Alexander Chong asked:


What is actually allergy rhinitis? Allergy rhinitis is an allergic disease, which is caused by the sensitinogen that reacting on the mucous membranes in the nasal cavity. It has two types; those are perennial and seasonal allergic rhinitis. Perennial allergic rhinitis occurs throughout the year; whereas, seasonal allergic rhinitis usually occurs during the blossoming or flowering season. In this season, plants start to release their pollen for breeding purpose. Pollen is one of the sensitinogens to the allergic rhinitis. Clinical features of allergic rhinitis are; itching in the nose, sneezing, watery nasal discharge and nasal obstruction. There are about 20 % of adults and children have seasonal or perennial allergic rhinitis.

Although it is prevalence in most of the countries regardless tropical or seasonal, most of the conditions are not treated adequately and the consequence is that allergic rhinitis becomes chronic. The chronic state of allergic rhinitis usually will lead to more serious complications of the upper and lower airways such as asthma, sinusitis and otitis media with effusion. Otitis media is an inflammation of the middle ear. Fluid is built up in the middle ear and causes temporary lose of hearing. However, if this chronic disease is not treated properly, it may lead to permanent hearing impairment.

 A few medical scientists had carried out surveys to study the epidemiologic links between allergic rhinitis and other airway diseases. What they had found out were, 78% of patients who had asthma were also had allergic rhinitis. They also found out that 99% of adults and 93% of adolescents, who had allergic asthma, also had allergic rhinitis. Besides, the other study that had been carried out for 23 years was found out that college students who previously had allergic rhinitis had three times higher the possibility to have asthma compared to those students who had not had allergic rhinitis What is actually allergy rhinitis? Allergy rhinitis is an allergic disease, which is caused by the sensitinogen that reacting on the mucous membranes in the nasal cavity. It has two types; those are perennial and seasonal allergic rhinitis. Perennial allergic rhinitis occurs throughout the year; whereas, seasonal allergic rhinitis usually occurs during the blossoming or flowering season. In this season, plants start to release their pollen for breeding purpose. Pollen is one of the sensitinogens to the allergic rhinitis. Clinical features of allergic rhinitis are; itching in the nose, sneezing, watery nasal discharge and nasal obstruction. There are about 20 % of adults and children have seasonal or perennial allergic rhinitis.

Although it is prevalence in most of the countries regardless tropical or seasonal, most of the conditions are not treated adequately and the consequence is that allergic rhinitis becomes chronic. The chronic state of allergic rhinitis usually will lead to more serious complications of the upper and lower airways such as asthma, sinusitis and otitis media with effusion. Otitis media is an inflammation of the middle ear. Fluid is built up in the middle ear and causes temporary lose of hearing. However, if this chronic disease is not treated properly, it may lead to permanent hearing impairment.

A few medical scientists had carried out surveys to study the epidemiologic links between allergic rhinitis and other airway diseases. What they had found out were, 78% of patients who had asthma were also had allergic rhinitis. They also found out that 99% of adults and 93% of adolescents, who had allergic asthma, also had allergic rhinitis. Besides, the other study that had been carried out for 23 years was found out that college students who previously had allergic rhinitis had three times higher the possibility to have asthma compared to those students who had not had allergic rhinitis before.

Many researches and works had been carried out to study the epidemiologic link between allergic rhinitis and sinusitis. The results had been well documented. The earlier study showed that 53% of children, who had allergic rhinitis, also had sinusitis. They proved this from the children abnormal sinus radiographs. Whereas, recent study showed that up to 70% of children, who had allergy and chronic rhinitis, had abnormal sinus radiographs. 78% of the patients who had recurrent sinus infection, rhinitis allergy was coming together with their extensive sinus disease. For the children who had otitis media with effusion, 40 to 50% of them had allergic rhinitis. This was confirmed by positive allergy skin tests or increased serum IgE antibodies to specific allergens test.

Scientist had proposed a model for the development of sinusitis and otitis media. Their proposed model assumes that the earliest cause for sinusitis is not bacterial infection but it is due to the obstruction in the nasal cavity, which hinders the normal movement of air and secretions in and out of sinuses. Virus that causes nasal inflammation is upper respiratory tract infection (URTI) type, which is called rhinovirus. Research had been carried out to study the effect of this virus to the nasal diseases. The result showed that when rhinovirus is inoculated into the nasal passage of a group people, one third of these people would develop sinus abnormities and typical sinus disease symptoms. Another study also showed that 87% of healthy adult, who voluntarily went through self-diagnosed colds, had maxillary sinuses illness.

Fluid inside the sinus cavity must be drained normally to keep the nasal healthy. When nasal being infected by bacteria or virus, or exposure to allergen, dust or chemicals, thicken secretion will be developed and it has higher possibility blocks the narrowed sinus ostia (opening that connect to the sinus cavity). Accumulation of these secretions in the sinus cavity will lead to further obstruction, mucosal swelling and also thicken the sinus mucosa. This will create an anaerobic environment that further favorite the bacterial growth and lead to infection. Congested sinus ostia must be resolved if not, it will lead to recurrent acute and eventually chronic nasal disease. This model also explained why chronic sinusitis is resistant to the antimicrobials treatment alone. To treat the sinusitis properly, antihistamines and corticosteroids have to be used as a combination with the antimicrobials treatment.

A similar model had been developed by scientist to explain the occurrence of otitis media with effusion. 83% of the children had at least once occurrence of acute otits media by the time they reach 3 years old. This model hypothesizes that nasal inflammation that is caused by allergens or URTIs virus will further cause inflammatory swelling and obstruction of the Eustachian tube. Obstruction of the Eustachian tube will increase negative pressure in the middle area and without improper ventilation; fluids will accumulate in the middle ear. Obstructed Eustachian tube will open occasionally with an effusion and this will **** the inner nasal secretion, which contain bacteria, virus and allergens into the middle ear cavity. Consequently, this will cause acute bacterial otitis media.

