Earaches, ear blockages and other ear-related conditions are common occurrences, especially in children. In many cases, allergic conditions contribute to recurring bouts of ear-related problems, such as:

• Ear infection (otitis media). This refers to an inflammation and/or infection of the middle ear typically preceded by or associated with a viral upper respiratory tract infection. This occurs more often in males than in females.
  
  
• Middle-ear disease (otitis media with effusion). This refers to fluid in the middle-ear space that develops after an ear infection, but without the symptoms of acute infection. Almost every ear infection is followed by days or weeks of middle-ear disease. However, some cases of middle-ear disease develop without a preceding bout of acute inflammation.

Allergic conditions, such as allergic rhinitis, can interfere with the function of the eustachian tube, which connects the nose to the middle ear. The tube allows air into the middle ear and drains fluid from the ears into the nasal cavity. Conditions such as allergic rhinitis can cause the eustachian tube to become blocked, which can lead to:

• Recurrent ear infections or fluid collection
• Ear pressure and pain
• Decreased hearing
• Ringing in the ears (tinnitus)
• Dizziness (vertigo)

Recurring ear problems can have serious consequences for hearing ability, which can affect language and other developmental skills. Antibiotics may be necessary to treat infections and ear tubes may be inserted to help drain fluid.

However, when the cause stems from allergy symptoms, the best long-term strategy may include addressing the allergy through avoidance, medications or other measures.

Ear-related conditions, such as ear infections, are very common, especially in children. Approximately 75 percent of children have an ear infection by their third birthday, and nearly half have three or more ear infections during this time, according to the National Institute of Deafness and Other Communication Disorders.

However, conditions such as allergic rhinitis produce mucus that can flow back into the eustachian tube, creating a blockage. The eustachian tube itself also can become inflamed, further closing the passageway. This prohibits air from reaching the middle ear, and keeps fluid from draining out.

When the eustachian tube is not working properly (eustachian tube dysfunction), bacteria can build up in the trapped fluid and cause infection or inflammation (otitis media). If infection is recurring, the condition is called chronic otitis media. Children are particularly prone to this condition, because their tubes are narrower and straighter than in adults. A child's eustachian tube is also positioned at an angle. This makes it easier for bacteria, viruses and allergens to enter through the throat.

In addition, a child's adenoids are larger than they are in adults. An infection can cause the adenoids, which are located near the eustachian tubes, to enlarge and interfere with the eustachian tube opening.

Over time, an infection in the middle ear can develop into a thick, sticky secretion that builds up and sticks to the auditory ossicles, three bones of the middle ear that are crucial to a person’s ability to hear. This condition is known as middle-ear disease (otitis media with effusion). As the secretion impairs the bones’ ability to conduct sound, a person's hearing may suffer a sharp decline.

Nearly all of the ear-related conditions triggered by allergies spring from eustachian tube dysfunction. A number of different conditions can result, including:

• Recurring ear infections. Bacteria build up in the trapped fluid, causing recurring ear infections.
  
  
• Ear pressure and pain. Pain associated with ear-related conditions can be severe.
  
  
• Decreased hearing. Fluid in the middle ear prevents the eardrum (tympanic membrane) and auditory ossicles from working properly, which can impair hearing.
  
  
• Ringing in the ears (tinnitus). People who hear a ringing, roaring, clicking or hissing sound in their ears suffer from tinnitus. This disorder stems from many possible sources, including hearing loss, loud noise, medications, and allergies and other health problems.
  
  
• Dizziness (vertigo). This is usually caused by an inner-ear disturbance or infection. The inner ear, which contributes to a person’s sense of balance, is made up of the cochlea and the labyrinth. Fluid buildup in these compartments can cause dizziness.

Some evidence suggests that nasal allergies and food allergies also can trigger symptoms of Ménière’s disease. This is a disorder of the balance mechanism of the inner ear that causes dizziness, hearing loss, painful ringing in the ears and sometimes nausea and vomiting. However, no connection between Ménière’s disease and allergies has been proved.

Most ear-related conditions are triggered by problems with the eustachian tube, which connects the nose to the middle ear. This tube is designed to allow air to flow in so that the pressure on the interior side of the eardrum (tympanic membrane) is equal to the pressure from the outside environment.  It also drains fluid from the middle ear.

