Allergic otitis is a sluggish inflammation of the middle ear of an allergic nature. It is accompanied by unpleasant itching, hearing impairment, specific secretions from the ear cavity. Typical pain sensations with otitis media are usually absent and can occur only when a secondary inflammatory process is attached. Diagnosis of the disease is carried out jointly by an allergist and an otorhinolaryngologist based on the collection of anamnesis, otoscopy and analysis of the results of allergic tests. The treatment of allergic otitis is mainly reduced to the elimination of a causally significant allergen and symptomatic therapy.
H65.1 Other acute non-purulent otitis media
Allergic otitis is an allergic inflammatory process localized in the middle ear, which is accompanied by swelling of the Eustachian tube, the middle ear cavity and increased accumulation of effusion in the tympanic cavity. Despite the fact that this pathology is isolated as a separate disease, its symptoms can hardly be called highly specific, since they are more often involved in the general inflammatory and allergic process.
Allergic otitis often occurs in infants and young children, usually after acute respiratory diseases, in people with reduced immunity, in workers of chemical or any other industry associated with the production or use of aggressive or allergenic substances in the production process. The disease threatens to significantly reduce the quality of life due to the possible development of hearing loss. Pathology is treated by specialists in the field of practical allergology and otorhinolaryngology.
Most often, the cause of allergic otitis is either respiratory or contact allergens. Due to the anatomical structure and location of the ears, they are more often exposed to bacterial, fungal, and household allergens. A hypersensitivity reaction may occur in response to exposure to antigens of medicines, cosmetic products, as well as chemically aggressive substances that are part of household chemicals.
A factor in the occurrence of allergic otitis, among others, is a genetic predisposition to both allergic diseases in general and allergic otitis in particular. A violation of the structure of the maxillofacial region of any origin increases the individual risk of this disease. For this reason, Down syndrome is a serious risk factor for the development of this pathology. Congenital or acquired immunodeficiency increases the possibility of allergic diseases. Active or passive smoking is an important prerequisite for the development of allergopathology. Allergic otitis often appears in patients suffering from concomitant diseases such as adenoids, bronchial asthma, chronic allergic rhinitis, urticaria.
The pathogenesis of this disease is determined by allergic and inflammatory processes. As a result of an allergic reaction, pathological changes occur in the mucous tissues of the eardrum, contributing to the suppression of its immune properties. This makes it more accessible to infectious agents that can enter it in various ways, including with blood or lymph flow. The described pathogenesis determines the characteristic primary symptoms – edema of the tympanic cavity and the cavity of the auditory tube of an allergic nature and the accumulation of a specific composition of effusion containing eosinophils.
Patients suffering from allergic otitis media usually note a strong incessant itching of the ear canal, the release of viscous mucus, often with pus from the ear cavity. The patient is uncomfortable with noise and a feeling of stuffiness in the ear, a decrease in auditory sensitivity. There may be a feeling of fluid transfusion in the ear after changing the position of the head. Body temperature is normal, less often subfebrile, which indicates an inactive inflammatory process. Severe shooting pains are observed only when a secondary inflammatory reaction is attached.
Due to the sluggish nature of inflammation, as well as the low severity and specificity of symptoms, allergic otitis can provoke very serious complications in the absence of timely diagnosis and treatment. Complicated allergic otitis threatens with decreased hearing acuity and autophony – enhanced perception of one’s own voice with one ear. Prolonged absence of properly selected treatment can provoke complications such as facial nerve paralysis, atrophy of the eardrum, the development of ear cholesteatoma – a tumor-like formation consisting of dead epithelial cells, pus, effusion surrounded by a capsule of connective tissue.
Diagnosis is carried out by analyzing symptoms, collecting anamnesis for concomitant allergic diseases, as well as diseases that are a risk factor for the occurrence of allergic otitis. With the help of otoscopy, an otolaryngologist determines the degree of mobility of the eardrum and assesses the condition of the ear cavity. Sometimes there is redness, in some cases – purulent discharge or bubbles with yellow contents – exudate. During the puncture of the tympanic membrane (paracentesis), a mucous viscous liquid with a high content of eosinophils is released. A number of audimetric tests can reveal hearing loss, which is especially important when examining children who find it difficult to describe their condition.
An allergological history allows you to take into account the genetic predisposition to such diseases, and allergological tests – to identify a certain allergen that causes a hypersensitivity reaction. Laboratory diagnostics is reduced to the analysis of peripheral blood and the discharge from the ear for the content of eosinophils. The allergic nature of the disease is also evidenced by the lack of effect from the traditional treatment of middle ear inflammation, improvement of the condition against the background of taking antihistamines. An allergist may suggest allergic otitis if the patient suffers from concomitant diseases such as bronchial asthma or allergic rhinitis. The fact of the presence of other allergic reactions, for example, urticaria, edema, itching, will also help the specialist to establish the correct diagnosis.
Diagnosis of the disease in children is complicated by the fact that often a small patient is not able to accurately describe his discomfort. Some children define subjective symptoms as “cracking”, complain of a feeling of fullness, fluid in the ears. Parents or other adults who have the opportunity to communicate with the baby for a long time may suspect allergic otitis media. The reason for visiting the office of a pediatric otolaryngologist may be inattention, absent-mindedness, constantly increased voice volume, delayed speech development of the child.
Treatment of allergic otitis
The complex of therapeutic measures is selected by a specialist based on the clinical picture, the course of the disease and the nature of the allergen that caused it. To identify the cause, an allergist conducts special allergy tests. After the allergen is determined according to the indications, specific desensitization (hyposensitization) is carried out – long-term regular allergen-specific immunotherapy – injections of gradually increasing allergen concentrations, starting with the minimum dose.
Local glucocorticosteroid therapy will help to get rid of the unpleasant itching of the ear cavity: hydrocortisone, corticosteroid ointments are used for this purpose. Antihistamines are also prescribed. Solutions of boric acid, hydrogen peroxide (3%), etacridine lactate-1 are used for washing the ear cavity. Patients are recommended a full-fledged diet saturated with vitamins, and if the allergen is a food product – a diet that excludes it. Patients are shown treatment of concomitant respiratory diseases of an allergic nature (vasomotor rhinitis, rhinosinusopathy). In case of secondary infection, antibiotics are prescribed according to the treatment regimen for chronic purulent otitis (drugs of choice – erythromycin, amoxicillin, a combination of sulfamethoxazole with trimethoprim).
In order to prevent the development of serious chronic complications with prolonged presence of the discharge in the middle ear, surgical treatment is carried out. A general cavity operation is performed, which is prescribed in order to stop the purulent process, prevent its progression and the development of life-threatening consequences. Such an operation is associated with the risk of hearing loss and the possible need for subsequent functional operations.
Prognosis and prevention
With allergic otitis, the prognosis in patients of any age is most often favorable. To avoid the appearance of this pathology, first of all, it is necessary to reduce contacts with the allergen to a minimum, and it is better to exclude them altogether. But in most cases it is not easy to do this, especially if we are talking about allergies to seasonal pollen, household dust, animal hair. It is easier for people suffering from food allergies to limit contact with the allergen by excluding the allergenic product from their diet.
Timely diagnosis of the disease by a specialist and properly selected treatment will significantly reduce the risk of complications and help to avoid surgical intervention. If possible, it is necessary to avoid self-medication not only in order to prevent complications, but also in order to prevent the development of resistance or the initiation of additional sensitization reactions when taking incorrectly selected antibiotics.