This is a guest article by Dr. Russell A. Faust, PhD, MD, FAAP, who blogs at Boogor Doctor. Recently, I asked him if there was a link between milk allergy and chronic ear infections. His article below offers an excellent understanding of what an ear infection is and why it is commonly seen in young children.
|Russell A. Faust, PhD MD FAAP
Do milk allergies cause ear infections?
Without giving a straight “yes” or “no” answer, the following describes the factors that link food allergies (specifically milk) and otitis media, in a 1-2-3-4 stepwise fashion.
Otitis media is a complex disorder, and I want to simplify this link as much as possible. Please write and let me know whether I have succeeded:
As a pediatric boogor doctor, I see plenty of ear infections – Otitis media is what we call the disorder in medicine. It is affected by both inherited and environmental factors.
(1) The highest incidence of otitis is among infants and toddlers.
This is the first factor to keep in mind: the age group – infants and toddlers.
Let’s define some basic terms before going further. Otitis media is inflammation of the middle ear space (see Figure).
Acute otitis media (AOM) is acute infection of the middle ear. Signs and symptoms are usually rapid in onset, and include fever, earache, and purulent fluid in the middle ear (pus). No signs and symptoms are universally accepted as definitively proving the diagnosis.
Otitis media with effusion (OME) is inflammation of the middle ear with a collection of fluid in the middle ear space. This fluid may be thin and watery, thick mucus, or pus – any of these, just fluid, but without acute symptoms.
Chronic otitis with effusion (COME) is the label given to OME when it has been present for more than 3 months.
The ear simply does not function when the middle ear space if full of fluid – hearing is reduced in the presence of middle ear fluid. When the fluid clears, hearing (nearly always) returns 100%. More on this in a little bit.
The middle ear cavity is normally air-filled. Anything else is considered pathology. Air or any gas within a closed cavity will be absorbed by the body. I don’t remember all of my partial-pressure formulas from physics classes, but if there is no way to get air into the middle ear cavity, this absorption will create a vacuum.
Let’s look at the Figure. The way air normally gets into the middle ear is through the Eustachian tube.
So here is the problem for infants and toddlers: the Eustachian tube is floppy.
Ever notice how a baby’s ears are soft and almost floppy? The cartilage inside is young and soft – just like the cartilage around their Eustachian tubes. So young Eustachian tubes are more floppy than mature Eustachian tubes.
Hence, infants and toddlers don’t get air into their middle ears very well. The result is:
(2) “Eustachian tube dysfunction” (ETD)
That’s the term for Eustachian tubes that don’t work normally. This is the second factor in the link between milk and otitis.
We can relate to what ETD feels like, at least for s short while – we are all familiar with the sensation in our ears from traveling in a plane, or going rapidly up or down many floors in a fast elevator. It feels like pressure, and our ears feel “stuffy” and our hearing is muffled.
When the Eustachian tubes don’t work normally, a vacuum is formed in their middle ears, this draws fluid in from surrounding tissues – OME.
This fluid can become infected –AOM, potential COME. This is one reason why infants and toddlers have a higher incidence of otitis media. Another reason is their immature immune systems – their immune systems are just not as wise and experienced as an adult’s, so they may be unable to fight off those infections.
We have seen that the Eustachian tubes in toddlers and infants are floppier than older children and adults. In addition to this given tendency to collapse, ANYthing that adds inflammation will make the collapse worse.
(3) Any inflammation of the lining of the Eustachian tube can worsen ETD.
This is the third factor in the link between milk allergy and otitis:
Inflammation worsens collapse of the Eustachian tubes. Chronic inflammation can increase the risk of otitis.
What can cause inflammation of the Eustachian tubes?
- Viruses, Bacteria
- Allergies – hayfever
- Allergies – food allergies
- Air Pollution – most commonly tobacco smoke, but any airborne irritant
- Chemical irritants – example: chlorinated pool water
For infants and toddlers, upper respiratory infections (URI) with viruses is the most common cause of inflammation that causes ETD.
Reflux (regurgitation of gastric contents) in babies and infants. Medical studies have shown that reflux can cause otitis media.
Studies that have looked for a link between otitis and allergies suggest that there is a link between allergies to milk and COME.
If we think about it, this link should not be surprising:
Remember, any inflammation, like allergies, will worsen Eustachian tube dysfunction in our age group with ear infections – infants and toddlers.
What is the most common allergy found in infants and toddlers? Allergies to the airborne allergens (the things that we react to) don’t really develop until later. In this age range, the most common allergic reactions are to foods.
(4) What is the most common food allergy in infants and toddlers?
Right: Dairy – milk and eggs. This is our fourth and final link between milk allergy and otitis.
So yes, there is a link between milk allergies and ear infections, but no, milk does not cause ear infections. Not any more than an allergy to grass or flowers causes ear infections.
Note that in those people who do respond to milk allergens, it often thickens their mucus secretions. This is not a good effect when we are talking about Eustachian tube function – thicker mucus makes it harder for the Eustachian tubes to work normally.
So, to recap:
- Otitis is common in infants and toddlers
- Eustachian tube dysfunction is common in infants and toddlers, and increases risk of otitis
- Inflammation of the Eustachian tubes, including inflammation from allergies, increases risk of otitis
- The most common food allergy in infants and toddlers is milk
What Can You Do With This Information?
Well, for starters, if your little boogorhead has recurrent ear infections, consider eliminating dairy from their diet for a few weeks. A good place to start is the recent article Preventing Food Allergies on Littlestomaks. When it is time to visit a doctor, try to visit a pediatric boogor doctor (Ear, Nose, & Throat specialist). Yes, any ENT doctor can place ear tubes to treat recurrent ear infections. You will find that a pediatric ENT doctor’s office will be more “kid-friendly” – their waiting rooms are usually full of books and toys for children of all ages, their nurses are devoted to the care of children, and their medical instruments are kid-sized. Not to mention that the docs themselves have devoted their lives to the care of children, exclusively.
During that visit, they may obtain a hearing test, they may consider allergies, or reflux, among many other potential factors for causing your child’s otitis. Be patient. Otitis media is a complex disorder, influenced by hereditary and environmental factors, and it can take awhile to sort it all out.
As an integrative holistic pediatric ENT specialist, my goal is to combine the best of conventional and alternative medicine to get my patients healthy. As a result, I am ultra-conservative with regard to surgery, especially for things like otitis media. The balance between aggressive and conservative can be tricky.
I waited too long to have my first son’s COME treated (he never complained, had no acute infections, just fluid), and his start of speech was delayed due to the reduced hearing while the fluid was in his middle ears. So – get it evaluated by a specialist, get it treated if necessary.
My son got his set of ear tubes (the only way to eliminate the chronic fluid in the middle ear cavity), hears normally now, and his speech has taken off (can’t shut him up, wouldn’t want to).