Earache archives

Ear Infections

Posted by Susan on January 05, 1999 at 18:00:33:

I have a 10 month old son who has had 5 ear infection since July. The last one was not cured by Amoxicyllin (pardon my spelling) so now he is taking Augmentin. I am now finding out about the scary effects of antibiotics - what can I do to prevent my little guy from getting another ear infection? We are due to see the doctor, who I really trust and respect, next week.


Follow Ups:


Re: My point of view. Part 1

Posted by David Feguson, D.C. on January 05, 1999 at 19:40:39:

In Reply to: Ear Infections posted by Susan on January 05, 1999 at 18:00:33:

I hope you have a printer.

Doc Dave

Two hundred pediatricians and two hundred chiropractors that were selected were surveyed to determine what, if any,
differences were to be found in the health status of their respective children as raised under the different health care models.
The 'chiropractic' children showed a 69% otitis media free response, while the 'medical' children only had a 20% otitis media
free response. 18.

93% of all episodes of otitis media treated with chiropractic care improved, 75% in 10 days or fewer and 43% with only one
or two treatments. This study's data indicates that limitation of medical intervention and the addition of chiropractic care may
decrease the symptoms of ear infection in young children. 14.

The author has presented a case series of five patients with chronic recurrent otitis media who underwent a program of
chiropractic case management, including specific spinal adjustments. All patients had excellent outcomes with no residual
morbidity or complications. The associated morbidity of current medical and surgical options for otitis media with effusion
(OME), coupled with a lack of rigorous experimental designs in some reports, further necessitates the exploration of alternative
approaches to case management. 28.

A misconception is that otitis media is a primary disease entity; more accurately it is a complication of other childhood
complaints such as the common cold, sinusitis, and sore throats. 1.

Based on these findings, the authors conclude that there appears to be no basis to the commonly held belief that swimming may
induce or exacerbate otitis media. In fact, the converse may be true. 19.

Inflammation in the nasopharynx and the pharyngeal portion of the eustachian tube was considered to be closely related to the
tubal constriction, which represents a considerable part of the cause of tubal ventilatory dysfunction in otitis media with effusion.
11.

Musculoskeletal eustachian tube dysfunction is an important etiological factor for otitis media. The eustachian tube dysfunction
manifests primarily by poor ventilation from the nasopharynx to the middle ear, by allowing sniff induced negative pressure in
the middle ear. 3.

In cases of secretory otitis media it is generally agreed that the usual basic factor is an inflammatory process with functional or
mechanical obstruction of the eustachian tube. 24.

Tympanostomy treatment in cases of chronic otitis media does not eliminate the dysfunction of the eustachian tube, but only
serves to substitute tubal function. 2.

Only 4% of the 222 infants with recurrent acute otitis media developed chronic otitis media with effusion and an additional 12%
continued having recurrent episodes. Spontaneous recovery from recurrent acute otitis media is common with increasing age.
Thus, until reliable causal evidence between recurrent otitis media and developmental disability is presented, chemoprophylaxis
or tympanostomy tubes seem superfluous for most infants after the age of 16 months. 10.

Myringotomy and tympanostomy with tube implantation are frequently both ineffective and expensive. 4. 15.

In a study of 6611 children, making generous clinical assumptions, 41% of the proposals for these reasons had appropriate
indications, 32% had equivocal indications, and 27% had inappropriate ones. About one quarter of tympanostomy tube
insertions for children in this study were proposed for inappropriate indications and another third for equivocal ones. 25.

It is concluded that the use of ventilation tubes in children with primary secretory otitis media is not justified. Observation has
shown that only a small proportion will require surgical treatment of the middle ear. A ventilation tube may be indicated in order
to combat hearing loss, but it should be borne in mind that its use involves a high risk of complications and sequelae which may
result in chronic middle ear disease. 16.

Medical treatment failures probably already surpass eustachian tube dysfunction as the most common reason for tympanostomy
tube insertion. 13.

Antibiotic treatment of otitis media is no more effective than placebo, and increases the risks of reoccurrence. 5.

To determine the effect of antibiotic treatment for acute otitis media in children six studies of children aged 7 months to 15 years
were reviewed. 60% of placebo treated children were pain free within 24 hours of presentation, and antibiotics did not
influence this. Antibiotics seemed to have no influence on subsequent attacks of otitis media or deafness at one month.
Antibiotics were associated with a near doubling of the risk of vomiting, diarrhoea, and/or rashes. Early use of antibiotics
provides only modest benefit for acute otitis media: to prevent one child from experiencing pain by 2-7 days after presentation,
17 children must be treated with antibiotics early. 27.

Otitis media with effusion usually resolves spontaneously. The available literature indicates that antibiotic treatment has at most a
short-term effect. Therefore it is not indicated for the treatment of otitis media with effusion. 17.

Antibiotics are not the best treatment for middle ear infections (otitis media) and doctors should stop routinely prescribing drugs
for them. 20.

Records from 2,089 otitis media patients were examined to determine incidence and treatment success. There was no
difference in success rates between antibiotic and no antibiotic therapies. 21.

Most clinical trials comparing the efficacy of different antibiotics have failed to show differences in clinical efficacy. To date, no
definitive trials of bacteriologic efficacy in children have been published. 22.

In a review and critical appraisal of the literature on antibiotic therapy for acute otitis media in children between 1939 and
1991, poor evidence supported the routine use of antibiotic therapy. This approach cannot be recommended for children 2
years and younger because this age group has been excluded from most studies. 28.

Few issues in clinical medicine are as controversial as the efficacy and risks associated with antibiotic treatment of otitis media.
Recent studies document the emergence and rapid spread of drug-resistant streptococcus pneumoniae in acute and
unresponsive otitis as well as persistent effusions and chronic suppurative otitis. It is best to avoid the antibiotic treatment
dilemma as much as possible by not over diagnosing otitis media. 12.

Oral decongestants are ineffective in treatment, or prevention, of otitis media in children. 7.

