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I have encountered six cases of acute otitis media during the past decade which attracted my attention by strongly suggesting allergic nature of the inflammatory reaction. Unfortunately I was able to elicit something definite in the history of only two cases respecting allergic troubles in progenitors.Male, age 45, son of allergic (asthmatic) mother, father of an allergic (asthmatic) son; attended dinner party where shortly after being seated at the table he began to notice an odd sensation in left ear. This quickly became an increasing earache, throbbing and obtunding hearing, and before the close of the meal spontaneous perforation with profuse serous discharge had taken place. Examination prior to this incident had revealed intact tympanic membrane and quiescent tympanic and eustachian structures. Temperature, pulse and respiration were normal, and upper respiratory tract showed no symptoms or evidence of inflammation that evening or the following days. The serous discharge was profuse for the first fifteen hours; the patient was kept in bed, given a high fluid intake with alkalizing citrates and bicarbonates. In thirtytwo hours the discharge ceased and eustachian inflation showed perforation closed the next day. Female, age 42, able to give very little information concerning health of progenitors; while shopping one morning experienced acute right earache, without premonitory symptoms of any kind. Examination showed tympanic membrane swollen and pink, and spontaneous perforation occurred during otoscopic inspection, about ninety minutes after onset of symptoms, with abundant clear serous discharge. She was put to bed at once; temperature, pulse and white cell count were normal; cochlear examination showed high degree of sound conduction impairment: general upper respiratory examination discovered no evidence of irritation except closure of right at CARLETON UNIV on June 28, 2015 aor.sagepub.com Downloaded from