Pediatrics - Chronic childhood ear infections

Treatment with surgery and antibiotics often unwarranted

by Paul Bergner

Medical Herbalism 4(3):1,4,6

Minor ear infections are the most common medical problem in children under six years old
in the United States. About nine out of ten children under six years old have at least one
ear infection. One child in three develops chronic congestion in the middle ear, which can
cause minor hearing loss, and make the child a candidate for the myringotomya surgical
operation to place tiny tubes through the eardrums to relieve pressure, allow drainage of
fluid, and restore hearing. The operation is one of the most common in the U.S. More than
600,000 such operations are performed each year at an annual cost of almost one billion
dollars.

The procedure is controversial, however, and some MDs have recommended in journals as
long ago as 1987 that the operation be discontinued until it is proven to be effective.
Alternative practitioners claim success treating most ear problems without the operation.

Acute ear infections are usually treated with antibiotics. If infections recur despite
antibiotic treatment, a child may develop chronic congestion of the middle ear, sometimes
called glue ear.

The eustachian tube, which runs form the middle ear to the throat, becomes blocked and
the ear cannot drain normally. The eustachian tube normally adjusts the pressure or drains
fluid from the middle ear three or four times a minute with swallowing. This process is
responsible for the popping of the ears with a sudden change in elevation.

The myringotomy is the usual next step in treatment. A microscope device is inserted in
the ear, and small incisions are made in the ear drum. Tiny tubes, shaped like grommets,
are then placed in the incision. The tubes eventually fall out and degrade. The procedure
takes about fifteen minutes, and does not require an overnight stay in the hospital. The
total cost, including hospital and physician fees is about $1500. Sometimes the doctor may
also remove the adenoids, lymphatic tissue in the upper throat that can swell and block the
lower end of the eustachian tube. The adenoid operation may require a longer hospital
stay.

Almost everything about conventional treatment of chronic ear infections, including both
antibiotic and surgical treatment, is the subject of controversy within the medical
community. Studies supporting the use of antibiotics and surgery usually measure only
short-term hearing improvement. Other studies, measuring the frequency of subsequent
infections, long term adverse effects, or long-term hearing loss question the necessity of
the treatments. Studies appearing in various journals show the following:
Doing nothing may actually be more effective than surgery. In one study, children with
congestion in both ears had a tube implanted in only one ear. The untreated ear had fewer
subsequent infections than the treated one. A 1989 study showed that the surgery offered
no advantage over doing nothing in terms of duration of the disease, recurrence of disease,
subsequent surgery, or hearing loss after twelve months, even for patients with serious
initial hearing loss.

Routine removal of adenoids, practiced by many surgeons, has no beneficial effect on the
accumulation of fluid in the middle ear and consequent hearing loss.

Most children receiving the operation continue to get ear infections.

The operation may have to be repeated, about 30% of the time, according to one study, and
more than 50% in children under two years old.

Chronic fluid in the ear and accompanying hearing loss tends to improve spontaneously. A
study shows improvement without treatment in more than 80% of children, with 50%
returning to near normal.

Treatment for allergies or food sensitivities may solve the problem.

Minor delay in speech development due to chronic hearing impairment is not likely to
have long-term consequences. Some physicians inappropriately warn parents that the
hearing loss will lead to learning disabilities.

Placement of tubes causes permanent scarring of the eardrums in about half of patients.

Serious complications, such as meningitis or brain abscess, are rare, and the operation does
not apparently reduce such complications. A Scottish study found that in the twenty years
between 1966 and 1986, these complications remained stable, even though the frequency
of the ear tube operation increased sixty-fold.

Children spontaneously outgrow chronic ear problems, usually by about age seven. The
adenoids naturally reduce in size, and as the skull becomes longer and higher with normal
growth, the eustachian tube becomes more vertical and drains more easily.

The immediate benefit of the surgery is immediate improvement of hearing and reduction
of pain. To a child with fluid in the ears, a normal conversational voice sounds like a soft
whisper. To compensate, the child amy turn up the television sound unusually high, or
may not hear the teacher well in school. Sometimes the parents think the child is ignoring
them. A few weeks after the operation the hearing usually returns to normal. The tubes
also relieve the main cause of painpressure in the middle ear. Many ear specialists
recommend surgery if an ear infection persists for more than thirty days, but others wait
six months in most cases, with medical supervision, until it is clear that hearing
impairment is continuing.
The dangers of surgery are those inherent in general anesthesia. Adverse reactions to
anesthesia affect about one child in three. The most common is simple nausea after
surgery, but reactions are life-threatening in about one child in a thousand. Antibiotic
therapy also has risks. About one patient in ten develop allergies to antibiotics. Bactrim, an
antibiotic commonly used to treat ear infections, can produce more than sixty kinds of side
effects. Some, although rare, are potentially fatal.