While once-a-day dosing was equivalent to twice-a-day dosing for amoxicillin prophylaxis, there was no benefit of amoxicillin
prophylaxis compared with a placebo control in preventing new AOM episodes. Because of the potential of excessive
antibiotic use to promote the acquisition of resistant pneumococci and the lack of effectiveness in this trial, routine use of
amoxicillin prophylaxis should be discouraged. 23.

Amoxicillin with and without decongestant-antihistamine combination is not effective for the treatment of persistent
asymptomatic middle ear effusions in infants and children. 8.

Patient recovery from otitis media seemed not to be influenced by either the type of antibiotic given, or the period of time for
which it was given, except that the rates of recovery were better in patient's of all age groups who did not receive any antibiotic
therapy at all. 6.

Within a prospective group study of five practicing otorhinolaryngologists, conventional therapy of acute otitis media in children
was compared with homeopathic treatments. Group A (103 children) was primarily treated with homeopathic single remedies.
Group B (28 children) was treated by decongestant nose-drops, antibiotics, secretolytics and/or antipyretics. Comparisons
were done by symptoms, physical findings, and duration of therapy and number of relapses. The children of the study were
between 1 and 11 years of age. The median duration of pain in group A was 2 days and in group B 3 days. Median therapy in
group A lasted 4 days and in group B 10 days. Antibiotics were given over a period of 8-10 days, while homeopathic
treatments were stopped after healing. In group A 70.7% of the patients were free of relapses within 1 years and 29.3% had a
maximum of three relapses. Group B had 56.5% without relapses and 43.5% a maximum of six relapses. Of 103 subjects 98
(95.1%) responded solely to homeopathic treatments. No side effects of treatment were found. 9.

1. Ballantyne J. The ear in paediatric practice. Practitioner 1985; 229(1407):809-12 / Medline ID: 86067665
2. Virtanen H. Eustachian tube function in children with secretory otitis media. Int J Pediatr Otorhinolaryngol 1983; 5(1):11-7 / Medline ID: 83184994
3. Todd NW, Feldman CM. Allergic airway disease and otitis media in children. Int J Pediatr Otorhinolaryngol 1985: 10(1):27-35 / Medline ID: 86084755
4. Gates GA; Wachtendorf C; Hearne EM; Holt GR. Treatment of chronic otitis media with effusion: results of tympanostomy tubes. Am J Otolaryngol 1985; 6(3):249-53 /
Medline ID: 85249128
5. Cantekin EI. Antibiotics to prevent acute otitis media and to treat otitis media with effusion. JAMA 1994; 272(3):203-4 / Medline ID: 94293436
6. Froom J, Culpepper L, Grob P, et al, Diagnosis and antibiotic treatment of acute otitis media: report from international primary care network, BMJ 1990; 300(6724):582-6 /
Medline ID: 90212921
7. Olson AL, Klein SW, Charney E, et al. Prevention and therapy of serous otitis media by oral decongestant, a double-blind study in pediatric practice. Pediatrics 1978;
61:679-84 / Medline ID: 78201214
8. Cantekin EI; McGuire TW; Griffith TL Antimicrobial therapy for otitis media with effusion ('secretory' otitis media) JAMA 1991; 266(23): 3309-17 / Medline ID: 92072085
9. Friese KH; Kruse S; Moeller H; Acute otitis media in children. Comparison between conventional and homeopathic therapy. HNO 1996; 44(8):462-6 / Medline ID: 96398163
10. Alho OP; Läärä E; Oja H; : What is the natural history of recurrent acute otitis media in infancy? J Fam Pract 1996; 43(3):258-64 Medline ID: 96390780
11. Takahashi H; Miura M; Honjo I; Fujita A; Cause of eustachian tube constriction during swallowing in patients with otitis media with effusion.Ann Otol Rhinol Laryngol
1996; 105(9); 724-8 / Medline ID: 96393273
12. Berman S; Management of acute and chronic otitis media in pediatric practice. Curr Opin Pediatr 1995; 7(5):513-22 / Medline ID: 96120875
13. Poole MD; Otitis media complications and treatment failures: implications of pneumococcal resistance. Pediatr Infect Dis J 1995; 4(14):S23-6 / Medline ID: 95312350
14. Froehle RM; Ear infection: a retrospective study examining improvement from chiropractic care and analyzing for influencing factors. J Manipulative Physiol Ther 1996;
19(3):169-77 / Medline ID: 96294956
15. Gates GA; Wachtendorf C; Hearne EM; Holt GR; Treatment of chronic otitis media with effusion: results of myringotomy. Auris Nasus Larynx 1985; 12 Suppl 1: S262-4 /
Medline ID: 86241798
16. Lildholdt T, Ventilation tubes in secretory otitis media. A randomized, controlled study of the course, the complications, and the sequelae of ventilation tubes., Acta
Otolaryngol Suppl (Stockh) 1983 (398): 1-28 / Medline ID: 84076229
17. Grote JJ; Antibiotics in otitis media with effusion. Ned Tijdschr Geneeskd 1997;141(2):76-7 / Medline ID: 97166702
18. van Breda WM; van Breda JM. A comparative study of the health status of children raised under the health care models of chiropractic and allopathic medicine. J Chiro Res
1989; 5:101-3 / Mantis ID: 10048
19. Robertson LM; Marino RV; Namjoshi S. Does swimming decrease the incidence of otitis media? J Am Osteopath Assoc 1997; 97(3):150-2 / Medline ID: 97261095
20. Froom J; Culpepper L; Jacobs M; DeMelker RA; Green LA; van Buchem L; Grob P; Heeren T. Antimicrobials for acute otitis media? A review from the International Primary
Care Network. BMJ 1997; 315(7100): 98-102 / Medline ID: 97384382
21. Tilyard MW; Dovey SM; Walker SA. Otitis media treatment in New Zealand general practice. N Z Med J 1997; 110(1042):143-5 / Medline ID: 97296886
22. Cohen R. The antibiotic treatment of acute otitis media and sinusitis in children. Diagn Microbiol Infect Dis 1997; 27(1-2):35-9 / Medline ID: 97272394
23. Roark R; Berman S. Continuous twice daily or once daily amoxicillin prophylaxis compared with placebo for children with recurrent acute otitis media. Pediatr Infect Dis J
1997; 16(4):376-81 / Medline ID: 97262931
24. Lehnert T, Acute otitis media in children. Role of antibiotic therapy., Can Fam Physician 1993; 39: 2157-62. / Medline ID: 94034451
25. Kleinman LC, Kosecoff J, Dubois RW, Brook RH, The medical appropriateness of tympanostomy tubes proposed for children younger than 16 years in the United States.
JAMA 1994; 271(16): 1250-5 / Medline ID: 94202440
26. Fallon JM. The role of the chiropractic adjustment in the care and treatment of 332 children with otitis media. J Clin Chiro Ped 1997; 2(2):167-83 / Mantis ID: 37610
27. Del Mar C, Glasziou P, Hayem M, Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis., BMJ 1997; 314(7093) :1526-9 /
Medline ID: 97326380
28. Fysh PN Chronic recurrent otitis media: Case series of five patients with recommendations for case management. J Clin Chiro Ped 1996; 1(2): 6 / Mantis ID: 36438





