 Chiropractic and Children
Chiropractic is safe and gentle especially for
Babies
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It
is wise to consider what chiropractic care can offer your baby or child.
Babies and children grow quickly, and their muscles, ligaments and
bones develop rapidly. Because of this, they may particularly benefit
from a drugless, painless and surgically free approach to good health.
The goal of chiropractic is to help allow the body to best function
and repair itself. Here are a few of the ways this practical care may
be helpful to your child.
It's an incredible fact that 40-50 pounds of pressure are exerted on
the infant's neck during the birth process. The baby's head is forced
to rotate
by 90 degrees while contractions squeeze their small frame.1 this stress,
combined with the weight of the baby's head, puts considerable pressure
on the neck, spine, nerves and muscles.2
Such trauma may contribute to several painful conditions often found in
babies.3 Symptoms can begin in the first days or months of an infant's
life and may plague a child throughout the early years. Early detection
of any distress may be beneficial. Chiropractic is extremely safe for especially
infants the amount of pressure applied to the child’s body is typically
a mere 1 to 2 ounces compared to the 40-50 pounds of pressure during delivery.
With the baby the adjustments are very slow and gentle.
Fortunately, your doctor of chiropractic may offer help for your baby
- and peace of mind for you.
Dr. Carlson has adjusted hundreds of babies and children as well as both
of his boys Caiden and Cameron. His children live the chiropractic lifestyle
of seeking
health through preventative measures through chiropractic care and nutrition.
Dr. Carlson specializes in pediatric care as well as developmental disorders.
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.
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
TODAY'S CHILDREN,
TOMORROW'S LEADERS!
Chiropractic: Kids and chiropractic
by Deb Donovan and Bob VanMetter
 An article in The New England Journal of Medicine stated that over 20
million babies and children visit a chiropractor each year (1988). It
is very likely that these numbers have already increased and will continue
to grow as more families are becoming interested in allowing the body
to heal on its own, through restoration of proper function.
It is commonly believed that a lack of symptoms implies that a child
is well. Actually a child is ill before becoming symptomatic. Absence
of symptoms does not imply wellness. An infection is opportunistic. When
the child is ill, it is easy for an organism to produce an infection
within his body.
When a medication or even a "natural" remedy is used, it merely "gets
you over the hump," but does not restore normal function to the
body. An antibiotic will kill the offending organism. But an antibiotic
will not restore wellness to the individual. Medication can cover the
symptoms -- hiding the fact that the immune system is depressed. Chiropractic
restores normal function, allowing the body to fight infection on its
own -- to heal itself.
CHIROPRACTIC AND INFANTS
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 As a concerned parent, you no doubt want to do everything possible
to ensure your children are as healthy as they can be. Many factors
contribute to your children's overall health, proper nutrition, rest,
exercise, love and chiropractic. Chiropractic is the vital link that
enables the growth, healing, and function of every tissue and organ
in the body. Chiropractors are concerned with small misalignments of
the spinal bones that damage the nervous system, called vertebral subluxations.
Subluxations cause interference to the delicate nerve system by decreasing
function and the body’s feedback from the spinal cord to the
brain. In addition, subluxations may cause direct insult to the spinal
cord itself. Your nerve system is responsible for coordinating and
controlling everything the body does including growth, repair and healing
of your entire body. Therefore subluxations should be corrected as
soon as possible. Subluxations also interfere with internal organ functions.
The results may be as simple as the inability to produce the proper
quantity and quality of chemicals. Chemicals naturally produced within
your child's body are responsible for functions as basic as raising
and lowering body temperature. Subluxations not only affect your children's
level of health but also their overall level of performance. Everything
from the ability to laugh, learn, develop coordination, digest food,
grow, hear and see is controlled by the nervous system and can be affected
by vertebral subluxations.
Bad News. Vertebral subluxations are common in children. The spine,
that surrounds and protects the spinal cord and nerve roots, is very
delicate. It has been estimated that the neck may be stretched twice
the normal length during birth. In addition, during the pushing stage
of labor, the spine may be misaligned as the baby is compressed and
pushed down the birth canal. If the young child is not subluxated
at birth, surely he or she will be when they are learning to stand and
walk. Children may fall twenty times a day, constantly introducing
forces into their small spines. They fall out of bed, off the couch,
off their bicycles, while roller-blading, running and playing. Possibly
doing damage that should have been corrected. It is sad to think
of
the millions of children that have vertebral subluxations. For some
subluxations may cause permanent damage to the nerve system and the
tissues it supplies. Then their health and potential has been reduced
to a level from which it may never rise. The sooner the nerve system
is allowed to function properly, the sooner health and life can be
restored.
