An Earful

[originally published in KCN, December 2002]

With a prevalence second only to that of the common cold, ear infections — more correctly known as “otitis media” in doctor jargon — may just seem like a part of growing up. Doctors estimate that children will have at least one by the time they turn six. Unfortunately, for many the occurrences are quite a bit higher — some as many as 12 in any given year. Perhaps this is why one doctor referred to otitis media as “an occupational hazard of childhood.” Truly though, the “hazard” lies in the common course of the “hamster wheel” medical treatments the majority will face. Aside from “well check ups,” otitis media is the number one reason a child will visit a pediatrician.

Antibiotics:  The “Knee Jerk” Treatment

The common scenario, which may ring true for many reading this article, goes something like this:  Ear infections…antibiotics…more ear infections…antibiotics…ear infections…antibiotics…more ear infections…more antibiotics…ear infections again…and eventually surgery for tubes. Sadly, for many, even with tubes, the ear infections don’t stop until the age of 6 or 7 — the age that they tend to naturally subside on their own anyway.

I don’t know about you, but something just doesn’t sit right with the above scenario. Especially when you look at the price tag of 4 billion dollars-plus each year. According to the Centers for Disease Control, 3,000,000 antibiotic prescriptions (Amoxicillin being the most common) are written annually for the treatment of otitis media. That’s a hefty number in light of the fact that a growing body of evidence has existed in the medical literature for well over decade that clearly states that this method of treatment just doesn’t work — in fact, it just might make it worse.

A 1994 study out of the Journal of the American Medical Association (JAMA) entitled “Antibiotics to Prevent Acute Otitis Media and to Treat Otitis Media with Effusion” found that the antibiotic treatment was no more effective than a placebo and ended up increasing the risk of the condition coming back two to six fold.

In 1990 an article in the British Medical Journal concluded the results of a study involving 3,660 children with acute otitis media in nine countries as saying, “Antibiotic treatment did not improve the rate of recovery….” In fact, “Patients who did not take antibiotics had a higher rate of recovery than those who did….”

In a Canadian medical journal, a 1993 study that reviewed the medical literature from 1939 to 1991 on antibiotics for acute otitis media found that “poor evidence supported the routine use of antibiotic therapy.”

A 2000 press release from the United States’ Agency for Health Care Research and Quality, made reference to a study conducted by the RAND Corporation that revealed that “nearly two- thirds of children with uncomplicated acute otitis media recover from pain and fever within 24 hours of diagnosis without treatment with antibiotics.  And, over 80% recover within 1-7 days. When treated with antibiotics, up to 93% of children recover during the first week.”

This slight advantage seen with the antibiotics jibes with a review of 33 studies on the effectiveness of various antibiotics for the treatment of acute otitis media conducted in 1994 at George Washington University and the University of Minnesota. Through meta-analysis they concluded that antibiotics only have about a 14% advantage over the body’s immune system.  Essentially this means that one would have to treat six children with antibiotics unsuccessfully in order to help a seventh.

Unfortunately, the “six” that are needlessly subjected to antibiotics don’t necessarily get off the hook with it just not working.  A federally-funded practice guideline for the management of otitis media with fluid build up instructed that with antibiotics, “potentially serious adverse effects — especially allergic reactions — do occur…. The most common adverse effects of antibiotic drug therapy are gastrointestinal, with diarrhea occurring in about 9% of children….” They go on to explain that dermatologic reactions can also be an issue in 3 to 5% of cases, as well as — at a lesser frequency — severe anaphylatic reactions. And while classified as “rare,” antibiotic treatment also has the potential of bringing on “severe hematologic, cardiovascular, central nervous system, endocrine, renal, hepatic, and respiratory adverse effects….”

And if the drug’s potential side effects were not enough, we also cannot ignore the fact that we are contributing to a much larger problem. Gone are the days in which we can take a prescription of antibiotics “just to be on the safe side” — because every time we do, we help to fortify drug-resistant strains of bacteria. Already doctors are faced with bacterial infections that once may have responded well to a particular antibiotic, but now require larger dosages or different types of the drug in order to gain the upper hand.  Ultimately this means that our liberal use of antibiotics may be potentially setting the stage for more serious illnesses in the future for which we may not have an adequate treatment.

Our dependence on antibiotics as a “knee-jerk” treatment for ear infections needs to stop — especially since it doesn’t really work. The lead author in the JAMA study referenced earlier and professor of otolaryngology, Erdem Cantekin, PhD, stated it well when he said, “Children are being abused by the antibiotic treatment in this country.” The solution to this abuse may very well start with the instruction that was offered in a pediatric journal regarding the management of ear infections: “It is best to avoid the antibiotic treatment dilemma as much as possible by not over-diagnosing otitis media.”

Here Come the Tubes!