Follow Ups:


Re: My point of view. Part 2

Posted by David Ferguson, D.C. on January 05, 1999 at 19:44:23:

In Reply to: Re: My point of view. Part 1 posted by David Feguson, D.C. on January 05, 1999 at 19:40:39:

Otitis Media in Young Children

By: Chris L. Hendricks, D.C. and Susan M. Larkin - Thier, D.C
Originally Published: The Journal of Chiropractic Research, Study and Clinical Investigation 1989; 2(1):9-13

ABSTRACT
This article explores the current medical literature on otitis media. Utilizing the information gathered from this literature search, a
research study is being developed to test the hypothesis that chiropractic adjustments of the cervical region may effect a
resolution of acute and chronic otitis media. The authors review anatomy of the middle ear and current medical treatment of
otitis media and propose a hypothesis for future chiropractic clinical research.

KEY WORDS: Antibiotic therapy, chiropractic, myringotomy,otitis media.

INTRODUCTION
Otitis media , an inflammation of the middle ear, is a problem that has plagued young children and the health care community for
years. [1] [2] A misconception is that otitis media is a primary disease entity; more accurately it is a complication of other
childhood complaints such as the common cold, sinusitis and sore throats.[3] [4] By the age of two, 33 percent of all children
have had three or more episodes of otitis media, and approximately 66 percent have had at least one attack.[5] [6] Children
between four and seven years of age experience more frequent attacks of otitis media than younger children.[1] [7] Otitis media is
a common cause for significant loss of school time among elementary school children.[8] Some learning disabilities can be traced
to the asymptomatic hearing loss associated with chronic otitis media.[3] [9] [10]

Currently, antibiotic therapy is the first step in the standard medical approach.[11] [12] Myringotomy and tympanostomy tube
placement are more radical procedures employed for non-responsive cases.[13] [14] Unfortunately, these surgical procedures
frequently are both ineffective and expensive.[15] [16] The annual cost of diagnosis and treatment of children with otitis media
reaches nearly $2 billion per year.[16]

Chiropractic has been ignored in the literature as a viable treatment for otitis media. There is a direct relationship between the
middle ear, the tensor veli palatini muscle and the superior cervical ganglion. Employing the basic tenets of the science of
chiropractic, it is logical to hypothesize that doctors of chiropractic may be able to effectively treat otitis media.

ANATOMY OF THE EAR
The ear is divided into three parts; the external ear , the middle ear and the inner ear. Since the inner ear is not germane to otitis
media, it will be excluded from this writing.[17]

THE EXTERNAL EAR
The external ear consists of the auricle and the external auditory meatus. The external auditory meatus is continuous with the
tympanic membrane, which transmits pressure to the three auditory ossicles of the middle ear: the stapes, incus and malleus.[17]
[18]

The tympanic membrane is divided into two parts: the pars flaccida (located in the superior aspect) and the remainder of the
membrane, the pars tensa.[19] The manubrium, or handle of the malleus attaches to the center of the tympanic membrane,
drawing it inward, which forms a concavity on the tympanic membrane's outer surface.[17] [18] The center of this concavity is
referred to as the Umbo. The cone of light, a landmark of the normal tympanic membrane, is visualized in the anterior inferior
quadrant, while the lateral or short process of the malleus is located in the posterior superior portion of the pars flaccida. [8] [17]
[18] [20] Posterior and parallel to the posterior to the upper portion of the handle of the malleus is the long process of the incus.
The head of the stapes is inferior to the incus.

THE MIDDLE EAR
The middle ear consists of the tympanic membrane and three additional openings or windows. The round window and the oval
window communicate with the inner ear and the final opening permits the eustachian tube to provide a drainage mechanism into
the paranasal sinuses.[17] [18] [21] (Figure 2). Sorry, couldn't put the picture on this page!

