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Case Study

 National Journal of Otorhinolaryngology and Head & Neck Surgery, Vol. 1(10) No. 2, August 2013

Introduction

Allergic Rhinitis is considered to be one of the most common

diseases affecting a wide range of people barring age. With

respect to this disease patients face morbidity issues that can

affect work and family life. Allergic rhinitis as such is

diagnosed with a clinical examination, correlated with

symptoms. The treatment protocol has been varied from time

to time with the discovering newer and safer pharmacologic

anti-allergic agents. Anti-histaminics and steroidal nasal

sprays have been the mainstay in the treatment of allergic

rhinitis. Each have their own merits and demerits.In our study,

we discuss the effect of anti-allergic medications and its effect

on the middle ear pressure.

Aims

1) To show the effect of allergic rhinitis over the middle ear

 pressure.2) To prove the protective action of antihistaminics

and steroidal nasal sprays on the middle ear pressure.

Materials and methods

Including Criteria: Patients with allergic rhinitis coming to

Department of ENT, PES IMSR, Kuppam were included

under the study. Excluding Criteria: Ear discharge, ear pain or

any associated ear problems were excluded.During the first

visit, the history was recorded and the patient examined and

evaluated. Intake of anti-histaminics or any other drugs for the

treatment of the same was also noted. Impedance audiometry

was done. Patients who had not taken any medication were

grouped as Group A (n=68) and were prescribed anti-

histaminics and steroidal spray as per their liking. Patients

who were already on anti-allergy medications were also

considered and grouped as Group B (n=60). Both these

groups underwent the routine examination, evaluation and

impedance tympanometry on their first visit. On their second

visit, after six to eight weeks after anti-allergy medication, the

routine evaluation and impedance tympanometry was carried

out.Observations

It was noticed that the patients already on anti-allergy

medications (Group B) were having normal middle pressure

on their first and subsequent visits also. Whereas patients in

Group A had Type C curve in 30% of the patients on their first

visit and subsequently on six to eight weeks of anti-allergy

medications the impedance tympanometry showed normal

middle ear pressure.

Results and Conclusions

In Group A patients who have not treated with anti-allergic

medications before showed Type C graph on impedancetympanogram. These patients were reverted back on

receiving anti-allergic medications and their middle ear

 pressure showed normal curve on impedance tympanogram.

Group B patients showed no such variation. They were having

normal pressure on their first visit and also on their

subsequent visit. We conclude that anti-allergic medications

have a protective influence on middle ear pressure.

Allergic rhinitis and its effect on middle ear p ressure1 2

Ashok Murthy V .,Meghna P .-Kuppam (A.P.)

Abstract

Introduction: Allergic rhinitis is one of the diseases of the industrialized nations. It is more prevalent in this modern age than ever

 before. With the better understanding of the physiologic mechanism and the pathophysiologic events we are able to discern

various reasons to understand the disease process. With this knowledge, we are able to evaluate and find a suitable remedy to

ongoing disease process. This study analysis the role of allergic rhinitis and its effect it has on the middle ear pressure.

Study design: Descriptive study / Prospective study

Study Centre: Tertiary Centre

Material & Methods: Group A: Sixty eight patients of allergic rhinitis were evaluated on their first visit and impedance

tympanometry was done and noted. On their second visit the process was repeated and results were compared. Group B: This

group consisted of sixty patients of allergic patients. They were evaluated as the previous group.

Results and Conclusion: Group A patients for whose impedance tympanogram showed Type C graph were reverted back to Type

A graph on treating with anti-histamines or steroid nasal spray.

Group B patients who were already on anti-allergy medications exhibited normal middle ear pressure. We conclude that allergic

rhinitis has affected the middle ear pressure but anti-allergy treatment can provide a protective influence on the middle ear.

Key words: Allergic rhinitis, middle ear pressure, impedance tympanogram, otitis media with effusion, anti-histamines, steroid

nasal spray.

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1 2Professor, Resident Department of ENT and HNS,PES Institute of Medical Sciences, Kuppam ( A.P.)

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 National Journal of Otorhinolaryngology and Head & Neck Surgery, Vol. 1(10) No. 2, August 2013

Discussion

Allergic rhinitis is a chronic condition which affects the nasal

mucosa over a period of time. As nasal mucosa is continuous

with the middle ear mucosa, the changes that can be seen in

the nasal mucosa continue into the ear. Eustachian tube

dysfunction is regarded as the underlying pathophysiologic

event for most cases of chronic otitis media. Allergy and

reflux are the best evidence based explanations for

intermittent nature of Eustachian tube dysfunction. Middle

ear mucosa, which evolves from the same ectoderm as the rest

of the upper respiratory tract epithelium, has been found to

have same active intrinsic immunologic responsiveness to

antigenic stimulus as do the nasal tract, sinuses and1

 bronchi. Many otolaryngologist do not accept allergy as an

etiology for otitis media with effusion(OME). This issue

remains controversial. Our study tries to focus on the issue in

 bringing some clarity on the topic. There are several large

literature reviews of the relationship of allergy to OME. Ojala

to quote: “it would seem that atopy is probably one cause of

 persistent therapy-resistant otitis media and it must be taken

into account when considering the treatment of a chronic2

ear”. Sprinkle and Veltri also found solid evidence to consider

allergy a major contributing factor to persistent middle ear3

effusion. Many studies have found allergy to be an4,5,6,7

independent risk factor for developing OME. The use of

antihistaminics and steroidal nasal sprays is the most

commonly used treatment protocol for allergic rhinitis.

Antihistaminics are the first line of treatment for most of the

 physicians. Controversy exists about the usage of long term

steroidal nasal sprays.Antihistaminics and steroidal nasal

spray used on the patients with allergic rhinitis do play a

 protective role as we have observed in our study. The changes

in the middle ear pressure was measured by impedance

audiometry-a standard method for measuring middle ear

 pressure.

References

1. Takeuchi K, Tomemori T, Iriyoshi N, et al. Analysis of T

cell receptor b chain repertoire in middle ear effusions.

Ann OtolRhinolLaryngol 1996; 105:213–7.

2. Ojala K, Sipila P, Sorri M, et al. Role of atopic allergy in

chronic otitis media: evaluation based on serum IgE and

nasal/aural cytologic findings in patients withoperated

chronic ears. ActaOtolaryngol 1982; 93:55–60.

3. Sprinkle P, Veltri R. Pathophysiology of serous otitis

media. Am J Otol 1986;7:113–8.

4. Chantzi FM, Kafetzis DA, Bairamis T, et al. IgE

sensitization, respiratory allergy symptoms, and

heritability independently increase the risk of otitis

media with effusion. Allergy 2006; 61(3):332–6.

5. Jero J, Virolainen A, Virtanen M, et al. Prognosis of acute

otitis media: factors associated with poor outcome.

ActaOtolaryngol 1997; 117(2):278–83.

6. Lazo-Saenz JG, Galvan-Aguilera AA, Martinez-Ordaz

  VA, et al. Eustachian tube dysfunction in allergic rhinitis.

Otolaryngol Head Neck Surg 2005; 132(4):626–9.

7. Doner F, Yariktas M, Demirci M. The role of allergy in

r e c u r r e n t o t i t i s m e d i a w i t h e f f u s i o n . J

InvestigAllergolClinImmunol 2004; 14(2):154–8.

Addr ess for cor respondence

Dr. Ashok Murthy V.

Professor, Dept. of ENT

PES Institute of Medical Science and Research

Kuppam (A.P.)– 517 425.

Cell +91 8374240280 / +91 9845949869

E-mail : ashokmurthy_army@yahoo.co.in

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