by Caroline von Fluegge-Chen
The following is an article featured in Pathways Magazine, a publication by the International Chiropractic Pediatric Association. The advice given is based on the opinions of the author of this article, a writer who has no affilliation with Balance Atlanta. They do not replace an in-office visit to your pediatrician. Please consult with your doctor. For more information, you may refer to www.ICPA4Kids.org.
Pathways Issue 23
Ear Infections Causes and Holistic Care
Middle ear infections are on the rise. The ailment, also known as otitis media, has become far more prevalent in children throughout the twentieth century, increasing 150 percent between 1975 to 1990 alone. This dramatic increase illustrates the parameters of wise antibiotic use and its abuse, while at the same time revealing the effects of breastfeeding and formula.
The middle ear is the part of the ear that is enclosed behind the eardrum. A tiny tube, called the Eustachian tube, drains any fluids from the middle ear into the throat. Colds and episodes of allergic runny nose, due to airborne allergens or allergies to cow’s milk or other foods, block this Eustachian tube with mucus and inflammation. When this tiny mucous-membrane-lined canal is closed off, inflammatory fluids build up in the middle ear cavity (serous otitis media), sometimes referred to as effusion. Over time, passage of nasal and throat bacteria into this tube, from pacifier use or especially when a child is lying on his back, can seed the middle ear. Bacteria can then multiply to large numbers when finding a friendly fluid-filled middle ear environment, creating painful infection (acute otitis media).
The major source of these infections is threefold: the withholding of protective mother’s milk; antibiotic treatment for mild or non-bacterial ear conditions; and inflammatory reactions to certain foods, particularly cow’s milk.
The occurrence of otitis media is 19 percent lower in breastfed infants; with 80% fewer prolonged episodes. The risk of otitis remains at this reduced level for four months after weaning and then increases. By 12 months after weaning, the risk is the same as in those who were never breastfed. In addition to providing general immunities to the infant, breast milk also provides specific antibodies that prevent otitis-causing bacteria from attaching to the mucous walls of the middle ear.
Misguided Concerns about Infection
The presence of fluid in the middle ear from chronic or acute conditions reduces a child’s capacity to hear. This fluid muffles sounds but does not damage the hearing mechanism, so hearing returns once the fluid is gone. While permanent hearing damage does not occur from acute or chronic otitis, chronic interference with hearing can delay language development.
In some cases of acute infection, treated or not, the eardrum may rupture. While fear is generated around this possibility, the rupture allows the pus to drain and the middle ear to dry, most likely resolving the infection. The eardrum will then heal with some scar tissue, just as it would have after tube insertion. This scar tissue, found in many an eardrum, typically affects hearing very minimally or not at all. (Drainage from an ear can also be an outer ear infection. This is common after swimming, and the condition will respond to ear drops. Drainage from the ear for more than two days, especially when associated with hearing loss, requires prompt medical attention.)
The major concern with ear infections is that infection could develop in the mastoid air cells behind the ear. This rare condition is called mastoiditis, and is primarily of concern because of the proximity to the brain. Mastoiditis, seen as redness behind the ear and protrusion of the outer ear, can occasionally lead not only to permanent hearing loss, but to brain damage as well. Although claims are made that the incidence of mastoidits has been greatly reduced since the introduction of antibiotics, this is not clear from a review of the literature. After the advent of antibiotics and CT scans, however, it is apparent that serious complications of acute mastoiditis have been reduced, and that the number of mastoid removals (mastoidectomies) has been reduced as well. In fact, antibiotic therapy for cases of mastoiditis appears to be valuable for preventing surgery in 86 percent of cases.
Just over half of all mastoiditis cases occur following bouts of acute otitis media. While there are other causes of mastoidits, fewer than 4% of the rare deaths from mastoiditis complications occur in cases that originated as ear infections.
Some mastoiditis is blamed on poor antibiotic treatment of ear infections; other cases are blamed on antibiotic therapy itself. At the 1998 meeting of the American academy of Otolaryngology, it was reported that serious cases of mastoiditis are rising as a direct result of strongly resistant bacteria developed through the common use of antibiotic therapy for ear infections.
Additionally, “masked mastoiditis,” in which the clearing up of the visible symptoms of the middle ear infection mask the existence of the mastoiditis, is a highly worrisome, occasionally seen condition that is directly caused by antibiotic treatment of ear infections. The behavior of the bacteria that promote this condition makes it very difficult to discover, and the condition has a high rate of dangerous complications.
The standard treatment for acute middle ear infections is antibiotic therapy. Alas, antibiotics are prescribed very often when simple fluid buildup is present without infection, as described earlier, or when the eardrum just appears red, suggesting inflammation. At times the eardrum can appear very red just from crying, allergies or a fever of other origin. It is impossible to accurately diagnose infection without puncturing the eardrum and taking a fluid sample. This leads doctors to suspect infection based upon the presence of symptoms, and prescribe antibiotics.
