|Year : 2017 | Volume
| Issue : 1 | Page : 10-13
Hearing profile in children with allergic rhinitis
Adekunle Adeyemo, Josephine Eziyi, Yemisi Amusa, Sanyaolu Ameye
Otorhinolaryngolgy Unit, Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
|Date of Submission||23-Feb-2017|
|Date of Acceptance||16-May-2017|
|Date of Web Publication||31-Aug-2017|
Otorhinolaryngology Unit, Department of Surgery, Obafemi Awolowo University, Ile-Ife
Source of Support: None, Conflict of Interest: None
We carried out this study to determine the profile of hearing of children with allergic rhinitis compared with normal controls.
Patients and methods
Children with allergic rhinitis between the ages of 4 and 16 years attending the Otorhinolaryngology Clinics as well as age-matched and sex-matched controls were recruited into this study. We obtained the participants’ bio data, symptoms and duration using a structured interviewer questionnaire. We then carried out a pure tone audiometry on the participants. The degree of hearing loss was determined on the basis of the WHO standard classification.
We recruited 99 children with clinical evidence of allergic rhinitis and an equal number of healthy controls completed the study. The mean age was 9.19±3.98 years in the test participants and 9.35±4.05 years in the controls, respectively.
Mild hearing loss on the right side was more than twice as common among patients, 24 (24.2%), compared with the controls, 11(11.1%). Left-sided mild hearing loss was more than four times more prevalent among patients with allergic rhinitis, 26 (26.3%), compared with the controls, six (6.1%).
Hearing threshold worse than 25 dB hearing level in the better-hearing ear was found to be significantly more prevalent among patients compared with the controls.
We could conclude that hearing is significantly worse in allergic children compared with controls, with disabling hearing loss being more significantly associated with allergic rhinitis.
Keywords: allergy, audiometry, children, hearing loss, rhinitis
|How to cite this article:|
Adeyemo A, Eziyi J, Amusa Y, Ameye S. Hearing profile in children with allergic rhinitis. Adv Arab Acad Audio-Vestibul J 2017;4:10-3
|How to cite this URL:|
Adeyemo A, Eziyi J, Amusa Y, Ameye S. Hearing profile in children with allergic rhinitis. Adv Arab Acad Audio-Vestibul J [serial online] 2017 [cited 2018 Nov 20];4:10-3. Available from: http://www.aaj.eg.net/text.asp?2017/4/1/10/213891
| Introduction|| |
The exact effect of allergy on hearing has remained controversial despite various studies. Although there are studies that have shown elevated hearing threshold among patients with allergic rhinitis ,,, a few studies have also suggested that patients with allergic rhinitis actually have better hearing compared with nonallergic individuals . Several mechanisms by which allergy could potentially affect hearing have been described. However, most research efforts had focused on otitis media with effusion (OME) as a consequence of allergy ,,.
We therefore sought to establish the association between allergic rhinitis and hearing loss in children.
| Patients and methods|| |
After obtaining ethical clearance from the Ethics and Research Committee of the hospital, we recruited children with allergic rhinitis between the ages of 4 and 16 years attending our Otorhinolaryngology Clinics in a tertiary healthcare center. The diagnosis of allergic rhinitis was made clinically by the investigator on the basis of the presence of at least two nasal complaints of watery nasal discharge, excessive sneezing, nasal obstruction, nasal itching, and conjunctivitis of more than 1-week duration without fever ,.
We also recruited age-matched and sex-matched control participants from among healthy nonallergic children for comparison. Control participants were recruited from among normal children of hospital staff, visitors to the hospital, and patients’ siblings matched for age and sex with the cases. For the purpose of this study, normal participants refer to children who are identical in all respects with the allergic group, differing only in the absence of clinical evidence of allergic rhinitis.
We excluded children with acute febrile illness, history of ear discharge, craniofacial abnormalities, or tympanic membrane perforation. We also excluded patients who had used steroids or a nasal decongestant in the last 1 month.