When it is finally deemed that the antibiotic therapy is unsuccessful in a chronic bout of otitis media and the middle ear has yet to drain its accumulated fluid, tympanostomy tubes are often recommended — so much that it was crowned the most common operation in children in 1988. A 1994 study in JAMA examining the appropriateness of tympanostomy tubes found that of the nearly 6,500 cases of otitis media that were proposed for the surgery, only 41% actually had the appropriate indicators — meaning that 59% of the children would have been needless recipients of this invasive procedure. Unfortunately, studies indicate that 75% of children with these ventilation tubes will experience a recurrence of fluid build up after 223 days.  Worse yet, a 1985 report in the American Journal of Otolaryngology found that 40% of the cases that underwent  insertion of tympanostomy tubes had resulted in permanent structural damage to the eardrum which became evident years later.  Sadly, 25% of the patients who were subjected to this procedure, on the unfounded rationale that doing so would prevent  hearing loss, experienced total hearing loss seven to ten years later because of the amount of structural damage the surgery itself had on the eardrum.  Heinz Eichanwald, M.D. said it best when he was quoted as saying, “Tympanostomy — now one of the most frequently performed surgical procedures in the US — not only often fails to achieve its aim of reducing the frequency of episodes of acute otitis media, but may be associated with a long-term risk of hearing loss.”

Clearly, antibiotics and tubes, while common practice for otitis media, do not work for most and come with their share of risks. Even at their best, when they are warranted in a particular case, they often fall short of addressing the underlying cause, which is probably why many parents find themselves in the endless “antibiotic cycle.”

Chiropractic:  An Option Worth Considering

The good news is that there are other options — some of which are extremely effective.  And this, I would have to say, is my primary purpose in writing this article.

In the opening paragraph I mentioned that otitis media, aside from “well checkups,” is the number one reason a child will visit a pediatrician.  Consider this though:  it is also the number one reason a child will visit a chiropractor. That’s right, a chiropractor. For some this may not make sense.  But being that it is the number one reason children visit a chiropractor, its worth giving a second look.

A 1997 study published in the Journal of Clinical Chiropractic Pediatrics involving 332 children found that “there is a strong correlation between the chiropractic adjustment and the resolution of otitis media….” The study found that depending on the type of otitis media, an average of 4 to 6 visits were needed to normalize the examination findings via otoscope and tympanogram.  Better yet, depending on the type of otitis media, 70 to 89% did not experience another bout of ear infection over a 6 month period from the initial date of presentation.

In 1989 a study in the Journal of Chiropractic Research surveyed 200 pediatricians and 200 chiropractors regarding the health status of their own children to determine if there was a notable difference in being raised under these two different health care models.  With respect to otitis media, 80% of the medical children reported occurrence verses only 31% of the chiropractic children.

Many case studies exist in the chiropractic literature.  One such case regarding a 19-month old female with a history of chronic acute otitis media was reported in 1995.  When the attempts to treat the problem with four series of antibiotics over a six month period proved to show no improvement, a course of chiropractic care was embarked upon.  Complete resolution of the otitis media was seen within two weeks.

These compelling studies are not just limited to the chiropractic literature base, however.  Gottfried Gutmann, M.D., one of Europe’s most prominent researchers in the field of physical medicine, reported back in 1987 that based on his examination and spinal adjustment treatments of over 1,000 infants and children, one of the most common consequences of upper neck problems seen in these young patients was an increased susceptibility to infection of the ear, nose, and throat.

Why the Medical Approach Often Fails

One of the reasons that the medical treatment of antibiotics and tubes has such a modest success rate, is that, as I mentioned above, it is not always addressing the underlying cause of the otitis media. Yes, otitis media can be caused from a bacterial infection — to which antibiotics would seem appropriate.  However, the infection can often be caused by a virus — to which the antibiotics would be rendered useless.  What needs to be realized though is that infection is only one possible cause of otitis media. Chiropractor Dr. Michael Schmidt, author of Healing Childhood Ear Infections, notes that “most instances of otitis media probably involve a multiplicity of events that have taken advantage of lower immune function, underdeveloped eustachian tube muscles, respiratory congestion, excessive mucus production, nutritional inadequacy, or any number of other factors.”  He goes on to state that the four major causes of fluid build up in the middle ear are “allergy, infection, mechanical obstruction, and nutritional deficiency.”  In other words, there is more to this condition than meets the eye (or ear) and finding its underlying cause, or causes, may take some work.  Ultimately, the treatment, like the possible causes, may end up being just as varied.

How Does Chiropractic Help the Ear to Drain?

So, how can chiropractic help?  Chiropractic treatment tends to mainly fall under the “mechanical obstruction” category; although, we can help with advice in the nutritional and allergy arena, and a handful of studies out there show that our adjustments have a positive effect on immune function.  Nevertheless,  through chiropractic adjustments to the cervical spine, we are able to encourage proper ventilation and drainage of the middle ear.

Under normal circumstances, the middle ear will accumulate fluid, but mechanisms are in place to drain it out — via the eustachian tube and the lymphatic system.  Proper operation of these mechanisms, to a degree, is dependent on the normal biomechanical functioning of the cervical spine. When one of the vertebrae, particularly those in the upper portion of the neck, lose their normal motion or position (known as a subluxation) — and in a child this can happen through any one of the many bumps and falls they encounter, not to mention the potential tugging they were subjected to during their birth — the delicate nerves that exit between these bones can become pinched or irritated.  This in turn causes the muscles supplied by these nerves to malfunction and the muscles in the immediate area to develop a state of increased tension or spasm.