GOOD NEWS! Vertebral subluxations can be corrected! Chiropractors are
trained to correct subluxations by means of a chiropractic adjustment.
This gives you and your children the opportunity to maximize and enhance
your health throughout life. Chiropractors can help everyone from newborns
to the elderly. Regardless of their age, everyone benefits from
Chiropractic care!
"Interference to the nervous system
results in permanent damage within a short period of time,
therefore chiropractic care should begin at birth."
Dr. Arpad DeNagy
The Rockefeller Institute
Chiropractic and Bedwetting
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Several recent studies have shown the benefits of chiropractic care
for children suffering from "Nocturnal Enuresis" more commonly
known as bedwetting. Several studies published in the Journal of Manipulative
and Physiological Therapeutics showed marked improvement in children
with this problem over children who did not receive chiropractic care.
In one study 171 children suffering with enuresis averaged 7 nights
of bed wetting per week prior to the study. After the children were
given
some initial chiropractic care the average child reduced the number of "wet" nights
to 4 nights per week. A full 25% of the children receiving chiropractic
showed a 50% reduction in wet nights. In addition, only 1% of the children
were considered "dry" prior to the study and prior to receiving
chiropractic care. After the study 15% of the children were then considered "dry".
In another study, 46 primary enuretic children were studied. Of this
group 31 were placed under chiropractic care while 15 were in the control
group and did not receive any chiropractic care. The results of this
study showed a 17.9% decrease in wet nights for the chiropractic group.
Over the same period of time no change was noted for the control group
who did not receive any chiropractic care.
Amazingly, improvement in some of the studies was shown to be immediate
after the first adjustment and remain stable thereafter.
SIDS and Chiropractic
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by Deb Donovan and Bob VanMetter
( ivillage.com)
Sudden infant death syndrome, or SIDS, is the sudden, unexpected and
unexplained death of a baby under one year of age. It is the most common
cause of infant death in developed countries, and affects close to 7,000
babies each year in the United States alone. The incidence of SIDS peaks
at two to four months, with 95 percent of the cases occurring prior to
the time a baby is six months old.
Researchers believe that many factors may combine to cause SIDS. A
traumatic event occurring before and during a baby's birth may increase
his risk
of SIDS. Many infants autopsied have had an immature or a damaged brain
stem. Spinal cord hemorrhage has often been found to be the principal
lesion. This can be a very mild trauma, often escaping notice of those
performing the autopsies.
Research clearly points to a reduction in deaths from SIDS when a baby
is placed on his side or his back to go to sleep. But, interestingly
enough, it has never been established why these reductions in deaths
occur with a change in sleeping position. It is no accident that the
incidence of SIDS has declined with this recommendation. It is quite
clear, chiropractically, that putting an infant to sleep on his side
or back is a less stressed position for any spine, especially one that
is already compromised.
References:
•
Towbin A, Spinal injury related to the syndrome of sudden death ("crib-death")
in infants. Am J Clin Pathol 1968; 49(4); 562-7
•
David Yashon, MD , FACS, FRCS "Spinal Injury" Second Edition,
1986; Chapter 18:346,348
• Byers RK, Spinal-cord injuries during birth. Dev Med Child Neurol 1975;
17(1)103-10
• Norman MC, Wedderburn LC, Fetal spinal cord injury with cephalic delivery.
Obstet Gynecol 1973; 42(3):355-8
• Walter CE, Tedeschi LG, Spinal injury and neonatal death. Report of six
cases. Am J Obstet Gynecol 1970; 106(2):272-8
•
Harris LS, Adelson L, "Spinal injury" and sudden infant death.
A second look. Am J Clin Pathol 1969; 52(3):289-95
Chiropractic & Colic
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Almost all infants develop periods of fussiness.