The procedure was then explained to the participants in the presence of their parents or legal guardians. Written consent was then obtained from the parent or legal guardians.
A structured interviewer administered questionnaire was administered to record participants’ bio data, symptoms, and duration. Thereafter, a detailed general physical examination including ear, nose, and throat examination was carried out. Patients with incidental findings of wax underwent wax removal manually using a Jobson–Horne probe under direct vision and proper illumination. Patients who could not tolerate manual wax removal were instructed to instill olive oil into the ear daily for at least a week, followed by ear syringing before undergoing pure tone audiometry and tympanometry.
Tympanometry was carried out using an Interacoustics AT22 (Interacoustic, Middelfart, Denmark) impedance meter. The tone frequency of the tympanometer that was used was 226 Hz. Each ear was tested separately and the tympanogram was classified according to the modified Jergers classification .
We then carried out a pure tone audiometry in a soundproof booth using an ISO-calibrated clinical audiometer (Interacoustic AD28; Interacoustic, Middelfart, Denmark) on each ear to determine the hearing threshold for octave frequencies of 250–8000 Hz for air conduction and 500–400 Hz for bone conduction for each ear. Pure tone average was calculated for each ear using the air conduction thresholds at 500, 1000, 2000, and 4000 Hz. The degree of hearing loss was based on the WHO classification.
Collected data were entered into a system and analyzed using the statistical package for social sciences (SPSS version 17; SPSS Inc., Chicago, Illinois, USA).
| Results|| |
Ninety-nine children with clinical evidence of allergic rhinitis and an equal number of healthy controls completed the study. The mean age was 9.19±3.98 years in the test participants and 9.35±4.05 years in the controls, respectively. The male to female ratio was 2 : 1 for both test and control participants. In the test participants, the mean duration of symptoms before presentation was 45.80±34.46 months.
A total of 396 ears were examined, composed of 198 ears in allergic rhinitis patients and 198 ears in control participants.
The most common complaint in the allergic patients is aural fullness/discomfort (28, 28.3%). Twelve (12.1%) and eight (8.1%) patients complained of tinnitus and hearing loss, respectively. No patient, however, reported a history of vertigo.
[Table 1] shows the proportion of comorbidities in these patients compared with control participants, which were found to be significantly higher. The most common comorbidity was dermatitis, found in 45 (45.5%) of the cases.
Type A tympanogram was found in 68.18% of the cases and in 90.91% of the controls. The detailed pattern is summarized in [Table 2]. There was a significant difference in the tympanometric findings between the cases and the controls (χ2=32.1023; P=0.000).
Seventy-four (74.74%) right ears among patients had a hearing threshold less than 25 dB hearing level (HL), whereas 88 (88.9%) controls had a hearing threshold less than 25 dB HL on the same side. Mild hearing loss on the right side was more than twice as common among patients, 24 (24.2%), compared with the controls, 11 (11.1%) ([Table 3]).
On the left side, 65 (65.6%) patients had a hearing threshold less than 25 dB HL compared with 91 (92%) controls with similar hearing. Left-sided mild hearing loss was more than four times more prevalent among patients with allergic rhinitis, 26 (26.3%), compared with controls six (6.1%) ([Table 3]).
The mean pure tone average on the right side was 20.80±5.95 dB HL for controls and 22.26±7.81 dB HL for allergic patients.
On the left, the mean pure tone average was 19.02±6.44 dB HL among controls and 23.78±13.45 dB HL among allergic patients.
Student’s t-test showed that the difference in the mean on the right side was not significant (t=3.81, P=0.51). However, the difference in the mean on the left side was statistically significant (t=23.16, P=0.001).
Hearing threshold worse than 25 dB HL in the better-hearing ear was found to be significantly more prevalent among patients compared with the controls (χ2=4.32, P=0.038) ([Table 4]).
|Table 4: Classification of hearing threshold in the better-hearing ear among patients and controls|
Click here to view
| Discussion|| |
Aural fullness or discomfort was found to be the most common ontological complaint in this study; it was found in more than a quarter of the cases. This is not unexpected, considering the relationship be allergy and OME ,. We considered the complaint of aural full/discomfort as a pointer to OME in this study. This is further corroborated by tympanometric type B and C patterns that occurred in significant proportions in cases as compared with the control group. We are not surprised that the tympanometric detection is higher because OME is a silent disease that often goes undetected. Moreover, patients are children and may not be able to describe the subtle symptoms of OME.
