27.10.2020

Treatment of Allergic Otitis

The complex of therapeutic measures is selected by a specialist on the basis of the clinical picture, the course of the disease and the nature of the allergen that caused it. To identify the cause of the allergist conducted special allergy tests. After the determination of the allergen, according to the indications, specific desensitization (desensitization) is performed – a long-term regular allergen-specific immunotherapy – injection injections of gradually increasing concentrations of the allergen, starting from the minimum dose.

Local glucocorticosteroid therapy will help get rid of the unpleasant itch of the ear cavity: hydrocortisone and corticosteroid ointments are used for this purpose. Antihistamines are also prescribed. For washing the ear cavity, solutions of boric acid, hydrogen peroxide (3%), ethacridine lactate-1 are used.

Patients are recommended complete nutrition, rich in vitamins, and if the allergen is a food product – a diet that excludes it. Patients indicated treatment of concomitant respiratory diseases of an allergic nature (vasomotor rhinitis, rhinosinusopathy).

In the case of the accession of a secondary infection, antibiotics are prescribed for the treatment of chronic purulent otitis (the drugs of choice are erythromycin, amoxicillin, a combination of sulfamethoxazole with trimethoprim).

In order to prevent the development of serious chronic complications with long-term discharge of discharge in the middle ear, surgical treatment is carried out. They conduct a general cavity operation, which is appointed to relieve the purulent process, prevent its progression and develop life-threatening consequences. Such an operation carries the risk of hearing loss and the possible need for subsequent functional operations.

Allergic  otitis media  is an allergic inflammatory process localized in the middle ear area, which is accompanied by swelling of the Eustachian tube, middle ear cavity and an increased accumulation of effusion in the tympanic cavity. Despite the fact that this pathology is highlighted as a separate disease, it is difficult to call its symptoms highly specific, since they are more often involved in the general inflammatory and allergic process.

Allergic otitis media is often found in infants and young children , usually after acute respiratory diseases, in individuals with reduced immunity, in chemical workers or any other industry associated with the production or use of aggressive or allergenic substances in the production process. The disease threatens to significantly reduce the quality of life due to the possible development of hearing loss. Pathology treatment is carried out by experts in the field of practical allergology and otorhinolaryngology.

Causes of Allergic Otitis

The most common cause of allergic otitis are either respiratory or contact allergens. Due to the anatomical structure and location, the ears are more often exposed to bacterial, fungal, and household allergens. Hypersensitivity reactions may occur in response to exposure to antigens of medicines, cosmetic products, as well as chemically aggressive substances that make up the means of household chemicals.

A factor in the onset of allergic otitis, among others, is a genetic predisposition for both allergic diseases in general and allergic otitis in particular. Violation of the structure of the maxillofacial region of any origin increases the individual risk of this disease. For this reason, Down syndrome is a serious risk factor for the development of this pathology.

Congenital or acquired immunodeficiencies increase the likelihood of allergic diseases. Active or passive smoking is an important prerequisite for the development of allergopathology. Often allergic otitis appears in patients suffering from comorbidities such as adenoids, bronchial asthma, chronic allergic rhinitis, urticaria.

Pathogenesis of Allergic Otitis

The pathogenesis of this disease is determined by allergic and inflammatory processes. As a result of an allergic reaction, pathological changes occur in the mucous tissues of the eardrum, which contribute to the suppression of its immune properties. This makes it more accessible to infectious agents that can enter it in various ways, including with the flow of blood or lymph.

The described pathogenesis determines the characteristic primary symptoms – edema of the tympanic cavity and the cavity of the auditory tube of an allergic nature and the accumulation of a specific composition of effusion containing eosinophils.

Symptoms of Allergic Otitis

Patients suffering from allergic otitis media usually notice a strong persistent itching of the ear canal, the discharge of viscous mucus, often with pus from the ear cavity. The patient is uncomfortable with noise and a feeling of congestion in the ear, reducing hearing sensitivity. There may be a feeling of fluid transfusion in the ear after changing the position of the head.

Body temperature is normal, less often subfebrile, which indicates an inactive inflammatory process. Severe shooting pains are observed only when the secondary inflammatory response is attached.

Allergic otitis complications

Due to the sluggish nature of inflammation, as well as weak severity and specificity of symptoms, allergic otitis media can provoke very serious complications in the absence of timely diagnosis and treatment. Complicated allergic otitis media threatens to reduce hearing acuity and autophony – enhanced perception of one’s own voice with one ear.

The prolonged absence of a properly selected treatment can provoke complications such as facial nerve paralysis, eardrum atrophy, the development of ear cholesteatoma, a tumor-like formation consisting of dead epithelial cells, pus, effusion surrounded by a connective tissue capsule.

Diagnosis of allergic otitis

Diagnosis is carried out by analyzing the symptoms, collecting anamnesis for concomitant allergic diseases, as well as diseases that are a risk factor for the occurrence of allergic otitis. With the help of otoscopy, a specialist otolaryngologist determines the degree of mobility of the eardrum and evaluates the condition of the ear cavity. Sometimes there is redness, in some cases – purulent discharge or blisters with yellow contents – exudate.

During the puncture of the eardrum (paracentesis), a viscous mucous fluid with a high content of eosinophils is secreted. Determination of hearing loss allows a number of audimetric tests, which is especially important when examining children who find it difficult to describe their condition.

Allergological history allows us to take into account the genetic susceptibility to such diseases, and allergy tests – to identify a certain allergen that causes a hypersensitivity reaction. Laboratory diagnosis is reduced to the analysis of peripheral blood and discharge from the ear for the content of eosinophils. The allergic nature of the disease is also evidenced by the lack of effect from the traditional treatment of middle ear inflammation, improvement in the condition of taking antihistamines.

An allergist may suggest allergic otitis media if a patient suffers from concomitant diseases such as bronchial asthma or allergic rhinitis. The fact that there are other allergic reactions, such as urticaria, edema, itching, will also help the specialist to establish the correct diagnosis.

Diagnosis of the disease in children is complicated by the fact that often a small patient is not able to accurately describe their discomfort. Some children define subjective symptoms as “crackling”, complain of a feeling of fullness, fluid in the ears. Suspect allergic otitis can parents or other adults who have the opportunity to communicate with the baby for a long time. The reason for visiting the office of the children’s otolaryngologist can be inattention, confusion, constantly increased loudness of voice, delayed speech development of the child.

Forecast and prevention of allergic otitis

In case of allergic otitis, the prognosis in patients of any age is most often favorable. To avoid the appearance of this pathology, first of all, it is necessary to minimize contact with the allergen, and it is better to eliminate them altogether.

But in most cases this is not easy to do, especially if we are talking about allergies to seasonal pollen, house dust, animal dander. People suffering from food allergies and easier to limit contact with the allergen, eliminating the allergenic product from your diet.

Timely diagnosis of the disease by a specialist and properly selected treatment will significantly reduce the risk of complications and help to avoid surgery.

If possible, self-treatment should be avoided not only to prevent complications, but also to prevent the development of resistance or initiate additional sensitization reactions when taking the wrong antibiotics.

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