From the information above that have been gathered from various scientific publications, we know that common nasal allergy should not be left untreated. This is because it will lead to obstruction, fluid accumulation, bacterial infection and acute disease. If these diseases are not treated properly or successfully, a chronic state of inflammation, nasal congestion, and sinus infection will be developed. And it can further cause mucosal damage and ultimately, chronic disease. If the disease spreads to the middle ear, it will cause permanent hearing impairment

 

Alexander Chong asked:

Otitis media is an inflammation that occurs in the middle ear. Middle ear space contains fluid that could be easily infected and the infected middle ear is called otitis media with effusion. The cause of the chronic OME (otitis media with effusion) for most of the allergic rhinitis patients is mainly due to the IgE-mediated allergies. IgE-mediated allergy is the allergy that happens when IgE antibody (one type of the white blood cell) binds with the mast cell. IgE antibody is being produced by the plasma cell when foreign particular from outside of the body entering into the blood through nasal mucosal surface. Once the IgE antibody binds with the mast cell around the nose, histamine is secreted from this cell and it is the main chemical that causes itching and hypersensitive of the nose.

According to the publication by a group of scientists, 50% of the children who had chronic OME also had nasal allergy. Effects of the seasonal allergic rhinitis to the Eustachian tube function and middle ear pressure had been studied by a few groups of medical scientists. According to one of the studies, Eustachian tube of the pollen allergic patients become obstructed increases from 15% to 60% from the starting to the maximum of the pollen exposure. In one of the studies, ragweed pollen, which is seasonal pollen, was let it exposed to a group of people. What had been discovered is that it will cause immune reactions in the Eustachian tube and nose. Apart from this study, the other study reported that house-dust mite, which was a perennial allergen, also caused Eustachian tube obstruction. In the same study, they found out that 55% of the adults, who had nasal allergy, experienced the development of the Eustachian tube dysfunction when this group of adult was exposed to house-dust mite. In the following study, new thing that had been found out was Eustachian tube obstruction happened more frequently for the patients who had allergic rhinitis. In allergen provocation studies, scientist found out that nasal obstruction usually occurred before the development of the Eustachian tube obstruction. In allergen provocation study, individuals who took part in this study were exposed to allergen to provoke their nasal allergy symptom. In this study, researchers also discovered that various of inflammatory mediators such as histamine have been detected in middle ear effusions of the children who had OME. If Eustachian tube obstruction that was caused by perennial exposure to allergen such as house-dust mite was left it untreated for quite a sometime, it could form middle ear disease, especially, when priming phenomenon occurs in the Eustachian tube. Priming phenomenon happens when mucosa in the organ responds to lower doses of allergen with repeated exposure. Allergic rhinitis could have priming phenomenon too when the mucosa in the nasal passage responds to low amount of allergen that has been inhaled through the nostril. For the Eustachian tube obstruction that was caused by seasonal exposure to allergen such as ragweed pollen, its physiologic hyperresponsiveness could extend beyond the ragweed season.

Studies show that half of the newly occurrence otitis media are diagnosed immediately after patient had been infected by viral URTI (virus that causes flu and common cold). By using traditional standard culture techniques, it is quite rare that viruses could be isolated from the middle ear effusions in the patient with otitis media. However, with the newly developed PCR-based molecular analysis, viruses in the middle ear effusions could be detected and discovered that 53% of the middle ear effusions are positive for viruses. An experimental, which was carried out by infecting real human with rhinovirus-39, had been carried out in Children’s Hospital of Pittsburgh to study the effect of this virus to the middle ear pressure and Eustachian tube. Result of this experiment showed a substantial increase of Eustachian tube dysfunction and also abnormal middle ear in approximately 30% of the people who had been infected in this study. However, all these people who had been infected by this virus had less possibility to develop an otitis media disease. In another study, where influenza A virus was intranasally inoculated to a group of peoples, 59% of the inoculated people experienced the development of middle ear under pressure and only 25% of these people developed otitis media. In this study, one of the inoculated people developed middle ear under pressure followed by purulent otitis media. This patient middle ear effusion was taken for PCR analysis and it showed positive result for both influenza A and Streptococcus Pneumoniae. Streptococcus Pneumoniae is some kind of spherical, Gram-positive, alpha-hemolytic bacterium and it is a member of the genus Streptococcus.  In this group of inoculated people, 80% of them who had infected by this virus experienced the development of Eustachian tube dysfunction and 80% of them had middle ear under pressure. With this group of infected people, five of them had developed OME on the 4th day after the viral exposure. One of the patients had dizziness and vertigo symptoms, which is mainly due to the inner ear malfunction. All these studies support the causes of otitis media by URTIs virus and causes of otitis media starting from the development of Eustachian tube obstruction and abnormal middle ear pressure. In the recent publication about the study of a group of children with acute otitis media, micro-organisms in the fluids of the middle ears of the children were isolated by the investigator of this study. They found out that 65% of the fluid samples that had been collected contained both bacteria and viruses. These results show that virus infection in the middle ear creates an environmental that is suitable for the breeding of bacteria.

Based on the information that had been collected from a few recent publications of the studies of the relationships of the allergic rhinitis to the OME (otitis media with effusion), we could conclude that allergic rhinitis or common cold/flu will cause Eustachian tube obstruction and middle ear pressure. When the situation becomes uncontrollable, Otitis media with effusion will develop and this may could permanent hearing impairment. Therefore, allergic rhinitis and common cold/flu should be treated immediately without any delay. This is because these common illnesses may become serious and develop to chronic sinusitis disease and otitis media with effusions, which is quite difficult to cure.