The presence of comorbid asthma in 16.2% of the cases is less than 19.6% found among Indian school children , but greater than 10.1% found in another multicenter study in Korea . A cross sectional population-based study across Europe reported 20.4% comorbidity of asthma in patients with a clinical diagnosis of allergic rhinitis, which is higher than the findings in the study of Bauchau and Durham . In Nigeria, Falade et al.  found asthma in 5.8% of children aged 6–7 years and 13% in children aged 13–14 years; their finding in the age group of 6–7 years is similar to the finding of 4% among the controls of this study who are of a similar age group. It is therefore clear that allergic rhinitis is associated with asthma in this study population. This is similar to what has been found in other climes. A high incidence of comorbid allergic dermatitis was found in this study, with up to 45% of the cases having a comorbid history of allergic dermatitis. This is more than 20.9% reported by workers in Korea . Allergic disorders are known to appear sequentially in children in a so-called ‘allergic march’; the first to appear is usually allergic dermatitis in early childhood, followed by allergic rhinitis and asthma. The high frequency of allergic dermatitis found in this study may be explained by the relatively young age of this sample and the presence of allergic march in them.
This study found a worse hearing threshold among allergic children compared with controls, suggesting that allergic rhinitis may be involved in some cases of childhood hearing loss. The potential effect of allergic rhinitis and hearing loss has been studied extensively. Most of these studies focused on the possibility of allergic inflammation causing middle ear effusion and hence conductive hearing loss ,. Despite extensive research efforts, however, the pattern of hearing among allergic individuals remains controversial with somewhat conflicting conclusions. The findings of this study support those studies that reported an elevated hearing threshold in allergic children. Apart from induction of OME and the attendant conductive hearing loss, there is evidence that allergic inflammation could occur in the inner ear, potentially precipitating sensorineural hearing loss ,; in fact, at least one case report has documented one case of seasonal sensorineural hearing loss attributable to allergy.
When sensorineural hearing loss occurs as a result of inner ear affectations, they tend to be of a higher degree compared with those with middle ear effusion; our study showed mild hearing loss to be more prevalent among allergic children compared with the controls, suggesting a middle ear etiology to be responsible. At the same time, moderately severe hearing loss and worse degree of hearing loss were found only among the allergic children; this may be a result of inner ear inflammation because of allergy even in this age group. The consequences of hearing loss in childhood have been studied extensively, with evidence that even mild hearing loss is associated with speech, language, and learning problems, ,; the foregoing therefore suggests that an association of disabling hearing loss with allergic rhinitis as shown in this study may be related to worse school performance in this group. However, our study design did not incorporate school performance into the study.
Various treatment and preventive measures are available for the management of allergic rhinitis and its sequelae. In fact, Lombardi et al.  successfully prevented a relapse of seasonal sensorineural hearing loss solely by effective management of patients’ allergic rhinitis, suggesting that allergic rhinitis-associated hearing loss may be effectively managed by treatment of patients’ allergy. This possibility, if confirmed, holds considerable promise in the prevention and management of childhood hearing loss and its associated sequelae.
| Conclusion|| |
We conclude that hearing is significantly worse in allergic children compared with controls with disabling hearing loss, being more significantly associated with allergic rhinitis, although our study cannot establish a cause and effect relationship between allergic rhinitis and hearing loss.
We recommend that attention should be focused on the hearing of allergic children to detect hearing loss early. Further research is needed in the fields of allergic rhinitis and pediatric hearing loss to establish a cause and effect relationship, and reliable diagnostic modalities and treatment protocol.
