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The Informed Parent

Questions and Answers: Ear Problems and Allergies

by John H. Samson, M.D., F.A.A.P.
Published on Jan. 01, 2000

Dear Doctor Samson,

My 3 1/2-year-old daughter has had a chronic ear problem most of her life. After numerous ear infections and antibiotic treatments, she had ear tubes implanted at the age of two.

Both her tubes are now out, but the ear problems have returned. She's been diagnosed as having fluid behind both ear drums with one ear drum retracted.

An acquaintance recently suggested I read two books written by Lendon H. Smith, M.D., concerning a link between chronic ear problems and an allergy to milk. After reading excerpts from the books concerning allergies, the examples Dr. Smith cites and my daughter's case run quite parallel.

As an infant, my daughter suffered from milk intolerance; thus, she was placed on a soy-based formula. At the time, her intolerance was easy to spot: she vomited. At the age of one she no longer exhibited stomach problems, so milk has been an important part of her diet ever since. No pediatrician (we've seen a few) ever suggested to me that a milk or food allergy might be the root of her problem.

In your opinion, is there any basis to Dr. Smith's connection between milk allergy and ear problems? Could the intolerance that once affected her stomach now manifest itself as ear problems?

We're on a waiting list of sorts to see an ENT who, most likely, will want to implant a second set of tubes. I'd very much appreciate an answer to my question.


There is no question that milk allergy can cause symptoms referable to the respiratory system. Chronic cough, wheezing, nasal congestion and ear fluid can be part of the symptom complex. We must remember that milk is not the only allergen that can provoke such problems. I'm sure the author you refer to would be the first to acknowledge that. Many other food products as well as airborne allergens are capable of causing recurrent ear fluid.

Usually, patients with recurrent ear fluid on an allergic basis have some nasal symptoms, but this need not be the case.

I think it is very important to discover the basic problem that mitigates tube placement when the first set of ventilating tubes are placed. As you have found out, simply having tubes surgically placed alleviates the symptoms but does not correct the underlying cause of the fluid collection. In other words, it buys you time to allow for diagnosis and correction of the primary factor.

Recurrent middle ear fluid is provoked by:

  1. large adenoids that obstruct the internal opening of the eustachian tube.
  2. allergic conditions that lead to the obstruction of the eustachian tube by fluid or tissue swelling.
  3. abnormally formed eustachian tube with a small bore or a tortuous course that predisposes it to occlusion, or
  4. immunologic deficit that leaves the patient prone to recurrent respiratory infections.

When these tubes are placed, be sure every effort is made to uncover the underlying cause. Direct measures can be taken to correct the problem before a third set of tubes are needed.

There is no question that a milk allergy can manifest itself as a stomach problem in infancy and later appear as a respiratory condition, recurrent rashes or even headaches.

It would seem reasonable to give your child an eight-week trial period off milk to see if there are any changes in her status. With the lack of daily symptoms such as cough, runny nose or wheezing, a trial off of cow's milk may be very difficult to access. Allergy testing or a more prolonged trial off cow's milk may be needed.

Remember, the insertion of ventilation tubes is only a temporizing procedure. The cure is dependent upon determining the condition that necessitated the surgery.

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