Allergic Rhinitis and Otitis Media with Effusion: Revisiting the Nose–Eustachian Tube–Middle Ear Connection

Objective:The link between allergic rhinitis (AR) and otitis media with effusion (OME) is still debated, especially in children, as is its nature and clinical relevance. This study examined the possibility of an allergy-related phenotype of OME by rigorously evaluating clinical, epidemiological, immunological, and anatomical evidence linking AR with ETD and OME.Methods:We prioritized clinical studies addressing AR, allergic sensitization, ETD, and OME in the narrative literature review, focusing on recent systematic reviews, meta-analyses, position papers, and research. Our review focused on the axis connecting the nose, Eustachian tube, and middle ear; type 2 inflammation; adenoidal illness; viral infection; diagnostic methods; and the impact of antiallergic medication on middle ear outcomes.Results:Although the strength of the relationship varies across studies, current evidence shows an association between AR and OME. New meta-analyses indicate that a clinically significant percentage of AR patients have objective evidence of middle-ear dysfunction or ETD, and that the likelihood of OME is higher in children with AR/rhinitis. This association may be due to several factors, including allergic inflammation, edema of the nasal mucosa around the Eustachian tube entrance, reduced tube opening and mucociliary clearance, negative middle-ear pressure, and type 2 inflammatory responses. Environmental factors, age-related anatomical changes, viral infections, and adenoidal disease can also alter these processes. However, evidence of direct causality is limited by the availability of studies, most of which are observational and heterogeneous.Discussion:A complex model, rather than a straightforward cause-and-effect mechanism, offers a more satisfactory explanation for the link between AR and OME. Antiallergic medication shouldn't be the first line of defense for every patient with middle ear effusion, and AR shouldn't be viewed as a universal cause of OME. However, in a subset defined by AR, persistent or recurrent ETD, and recurrent or chronic OME, modifiable allergic inflammation may be a major factor. This finding lends credence to the idea of an allergy-associated OME phenotype and may enable more personalized diagnostic and treatment options.Conclusion:The nasal passages, pharynx, Eustachian tube, and middle ear are all parts of a larger immunological and anatomical network. Modern research supports the idea that AR, ETD, and OME are related, but it does not establish a uniform causal relationship. A phenotype-based approach could help identify patients who could benefit from comprehensive management by identifying and appropriately treating allergic inflammation. To what extent might targeted AR regulation affect OME's natural history, recurrence, or treatment needs? This important question needs to be addressed in future prospective research.