Otitis Media

Overview: Otitis Media

• Otitis media (OM) literally means “inflammation of the middle ear” and is commonly known as an “ear infection.”

• Fluid, either sterile or containing infective pathogens, develops behind the tympanic membrane (TM), with drainage impeded by a congested eustachian tube.

• In children, the eustachian tube is small and at times tortuous, leading to increased susceptibility to OM.

• The National Institutes of Health delineates OM into three categories:

  • Acute OM (AOM), OM with effusion (OME) and chronic OM with effusion (chronic serous OM, or CSOM).

  • AOM is the most frequently diagnosed subtype, typically following upper respiratory congestion and causing acute inflammatory symptoms such as pain and fever.

  • Earache may be caused by inflammation of the TM and by distention of the TM by pressure from fluid trapped behind the TM.

  • OME may persist asymptomatically for some time following AOM, but it may also be associated with recurrent AOM episodes, as well as chronic inflammatory changes.

  • This state of persistent fluid presence behind the TM, known as CSOM, may be associated with auditory and speech impairment.

  • Most cases of AOM are preceded by upper respiratory tract inflammation and congestion. Common triggers include viral (influenza, adenovirus) and bacterial pathogens (non- typeable Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis), atopy (allergic rhinitis and cow's milk allergy), exposure to prenatal and postnatal tobacco smoke, and exposure to air pollution.

Important Points to Consider: Otitis Media

• A “wait-and-see” approach is now increasingly prescribed, using symptomatic relief measures instead of initial antibiotic treatment.

• Effective preventive measures include breast-feeding and avoiding environmental triggers such as second-hand smoke and air pollution.

• Children receiving osteopathic manipulative treatment have significantly fewer episodes of acute otitis media, surgical procedures, and “surgery-free months.”

Prevention Prescription

• Limit exposure of children to environmental tobacco smoke and air pollution.

• Encourage exclusive breast-feeding for the first 4 to 6 months of life.

• Recommend a diet high in nutritious foods such as fresh fruits and vegetables, whole grains, and hormone- and antibiotic-free proteins.

• Advise those with clinical signs and symptoms of allergy and inflammation to avoid cow's milk, and identify all food allergies and eliminate consumption of offending foods.

• Avoid unnecessary antibiotic exposures.

• Consider preventive use of cod liver oil given once daily with dosing based on omega-3 fatty acids as appropriate for age and weight, xylitol at 10 g/day divided five times per day, and prebiotics or probiotics given once daily at a dose typically exceeding 5 billion colony-forming units of live probiotics.

Therapeutic Review: Otitis Media

Environmental

• Remove potential allergens and triggers of upper respiratory inflammation (tobacco smoke, cow's milk protein).

Botanicals

• Naturopathic/botanical ear drops: Instill 2 drops in affected ear(s) every 4 hours as needed for pain.

Homeopathy

• Use individualized homeopathic remedies for symptoms associated with acute otitis media

Maniupulative and Body Based Methods

• Consider a trial of osteopathic or chiropractic treatment, especially for patients with otitis media with chronic effusion who are at high risk for surgical intervention.

Pharmaceuticals

• Use antibiotics judiciously in children less than 6 months of age and in all patients with significant systemic symptoms (fever, irritability) affecting daily functioning.

• Use ibuprofen or acetaminophen judiciously for pain relief.

Surgery

• Myringotomy tubes