One of the muscles controlled by these nerves, the tensor veli palantini,  ensures that the eustachian tube is able to drain the middle ear; however, it is postulated that the neck subluxation interferes with this process.  Also, the spastic muscles caused by the subluxation process tend to choke the flimsy lymphatic vessels which usually assist in the middle ear’s ability to drain.  Add to all this an upper respiratory infection, sinusitis, cold, sore throat, allergic reaction to a food, or an inflammatory diet, for example — not to mention the disadvantaged fact that a child has nearly horizontal eustachian tube orientation (adult eustachian tubes angle downwards at 45˚, encouraging drainage)– and you’ve got yourself the makings of an earache that won’t want to go away.

You may get lucky with  a course of antibiotics doing the trick.   But even if it does, it will do little for the fluid that  accumulates as a by-product of the involved inflammation and/or the body’s white blood cell invasion on the offending agent. If the antibiotics are successful at killing off any bacteria that may have been present, the fluid that remains is now just a sterile, “98.6˚ jacuzzi” — the perfect breeding ground for the infection that’s just around the corner.  By normalizing the spinal biomechanics, if this indeed is what is needed, the muscles can relax to allow lymphatic drainage, and the nerves can begin to provide proper signals to the muscles that control the eustachian tube drainage.

Having said all that, I need to emphasize that chiropractic is not a “treatment” for otitis media, or any disease for that matter.  What we observe as D.C.’s is that when the subluxation complex is corrected, the condition of otitis media frequently resolves.   And while the chiropractic adjustment of the subluxation may do wonders at alleviating the otitis media, in some cases, even this may not be fully addressing the underlying cause.

Other Factors to Consider

There are many other aspects to consider.  Eliminating dairy and/or sugar from the diet, as well as, avoiding eating the same foods every day can prove to be very helpful. Steering clear of junk foods and concentrating on a whole foods diet may also offer immense improvement.  Breast feeding seems to have some protective qualities, whereas bottle feeding tends to increase one’s risk.  A study in Nutrition Reviews showed that breast fed babies exclusively fed breast milk for 16 weeks or more had a 50% lower rate of acute otitis media.  Other risk factors that tend to bring about otitis media more often are second hand smoke, day care facilities, and the use of pacifiers.

Unfortunately, space does not allow me to expand much further.  If you would like more information, consult your local chiropractor.  I would also highly recommend getting a copy of Dr. Schmidt’s book mentioned above, as well as seeking the guidance of a nautropathic physician.  The bottom line is that otitis media is a complex issue.  No one doctor has all the answers.  Our philosophies and treatment approaches may not always match, but I have to think that our underlying, heartfelt goals are the same:  to help the patient get better.  Dr. Schmidt sums up the otitis media issue well:  “Keep your options open and become fully informed. Through education and cooperation, we can bring about effective solutions to our number one pediatric health problem.”

sources used for this article:
AAP – Practice Parameter:  Managing otitis media with effusion in young children.
Agency for Health Care Research and Quality (press release) Clinical evidence shows limited effect of antibiotic treatment on children with acute otitis media.  Rockville, MD. 2000.
Anrig.  Otitis media.  Dynamic Chiropractic 15(16) 1997.
Anrig.  A  review of the federal guidelines for OME.  Dynamic Chiropractic 12(20) 1994.
Batcha.  Winter wonder:  why ear infections are the most confusing diagnosis of all.  Child.  November 2002.
Berman.  Management of acute and chronic otitis media in pediatric practice. Curr Opin Pediatr. 7(5) 1995.
Cantekin.  Antibiotics to prevent acute otitis media and to treat otitis media with effusion. [comment on Williams 1993 research] JAMA 272 (3).1 1994
Children’s Chiropractic Research Foundation:
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Chiropractic helps in prevention of recurring ear infections.
Ear infections:  antibiotics and tubes.  Stop the insanity!.
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Pacifiers may increase ear infection risk.                                                       
Rosner.  A story goes with it:  otitis media and the sanctity of medical guidelines.  Dynamic Chiropractic    19(01) 1999.
Routine use of antibiotics for otitis media unproven, concludes international researchers.  Dynamic Chiropractic 15(20) 1997.
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Schmidt.  Healing childhood ear infections:  prevention, home care, and alternative treatment — 2nd ed. North Atlantic Books.  Berkeley, California.  1996
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Tell me about:  childhood earaches.
Thill et. al. The response of a patient with otitis media to chiropractic care.  Life Work.  3: 23-28.  1995.
Van Breda, W and van Breda, J.  A Comparative Study of the Health Status of Children Raised Under the  Health Care Models of Chiropractic and Allopathic Medicine.  Journal of Chiropractic Research. (summer: 101-3) 1989.
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Warner, T.  Ear infections and antibiotics:  an antiquated paradigm. The Chiropractic Journal. April 1999.
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One Comment on “An Earful”

  1. […] chiropractic care. Here is the article written by my husband on ear infections, and here is the one written about Licking […]

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