Antihistamines/ Decongestants and Ear Effusions

Otitis media with effusion (OME) refers to fluid in the middle ear space without the symptoms of an acute ear infection like fever or redness of the ear drum. Fluid builds up when the Eustachian tube, which connects the inner ear to the back of the throat and drains secretions, gets blocked by inflammation from respiratory infections, allergies, or environmental irritants like cigarette smoke. It usually affects younger children. Treatment may consist of observation, antibiotics, hearing tests, and ear tube placement depending on how long the ear effusion has been present.

A new study released by the Cochrane Database reviewed the use of antihistamines and decongestants and found no benefit of these medications in the treatment of OME and does not recommend their use.

However, the study did not differentiate between allergic and non-allergic OME patients. Up to 40% of OME have an allergic component and numerous studies have shown improvement in OME patients with allergic rhinitis with use of antihistamines and other allergy medications, avoidance of allergy triggers, and allergen immunotherapy in resolving and preventing recurrent OME episodes.

The bottom line is: One size does not fit all. While antihistamines and decongestants may not work for OME patients without allergies, they are effective in OME patients with allergies particularly in preventing recurrent episodes.

Learn more about allergy symptoms and ask your doctor about allergy testing, .


  1. Cochrane Database Syst Rev. 2006 Oct.18;(4):CD003423.
  2. Stillwagon PK, Doyle WJ, Fireman P: Effects of an antihistamine/decongestant on nasal and eustachian tube function following intranasal pollen challenge. Ann Allergy 58:422-426, 1987.
  3. Chan KH, Swarts JD, Tan L: Middle ear mucosal inflammation: an in vivo model. Laryngoscope 104:970-980, 1994.

Hurst DS: Allergy management of refractory serous otitis media. Otolaryngol Head Neck Surg June, 102(6):664-669, 1990.

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