This page is for the Mom and Dad who are frustrated because their child is always sick!

See Comments on INFANTS, Children 5-15, and Adults

Ear disease comes in patterns that range from one extreme of RECURRENT ACUTE OTITIS to the other of PERSISTANT Otitis Media with EFFUSION.


On one hand are children with RECURRENT ACUTE OTITIS = when your child has one infection after another. Each infection has fever, pain and clears in 48 hours on antibiotics. These infections are caused by bacterial in over half the cases, and viral the other times. Antibiotics have proven to be effective about half the time. These are NOT the cases I am talking about.

On the other extreem are children who demonstrate a pattern
of PERSISTANT Otitis Media with EFFUSION = OME = middle ear infections with fluid.
These children have an acute infection only half the time which just do not clear. On recheck with your physician the ear is not red or inflammed and one antibiotic after another does no good because THIS IS NOT A BACTERIAL INFECTION!!.
Or at other times children with OME may present with just fluid in the ear which refuses to clear. These are the children with CHRONIC fluid or effusion.

Think of children following into a grid:

Under 3 years  Older than 3 years   Recurrent Acute Otitis      Chronic otitis with fluid in ears    XXXX

90% of the Children Over 3 years XXXXX with chronic fluid have allergies.

The children you should suspect of having allergy are:

l. The child whose fluid persists for over 2 months.

2. The child who has tubes which continually drain.

3. The child with a hole in his ear drum which drains.

4.The child who has failed their school hearing test and has no history of ear infections.

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So how can you tell if they really have allergy?

1) First, is it just their ears that bother them??

It is possible that the "target" of their allergy is only their ears, just like some people only have a runny nose with hayfever? More likely the child also shows other signs of allergy:

Runny nose, dark circles around their eyes, cranky behavior, recurrent sinus infections or bronchitis, asthma, constant sniffling or clearing their throat, excema or food intolerance.

2) Second, demand a test for allergies:

Blood tests called RAST will pick up most dust, pollen or animal allergies.

The best blood test is an ELISA test. I use Molecular Medicine's Lab (no commercial connection) because it is the most accurate and picks up MOLD and FOOD allergies that RAST usually misses. They call it a THABEST Test.
Molecular Lab:
95 East Main Street
Denville, New Jersey 07834

Ask your doctor to run a THABEST or RAST SCREENING PANEL for 12 things:

Dust Mites (2), Cat, Dog, Grass, Tree, Ragweed, at least 2 MOLDS, and 4 foods - Milk, Corn, Soy, Wheat.

Health Insurance including Medicaide will pay for the test.

HELP:

As an alternative, get A REFERRAL TO AN ALLERGIST to do INTRADERMAL SKIN TESTING. If your child is going to have tubes placed - especially for a SECOND SET OF TUBES - have the skin testing done while he is asleep!![48] I now routinely do the blood testing and skin testing in the Operating Room whenever I am putting in the first set of tubes if the child is over 4 years old. We have proven that 90% of this group of children will have allergies.[57, 57 c]

There is a very important difference between the general ALLERGIST - who is excellent in treating asthma - but has no training and usually no interest as a specialist in treating ear disease, and an E.N.T. ALLERGIST. Furthermore, the allergist-immunologist rarely treats mold or food allergies. And lastly, the allergist-immunologist usually does "Prick Testing" - which is an excellent but weak screening test. The sensitivity of allergy tests has advanced with the invention of RAST and THABEST blood testing. For these reasons I am frequently asked to see patients in whom the allergist-immunologist has failed to diagnose the allergy likely related to the child's ear disease. For that reason, you must look for a specialist trained in both Ear, Nose and Throat Surgery (Otolaryngologist) and Allergy.

These physicians, like myself, are certified as Fellows of the American Academy of Otolaryngologic Allergy - AAOA. They know and understand ear disease and its relation to allergy. A Fellow of the AAOA can evaluate your child completely - sort of like "One stop shopping".
Mailto:AAOA@AOL.com


Allergy Testing: One of the pitfalls of any study is the diagnosis of allergy. This quarter century has seen the advent of increasing standardization and quantification of allergy diagnostic testing. When low potency extracts are used, skin prick tests are less sensitive and reproducible than intradermal tests and in patients with a low sensitivity, intradermal tests may have the only positive results.[20] Skin tests have a higher diagnostic sensitivity for symptomatic allergy than specific IgE or total IgE,[22] especially in food allergy testing.[63],[16] Prick test results correlate well with symptoms, although for patients with a low sensitivity - intradermal skin tests have the only positive results.[29]

During the past 60 years only eleven investigators used intradermal skin testing to evaluate their entire patient populations.(Table I).

Table I:
Studies of OME patients
with allergy confirmed by skin testing

Year	AUTHOR	[REFERENCE #]	No. Pts	% Positive skin tests	% Improved with allergy therapy
'42	Dohlman	[32]	178	56 %
'42	Mao	[78]	252	29 %
'49	Jordan	[60]	123	74 %	98 %
'58	Solow	[122]	50	72 %
'61	Lecks	[70]	82	88 %
'65	Fernandez	[37]	113	55 %	95 %
'65	Whitcomb	[150]	38	100 %	87 %
'67	Draper	[35]	340	53 %	91 %
'80	Hall	[48]	92	100 %	82 %
'88	Tomonaga	[138]	259	72 % of OME cases
			605	89 % of Nasal allergy	29 % of controls
'90	Hurst	[55]	20	100 %	100 %
'96	Hurst *	[55 b]	73	97 %

* patients not included in 1996 study

Other sources of Help

Additional LINKS for Allergy And Ear Disease:

AAOA (American Academy of Otolaryngic Allergy)

 

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