Can allergic rhinitis cause middle ear infection?

The Eustachian tube links the middle ear with the back of the nose and helps equalise pressure. Allergy-related swelling can stop it opening normally. This may cause blocked ears, popping, muffled hearing or a feeling of pressure, and fluid can collect behind the eardrum. Trapped fluid can sometimes become infected, particularly after a viral cold, but allergy symptoms and infection are different problems. Ear pain, fever, irritability in a child, or fluid coming from the ear needs an examination because the eardrum cannot be assessed reliably from symptoms alone. Avoid placing drops or objects in the ear unless a clinician advises it.

Manage the nasal allergy according to advice from a clinician or pharmacist. Avoid smoke and known triggers, and use prescribed nasal treatment with the recommended technique. Gentle swallowing, drinking and yawning may help pressure equalisation; do not forcefully blow the nose or repeatedly try to pop the ear. Pain relief may be suitable for some people, but check the label and ask a pharmacist if you are pregnant, treating a child, or taking other medicines. Antibiotics are not appropriate for every earache, so an ear examination is useful when pain or fever is present.

Arrange a review for ear pain, new hearing loss, repeated ear blockage, fever, or symptoms that do not settle. Seek urgent care for swelling behind the ear, a very unwell child, severe dizziness, facial weakness, severe headache, or pus or blood draining from the ear. Sudden hearing loss should be assessed urgently. A clinician can distinguish pressure from infection and check whether fluid is affecting hearing.

Is the ear blocked by fluid, or is there an active infection? Could controlling my nasal allergy improve the pressure? Does my hearing need a formal check, especially if this is affecting school, work or speech?