The middle ear or tympanic cavity is an epithelial lined cavity, hollowed out of the temporal bone. The eustachian tube, lined
with ciliated columnar epithelium containing goblet cells, connects the middle ear cavity to the paranasal sinuses.[21] [22]

The paranasal sinuses connect with the nasal cavity via the normally patent ostium of the eustachian tube.[23] The middle ear
cavity and the sinuses constantly accumulate transmucosal exudates and require a mechanism to clear this fluid.[21] [24] The entire
epithelial lining is ciliated so that, under normal circumstances, ventilation and drainage readily occur through the ostium. If the
ostium is even partially blocked, as occurs in pathologic conditions, such as sinusitis, the common cold and sore throats,
accumulations of fluid with mucosal inflammation and/or infection will result. [3] [21] [24] [25] [26]

When the eustachian tube functions normally, there is a clearance of fluid, exchange of gases and equalization of pressure. [24]
[27] This occurs by contraction of the tensor veli palatini muscle. [16] [18] [21] This muscle is innervated by the mandibular branch of
the trigeminal nerve with motor fibers. These fibers exit the middle cranial fossa through the foramen ovale and unite outside the
skull, forming portions of the superior cervical ganglion located between the C-1 and C-4 nerve roots. [5] [17] [26] [28] [29]

The eustachian tube in infants is nearly horizontal, and slowly acquires an angle of 45° by the time the child reaches the age of
seven.[8] The ostium very closely approximates the lymphatic tissue of Waldeyer's Ring. As the child grows and the eustachian
tube assumes a greater angle, more space develops between the ostium and this lymphatic tissue.[8] [20] However, during
frequent upper respiratory infections in early childhood, the lymphatic tissue hypertrophies and may block the eustachian tube
opening. [30] [31] This makes ventilation of the middle ear impossible and provides a simple explanation for the occurrence of
otitis media.

PATHOPHYSIOLOGY
Otitis media is classified by duration and type of exudate.

Acute Otitis Media
Acute otitis media is a disorder generally seen in young children ages 0 through 7 years of age following an upper respiratory
infection.[3] [8] [20] The acute type of otitis media is an infection that lasts less than three weeks and produces a purulent exudate
that is either bacterial or sterile. The organisms responsible for the development of the disease are pneumococci (30%). H.
Influenzae (20%). Beta-hemolytic streptococcus (10%), and sterile injection (40%). [8] [32] [33] [34] In the case of bacterial
infection the eustachian tube is partially open allowing contamination from the nasopharynx by reflux (seen in tympanic
membrane rupture or tube placement), aspiration (as seen in an increase in middle ear pressure) and insufflation (as seen in
crying, nose blowing, sneezing, and swallowing when the nose is obstructed). The tensor veli palatini muscle is the only active
opener of the eustachian tube. When there is total obstruction of the eustachian tube, drainage of effusion is prohibited by
impaired mucociliary transport and by sustained negative pressure in the middle ear. The process results in the accumulation of
sterile transudate in the middle ear.[20]

Diagnosis of acute otitis media depends on the appearance of the tympanic membrane, patient presentation and /or a recent
history of upper respiratory infection. [8] [25] [35] [36] The tympanic membrane may appear either red or yellow, depending upon
the amount of fluid present in the middle ear. In the early stages, bulging may be limited to the pars flaccida, but later the entire
tympanic membrane bulges outward giving it a doughnut like appearance.[8] [20] [35]

The major clinical presentations of acute otitis media are earache, fever and bulging of the tympanic membrane. Otitis media
caused by H. Influenzae more often presents with a low grade fever, minimal pain and only a slightly bulging tympanic
membrane. If the tympanic membrane is inflamed but flat, the exudate is most probably sterile. If only the pans flaccida is
bulging, a 20 percent probability of bacterial infection exists. Beta- hemolytic streptococcus is frequently the organism present
in cases where there is a spontaneous rupture of the tympanic membrane. [8] [20] [35] [36]

The drugs of choice are broad ranged antibiotics (e.g. Ampicillin, Amoxicillin, Erythromycin, Cefaclor and Sulfonamide) for a
period of ten days. Sterile effusion will not respond to antibiotics. If there is not improvement within 36 hours antibiotics should
be discontinued. [37] [38]

Chronic Otitis Media
Chronic otitis media is an infection seen most often in school-aged children, which lasts longer than three months and produces
a thick and tenacious secretion found in the middle ear. [39] [40] It is characterized by a dull, immobile tympanic membrane due to
persistent fullness of the middle ear with sterile exudate. There is no superimposed infection. [2] [16] [41] The main cause often
complete occlusion of the eustachian tube. which, creates a vacuum in the middle ear. [42]

Chronic otitis media. unlike the acute variety is usually clinically asymptomatic.[39] Permanent hearing loss is commonly
encountered although its gradual onset frequently goes unnoticed. The patient may complain of fullness in the ear or the
sensation of "speaking in a barrel". This type of otitis media is closely associated with learning disabilities. The child frequently
presents as agitated. irritable or unable to concentrate in school. [43] [44] [45] [46] [47] [48]

Upon examination. the tympanic membrane may appear mildly infected and dull, or it may appear normal in the resolution stage
there may be fluid levels or air bubbles seen on the tympanic membrane indicating a return of eustachian tube function.[3] [8]

CONVENTIONAL MEDICAL TREATMENT
Many methods and approaches have been utilized by the medical community for the treatment of otitis media. In the 1940’s
and 1950’s patients underwent adenoidectomies, on the assumption that the adenoids were occluding the eustachian tube
opening. The uselessness of the surgery became apparent, hence the practice was gradually abandoned. [8]

In the 195O’s and early 1960’s, the practice of lancing the tympanic membrane (myringotomy) was the procedure of choice.
[49] [50] While somewhat successful, this surgery addressed only half the problem of otitis media. Following the myringotomy,
fluid is released for a short period of time, but the opening created by the procedure closes quickly, allowing fluid build up.
Even the short period of ventilation did not seem to have any effect on the negative pressure vacuum created by the eustachian
tube dysfunction. [51]

In the mid 1960’s tympanostomy tubes were introduced.[49] [52] In the same surgical procedure practiced today, the tympanic
membrane is incised and a drainage tube inserted and secured. The tubes are generally held in place for a period of six months
then removed if they have not been spontaneously aborted. During the time the tympanostomy tubes are in place, the patient
experiences a decrease in symptomatology. [2] [8] [13] [14]

INEFFECTIVENESS OF MEDICAL TREATMENT
Since the 1940’s antibiotics have been the medical community's first approach to most aliments. As previously stated, 40
percent of otitis media cases are the result of sterile effusion , and therefore unresponsive to the antibiotics. [43] [53]

