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Wise et al.

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< 0.0001). In an exception to the previously noted studies, Sadeghi-Shabestari et al. 1940 compared 117 children aged 1 to 14 years with adenotonsillar hypertrophy to 100 controls of similar age for allergen SPT, total IgE, and smoking parents. They reported 70.3% of the adenotonsillar hypertrophy group had a positive SPT compared to 10% of the control group ( p = 0.04); however, they included SPTs for foods (highest positive allergen subgroup) and latex. In a study that is difficult to categorize by recruitment, 155 children (mean age 8.7 years) referred from Pediatric Allergy to Otolaryngology were assessed by rigid nasal endoscopy and SPT. Children on allergy medication were excluded. They observed a negative correlation between AH and allergen positivity ( r = −0.208, p = 0.009). 1941 Immunologic evidence of allergy in adenoid tissue is limited in the literature. Ni et al. 1942 found a higher Th17/Treg ratio in adenoid tissue from children with AR than controls. Masieri et al. 1943 reported Th1 gene expression in non-allergic adenoid tissue, Th1 and Th2 gene expression in adenoid tissue in those with AR treated with antihistamines, and a down regulation in Th1 and Th2 gene expression in adenoid tissue from children treated with SLIT. Both studies were small. Treatment studies are also limited. One retrospective, uncontrolled study (n = 47) reported improvement in rhinitis symptoms in similar percentages for both AR (86%) and NAR (76%) after adenoidectomy. 1944 The effect of INCS on reducing nasal obstruction in the setting of AH, independent of allergy, has been demonstrated in systematic reviews, 1932,1945 but whether this is due to decrease in adenoid size is less clear and blinded studies are uncommon. 1946 In conclusion, there is a trend among allergic children who are assessed for AH to have increased prevalence AH compared to non-allergic controls. However, when children are selected for upper airway obstruction and then assessed for inhalant allergy sensitivity, a consistently increased prevalence of allergic sensitivity is not found. One potential explanation for this discrepancy is that symptomatic AH peaks in younger children than pediatric AR, with the allergic cohorts having a higher average age. This is supported in the literature by Pagella et al. 1947 who retrospectively reviewed records of children referred to Otolaryngology for nasal symptoms (n = 795). They found an association between allergy and AH in children aged 8 to 14 years ( p = 0.0043), but not for children aged 1 to 7 years ( p = 0.34). • Aggregate Grade of Evidence: C (Level 4: 11 studies; Table X.F). Ear symptoms are commonly experienced by patients with AR. Ear fullness and pressure, otalgia, popping or other sounds during swallowing, and transient hearing loss can all be manifestations of Eustachian tube dysfunction. The Eustachian tube opens into the nasopharynx and is in direct continuity with the upper respiratory tract. Inflammation of the nasal mucosa may involve the torus tubarius or Eustachian tube mucosa, resulting in obstruction that leads to negative pressure as middle ear gases are resorbed. Frequent sniffing or swallowing during nasal obstruction may transmit negative pressure to the middle

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X.G. Otologic conditions Eustachian tube dysfunction

Int Forum Allergy Rhinol . Author manuscript; available in PMC 2020 June 10.