However, severe nasal allergies produce mucus that can flow back into the eustachian tube, creating a blockage. The eustachian tube itself also can become inflamed, further closing the passageway. This prohibits air from reaching the middle ear, and keeps fluid from draining out. Common nasal allergy triggers include:

• Pollens. Small, powdery grains of flowering plants that can easily become airborne. These are most often produced by trees, grass and weeds.

  

   
• Molds and mildews. Tiny fungus spores that can become airborne. These often thrive outdoors in soil, vegetation and rotting wood. They can be found indoors as well, especially in damp areas such as basements and bathrooms.

  

   
• Dust mites. Microscopic insects that live within household dust.  They are often found indoors where there is less air circulation and on surfaces like carpets, bedding and stuffed animals.
  
  
• Animal dander. Tiny scales or particles from an animal’s skin. These very often come from a dog or cat.
  
  
• Cockroach debris. Droppings, eggs, saliva and small pieces of outer shell of cockroaches. These can be found indoors, even if an infestation of live pests is not currently a problem.

Recent studies have found that their may be a link between children with food allergies and increased incidences of ear infections. However, the evidence is not conclusive and research into the question continues.

Because allergies can lead to many different ear-related conditions, they also trigger a number of signs and symptoms, including:

• Ear pressure and pain
• Decreased hearing or hearing loss (temporary)
• Ringing in the ears (tinnitus)
• Dizziness (vertigo)
• Sense of fullness and “popping” in the ears
• Ear itchiness
• Drainage from the ear
• Congested and/or runny nose
• Nausea, vomiting
• Fever
• Snoring

Children may be irritable, inconsolable and/or pull at their ears. Increased crying, difficulty sleeping, loss of appetite and increased breathing through the mouth may also occur. 

Prolonged ear-related problems can affect hearing, which may result in delayed speech development and other developmental disorders.

Although it is a rare occurrence, ear infections can lead to permanent hearing loss. The risk for this complication increases with each ear infection.

In order to prevent hearing loss and other complications, patients displaying the signs and symptoms of an ear infection should see a physician.

Diagnosis begins with the collection of a thorough medical history. The physician will ask detailed questions regarding the patient’s symptoms, as well as their history of ear-related conditions and personal and family history of allergic conditions. A physical examination, focusing on the patient’s ears, nose and throat, will follow. The physician often uses an otoscope to search for signs of eustachian tube blockage, such as air bubbles or fluid behind the eardrum.

Most children with an ear-related condition such as otitis media will have rhinitis so it becomes important to distinguish between whether the condition is related to an infection or an allergy. The following might indicate a diagnosis of infection:

• Fever
• Malaise (general ill feeling)
• Profuse active rhinorrhea (runny nose)
• Presence of same illness in immediate family members
• Pus associated with rhinorrhea or pharyngitis (inflammation of the pharynx, a tube located between the mouth and the esophagus)

On the other hand, the following might indicate a diagnosis of allergy:

• Prolonged seasonal or perennial rhinitis with itching and sneezing
  
  
• Red, itchy, swollen eyes
  
  
• “Popping” or “snapping” sounds in the ears
  
  
• Hearing loss, ear discomfort, tinnitus (ringing in the ears) or vertigo
  
  
• Family history of allergy
  
  
• Seasonal runny nose or constant “cold”
  
  
• Accompanying symptoms of atopic dermatitis and allergic asthma
  
  
• Older age (e.g., school age)

Pneumatic otoscopy can be used to confirm suspicions that a patient may have fluid in the middle ear as a result of eustachian tube blockage. This procedure allows a physician to visually examine a patient’s eardrum (tympanic membrane) to see how well it moves in response to pressure changes inside the ear. Poor movement indicates that fluid is behind the middle ear. Discoloration of the eardrum also may indicate an ear infection.

Tympanometry is a more precise test of a patient’s eardrum function. During the test, a probe is placed inside the ear and an airtight seal is created. Air pressure inside the ear then is increased and decreased at intervals to detect how well the eardrum responds. The results are recorded in a machine called a tympanometer.

If otitis media with effusion has been present for longer than three months, a hearing test may be performed. If hearing is abnormal in at least one ear, antibiotic therapy may be considered. If hearing loss is detected in both ears, antibiotic therapy will be recommended.