The side effects of antibiotic usage include allergic reaction (e.g. hives, shortness of breath, anaphylactic shock). gastrointestinal
upsets (e.g. nausea, vomiting, diarrhea), superimposed yeast infections (caused by candida albicans resulting in thrush and
vaginitis), and finally, an increase in tolerance of the child to antibiotics, rendering the drugs ineffective at some point. Some
sources believe that the increased frequency of otitis media noted in this decade is due to antibiotic resistance. [8] [20] [54]

Children through the age of two who have had two or more episodes of acute otitis media in the same ear are considered to be
appropriate candidates for myringotomy. [13] [14] Children over two who have had three episodes of otitis media in the same ear
are considered to be candidates for myringotomy with the placement of ventilating tubes.[55] [56] However, 98 percent of
children who have had myringotomies will experience a recurrence of effusion buildup after 53 days, and 75 percent of children
with ventilation tubes will experience a recurrence after 223 days. [15] [57] [58]

Evidence suggests short term adverse effects of myringotomy and tympanostomy tubes include the occlusion of the incision
before pressure equalizes and the displacement of tubes, requiring a second surgical placement.[58] There is mounting evidence
that these surgical procedures produce adverse effects which will show up years later.[55] [56] [57] [58]. Forty percent of the cases
of the insertion of tympanostomy tubes have resulted in permanent structural damage to the tympanic membrane, such as the
atrophy of the tympanum presenting five or more years later, Twenty-five percent of the persons subjected to this procedure
for the prevention of deafness experienced total hearing loss seven to ten years later.[5]

CONCLUSION
The key to the pathogenesis of otitis media appears to be the eustachian tube. Inappropriate function of the tensor veli palatini
muscle, the small muscle responsible for opening and closing the eustachian tube, may be due to delayed nerve supply. When
normal function is present, fluid is free to drain away from the middle ear. In abnormal function, fluid is trapped and the middle
ear initiates an inflammatory response. [17] [28]

Motor nerve fibers can be traced from the tensor veli palatini, to the superior cervical sympathetic ganglion. The cervical plexus
receives these fibers between the spinal levels of C-l through C-4. Subluxation’s affecting these levels may be responsible for
deranged function of the tensor veli palatini muscle resulting in the pathological response of otitis media. Restoring the spine to
its proper alignment through chiropractic care should result in the return of normal nerve supply to the tensor veli palatini muscle
and ultimately normal function of the eustachian tube. A controlled clinical trial of the efficacy of chiropractic care on otitis
media is indicated to verify this conclusion. Such a study is planned by the authors and should begin later this year.

ACKNOWLEDGMENTS
The authors wish to acknowledge the editorial support of Alana C. Ferguson and Carol J Goetzke, Palmer College of
Chiropractic. Illustrations are by Larry Sigulinsky, DC