This is often referred to as colic. It has been defined as periods
of irritability, fussiness
and inconsolable crying in a healthy baby (which lasts for at least
3 hours a day, at least 3 days a week).
Problems in areas other than the gastrointestinal tract can be improperly
diagnosed as colic. If a baby is crying inconsolably, it is very
difficult to know if he or she is actually suffering from a digestive
disturbance.
Since many subluxations (spinal bone misalignments that compromise
the nervous system) in infants are in the upper cervical area,
there is a
strong possibility, especially when there has been a history of
birth trauma, that these babies are suffering from head and neck pain
due
to spinal subluxations in this area. In a study looking at babies
receiving chiropractic care for colic, 94% saw improvement in their
baby's behavior
within 2 weeks of initiation of care. A little over half of these
babies had already been unsuccessfully treated, usually by pharmacological
means
(Klougart et al., 1989). Another study found 91% of babies experienced
a reduction in colicky behavior following as little as two chiropractic
adjustments (Nilsson, 1985).
Despite these results, don't be confused. Chiropractic is by no
means a treatment for colic. The goal of the Chiropractor is
to correct
vertebral subluxations that damage the nervous system and prevent
the body from
functioning properly. If a child's body is compromised, functioning
at less than perfect, due to a vertebral subluxation, then when
the subluxation
is corrected and the body functions better, the above mentioned
results are not surprising. Regardless of how your baby looks,
acts or feels,
vertebral subluxations ALWAYS do damage. Have your children checked
for vertebral subluxations today to give them the best chance
to grow up
healthy and strong.
Colic studies
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Colic is defined as the excessive incosolable crying that affects 8%
to 40% of the infant population starting at the second or third weeks
of life. Management focuses on making the appropiate diagnosis, reassuring
the parents, and instituting a conservative manual treatment, such
as adjusting and/or pharmacologic treatment if necessary.
Talmage DM; Resnick D. Infantile colic: Identification and management.
Top Clin Chiropr. 1997; 4(4): 25-9 / Mantis ID: 37795
“
Spinal manipulation is effective in relieving infantile colic,” concluded
researchers. The study enrolled infants who were diagnosed with infantile colic.
For a period of two weeks, half of the subjects underwent chiropractic spinal
manipulation, while the other half received the drug dimethicone. “From
trial day 5 onward the manipulation group did significantly better that the
dimethicone group,” according to the report. Specifically, by the end
of the experiment, crying had plummeted 2.7 hours per day in the chiropractic
group. In contrast, crying had dropped only 1 hour per day in the dimethicone
group. In the course of the 12 days of the study, the children being adjusted
saw a 67% reduction in crying and the drug group saw a 38% reduction in crying.
The mean number of adjustments given during the two-week study was 3.8.
Wiberg JM, Nordsteen J, Nilsson N. The short-term effect of spinal
manipulation in the treatment of infantile colic: a randomized controlled
clinical trial
with a blinded observer. J Manipulative Physiol Ther 1999;22(8):517-22
/ UI: 20008926
This study outlines the chiropractic care of an eleven-month-old male
with severe, complicated, late onset infantile colic. The infant had
been unable
to consume solid foods for a period of four months, and suffered from
severe constipation. In addition, this subject demonstrated extreme muscular
weakness
and lack of coordination The baby was unable to crawl, stand, or walk,
and was greatly unresponsive to his surroundings. Results: Immediate
improvements in muscle strength, coordination, responsiveness, and ability
to consume
solid foods without vomiting.
Killinger LZ; Azad, A. Chiropractic care of infantile colic: A case
study J Clin Chiro Peds 1998; 3(1) :203-6 / Mantis ID: 39686
This case study details the chiropractic management of a three-month-old
male with a medical diagnosis of colic who also exhibited projectile
vomiting. Complete
resolution of all symptoms was achieved within a 2-week treatment
period. Care consisted of chiropractic spinal adjustments and craniosacral
therapy.
Van Loon M. Colic with projectile vomiting: A case study J Clin Chiro
Peds 1998; 3(1) :207-10 / Mantis ID: 39687
A satisfactory result occurred within 2 weeks in 94% of the cases
receiving chiropractic care. 51% of these infants had prior, unsuccessful
treatment,
usually drug therapy (83%).
