Secretory otitis media, first described by Politzer in 1869, received little mention in the literature until 1931 when Proetz noted a relationship between patients with allergic rhinitis and chronic OM.[102] Koch's study of 222 patients was the first to include observations of eosinophilia in otorrhea "supporting the contention that the middle ear takes part in allergic reactions similar to those seen in the nose and sinuses".[66] Observations as to its incidence, etiology, pathology and therapy were reported with increased frequency through the 50's and 60's as the use of Armstrong's ventilation tube, antibiotics and research in immunology flourished. Hays[52] urged investigation of systemic factors such as allergy and hormonal disturbance in patients with otitis.
Investigators including Boor, Suechs, Senturia, Lim, and Reisman[18],[72],[116],[126],[106] concluded that there is an imposing lack of evidence to substantiate the claim of an allergic cause in the majority of cases of OM. Senturia critically analyzed the literature in the early 60"s and although he did not disagree with the fact that many patients with MEE may be allergic, he found no clinical or pathologic basis from which to correlate nasal allergy with recurrent otitis media.
Fernandez and McGovern in 1965 suggested that an allergic mechanism is not only the major cause of chronic otitis media, but is a predisposing factor in as many as 85% of children with acute otitis as well. Shambaugh suspected allergy as an etiology of chronic draining mastoid cavities or middle ears of patients with OME, citing empirical data. He cautioned that: "surgical mastoidectomy, simple or radical is not indicated. With competent allergic diagnosis and management, preferably by the otologist trained in allergic methods, the otorrhea is finally brought under control."[117]