REFERENCES

1. Stahlberg MR; Ruuskanen O; Virolainen E; Risk factors for recurrent otitis media. Pediatr Infect Dis 1986; 5(1):30-2 / Medline ID: 86120642
2. Gebhart DE; Tympanostomy tubes in the otitis media prone child. Laryngoscope 1981; 91(6):849-6 / Medline ID: 81219956
3. Ballantyne J. The ear in paediatric practice. Practitioner 1985; 229(1407):809-12 / Medline ID: 86067665
4. Todd NW, Feldman CM. Allergic airway disease and otitis media in children. Int J Pediatr Otorhinolaryngol 1985: 10(1):27-35 / Medline ID: 86084755
5. Stangerup SE; Tos M; The etiologic role of acute suppurative otitis media in chronic secretory otitis. Am J Otol 1985; 6(2):126-31 / Medline ID: 85172173
6. Tos M; Poulsen G; Borch J; Tympanometry in 2-year-old children. ORL J Otorhinolaryngol Relat Spec 1978; 40(2):77-85 / Medline ID: 79135974
7. Eichenwald HE; Otitis media in the child. Hosp Pract (Off Ed) 1985; 20(5a):50-5,57,60-1 / Medline ID: 85208013
8. Kemp, Silver, O'Brien. Current pediatric diagnosis and treatment. Norwalk, Connecticut: Lange 1987 / ISBN: 0838514405
9. Downs MP; Effects of mild hearing loss on auditory processing. Otolaryngol Clin North Am 1985; 18(2):337-44 / Medline ID: 85241654
10. Parisier SC; The clinical estimation of the eustachian tube function in serous otitis media. Bull N Y Acad Med 1974; 50(9):971-80 / Medline ID: 75015790
11. Harrison CJ; Marks MI; Welch DF; Microbiology of recently treated acute otitis media compared with previously untreated acute otitis media. Pediatr Infect Dis 1985;
4(6):641-6 / Medline ID: 86093888
12. Linthicum FH Jr; Histopathology of the middle ear in chronic otitis media. Adv Otorhinolaryngol 1978; 23:29-44 / Medline ID: 78100019
13. Stool SE; Myringotomy--an office procedure. Clin Pediatr (Phila) 1968; 7(8):470-3 / Medline ID: 68364041
14. Schwartz RH; Rodriguez WJ; Schwartz DM; Office myringotomy for acute otitis media: its value in preventing middle ear effusion. Laryngoscope 1981; 91(4)616-9 / Medline
ID: 81171876
15. Gates GA; Wachtendorf C; Hearne EM; Holt GR. Treatment of chronic otitis media with effusion: results of tympanostomy tubes. Am J Otolaryngol 1985; 6(3):249-53 /
Medline ID: 85249128
16. Bluestone CD; Update on antimicrobial therapy for otitis media and sinusitis in children. Cutis 1985; 36(5a):7-12 / Medline ID: 86134794
17. Gray H; Anatomy of the Human Body. 29th American ed. CM Gross ed. New York, Lea and Febiger, 1973.
18.Warwick R; Williams P; Gray's Anatomy. 35th Britich ed. Philadelphia, WB Saunders Co., 1973
19. Stenfors LE; Carlsöö B; Hellström S; Salén B; Winblad B; Structure of the pars flaccida after occlusion of the Eustachian tube or blockade of the tympanic isthmus. Int J
Pediatr Otorhinolaryngol 1982; 4(3):251-8 / Medline ID: 83006226
20. Behrman R; Vaughan V III. Nelson text book of Pediatrics. 13th ed. Philadelphia: WB Saunders Co., 1987
21. Harker LA; Middle ear disease from eustachian tube malfunction. Alaska Med 1972; 14(3):90-4 / Medline ID: 72253056
22. Sade J, Meyer FA, King M, Silberberg A; Clearance of middle ear effusions by the mucociliary system. Acta Otolaryngol (Stockh) 1975; 79(3-4):277-82 / Medline ID:
75180900
23. Bylander A; Function and dysfunction of the eustachian tube in children. Acta Otorhinolaryngol Belg 1984; 38(3):238-45 / Medline ID: 85093476
24. Siedentop KH; Tardy ME; Hamilton LR; Eustachian tube function. Arch Otolaryngol 1968; 88(4):386-95 / Medline ID: 68411051
25. Guyton AC; Textbook of Medical Physiology. 4th ed. Philadelphia: WB Saunders Co., 1971
26. Sad´e J; Wolfson S; Sachs Z; Abraham S; The eustachian tube midportion in infants. Am J Otolaryngol 1985; 6(3):205-9 / Medline ID: 85249117
27. Sad´e J; Halevy A; Hadas E; Clearance of middle ear effusions and middle ear pressures. Ann Otol Rhinol Laryngol 1976; 85( 2 Suppl 25 Pt 2):58-62 / Medline ID: 76182889
28. Webster DB; Packer DJ; Webster M; Functional anatomy of the external and middle ear. Ear Nose Throat J 1985; 64(6):275-81 / Medline ID: 85230199
29. Chusid JG; Correlative neuroanatomy and functional neurology. 16th ed. Norwalk, Connecticut: Lange 1976.
30. Tos M; Pathogenesis and pathology of chronic secretory otitis media. Ann Otol Rhinol Laryngol Suppl 1980; 89(3 Pt 2 ):91-7 / Medline ID: 81084625
31.Proud GO; Eustachian tube function and middle ear pressures as they influence susceptibility to disease. Laryngoscope 1972;82(9)1643-6 / Medline ID: 73024520
32. Persico M; Barker GA; Mitchell DP; Purulent otitis media. Otolaryngol Head Neck Surg 1985; 93(3):330-4 / Medline ID: 85269371
33. Sipila P, Jokipii AM, Jokipii L, Karma P. Bacteria in the middle ear and ear canal of patients with secretory otitis media and with non-inflamed ears. Acta Otolaryngol
(Stockh) 1981; 92(1-2):123-30 / Medline ID: 82087527
34. Laxdal OE, Blake RM, Cartmill T, Robertson HE, Etiology of acute otitis media in infants and children. Can Med Assoc J 1966; 94(4):159-63 / Medline ID: 66064841
35. Puhakka H, Virolainen E, Aantaa E, Tuohimaa P, Eskola J, Ruuskanen O, Myringotomy in the treatment of acute otitis media in children. Acta Otolaryngol (Stockh) 1979;
88(1-2):122-6 / Medline ID: 79252126
36. Holmberg K; Axelsson A; Hansson P; Renvall U; The correlation between otoscopy and otomicroscopy in acute otitis media during healing. Scand Audiol 1985; 14(4):191-9
/ Medline ID: 86151299
37. Klein JO; Teele DW; Isolation of viruses and mycoplasmas from middle ear effusions: a review. Ann Otol Rhinol Laryngol 1976; 85(2 Suppl 25 Pt 2):140-4 / Medline ID:
76182850
38. Herberts G; Jeppsson PH; Nylén O; Branefors-Helander P; Acute otitis media. Etiological and therapeutical aspects on acute otitis media. Pract Otorhinolaryngol (Basel) 1971;
33(3):191-202 / Medline ID: 72067099
39. Lildholdt T, Secretory otitis media. The significance of negative middle ear pressure and the results of a controlled study of ventilation tubes. Dan Med Bull 1983; 30(6):
408-15. / Medline ID: 84056736
40. Rahko T; Virolainen E; The eustachian tube function in secretory otitis media in children: a follow-up study. Scand Audiol 1977; 6(3):133-6 / Medline ID: 78054521
41.Milner RM; Weller CR; Brenman AK; Management of the hearing impaired child with serous otitis media. Int J Pediatr Otorhinolaryngol 1985; 9(3):233-9 / Medline ID:
86032734
42. Virtanen H, Eustachian tube function in children with secretory otitis media. Int J Pediatr Otorhinolaryngol 1983; 5(1):11-7 / Medline ID: 83184994
43. Bluestone CD; Kenna MA; Chronic suppurative otitis media: antimicrobial therapy or surgery? Pediatr Ann 1984; 13(5):417-21 / Medline ID: 84247087
44. Fria TJ, Cantekin EI, Eichler JA, Hearing acuity of children with otitis media with effusion. Arch Otolaryngol 1985; 111(1); 10-6 / Medline ID: 85096414 / Medline ID:
85096414
45.Hall DM; Hill P; When does secretory otitis media affect language development? Arch Dis Child 1986; 61(1):42-7 / Medline ID: 86157700
46. Meyerhoff WL; Giebink GS; Shea DA; Silent otitis media. Ann Otol Rhinol Laryngol 1984; 93(2 Pt 1 ):136-9 / Medline ID: 84177058
47. Briggs DR; Applebaum EL; Noffsinger D; Eustachian tube function in children. J Otolaryngol 1976; 5(1):12-8 / Medline ID: 80117981
48. Lous J; Fiellau-Nikolajsen M; Epidemiology and middle ear effusion and tubal dysfunction. A one-year prospective study comprising monthly tympanometry in 387
non-selected 7-year-old children. Int J Pediatr Otorhinolaryngol 1981; 3(4):303-17 / Medline ID: 82119252
49. Butler EC; Burns P; The tympanic ventilating tube: its role in eustachian tube dysfunction. Tex Med 1972; 69(12):88-9 / Medline ID: 73068553
50. Archard JC; The place of myringotomy in the management of secretory otitis media in children. J Laryngol Otol 1967; 81(3):309-15 / Medline ID: 67120998
51. Bennett RJ; Chakraborty AN; Primary myringotomy for secretory otitis media in children. J Laryngol Otol 1969; 83(6):589-600 / Medline ID: 69207974
52. Persico M, Podoshin L, Fradis M, Grushka M, Golan D, Foltin V, Wellisch G, Cahana Z, Kolin A, Winter S, Recurrent acute otitis media--prophylactic penicillin treatment:
a prospective study. Part I. Int J Pediatr Otorhinolaryngol 1985; 10(1):37-46 / Medline ID: 86084756
53. Prellner K, Hallberg T, Kalm O, M ansson B, Recurrent otitis media: genetic immunoglobulin markers in children and their parents. Int J Pediatr Otorhinolaryngol 1985;
9(3):219-25 / Medline ID: 86032732
54. Herzon FS; Tympanostomy tubes. Infectious complications. Arch Otolaryngol 1980; 106(10):645-7 / Medline ID: 81020765
55. Pratt LL; Murray J; The placement of middle ear ventilation tubes: some indications and complications. Laryngoscope 1973; 83(7):1022-6 / Medline ID: 73221501
56. Poulsen G, Tos M, Tubal function in chronic secretory otitis media in children., ORL J Otorhinolaryngol Relat Spec 1977; 39(2):57-67 / Medline ID: 78011115
57. Van Cauwenberge P, Cauwe F, Kluyskens P; The long-term results of the treatment with transtympanic ventilation tubes in children with chronic secretory otitis media. Int J
Pediatr Otorhinolaryngol 1979; 1(2):109-16 / Medline ID: 81093106
58. MacKinnon DM; The sequel to myringotomy for exudative otitis media. J Laryngol Otol 1971; 85(8):773-94 / Medline ID: 71275399


