Do Nasal Allergies Cause Ear Infections?

Children especially vulnerable due to middle ear structure

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Middle ear infections (referred to as otitis media) are one of the most common reasons why kids see a doctor. They happen frequently in infants and smaller children because their Eustachian tubes, which connect the ear to the throat, are not fully developed. In most cases, the infections will develop during a sore throat or cold when bacteria or virus migrate to accumulated fluids in the ear.

There are many factors involved in a pediatric ear infection, including the child's age, the shape of the middle ear, and any exposure the child may have had to infection or irritants.

Among these irritants are allergy-causing agents known as allergens. These are substances like pollen, food, or cat dander that trigger an allergic response and lead to symptoms involving the eyes, ears, skin, and respiratory system.

Ear Infection and Allergic Rhinitis

One of the most common symptoms of allergy is rhinitis, commonly referred to as hay fever. With rhinitis, a child will typically experience sneezing, runny nose, nasal congestion, and watery, itchy eyes. Allergic rhinitis may occur seasonally (when pollen levels are high), periodically (when exposed a specific allergen), or chronically (on persistent basis).

There is increasing evidence that allergic rhinitis is directly linked to otitis media. In fact, as many as 30 percents to 45 percent of people with allergic rhinitis will experience some form of middle ear infection. Most of these are related to poorly controlled allergies which cause excessive secretion in the Eustachian tubes and middle ear.

What we are now starting to understand is that allergies cause the release of inflammatory chemicals that not only stimulate these secretions but causes damage to the lining of the ears. When this happens, the combination of inflammation and fluid accumulation provides the perfect environment for an infection.

Moreover, improper ventilation of the ear, especially in smaller children, can cause air to become trapped within the canal. This creates negative pressure that can literally pull the eardrum inward. This not only causes pain, it can exacerbate any infection that may have already taken hold.

Diagnosing Middle Ear Infection

Diagnosis of a middle ear infection will usually start with a physical examination using an otoscope to look inside the ear canal itself. Based on the child's symptoms, the pediatrician can often make a diagnosis as to the cause. If there is pus or any discharge from the ear, a swab may be taken for lab analysis.

The doctor may also perform a test called tympanometry to determine whether the middle ear is operating normally. For this investigation, a device will be inserted into the ear canal to change the pressure and make the eardrum vibrate. The test is important as it can help diagnose problems that may lead to hearing the loss in children.

Treating Allergy-Related Ear Infections

People with allergy-related middle ear infections will typically benefit from allergy relief and the treatment of the associated infection (either with antivirals or antibiotics).

Allergy treatments may include oral antihistamines (with and without decongestants), prescription nasal sprays (nasal steroids, nasal antihistamines), or allergy shots.

By contrast, in children with chronic ear infections, the use of oral antihistamines or nasal sprays doesn't appear to offer any benefit in either preventing or minimizing the condition. Allergy shots may help simply by avoiding allergy in the first place. If used, allergy shots should only be considered for children three years of age or older.


Bonney, A. and Goldman, R. "Antihistamines for children with otitis media." Canadian Family Physician. 2014; 60(1):43-46.

Lieberthal, A.; Carroll, A.; Chonmaitree, T. et al. "The Diagnosis and Management of Acute Otitis Media." Pediatrics. 2013; 2013; 131(3):e964-99.