The Correlation Between Allergies and Hearing Loss
By Jeffrey S. Weingarten, M.D.; Lauren L. Murrill, M.D.; and April R. Crovak, Au.D.
Atopy, or allergies, have a substantial and multifactorial impact on hearing. There are many reasons that patients present to the otolaryngologists’ office. Among the most common are the hearing loss and sinonasal complaints associated with allergies.
An allergy is a chemically complex hypersensitivity reaction to an allergen leading to an increased immune response. The reaction involves white blood cells, immunoglobulins and a large number of chemical mediators.
There are thousands of items that cause an allergic reaction but often this allergy is to pollens, animal dander, molds or dust mites and can be seasonal or year round. Patients with allergies note frequent sinus infections, nasal congestion, rhinorrhea and facial pressure.
Hearing Loss: An Allergic Response
Hearing loss, partial or total, is a frequent manifestation of the allergic response. This effect may originate in the external ear canal, the middle ear or the inner ear and result in a sensorineural or conductive hearing loss.
The external auditory canal is the interface between the hearing mechanism and the environment. This region has exposure to microbes, chemicals and antigens, which can cause a large number of disorders resulting in inflammation, pain, debris accumulation and swelling.
Urticaria, or allergic rash, can be caused by a cutaneous hypersensitivity reaction to many materials including ear mold material, medications, work-based chemicals, insect bites and others. The associated swelling and/or drainage may result in a conductive hearing loss necessitating medical intervention.
The most common way in which allergies lead to an increased incidence of conductive hearing loss is through eustachian tube dysfunction. The eustachian tube connects the middle ear to the nasopharynx and is lined by the same mucosa of the nose and throat. Allergies cause inflammation and swelling of this tissue.
The eustachian tube swells in response to an allergic reaction, improper ventilation of the middle ear then occurs. Inflamed mucosa coupled with improper ventilation frequently leads to fluid collection in the middle ear or otitis media with effusion (OME). This middle ear effusion may become infected resulting in suppurative otitis media. Any fluid in the middle ear causes a conductive hearing loss.
Suppression of the Body’s Defense Mechanisms
Additionally, the body’s defense mechanisms are suppressed in patients with allergies, reducing the body’s ability to fight infections in the upper respiratory tract and middle ear. Over time, this leads to chronic inflammation with increased production of a thick, tenacious mucin in the ear, nose and sinuses. These patients develop middle ear fluid, often viscous, with impaired mucociliary clearance and prolonged OME with hearing loss.
OME is very common in childhood and is the most common cause of pediatric hearing loss. Often this fluid collects as a thin fluid, becoming thick and mucoid over time or recurrent episodes. This fluid can cause a conductive hearing loss and may lead to speech delay, education difficulties, behavior disorders and psychosocial issues.
Specifically, prolonged or frequent fluid events and the accompanying hearing loss, may result in arrested speech and language development. If the fluid doesn’t resolve spontaneously, surgical placement of tympanostomy tubes immediately clears the fluid and usually resolves the hearing loss.
Hearing Damage From Allergies
Recurrent events may result in permanent anatomical and hearing damage to the tympanic membrane and ossicles. Cholesteatomas may form. OME is often associated with a diagnosis of allergic rhinitis and links with both inhalant and food allergies have been noted. Interestingly, when food allergens were detected on skin testing, an elimination diet resulted in resolution of OME in 86 percent of patients.
Meniere’s disease, in some cases, has an association between allergies and the inner ear. Meniere’s disease is a chronic, episodic disorder with fluctuating sensorineural hearing loss, vertigo, tinnitus and aural fullness. This is usually unilateral, but may be bilateral. Although the exact mechanism is poorly understood, some believe that this disease has allergy as one of the theorized and treatable etiologies.
Studies suggest that patients with Meniere’s disease have a higher rate of positive allergy testing and elevated Immunoglobin E when compared to the general population, suggesting a heightened immune response. Some theorize that the endolymphatic sac, the affected organ in Meniere’s disease, is a target for allergic activity as it has histamine receptors. In patients who have a diagnosis of
Meniere’s disease as well as an allergy history with positive allergy testing, treating their allergies with either medication or immunotherapy may provide improvement in their Meniere’s symptoms and should be considered as part of the treatment plan to help manage this chronic disease.
A Team Approach
Clearly, allergies and hearing loss have a close association and substantial impact on health and quality of life. It is the responsibility of the patient to seek out early identification and treatment of their symptoms.
There is an absolute need for the multidisciplinary hearing healthcare team to accurate diagnoses and treat the pediatric and adult patient. This team approach results in optimized hearing healthcare.
- Jeffrey S. Weingarten, M.D., is the Medical Director, Hearing Healthcare Division, at the Ear, Nose and Throat Consultants.
- Lauren L. Murrill, M.D., is the Medical Director, Allergy Division, at the Ear, Nose and Throat Consultants.
- April R. Crovak, Au.D., is the Site Director, Hearing Aid Center, at the Ear, Nose and Throat Consultants.