Follow Ups:


In laymen's terms...

Posted by RocketHealer Jim++ on January 06, 1999 at 05:21:06:

In Reply to: Re: My point of view. Part 2 posted by David Ferguson, D.C. on January 05, 1999 at 19:44:23:

Doc Dave:

As Clinton would (Perhaps :-) say: It's the eustachian tube, stupid! [The key to the pathogenesis of otitis media appears to be the eustachian tube.]

So apparently the solution (NOT antibiotics) when little Jonnie (or Susie) is crying with a middle ear infection, is to go to your chiropractor and ask him/her to "Fix my tensor veli palatini muscle, Please!, by restoring my spine to
its proper alignment through chiropractic care and do it right NOW!" I'm not sure that I buy this "solution". Obviously I simply don't understand.

The article also says: "more accurately it is a complication of other childhood complaints such as the common cold, sinusitis and sore throats." This I think I understand, but not what to do about it, the crux of the problem, as I see it.

Seems to me that a better "cure" for middle ear infections would be to address the underlying causes/problems of the common cold, sinusitis, and sore throats. Unfortunately, when you have one of these ear beasts, you want relief right now, not prevention for the next possible occurrence. And in the cases I'm familiar with, the antibiotics usually, but not always, seem to offer that few-hours relief so we can continue with life while we heal.

Obviously I've missed something here. Can someone please straighten me out so we here will all know what to do the next time we or someone we love gets a middle ear infection.
And secondly, how to prevent recurrence?

Thanks.
RocketHealer Jim++



Follow Ups:


Re: In laymen's terms...

Posted by David Ferguson, D.C. on January 06, 1999 at 08:26:51:

In Reply to: In laymen's terms... posted by RocketHealer Jim++ on January 06, 1999 at 05:21:06:

In laymans terms. Kids are going to get colds, sore throats, etc.. Trying to minimize the amount of colds they get is one facet of staving off ear infections but is only part of the answer because they will ALWAYS catch some bug now and then. Another part of the key is to make sure that when they do get these bugs that everything is functioning at it's optimum potential and the eustachian tube is the drainage for the fluid that builds up in the ear. TUBES seem to be the medical answer for getting proper drainage and for us, well, we want to try and make sure that the drainage system we are born with is functioning properly before tubes become an issue.

I'm not sure what part is such a great leap of understanding from the medical point of view. Kid gets sick, ears fill up, hurt like hell, need to get fluid out. "They" like to use tubes and we think using the tubes that exist is a better idea. Obviously, accepting the idea that there is a connection between the spine and the eustachian tube is difficult for most people to understand and that's why I included that anatomical literature.

I am certainly not asking you to "buy" all of this as a solution. Colds will come no matter how much viatmin C and mitttens you drown you child with, and there will always be some ear infections. Infections that are due to dietary allergies are also and ENORMOUS part of the equation and have just as easy of an answer. What I am asking you to "buy" is the fact that human beings are born with an innate ability to heal themselves and if we find the right things that block this ability, and remove them, that we can put a child in a position to more easily recover from illness.

One of the benefits of the truth is that it sells itself.


"New ideas are always criticized - not because an idea lacks merit, but
because it might turn out to be workable, which would threaten the
reputations of many people whose opinions conflict with it. Some people
may even lose their jobs." - physicist, requested anonymity


Follow Ups:


Sorry if I came across argumenative

Posted by RocketHealer Jim++ on January 06, 1999 at 08:58:28:

In Reply to: Re: In laymen's terms... posted by David Ferguson, D.C. on January 06, 1999 at 08:26:51:

Thanks for the kind reply. I guess I was wearing my Sufferer (I've had frequent ear infections) / Husband (my wife has had frequent ear infections) /Father (of sons with repeated ear infections) /Rocket Scientist(Skeptic?) hats all at the same time when I wrote that reply. It came across much less loving and accepting than I intended it. (but it just might be a typical layperson reaction??) Perhaps it is the snow/ice/slippery roads/school closings etc. effects stressing some of us just now into beings from alternate dimensions. Or not!