If an allergy is the suspected cause of an ear-related condition, the following allergy tests may be performed:

• Skin testing. A small amount of an allergen is introduced to the patient’s skin to determine if the person is allergic to that allergen. After a period of time, the skin is examined for reactions to any of the allergens. If a rash or small bump develops, the patient is most likely allergic to that substance.
  

  

  
  
• Allergy blood tests. A sample of the patient’s blood is tested for substances that indicate an allergic reaction has occurred to a specific allergen. The most commonly used blood test for allergy-related conditions is the radioallergosorbent test (RAST).
  
  
• Food allergy tests. Patients may be asked to avoid (or, in rare cases, to ingest) specific foods according to a timetable to determine if allergic reactions can be avoided.
  
  
• Other related tests. Any number of tests that may be used in diagnosing the causes of allergy-related symptoms, including those to determine lung or nasal function and to rule out other causes of allergy-like symptoms (such as infection). Additional tests may include nasal smear, nasal endoscopy or x-rays of the chest, nose or sinuses.

Ear infections are usually treated with antibiotics. If allergies are causing the ear infections, then it becomes important to find the source of the allergies. For instance, an allergy skin test may be performed, in which the skin is pricked with several potential allergens. If a rash or small bump develops, the patient is most likely allergic to that substance.

When an allergen is identified, the most effective treatment is to avoid the allergen, if possible. In addition, prescription medications such as antihistamines, decongestants, cromolyn sodium and corticosteroids may be prescribed to reduce allergy symptoms. Successful treatment of allergies will in turn make eustachian tube problems – and thus, ear–related conditions – much less likely.

Ear-related problems are frequently caused by the symptoms of allergic rhinitis (hay fever). A physician may recommend allergy shots (immunotherapy), which have been very successful at reducing the severity of symptoms. In this treatment, low doses of an allergen are injected into a patient over a period of time. The goal is to increase the patient’s tolerance to the allergen while reducing symptoms brought on by an allergic reaction.

Patients can practice several habits that will help keep their eustachian tube open. Swallowing activates muscles at the back of the throat that help pull open the tube. Eating, drinking and chewing gum can all activate this process. Babies also may open their eustachian tubes by sucking on a bottle or pacifier. Yawning has an even more pronounced effect on the throat muscles that open the tube.

Individuals can also take a deep breath, close their mouth, pinch their nostrils and blow. This often will force open the eustachian tube. However, this should be done with caution, because blowing too hard can damage the eardrums. Children can often safely open the tubes by blowing up balloons.

Home remedies can help reduce symptoms of ear-related conditions triggered by allergies. Reducing nasal congestion helps to open up both the nasal passages and the eustachian tube. The following steps can help clear both the nose and the ears:

• Use a saline solution to gently irrigate the nasal passages
  
  
• Apply warm compresses or heating pads to the ear and sinuses
  
  
• Take hot showers and use a vaporizer to dislodge nasal mucus
  
  
• Drink plenty of liquids, but avoid alcoholic beverages, which tend to swell nasal-sinus membranes
  
  
• Avoid tobacco smoke and other allergens that trigger symptoms

An adenoidectomy may be considered to relieve obstruction of the eustachian tubes. In this surgery, the adenoid glands are removed. The adenoids are located between the nasal airway and the back of the throat (nasopharynx).

Finally, myringotomy may be an option for patients who try various treatments, yet still have problems related to the eustachian tube. Myringotomy is the surgical placement of ventilation tubes into the ears to allow drainage of fluid from the middle ear. Such a procedure is considered safe for young children, who often experience a significant improvement in hearing.

Those who have allergies that trigger ear-related conditions should be particularly careful not to fly or scuba dive during flare-ups. These activities involve atmospheric pressure changes that can cause ear barotrauma, a discomfort in the ear. Those with blockage of the eustachian tube are more prone to barotrauma.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctors the following questions regarding ear-related conditions:

1. What tests will you use to determine the type of ear condition I have?
   
   
2. What risks are associated with my ear-related condition?
   
   
3. What may be causing my ear-related condition?
   
   
4. What treatments are available to me?
   
   
5. Can you recommend any home remedies?
   
   
6. What over-the-counter medications are safe to take for my ear-related symptoms?
   
   
7. Are there prescription medications that may help?
   
   
8. Are there any activities I should avoid until symptoms subside?
   
   
9. What symptoms should I be immediately reporting to you?
   
   
10. Might I benefit from allergy testing?