Middle Ear Infections in Children Linked to Food Allergies

Just the mention of otitis media makes many parents of young children cringe. Otitis media -- middle ear infection -- affects two-thirds of children in the United States by age 2 and is the most common cause of acquired hearing loss in children. Many get these ear aches again and again, despite treatment with antibiotics.

This recurrent condition does not always cause pain, but just the buildup of fluid behind the eardrum can impair hearing and lead to permanent damage. Consequently, some 670,000 children a year wind up with tubes surgically implanted into the middle ear to keep it ventilated. Overall, otitis media represents a $3.5 billion-a-year U.S. health care cost.

Food allergies may underlie many of these multiple episodes, reports Talal M. Nsouli, an allergist at the Georgtown University School of Medicine in Washington, D.C. He and his colleagues tested 104 children with recurrent ear problems for food allergies. About a third proved allergic to milk. and another third reacted to wheat with a total of 81 children having some allergy to a food they often ate. The scientists then had parents keep those children from eating the offending food for 4 months. Seventy children got better. "Those who avoided those foods had significant clearance of the ear," Nsouli says.

Then parents added those foods back to the diets of the 70 children. Within 4 months, the middle ears became clogged in 66 of the children, a result that reinforces the link between food allergies and persistent ear problems, Nsouli and his colleagues note in the September 94 Annals of Allergy.

During the testing period, the researchers periodically examined the ears, checking the eardrums in particular, and monitored the buildup of fluid inside the ear using an instrument called a tympanometer. They tried to account for many of the factors that make the evaluation of treatments for this condition so difficult, Nsouli adds. "Hopefully, most of the ear, nose, and throat doctors will start looking at these patients in light of allergies." says otolaryngologist Richard E. Linde of the George Washington School of Medicine in Washington, D.C. and one of the study's co-authors.

Considering food allergies in children with these problems "might prevent surgery and might prevent permanent damage, "Nsouli says.

Cross-sectional view of the top of the head shows ways allergenic foods may affect the middle ear.

1) Stuffed-up noses cause fluid from the throat to move into the middle ear.
2) Nasal fluids drain into the Eustachian tube.
3) Or that tube swells shut because of an allergic reaction, causing a negative pressure in the middle ear.-E Penisi
SN vol.146No.15

Frequency Distribution of Allergies to Individual Foods in 81 Subjects with Food Allergy:

Cow milk-- 38%
Wheat-- 33%
egg white-- 25%
peanut-- 20%
soy-- 17%
corn-- 15%
orange-- 10%
chicken-- 5%
Apple-- 4%

Frequency Distribution o of Positive Reactions to Foods in Study Population According to Number of Food Allergens:

No of Positive Food Allergens:
(1)-- 3.6%
(2-4)-- 81.5%
(5-7)-- 3.7%
(8-10)-- 1.3%

Nsouli TM; Nsouli SM; Linde RE; O'Mara F; Scanlon RT; Bellanti JA.
Role of food allergy in serous otitis media.
Annals of Allergy, 1994 Sep, 73(3):215-9.
(UI: 94379492)
Pub type: Clinical Trial; Journal Article.

Abstract: BACKGROUND. The relationship between IgE-mediated hypersensitivity and recurrent serous otitis media has not been completely established. OBJECTIVE. The purpose of the present study was to examine the prevalence of food allergy in patients with recurrent serous otitis media. METHODS. A total of 104 unselected patients (age range 1.5 to 9 years, mean 4.6 years) with recurrent serous otitis media were evaluated for food allergy by means of skin prick testing, specific IgE tests, and food challenge. Patients who were allergic to food(s) underwent an exclusion diet of the specific offending food(s) for a period of 16 weeks. A non-double blinded food challenge was performed with the suspected offending food(s). Their middle ear effusion was monitored and assessed by tympanometry (Welch Allyn Model 23600) during the pre-elimination, elimination and challenge diet phases. RESULTS. There was a significant statistical association, by chi-square analysis, between food allergy and recurrent serous otitis media in 81/104 patients (78%). The elimination diet led to a significant amelioration of serous otitis media in 70/81 (86%) patients as assessed by clinical evaluation and tympanometry. The challenge diet with the suspected offending food(s) provoked a recurrence of serous otitis media in 66/70 patients (94%). CONCLUSIONS. The possibility of food allergy should be considered in all pediatric patients with recurrent serous otitis media and a diligent search for the putative food allergen made for proper diagnostic and therapeutic intervention.