One-third of all ear infections are viral, and the distinction cannot be made upon examination. Antibiotics do not kill viruses, and can make viral infections worse by wiping out competing bacterial flora and encouraging secondary bacterial infections of resistant strains. Although seldom recognized, a number of chronic ear infections are actually fungal in nature (candida), produced when multiple courses of antibiotics disrupt the normal floral balance and encourage fungal growth.
Many large studies have shown that antibiotic treatment provides only a small benefit over no treatment at all for short-term resolution of ear infections. A 1994 analysis reviewed 33 studies, covering 5,400 cases of acute otitis, and found that spontaneous recovery without medical treatment occurred in 81% of acute cases. Short-term recovery occurred 95% of the time when antibiotics were used.
At least one third of children on antibiotics experienced side effects. Although their rate of short-term resolution was slightly improved, there was no long-term benefit to antibiotic therapy: Medicated children demonstrate no less otitis four weeks after antibiotic treatment than those treated with placebos. In fact, there was a higher rate of returning acute ear infection seen in those who received antibiotic therapy, and the return of serous otitis was two to six times higher in those treated with antibiotics.
However, when language development is retarded due to prolonged middle ear fluid, the temporary hearing improvement provided by the tubes might be worth the risks.
Generally, fever or great localized pain accompany signs of drum inflammation (redness) and fluid buildup (bulging of drum) in a true acute infection. The most sensible modern recommendation regarding ear infection treatment is to use antibiotic therapy only in genuinely acute infections that do not resolve on their own within a few days. This regimen is currently followed in several European countries with positive results; it also reduces the development of bacterial strains resistant to antibiotics. A heating pad over the ear affords some relief, and many feel that recovery can be hastened by warm garlic or tea tree oil drops in the ear. Favorite antimicrobial supplements, such as goldenseal or grape-seed extract, may prove beneficial. Fever should not be reduced, as it is the body’s own powerful process for killing infecting microbes.
The value of surgical insertion of tubes through the eardrum to treat chronic ear conditions is widely debated. There are many risks involved, including a much greater return of infection once the tubes are gone.
In conclusion, medical treatments complicate the picture of middle ear infections without providing long-term benefits. Removing the chief causes of middle ear infections should be the preferred goal. This can be achieved by providing breast milk, avoiding overuse of antibiotics and recognizing, treating and avoiding exposure to allergens, especially food allergies.
Holistic Care of Middle Ear Problems in Children
Holistic care provides comprehensive treatment for the recurrent or persistent ear problems that are so common in young children. The symptoms of ear infections and fluid collection in the middle ear often begin in a baby’s first year, and they can persist into the toddler and preschool ages. Once children reach age 5 or 6, and their Eustachian tubes are more developed, some tend to grow out of these problems. The problems associated with fluid in the ears, including hearing loss, chronic swelling of mucous membranes, lowered resistance to infection and impaired Eustachian tube function can all be addressed using a combined approach of holistic methods.
Don’t expect fluid in the middle ear to resolve quickly, however. It takes at least two to three months to resolve the issues that contribute to the fluid buildup and facilitate drainage of the middle ear. The following treatments, when used in combination, should address the problems.
Eliminate dairy products from your child’s diet. Milk products are the most common reason for production and stagnation of phlegm in children, and some children are allergic to dairy products. This includes cheese, yogurt and butter.
Allergies, of course, can contribute to ear problems and chronic congestion. In older children environmental allergies may play a part, and at any age food sensitivities may be a subtle contributor to these problems. IgG allergy testing can be helpful to assess these sensitivities in children over 18 months.
Fluid collection in the ears represents just one aspect of the phlegm dampness syndrome that plagues so many children. To address the important issue of mucus production, they often need Chinese herbal formulas as a part of their treatment program. Your herbalist will be able to design a specific individualized program of herbs to help your baby. These may include herbs to bolster immune function, herbs to combat the heat and pathogenic factors that contribute to recurrent or chronic ear infections and herbs to relieve phlegm.
One very important formula for this purpose is minor bupleurum (xiao chai hu tang). Blue Poppy Pediatric Formulas makes a modified version of this formula (Bupleurum & Angelica) to specifically target ear problems. The treatment addresses the digestive dysfunction that leads to dampness and phlegm production. According to Blue Poppy, the formula is intended “for treatment of pediatric food stagnation transforming into heat and ascending through internal branches of the large intestine channel to steam and fume in the region of the ear. The pattern is commonly seen in pediatric otitis media characterized by pain, fever, restlessness, ear tugging, but no purulent discharge”.
Other formulas, such as Grow & Thrive by Chinese Medicine Works, promote healthy digestive function and strong immune system. Specific formulas may be needed to address mucus production if it is a prominent factor in the child’s condition. There are many such formulas for your herbalist to prescribe. Other symptoms, such as coughing or accompanying allergies, may indicate the need for a staged program of herbal treatments that heal the various layers of a problem.
