PURPOSE: The purpose of this study is to examine the influence of allergic rhinitis (AR) and asthma on the incidence of otitis media (OM), which in turn serves as a mediator for the need for tympanostomy tube placement (TTP). METHODS: A comprehensive logistic regression analysis was performed, incorporating multiple variables to assess the relationship between AR, asthma, and the likelihood of TTP. OM was considered the mediating variable in this relationship. The analysis adjusted for a range of demographic and health-related covariates to ascertain the independent effects of the allergic conditions. Mediation analysis was utilized to evaluate the extent to which otitis media influences the association between AR and asthma and the need for TTP. Additionally, sensitivity analyses were conducted to assess the robustness of the findings against potential missing data. RESULTS: The study revealed significant associations between AR and asthma with the prevalence of OM, which in turn significantly increased the odds of TTP. Specifically, the odds ratios (ORs) for AR were 2.46, 2.44, and 2.19 across models 1, 2, and 3, respectively, indicating a robust correlation with TTP. Asthma also showed a consistent positive relationship with TTP, with ORs of 1.95, 1.94, and 1.56 for the respective models. Mediation analysis provided evidence that OM significantly mediated the relationship between AR and TTP, with an Average Causal Mediation Effect (ACME) of 0.02219, translating to 2.22% of the total effect being mediated through OM. For asthma, the ACME was 0.01395, indicating a 1.4% mediation effect. The Average Direct Effects (ADE) for AR and asthma were 0.03151 and 0.02084, respectively, suggesting substantial direct and indirect effects on TTP. Sensitivity analyses, accounting for missing data, further substantiated the robustness of these associations, with adjusted ORs for AR and asthma remaining highly significant. CONCLUSION: The study concludes that AR and asthma are key drivers of OM, which acts as a mediator for TTP. The significant mediation effects highlight the importance of managing these allergic conditions to potentially reduce the incidence of ear infections and the necessity for TT surgery. Further research is encouraged to explore the intricate links between allergic conditions and otological health, facilitating the development of more effective clinical interventions.