I am very appreciative of health-related information that not only tells one what to do, but also WHY it just might work.

All that said, given that preventative measures have been ineffective in preventing a middle ear infection and little Johny is crying at the top of his lungs, could someone suggest a stepwise solution without and with medical assistance:

Without medical assistance:
(I.E. snowbound at home)
Step 1
Step 2
Step 3...

With medical assistance:
1. Who to contact
2. What to tell them
3. What tests to expect
4. What to ask for
5. Typical treatments
6. What to expect
7. Recovery time...

Thanks again,
RocketHealer Jim++


Follow Ups:


Re: You didn't

Posted by David Ferguson, D.C. on January 06, 1999 at 13:38:19:

In Reply to: Sorry if I came across argumenative posted by RocketHealer Jim++ on January 06, 1999 at 08:58:28:

I didn't take your questions as argumentative and I surely would rather you ask than either just disregard what I say or follow it blindly. The better you understand, the better you can make your own decisions. I learned a long time ago that even the most minute amount of hostility is a communication problem. Some of my statement might have been misconstrued as being directed at you when really they were just generalizations of the public in general (like: I don't know why it is such a stretch for people to understand)

As for a step by step approach, I have none. Health care is a science and an Art. Ear infections fall as much in the art category as most any illness. If I were in your snowshoes I would look DIRECTLY at dietary considerations regarding milk and other dairy products. I would make sure the child has the vitamin and mineral intake necessary to keep his/her immune system functioning at an optimum level. I would plan on giving chiropractic a try after the thaw. B-6 is a natural anti-inflammatory. Hopefully others will have some other things to add. Best!!!!!

I'm sure you have read these before but what else do I have to do on my lunch hour ;-)

Two hundred pediatricians and two hundred chiropractors that were selected were surveyed to determine what, if any,
differences were to be found in the health status of their respective children as raised under the different health care models.
The 'chiropractic' children showed a 69% otitis media free response, while the 'medical' children only had a 20% otitis media
free response. 18.

93% of all episodes of otitis media treated with chiropractic care improved, 75% in 10 days or fewer and 43% with only one
or two treatments. This study's data indicates that limitation of medical intervention and the addition of chiropractic care may
decrease the symptoms of ear infection in young children. 14.

The author has presented a case series of five patients with chronic recurrent otitis media who underwent a program of
chiropractic case management, including specific spinal adjustments. All patients had excellent outcomes with no residual
morbidity or complications. The associated morbidity of current medical and surgical options for otitis media with effusion
(OME), coupled with a lack of rigorous experimental designs in some reports, further necessitates the exploration of alternative
approaches to case management. 28.


14. Froehle RM; Ear infection: a retrospective study examining improvement from chiropractic care and analyzing for influencing factors. J Manipulative Physiol Ther 1996;
19(3):169-77 / Medline ID: 96294956

18. van Breda WM; van Breda JM. A comparative study of the health status of children raised under the health care models of chiropractic and allopathic medicine. J Chiro Res
1989; 5:101-3 / Mantis ID: 10048

28. Fysh PN Chronic recurrent otitis media: Case series of five patients with recommendations for case management. J Clin Chiro Ped 1996; 1(2): 6 / Mantis ID: 36438



Reply to David Ferguson

Posted by Susan on January 06, 1999 at 14:48:44:

In Reply to: Sorry if I came across argumenative posted by RocketHealer Jim++ on January 06, 1999 at 08:58:28:

Thanks for your reply, but I I think it was way over my head..... Regarding the relationship between Dairy and ear infections - my son is 100% milk-based formula-fed. What do I do?



Follow Ups:


Re: Dr. Stoll Help Us Out

Posted by David Ferguson, D.C. on January 06, 1999 at 18:19:00:

In Reply to: Reply to David Ferguson posted by Susan on January 06, 1999 at 14:48:44:

I'm not well versed on all those options. Hopefully Dr. Stoll will teach us both something on this.



Re: Ear Infections (Alternatives & Prevention)

Posted by Walt Stoll on January 07, 1999 at 15:15:28:

In Reply to: Ear Infections posted by Susan on January 05, 1999 at 18:00:33:

Dear Susan, et.al.,

This has been discussed before & is in the archives. I would recommend they be read again. Then, I will be happy to field more questions.

First, listen to Doc Dave since he knows more about the structural Chiropractic factors than I do.

Just a brief summary: diagnostic triage at home is described in my book in the back; prevention means being healthy--
I do not agree that "colds & flu" are inevitable in children.

I know a number of children who NEVER had one cold or flu in their lives (no otitis either). The common demominator seemed to be Chiropractic Primary Care, vegetarianism and whole foods diet and an absence of immunization. Their wellness also seemed to make them be the only kids who did not get the common childhood diseases (without immunization) AND, if they DID get a childhood disease, it was so mild as to be almost subclinical. Whole house humidification in the cold climates also helped this statistic for ALL diseases spread by inhalation.

Once the infection is present, pain medications and a heating pad is about the only thing that helps.

Obviously, prevention is the most important thing and avoiding dairy #1 and wheat #2 eliminates more than 95% of recurrences all by itself.

Switching to a soy based formula with a meticulous elimination of ANY cow based dairy product would be worth while right away. For the few children who still had recurrence, maintaining the dairy free diet and also making it wheat free would be helpful.

Finally, for those rare kids that still do get recurrence, a knowlegable clinical ecologist would need to be seen in consultation. Don't forget about the Chiropractic adjustments.

Walt




Return to Dr Stoll Home Page

Post a Message

Main Archives Page

More Earache archives