Otitis Media in Children

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Middle Ear: Otitis Media

The middle ear is connected to the throat by the Eustachian tube and often participates in infections and allergic inflammation that starts in the nose and throat. Recurrent middle ear pain and fluid collections (serous otitis media) that impair hearing are common in the first five years of life. Congestion or inflammation of the nose (rhinitis), sinuses (sinusitis), ear (otitis) and throat (pharyngitis) are most often caused by viral infections. Other causes are airborne irritants, allergens and food allergy.

Serous otitis recurrences are referred to as recurrent otitis media (ROM) which costs $2 billion per year to treat in the US and is responsible for an estimated 10 million medical office visits per year. ROM is often blamed on infection and children are prescribed repeated courses of antibiotics with no benefit.

Food Allergy Causes Serous Otitis Media

ROM may be eliminated by proper diet revision. Milk, wheat, and egg white allergy are the most common causes of respiratory symptoms, but other foods can do this. Food allergy is suggested by symptoms that recur for months or years such as nasal stuffiness, snoring, increased mucus flow in nose and throat, and recurrent sore throats.

Nsouli et al reported that of 104 children with chronic serous otitis media 78% had positive skin tests for food and an elimination diet led to a significant amelioration of symptoms in 86% . The most common allergenic foods were cow's milk (38%), wheat (33%), egg white (25%), peanut (20%) and soya (17%). The authors concluded that food allergy should be considered in all children with ROM.

Nsouli TM; Nsouli SM; Linde RE; O'Mara F; Scanlon RT; Bellanti JA Department of Pediatrics, Georgetown University School of Medicine, Washington, DC. Ann Allergy, 73: 3, 1994 Sep, 215-9

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 children with recurrent serous otitis media.

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