Allergic disease is commonly associated with asthma, eczema and rhinosinusitis. The authors reviewed possible associations between allergy and otologic diseases. The authors first explored the possible association between allergy with otitis media with effusion (OME) and found the majority of patients with OME also have allergy. This is likely to be secondary to eustachian tube dysfunction and inflammation to the middle ear lining. The authors also found several uncontrolled and non-randomised studies that showed potential benefits of immunotherapy for OME. Eosinophillic otitis media (EOM) on the other hand is a relatively new disease entity and is associated with bronchial asthma. Patients are often aged between 50–60 years old and have nasal polyposis/rhinosinusitis. The fluid build-up is typically very viscous and yellowish in colour leading to blocked grommets. When the fluid is examined, they showed high levels of IgE and eosinophils compared with control patients suggesting an association between allergy and EOM. Treatment for EOM varies from intratympanic steroid injection to use of anti-IgE agent omalizumab (very expensive) to grommet insertion. Further studies are needed to establish best treatment options for this condition including potential role for immunotherapy. Finally, the authors explored the association between allergy and Ménière’s Disease (MD). This possible association between MD and allergy was first published in 1923 and there are proposals that allergy causes inflammation and disruption to the endolymphatic sac leading to endolymphatic hydrops. In support of this theory, a prospective questionnaire-based study found that patients’ overall MD control improved following immunotherapy treatment. However, MD is likely to have a multifactorial aetiology and treatment for allergy alone may not help. The authors rightly postulated that more research is needed but immunotherapy is relatively low risk and may be considered in patients who have difficult to control disease and positive allergy testing. 

The role of allergy in otologic disease.
B Yang, C Brook
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Wai Sum Cho

Queens Medical Centre, Nottingham, UK.

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