The authors thank G.M. Ogunniyi, our principal audiologist, for assisting with the audiometry of the participants.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lasisi AO, Abdullahi M. The inner ear in patients with nasal allergy. J Natl Med Assoc 2008; 100:903–905.
Baker BM, Baker CD, Le HT. Vocal quality, articulation and audiological characteristics of children and young adults with diagnosed allergies. Ann Otol Rhinol Laryngol 1982; 91:277–280.
Singh S, Nagarkar AN, Bansal S, Vir D, Gupta AK. Audiological manifestations of allergic rhinitis. J Laryngol Otol 2011; 125:906.
Karabulut H, Acar B, Dagli M, Karadag AS, Baysal S, Karasen RM. Investigation of hearing in patients with allergic rhinitis. Iran J Allergy Asthma Immunol 2011; 10:29–33.
Derebery MJ, Berliner KI. Allergy and the contemporary otologist. Otolaryngol Clin North Am 2003; 36:989–1008.
Bernstein J, Lee J, Conboy K, Ellis E, Li P. Further observations on the role of IgE-mediated hypersensitivity in recurrent otitis media with effusion. Otolaryngol Head Neck Surg 1985; 93:611–615.
Alles R, Parikh A, Hawk L, Darby Y, Romero JN, Scadding G. The prevalence of atopic disorders in children with chronic otitis media with effusion. Pediatr Allergy Immunol 2001; 12:102–106.
Bousquet J. Strategies to treat allergic disease. Drugs Today (Barc) 2008; 44(Suppl B):25–27.
Bousquet J. Allergy and asthma: from the bedside to the bench and international actions. Pol Arch Med Wewn 2008; 118:363–366.
Jerger J. Clinical experience with impedance audiometry. Arch Otolaryngol 1970; 92:311–324.
Luong A, Roland PS. The link between allergic rhinitis and chronic otitis media with effusion in atopic patients. Otolaryngol Clin North Am 2008; 41:311–323.
Yeo SG, Park DC, Eun YG, Cha CI. The role of allergic rhinitis in the development of otitis media with effusion: effect on eustachian tube function. Am J Otolaryngol 2007; 28:148–152.
Saini A, Gupta M, Sharma BS, Kakkar M, Chaturvedy G. Rhinitis, sinusitis and ocular disease. Prevalence of allergic rhinitis in urban school children, Jaipur City, India. World Allergy Organ J 2013 6(Suppl 1):P164.
Min YG, Choi BY, Kwon SK, Lee SS, Jung YH, Kim JW et al.
Multicenter study on the prevalence of perennial allergic rhinitis and allergy-associated disorders. J Korean Med Sci 2001; 16:697.
Bauchau V, Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J 2004; 24:758–764.
Falade AG, Olawuyi JF, Osinusi K, Onadeko BO. Prevalence and severity of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in 6- to 7-year-old Nigerian primary school children: the international study of asthma and allergies in childhood. Med Princ Pract 2004; 13:20–25.
Nguyen LH, Manoukian JJ, Sobol SE, Tewfik TL, Mazer BD, Schloss MD et al.
Similar allergic inflammation in the middle ear and the upper airway: evidence linking otitis media with effusion to the united airways concept. J Allergy Clin Immunol 2004; 114:1110–1115.
Nguyen L, Manoukian JJ, Tewfik TL, Sobol SE, Joubert P, Mazer BD et al.
Evidence of allergic inflammation in the middle ear and nasopharynx in atopic children with otitis media with effusion. J Otolaryngol 2004; 33:345–351.
Blair JC. The effects of mild sensorineural hearing loss on academic performance of young school-age children. Volta Rev 1985; 87:87–93.
Bess FH, Dodd-Murphy J, Parker RA. Children with minimal sensorineural hearing loss: prevalence, educational performance, and functional status. Ear Hear 1998; 19:339–354.
Lombardi C, Tansini A, Passalacqua G. Seasonal sensorineural hearing loss associated with allergic rhinitis: a case report. J Allergy Clin Immunol 2006; 117:468–469.
[Table 1], [Table 2], [Table 3], [Table 4]