensitization, respiratory allergy symptoms, and
heritability independently increase the risk of otitis
media with effusion. Allergy 2006; 61(3):3326.

5.

6.

7.

Jero J, Virolainen A, Virtanen M, et al. Prognosis of acute

otitis media: factors associated with poor outcome.
ActaOtolaryngol 1997; 117(2):27883.
Lazo-Saenz JG, Galvan-Aguilera AA, Martinez-Ordaz
VA, et al. Eustachian tube dysfunction in allergic rhinitis.
Otolaryngol Head Neck Surg 2005; 132(4):6269.
Doner F, Yariktas M, Demirci M. The role of allergy in
recurrent otitis media with effusion. J
InvestigAllergolClinImmunol 2004; 14(2):1548.

Address for correspondence

Dr. Ashok Murthy V.
Professor, Dept. of ENT
PES Institute of Medical Science and Research
Kuppam (A.P.) 517 425.
Cell +91 8374240280 / +91 9845949869
E-mail : ashokmurthy_army@yahoo.co.in

National Journal of Otorhinolaryngology and Head & Neck Surgery, Vol. 1(10) No. 2, August 2013