Conventional medical texts cite reasons for the tube becoming blocked. Many causes have
nothing to do with bacteria, showing why antibiotics may often be inappropriate treatment.
The myringotomy does nothing to remove these underlying causes. See the accompanying
article by Dr. Mary Bove for a review of causes from the perspective of a naturopathic
physician.

Bacterial infection

The most common cause of acute ear infections is an upper respiratory infection that
spreads to the ears. Inflammation from the infection causes the eustachian tube to swell
shut, and traps bacteria in the middle ear cavity. However, no bacteria at all are present in
about a third of acute ear problems, and in more than half the cases of chronic eustachian
tube blockage.

Antibiotics

Inappropriate use of antibiotics may actually cause the problem it is intended to solve.
Over-prescription of antibiotics or prescription of the wrong kind can promote the
development of stubborn resistant strains of bacteria and lead to chronic infection of the
lining of the eustachian tube. An important cause of inappropriate use is also parents
failure to follow prescription instructions. Antibiotics should be given for the full period
on the label, even if symptoms improve before then. Stopping the treatment in mid-course
can promote resistant strains of bacteria.

Allergies and environmental irritations

Allergies or sensitivities to food, dust, pollen, animal hair, or other substances may
cause swelling and lbackage of the eustachian tube. Household cigarette smoke may also
cause problemschildren with one or more smoking parents have significantly higher
incidence of ear infections than children in smoke-free households.

Bottle feeding

Babies who drink out of a bottle while lying on their back may get milk directly into the
eustachian tube. Many studies have also shown that children who are breast fed for the
first year have fewer infections than children who are weaned earlier.

Food sensitivities
 Conventional journals do not in general recognize food sensitivities, but some
physicians routinely screen for milk sensitivity, especially when the history shows that the
problems began immediately after introducing cows milk to the diet. MD allergy
specialists suggest that allergies are responsible for about half the cases of otitis media in
children. Naturopathic physicians condsider food sensitivities as a major cause of otitis
media, and routinely screen for allergies to substances such as milk, wheat, eggs, citrus,
peanut butter, and soy (especially if the baby was fed a soy formula.) Besides screening for
offending foods, naturopathic physicians may treat acute or chronic ear infections with
homeopathic and herbal medicines and nutritional supplements. The rationale is to remove
underlying susceptibility to infection, rather than to fight bacteria directly. See the
accompanying article by Dr. Bove for more details about treatment. By removing the
cause, other related problems such as poor sleep, bad mood, headaches, skin rashes,
digestive upsets, bladder problems in girls, and bed wetting often improve with natural
treatment.

Case 1

Diagnosis: Suppurative otitis media with performation of tympanic membrane and non-
strep pharyngitis.

Patient: Four year old female, 38 inches, 47 lbs., with single mother. Low income status
affects diet.

History: Patient has been sickly most of her life, with frequent colds.

Herbal treatment: Commercial ear drops (hypericum oil and garlic oil with mullein).
Warm the oil, then place two drops in the ear with a cotton plug, four times a day. Tincture
of echinacea (mixture of E. angustifolia and E. purpurea: five drops in back of throat three
times a day, away from meals. Continue for two weeks.

Other treatment: Hydrotherapy for fever reduction (wet sock treatment; cold wet socks
on feet wrapped in warm dry socks or blanket). Counseled to decrease sugar, milk, and
citrus.

Follow up at seven days Ear pain and discharge had resolved three days after treatment
began. The membrane was closed with evidence of scarring; hearing was improved. Sore
throat and runny nose were resolved. Patients energy and appetite were normal.

Follow up at fourteen days No evidence of infection in ear. Tympanic membrane has

scar in midline. Mucous membranes of nose, ear, eyes, throat within normal limits. Ear
drops discontinued. Echinacea discontinued for ten days. Reinforced nutritional guidelines.
Patient to continue with echinacea with 14 days on and ten days off for remainder of the
winter.

Practitioners comments: The patient responded quite well to the infection despite a
compromised immune system, borderline nutritional and environmental support. The
closure of the tympanic membrane and the complete healing of the ear in the short
duration was remarkable.

Case 2

Diagnosis: Bilateral otitis media.

Patient: Fifteen-month-old male. 28 inches, 20 lbs. Middle Eastern culture, parents want
natural treatment.