Klougart N, Nilsson N, Jacobsen J, Infantile colic treated by chiropractors:
a prospective study of 316 cases. J Manipulative Physiol Ther
1989; 12(4):281-8 / Medline ID: 89361049
A case study of a 3 month old female suffering from colic with
sleep interruption and appetite decrease is presented. Favorable
outcome
was realized with
adjustment of the child's spine. The results were obtained
from direct observation and
involvement of both parents and from interviews at each treatment.
Specific Adjustments to T7 and the upper cervical area relieved
symptoms of infantile
colic in a relatively short period of time. The patient received
three adjustments with approximately a two week period of time
in between
adjustments.
Pluhar GR; Schobert PD; Vertebral subluxation and colic: A
case study. J Chiro Research and Clin Invest 1991; 7(3):75-6
/ Mantis
ID: 13429
In a retrospective uncontrolled questionnaire study of 132
infants colic, 91% of the parents reported an improvement,
which occurred
after an average
of
two to three manipulations, and one week after the treatment
started.
Nilsson N; Infant Colic And Chiropractic. Eur J Chiropr 1985;
33(4): 264-265 / Mantis ID: 12365
" Subluxation alone is a rational reason for chiropractic care throughout
a lifetime."
Dr. Lee Hadley, M.D.
Posture
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 Signs to watch for include posture signals such as:4
•
tilting the head
•
neck sensitivity
•
inability to lie on their back
•
crying when moved out of their favorite sleeping position
•
difficulty in breast feeding
•
limited motion (perhaps with a leg or an arm)
•
a bent body position
•
Unusual differences in the appearance of one side of the body from the
other (such as one hip being higher)
Swelling, pain or constant crying and irritability are also signs of
distress that should be evaluated, along with any unusual problems with
eating, sleeping or playing.
Because babies and children are less able to tell you exactly what hurts,
you may find your chiropractic's skills especially welcome in being able
to access your child's overall health and physical structure. As a trained
professional with a minimum of seven years of college study, your practitioner
of chiropractic can offer sensitive, professional diagnosis and skilled,
safe care as warranted.
In addition to possible musculoskeletal disorders such as restricted
motion or postural problems, there is growing evidence to suggest that
your chiropractor's special skills may also be helpful when evaluating
the following condition.
Scoliosis
 Everyone's spine has natural curves. These curves round our shoulders
and make our lower back curve slightly inward. But some people have spines
that also curve from side to side. This condition is called "scoliosis".
Scoliosis affects one in nine young women and approximately four percent
of the total population. It is the most deforming orthopedic problem
confronting children, affecting them during their active growth phase
and essentially subsiding upon completion of spinal growth, leaving the
child with a permanent deformity.
Early detection and treatment can be effective in halting or slowing
its progress and in many cases result in improvement.
How a Child's Spine Develops
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At birth, a child's spine is a single curve, shaped like a C; the newborn
lacks the strength to hold up his or her head. At about six months, neck
muscles develop and help the infant hold up his head. At about nine months,
the lower back curves, the muscles in the lumbar area develop and the
child learns to crawl and stand. The child now has the strength and balance
to walk and run. Like an adult, the child now has three natural curves
in the spine to support the body.
As they learn to walk and run, children fall, and can suffer strains
and sprains as a result. Detecting these problems at a young age is critical
for the proper development of your child’s spine. Many postural
problems and back pains we experience as adults frequently are traced
back to falls as children or a traumatic childbirth. Having your child’s
spine checked by a chiropractor at a young age is important for proper
development of the bones of the spine.
Ear infections, bed-wetting, hyperactivity, chronic colds and other
health problems may be the result of nervous system interference or malfunction
caused by spine-related problems. Appropriate chiropractic care can
help
to restore normal spinal and nervous system function. When the nervous
system is functioning properly, chiropractors discover that many health
problems resolve themselves.
How You Can Help
• Provide a firm bed.
• Insure your child has a well-balanced diet.
• Teach your child not to slouch.
• Use an approved car seat that supports your child's head and neck.
• When lifting a baby, always support the back and neck with your hands.
Pick up an older child by grasping his body under the arms.
•
Don’t put young children in walkers prior to the child learning
how to walk on their own. This could put pressure on the lower vertebra
of the spine and cause a fracture if the spine is not ready for the force
of gravity.
