Ear Infections: The Overlooked Food Connection

Pediatricians see more children because of middle ear problems than any other health issue. The condition, otitis media, and can occur with or without “effusion” (OME). In a case of OME, fluid in the ear occurs without an acute infection.

The National Institute on Deafness reports that three out of four children have had at least one ear infection by age three. Most toddlers have two to three ear infections per year, and some continue to struggle with them as they get older.

Ear infections usually start with a viral infection, like a cold. As the middle ear lining swells from the infection, fluid builds up behind the eardrum. This can become a breeding ground for a secondary bacterial infection.

Typically, acute ear infections are self limiting and about 80% clear up on their own, with or without medication. For that reason, the American Academy of Pediatrics recommends a 72-hour “wait and see” approach before antibiotics are considered when the child is older than 6 months; otherwise healthy; and has mild symptoms with an unclear diagnosis.

At times, use of an antibiotic can be crucial. Standard treatment with antibiotics is often recommended for children younger than 6 months old, and children and adults who’ve had two or more ear infections in the past month. In addition, other clinical signs can be a signal for the use of antibiotics.

Identifying the cause

Several factors can cause otitis media with effusion. Food allergy is a key culprit that is often overlooked by physicians and families. Three studies described below highlight a connection between food allergy and OME.

Study One (2004)¹

In this study, there were three groups of children:

1. One group had ear infections with fluid buildup
2. Another had food allergies
3. The last group had neither ear infections nor known food allergies.

It was learned that almost half of those with ear infections (Group A) also had food allergies. Of those in Group B, 25% had ear infections as well as food allergies. In Group C, less than 20% were found to have food allergies and only 3% developed an ear infection.

The conclusion of the researcher, Dr. B Aydogan, was that food allergy may play a role in the cause of otitis media with effusion.

Study Two (1994)²

Another significant study on food allergy and ear infections was published in the Annals of Allergy. Dr. Talal Nsouli (an allergist at the Georgtown University School of Medicine) and his team tested more than 100 children who had recurring ear infections. Each was assessed for food allergies. About a third were shown to be allergic to milk and yet another third were sensitive to wheat. Four of five had an allergy to some type of food that was being consumed on a frequent basis.

Once the offending foods were identified, researchers then requested parents to keep these foods out of their child’s diet for 4 months. Meanwhile, ear infection complaints were monitored. As a result of these dietary changes, 7 in 10 children significantly improved as assessed by clinical evaluation and tympanometry.
For the next step in the study, parents were asked to add the identified troublesome foods back into their child’s diet. Within four months, 94% had a recurrence of fluid built up in the ear.

It was suggested that the possibility of food allergy should be considered in all pediatric patients with recurrent OME, and a “diligent search” for the food allergen(s) be made.

Study Three (2001)³

Dr. C M Arroyave located twenty-five patients with recurrent OME and food allergy, based on positive skin testing. The most common food allergies found were milk, egg, beans, citrus, and tomato.

An elimination diet was then followed by removing foods that each was sensitive to. The result was significant improvement of the otitis in 22 of the 25 patients based on clinical evaluation and tympanometry.

When a challenge diet was undertaken as the final step in the study, by returning the suspected offending foods to the diet, there was a recurrence of the otitis.

Dr. Arroyave urged: “These results demonstrated the association between recurrent OME and food allergy. Therefore, all patients with recurrent otitis media with effusion should be investigated for food allergy.”

¹Aydogan, B. Otolaryngology-Head and Neck Surgery, June 2004; vol 130: pp 747-750.

²Nsouli TM. Nsouli SM; Linde RE; O’Mara F; et al  Role of food allergy in serous otitis media, Annals of Allergy, 1994 Sep, 73(3):215-9.

³Arroyave, CM. Recurrent otitis media with effusion and food allergy in pediatric patients Rev Alerg Mex. 2001 Sep-Oct;48(5):141-4.