History: Treatment with a course of antibiotics was ineffective. One ear was red, swollen
and painful, and the other slightly red with increased serous fluid.

Herbal treatment: 2 drops of Lomatium dissectum isolate in office, plus five drops of
echinacea tincture (mixture of E. angustifolia and E. purpurea). Take five drops of
echinacea each two hours during the day only for three days.

Other treatment: 500 mg. Vitamin C. daily. Watch diet.

Follup up at three days Mother called to say patient was almost 100% better. Reduced
dosage of tincture to five drops three times a day.

Follow up at seven days Patient almost completely better. Discontinued echinacea.

Continue with vitamin C. supplement.

Practitioners comments I assume after lack of resolution with antibiotics that the
lomatium/echinacea treatment was the reason for the cure. Strict diet, vitamin C. probably
increased speed of recovery.

Case 3

Diagnosis: Serous otitis media.

Patient: Eleven-month-old boy.

History: Treatment with a course of antibiotics was ineffective. Has recurrent ear
inflammation once a month.

Herbal treatment: Commercial ear drops: (garlic oil, hypericum oil, with mullein.)
Three drops in ear. Child started crying and was extremely irritable. Ear was extremely
red. Discontinued use and gently wiped out the ear canal. Three hours later tried another
dose. Child screamed again. The ear canal again appeared a bright red color. Drops were
permanently discontinued.

Follow up at ten days after a ten-day course of antibiotics, the otitis media had cleared
up.
 Practitioners comments This botanical formula was unsuitable for this patient. I think
the garlic oil in the tincture was simply too irritating to an already inflamed surface and
hypersensitive ear. The next prescription will contain echinadea and/or pokeroot, mullein,
and hypericum oil.

Case Commentaries: Paul Bergner

Case one was included here because it demonstrates a typical successful treatment for
ear infection, using both topical and internal treatment, with some artful nuances.
Warming the ear drops adds to their soothing properties and may make the herbal
components more available to the tissues. Some practitioners smoke mullein and blow the
warm smoke into the ear through a rolled up piece of paper. Its not clear whether mullein
smoke has a medicinal effect, or whether the hot smoke alone is relieving for some
patients. Putting echinacea directly onto a sore throat is soothing for some people. Taking
periodic breaks while taking ehinacea for long periods is also prudent. It is probably best
in the long run to let the natural immune system do its work unaided as much as possible.
Echinacea is an immune stimulant, and, as a rule, what stimulates can exhaust if given for
long periods. Im not aware of any evidence or testimony, either from Eclectic literature or
from modern research, that echinacia is safe to take for indefinitely long periods of time.
Most natural healers would not consider its main noted side effectjoint painto be a
minor one on the scale of possible side effects, ie. It is deep in the system rather than near
the surface. Note how the practitioner integrated herbal therapy with lifestyle
modifications. Many cases of otitis media require a modification of the diet for permanent
relief.

In case two, the lomatium isolate is a proprietary product extracted from Lomatium
dissectum, an herb with suspected antiviral properties. L. dissectum is relatively rare, and
has possible skin rash as a side effect. [Ed. Note: wed appreciate correspondence from
anyone observing this or other side effects with Lomatium.] Note the high frequency of the
echinacea dose in the acute phase, reduced to three times a day after the condition is stable.
This same strategy is appropriate for adults. This dose can be arrived at by a rule of thumb
for doing: weight/150 lbs x adult dose. Thus 20/150 x 30 to 40 drops is 4 to 5.3 drops. This
formula can be used for adults of various sizes as well.

Case three was included for the side effect. Garlics energy is extremely heating. Watch
for aggravation in hot conditions. I saw a patient once who took garlic capsules because
she heard they were good for her, and they aggravated a long-dormant case of
rheumatoid arthritis. I think the practitioner here gave up on herbal treatments too soon. I
think the suggestion of putting poke root in the next formula is probably not appropriate
for a child this age.

Commentary: Sharol Tilgner

In case one, putting echinacea directly on an inflamed sore throat is soothing to some
patients, but irritating to others. It may be the alcohol that is irritating.
 In case two, it is possible that herb worked where antibiotics failed because there was a
viral or fungal infection in the ear. Antibiotics are only effective against bacterial
infections, whereas immune-stimulating herbs will increase resistance to any kind of
infection.

In case three, I wonder whether glycerine was used in the formula. Glycerine can cause an
initial irritation. This effect is followed by an antiseptic and emollient action.
Copyright 2001 Paul Bergner

http://medherb.com/Therapeutics/Pediatrics_-_Chronic_childhood_ear_infections.htm#_VPID_90