The symptoms of allergy of the ears, nose, throat, and sinuses are caused by swelling of the membranes which line these cavities. Allergy can be seasonal (for example, only occurring in the spring or fall) or perennial (symptoms occur year round).
- Allergy Desensitization
Seasonal Allergies: In most cases patients require only seasonal medication. There are three major medications which can be used. Some patients require all three medications taken together, while others require only one. These medications are antihistamine-decongestants (of which there are over forty different types), cortisone-type nasal sprays, such as, beconase, vancenase, flonase, nasalide, and others (the only nasal sprays which usually will not harm the nose during long-term use), and injectable steroids, each injection of which will last from two to four weeks. The doctor must determine individually which medication or combination of medications gives the patient the best symptomatic relief.
Perennial Environmental Allergies: Some patients have symptoms of environmental allergy year-round. These patients cannot be treated with medication alone because medication will eventually become ineffective over a period of time when used alone. For symptomatic control, perennial allergic patients will require some combination of allergy shots, surgery, and medication. For example, some patients will require surgery only with occasional medication, while others require allergy shots only with occasional medication, and still others will require all three modes of therapy–allergy shots, surgery, and medications.
Primarily Surgery with Occasional Medication: Patients whose major symptoms are primarily nasal airway obstruction and/or recurrent swelling and/or infection of the maxillary sinuses (those sinuses which are locate below the eyes, see figure above) can be treated with surgery with occasional medication in most cases. Some patients may still require allergy shots in addition. Surgery is designed to relieve the nasal airway obstruction due to the swelling of the mucous membranes inside the nose and relieve the pressure in the sinuses which is caused by swelling of the membranes sinuses which blocks the natural outflow tract of the sinuses. Surgery accomplishes the removal by micro-cautery and/or laser of the inferior one-half of the inferior turbinate (that tissue inside the nose which swells and causes the nasal airway obstruction, see above figure). If the sinus is blocked from swelling, a small surgical window is made into the sinus which allows the sinus to then drain freely and reduces the pressure inside the sinus. This type of surgery is accomplished without incisions via a small telescope placed inside the nose, using either local or general anesthesia. Most patients can be done on an out patient basis.
Allergy Desensitization: Patients who require allergy shots usually have a combination of many year-round symptoms. These may include;
- Nasal airway obstruction
- Increased nasal discharge
- Recurrent sinus headaches, which may occur above, behind, and below the eyes
- Recurrent sinus infections
- Pressure in the sinuses
- Recurrent fluid in the middle ear with decreased hearing and pressure in the ear
- Dizzy episodes
- Fluctuating hearing loss with fluid build-up in the inner ear
- Watery, itchy eyes
- Increased post nasal drip with occasional sore throat
Patients who have a combination of the above symptoms year round should first have an allergy test. This test involves drawing blood samples. From the blood sample a determination is made on the antibody level to common environmental antigens and a total IgE serum antibody level. The total IgE antibody level is the antibody in the blood which is responsible for the allergic symptoms. There are three possible results from the allergy screen:
Negative Test: Which could mean that the patient is allergic but it was not detected by testing and may still benefit from a mixture of pollen and environmental injections, or that the patient’s allergy symptoms are not caused by elevated IgE antibody levels and therefore will not benefit from allergy shots, and no further testing is needed.
Strongly Positive Allergy Screen: Which means that antibody levels of IgE antibody are high and a serum can be made from these test results so that the patient can begin allergy shots to immunize them to the items to which they are allergic. Patients will receive the initial allergy shots weekly. When the maintenance dosage is reached, the shots can be given every 2, 3, or 4 weeks. Usually allergy symptoms improve after approximately 12 weeks of injections. The success rate for symptomatic improvement on allergy shots is 70% with a 30% failure rate even with a positive allergy screen.
Borderline Blood Test: The IgE antibody level was not high enough to measure the series of environmental antigens in the blood, but the patient may still benefit from desensitization.
The patient must take weekly injections for a period of two years and then be reevaluated. Rarely is a patient “cured” of allergy, but rather most patients require on-going maintenance of allergy shots for years. Some patients may be able to discontinue allergy shots after several years because of a change in their immune system. For example, some children who are very allergic begin having no symptoms during adolescent years because of changes in the growth and development of their immune systems.
Triple Combination Therapy: The severely allergic patient may require surgery, allergy shots, and allergy medication, all of which may make the patient’s symptoms much improved, though not completely eliminated. Combination therapy in severe allergy cases makes the patient much more comfortable, although not completely well. For example, the patient may have complete nasal airway obstruction with recurrent infection in all the paranasal sinuses, recurrent sinus headaches, fluid in the ears, dizziness, and sore throats. Surgery in this patient would be required to provide a permanent open nasal airway to create drainage passages so that all the sinuses may drain freely. Allergy shots would be added to help reduce the lining swelling which causes the current headaches. Finally, medication would be added as necessary for breakthrough symptoms of increased nasal drainage, increased sinus pressure, and ear pressure. Still, in the severe patient, all of the symptoms may not be eliminated but only improved.
However, the majority of patients obtain complete symptomatic relief with either combination therapy or single mode therapy.