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Clinical Review Extracts from “Concise Clinical Evidence”

Clinical reviewChronic suppurative otitis mediaCommentary: Interpreting the evidence

BMJ 2002; 325 doi: (Published 16 November 2002) Cite this as: BMJ 2002;325:1159

Rapid Response:

Allergic rhinitis and Chronic otitis media

There is increasing evidence to suggest that allergic rhinitis and
otitis media coexsist. It has been reported that up to 30-45% of patients
with allergic rhinitis have otitis media. Poorly controlled allergic
rhinitis can lead to chronic otitis media, chronic sinusitis and hearing
impairment. Individuals with allergic rhinitis have increased secretions
in their euschaen tubes and middle ear, which may contribute to the
development of otitis media. The inflammatory mediators , cytokines and
colony stimulatory factors released by mast cells in response to an
allergen result in increased secretions and mucosal damage. Also,
euschasean tube dysfunction leads to negative pressure in the middle ear
and improper ventilation, which further contributes to infection.
Persistent serous otitis media when untreated can lead to suppurative
otitis media.

Since, allergic rhinitis can lead to recurrent and persistent otitis
media proper treatment of the allergic condition is of utmost importance
in the treatment of otitis media. Therefore, one would anticipate that
anti allergic treatment would reduce the morbidity and health care cost
involved with otitis media.


1 Doyle WJ. The link between allergic rhinitis and otitis media. Curr
Opin Allergy Clin Immunol 2002 Feb;2(1):21-5

2 Fireman P. Otitis media and eustachian tube dysfunction: connection
to allergic rhinitis. J Allergy Clin Immunol 1997 Feb;99(2):S787-97

3 Bernstein JM. Role of allergy in eustachian tube blockage and
otitis media with effusion: a review. Otolaryngol Head Neck Surg 1996

Competing interests:  
None declared

Competing interests: No competing interests

30 December 2002
G.N. Malavige
lecturer in Microbiology
university of Sri jayawardenapure, Sri Lanka