Mucus collection in the ears or sinuses signifies an inflammatory process; omega-3 supplements, in the form of fish oil, help to relieve this state. Since infection is commonly a component of the middle ear problem, a probiotic formula supplement can normalize the flora and prevent infections. Other immune system activators will also help prevent these infections. These include colostrum, whey protein (in the absence of dairy allergy) and mushroom formulas (reishi, shitaki, cordyceps). Chinese Medicine Works’ Resilience, a liquid extract of mushrooms, can be used for older babies. Additionally, vitamin D is essential for adequate immune system function. During the winter months when there is minimal sunlight, all babies should be given a 1000 IU vitamin D supplement. Older children should receive 2000 IU.
Homeopathy provides a powerful tool for improving the constitutional health of babies with ear problems. It also has specific remedies for improving the function of the Eustachian tube. The most commonly indicated homeopathic remedies for middle ear effusion, according to nineteenth century homeopathic ear specialists (and confirmed by clinical experience since then), are Kali muriaticum and Mercurius dulcis.
Kali muriaticum (potassium chloride) is more often called for when children have a white or greenish yellow nasal discharge, enlarged tonsils and a stuffy sensation in the ear with hearing loss. Mercurius dulcis (mercury chloride), by contrast, should be used when the child has thickened, retracted eardrums with more scarring and a granular appearance to the tonsils. Merc-dulc shares similar symptomatology with other forms of homeopathic mercury, including diarrhea with greenish stools. A differentiating point in older children is that cold drinks ameliorate the conditions of Merc-dulc, but cold air and cold drinks aggravate the conditions of Kali-mur.
Kali-sulphuricum is another important remedy for consideration in middle ear effusion. Kali-sulph discharges tend to be thin, yellow and sticky, accompanied by hearing loss from the effusion. Noises in the ears are common in older children, with itching of the ears and evening pain.
It is often important to treat the underlying constitutional picture with a deep-acting homeopathic medicine that addresses the entire symptom complex of the child. This stimulates an adequate healing process and facilitates the cure of the underlying immune dysregulation that accompanies these symptoms.
Classical chiropractic theory recognizes that misalignment of the spine in babies can pull on the muscles of the neck, causing tension and dysfunction. Proper function of the Eustachian tube depends upon balanced head and neck musculature. Correcting an imbalance in these structures allows for healthy function of the Eustachian tube, draining fluid from the middle ear and distributing air to the middle ear cavity. Correcting any misalignment of the spine in the neck also improves immune system function, since the first and second spinal nerves have a direct effect on immune system responses.
The Eustachian tube resides in a bony canal of the skull and passes through the temporal and sphenoid bones. A misalignment of these bones in babies can put pressure on the Eustachian tube. Cranial adjustment and restoration of proper alignment of these bones and the cartilage of the Eustachian tube will take pressure off the tube and help restore normal function.
These spinal misalignments also impair normal nerve and immune system function, hampering a child’s innate capacity for health. As part of a complete holistic program, chiropractic care will work to normalize function of the structures in the ear and bolster the health of the child’s immune system.
Antibiotics and ear infections
In cases where the immune response lags behind infection that is ddangerously decimating the body, the 1950s advent of antibiotic medications saved the lives of millions of people who would have otherwise succumbed. However, the overzealous use of these wonder drugs has now created a new realm of powerful diseases we are unable to fight with existing antibiotics.
Once a resistant bacteria has been created in response to antibiotic therapy, it has the power to transfer its resistance to other microbes, developing new resistant strains. This has been an especially significant issue for the young, who have been chief targets for antibiotic misuse because they are more susceptible to infections and infections are more worrisome in them. Powerful, antibiotic-resistant strains spread easily around day care centers.
Tuberculosis and pneumonia were once conquered with antibiotics, but we are now threatened again by TB epidemics and increased pneumonia deaths.
The excitement over antibiotics has also led to reduced hygiene in hospitals. Hospital sanitation peaked decades ago, when its importance was first widely recognized. Now 10% of the patients in hospitals acquire infections, a large portion of which are resistant to antibiotics due to their expansive use in hospitals. Three percent of these patients die from their infections.
Antibiotics have many possible side effects, including diarrhea, malabsorption, cramping, yeast infections, agitation, rashes and blood disorders. By wiping out much of the normal flora throughout the body, antibiotics leave patients, especially children, far more vulnerable to other infections, such as thrush (oral yeast), and dangerous intestinal microbes that cause diarrheal illness. Infectious diarrhea follows antibiotic use at rates ranging from 5 to 39 percent, depending on the drug.
The most common intestinal infection caused by antibiotics is colitis from clostridium infection, which has a 3.5 percent mortality rate.
Significantly, antibiotics are generally inappropriate for treating ear infections. They have no effect on viruses and are certainly inappropriate for colds and flus, where they can lead to secondary infection. Yet the majority of children visiting physicians with these complaints will receive antibiotic prescriptions. This is unfortunate. Most of the time, children are better off left to fight illness with their own immune systems, while their parents and physician provide careful monitoring.