Allergies and the Ear
Dr. John Overholt • October 17, 2016
The Ins and Outs of Ears and Allergies
When people think of allergy problems, what comes to mind most often are the classic symptoms of sneezing, runny nose, and itchy eyes. Many people don’t realize that the ears can be affected by allergies, too.
The ear can be divided into three sections: outer, middle and inner.
The outer ear is made up of the ear we see, called the pinna, and the ear canal. The pinna and canal help catch and funnel sound vibrations toward the middle ear. The middle ear begins with the eardrum or tympanic membrane and contains the auditory bones-hammer, anvil, and stapes(STAY-peas)- which transmit sound vibrations to the inner ear or cochlea (COKE-lee-uh). The cochlea converts those vibrations into nerve impulses which can be interpreted by the brain as sound. The cochlea also contains the body’s balance apparatus- the vestibular (ves-TIB-you-luhr) system.
Allergies primarily affect the middle ear. As you can see, the middle ear has a drainage tube or pressure release valve called the eustachian (you-STAY-shun) tube. If this tube is clogged with mucus or its opening is blocked by allergy swelling, then pressure and fluid can build up in the middle ear. This gives us the sensation of being down a well, having the need to “pop” our ears frequently, and can result in diminished hearing. Fluid build-up also creates a good environment for infection to occur. Middle ear infections, called otitis media or OM, occur commonly in early childhood and are a frequent reason for antibiotic treatment and missed school days. Allergies are a well recognized cause for recurrent OM and kids who have more than their share of middle ear infections should be allergy tested.
Disorders affecting the inner ear, such as Meniere’s disease, may have an allergic component as well. Patients who fail to respond to conservative therapy may benefit from allergy desensitization, though evidence to support this comes largely from case series and anecdotal evidence.
External ear infection, otits externa (OE) or swimmer’s ear, is usually caused by a water loving bacterium called pseudomonas (soo-duh-MOAN-us). It is usually not related to allergies.
Finally, a word about itchy ears. You really want to scratch them, don’t you? Well, remember what your mom said: Never put anything in your ear smaller than your elbow! The skin in the ear canal is paper thin and very easy to irritate. Although sticking a Q-tip in there might feel good for a few seconds, it will just make the ears itch more afterward.
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If you spend any time browsing the internet or social media, you’ve likely seen advertisements for mail-in allergy kits. They promise to test for hundreds of food intolerances and environmental sensitivities using just a few strands of your hair or a quick saliva swab. It sounds incredibly convenient, painless, and comprehensive. But if it sounds like a gimmick, it probably is. While these mail-in tests are heavily marketed, they often lack scientific backing and can leave patients feeling more confused than comforted. The Science of Allergy Testing. What Are We Looking For? To understand why hair and saliva tests don't work, we have to look at how the immune system reacts to allergens. When you have a true allergy, your body produces a very specific type of antibody called IgE (Immunoglobulin E) . These antibodies bind to mast cells (allergy cells), which are on high alert to protect you from perceived invaders like pollen, dust mites, or specific food proteins. The fundamental flaw with mail-in hair and saliva kits comes down to basic biology: Wrong Locations: Mast cells and IgE antibodies are not traditionally found in your hair follicles or saliva. Unreliable Results: Because these testing methods are looking in the wrong place, they are highly unstandardized and unvalidated. You are highly likely to get a flood of false positives or false negatives that are impossible to interpret accurately. What the Experts Say: Major medical organizations strongly advise against these methods. The National Institute of Allergy and Infectious Diseases (NIAID) explicitly recommends against using hair analysis for food allergy evaluations due to a lack of diagnostic value. Furthermore, the American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma & Immunology (ACAAI) have issued strong practice guidelines stating that hair analysis should not be used to evaluate food allergies. The Big Misconception: IgE vs. IgG Many mail-in companies charge anywhere from $150 to upwards of $600 for "sensitivity" panels. When patients produce these multi-page reports, the testing is almost always checking for IgG (Immunoglobulin G) antibodies, not IgE. There is a massive difference between the two:
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