By Beth Field, AuD, and Becca Kane, AuD

Many of us look forward to the change of seasons, which brings beautiful foliage in the fall and a dramatic burst of vibrant green and the return of flowers come spring. But for more than 50 million people in the U.S. with seasonal allergies, the shift in seasons can be a prolonged period of misery marked by nasal congestion, runny nose, sneezing, itchy eyes, and other symptoms that mimic a cold that won’t go away.¹ For some, the allergic reaction causes ear problems that can trigger or aggravate tinnitus. Here we explore why that’s the case and how it can be managed.

What Are Seasonal Allergies?

The most common cause of seasonal allergies is pollen, which are tiny seeds of flowering plants, trees, and grasses carried by the wind. In the spring, tree pollen is the primary allergy trigger that gives way to grass pollen in late spring and summer and ragweed pollen in the fall. Rain and humidity, which fluctuate with seasonal shifts, can fuel mold, another common cause of allergies. Although pollen is a harmless substance, a person with allergies experiences an immune response to protect the body against the allergen, which is perceived as a threat. When you’re allergic to something, whenever you encounter the allergen, the immune system releases histamine into the blood, which results in the unpleasant constellation of allergy symptoms. The more severe the allergy, the worse the allergic response.

Allergies and Your Hearing System

An allergic reaction can cause a variety of ear issues, including eustachian tube dysfunction and middle ear fluid congestion, which makes hearing feel muffled. It’s critical to understand the role of the eustachian tube, which is vital to maintaining middle ear health when considering the impact of allergies on the hearing system. The eustachian tube connects your ear to your throat and is responsible for draining fluid and equalizing pressure on both sides of your eardrum. Eustachian tube dysfunction is when the tube becomes blocked or is not equalizing pressure correctly.¹ This occurs when histamine, released in response to an allergen, triggers inflammation of the mucous membranes and causes an overproduction of mucus in the nose and ears. Normally, excess mucus in the middle ear space drains through the eustachian tube, but a “dysfunctional” eustachian tube fails to drain correctly, causing ear fullness, ear popping, conductive hearing loss, and, in some instances, tinnitus.

A common cause of conductive hearing loss is when fluid in the middle ear or negative pressure at the tympanic membrane prevents soundwaves from traveling to the cochlea, the hearing organ. Any time our peripheral hearing system isn’t functioning correctly, there’s a possibility of tinnitus. For instance, when sounds are muffled by fluid in the middle ear, the resulting hearing loss may cause an increased perception of tinnitus. If there is a middle ear issue, such as conductive hearing loss, allergies can increase tinnitus in certain cases or cause a temporary flare-up. Eustachian tube dysfunction can be quite uncomfortable. Typically, the discomfort resolves when the fluid drains. However, in some cases, the fluid remains trapped, where it can become a breeding ground for bacteria and viruses that lead to sinus infections or otitis media with effusion (OME), more commonly called an ear infection. If you feel pain accompanied by pressure, it’s time to visit your physician.

Once the fluid drains and the eustachian tube attempts to return to normal functioning, some people experience ear popping as a result of ongoing inflammation.

Diagnosis, Prevention, and Treatment

If over-the-counter antihistamines— their drying effect improves eustachian tube function—don’t work, it’s time to see a physician. Also note that nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, which some people take for allergy relief, can cause tinnitus as a side effect at certain dosages. Your physician can determine whether there’s an underlying medical issue contributing to the problem or can refer you to an allergist to identify the best intervention to improve day-to-day quality of life during allergy season.

An allergist can conduct tests to determine allergies, their severity, and the best way to manage them. Understanding triggers can help you avoid them as well as take actions to lessen their impact (see box below).

Tinnitus Management During Allergy Season

Allergies can cause ear-related symptoms that might contribute to tinnitus flare-ups in patients with preexisting tinnitus, but note that the allergy is not the cause of tinnitus. Yes, tinnitus flare-ups can feel overwhelming, so draw on what has helped you cope in the past and devise a strategy to head off allergy flare-ups to minimize the impact of seasonal allergic reactions. By managing your allergies to avoid symptoms that interfere with the hearing system, and practicing tinnitus management techniques, there’s no reason you too can’t enjoy the change in seasons!

¹ American Academy of Allergy, Asthma & Immunology https://www.aaaai.org

² S. Hamrang-Yousefi, J. Ng, & C. Andaloro. (2022). Eustachian tube dysfunction. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/ books/NBK555908/

• Take allergy medications as directed to control the allergic response.
• If you use over-the-counter allergy medications for longer than a week or two, consult your physician to determine which medications are safe for long-term use.
• If an allergy medication no longer helps, see an allergist for guidance.
• Check pollen forecasts and avoid being outside on days when the pollen count is high or when the wind is strong.
• Wear a quality mask outdoors to reduce exposure to allergens.
• Avoid yardwork during peak pollen and mold days.
• Keep windows closed during pollen season.
• Change clothes and wash them after being outdoors.
• Use HEPA filters—high-efficiency particulate air filters—to remove pollen, dander, dust mites, and other airborne allergens to improve indoor air quality.
• Don’t allow pets in your bedroom.
• Remove carpet and drapes if possible.
• Use masking if your tinnitus flares because of allergies.
• Do things indoors, such as yoga, deep breathing, and mindfulness, to reduce stress. Stay hydrated to help relieve congestion.
• Breathe in warm steam or take a hot bath.