•
Avoid the devices that allow a young child to bounce in a seat (the units
that attach to an entryway). This may also cause a fracture of the spine
if the child’s spine is not properly developed.
• Discourage friends from throwing your child in the air as this can cause
a whiplash injury to the neck.
And of course, schedule a regular spinal check-up with a chiropractor
to ensure that your child's spine is developing properly and the nervous
system is functioning at its full potential!!
Fever in Children - A Blessing in Disguise
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By Linda B. White and Sunny
Mavor
Originally printed in Mothering Magazine
Excerpted from Kids, Herbs, and
Health: A Parents' Guide to Natural Remedies by Linda B. White, MD, and
Sunny Mavor, AHG, $21.95, with permission
from Interweave Press, 1999.
Fever is not a disease but rather a symptom of an illness.
• Childhood fevers frighten grownups.
• Fever is maligned and misunderstood.
• Controversy surrounding the management of fever causes anxiety for parents,
because they are not completely sure what to do when their child has
one.
It may help parents to remember that fever is only one part of the
picture of an illness. In fact, for children under eight years of age,
and especially
for infants, the severity of a fever is an unreliable indicator of
the severity of the child's illness.
For example, infants and toddlers can be very sick with a low or even
subnormal temperature. Conversely, children three to eight years old
can be running about quite cheerfully with a fairly impressive fever.
The important thing is how your child is acting, not the thermometer
reading.
Defining Fever
First, let's define normal body temperature. Most people say 98.6ºF
(37ºC) is normal, but this doesn't account for individual variations
or the fact that kids tend to run slightly hotter than adults. You can
think of anything between 97º and 99.4ºF (36º and 37.4ºC)
as normal.
Consumption of hot food, recent exercise, overbundling, hot weather,
or an overheated room can drive body temperature up a degree or two.
Body temperature also varies during the course of the day, and, with
teenaged girls, the menstrual cycle.
Fevers usually hit their highest point in the late afternoon.
Conversely, kids often have their lowest temperature of the day early
in the morning. So don't panic at 4 p.m. when your child's fever rises
slightly; this does not necessarily forebode a raging fever. On the
other hand, if your child has a low-grade fever upon awakening, you
may want
to keep him home.
How Fever Happens
Infections most commonly launch fever, especially in children. Other
triggers include transfusion reactions, juvenile rheumatoid arthritis,
tumors, inflammatory reactions caused by trauma, medications (including
some antihistamines, antibiotics, or an overdose of aspirin), immunizations,
and dehydration.
Most physicians do not believe that teething directly causes significant
fever, but we have seen it happen.
When infectious "bugs" stimulate white blood cells in a specific
way, they release a substance called endogenous pyrogen, which signals
the brain's hypothalamus to raise the body's thermostat setting. In turn,
the body heats up by increasing its metabolic rate, shivering, or seeking
warm environments.
It also minimizes heat loss by restricting blood flow to the skin,
giving it a pale appearance. Once body temperature rises, the skin
flushes and
sweats. A fever sufferer may lose appetite and feel lethargic, achy,
and sleepy. When these phenomena happen to our children, we just tuck
them into bed and let them sleep.
A basic fever, one due to minor bacterial or viral illness, can be
an expression of the immune system working at its best. Given that
most
animals (vertebrates anyway) mount a fever in response to illness,
it's likely that humans have preserved this evolutionary response because
it improves survival. Some research supports this theory; animal studies
show when fever is blocked, survival rates from infection decline.
Fever increases the amount of interferon (a natural antiviral and anticancer
substance) in the blood. A mild fever also increases the white blood
cells that kill cells infected with viruses, fungi, and cancer, and
improves the ability of certain white blood cells to destroy bacteria
and infected
cells. Fever also impairs the replication of many bacteria and viruses.
Bottom line: A moderate fever is a friend, but not one you want to
spend a lot of time with. So it makes sense to avoid suppressing moderate
fevers
with drugs, while continuing to monitor your child for dramatic increases
in temperature and worsening of any other of his symptoms.
Can Fever Do Harm?
Any time body temperature increases, salt and water are lost via sweating,
and stores of energy and vitamins, especially the water-soluble ones,
are burned up. During moderate fevers, we can compensate for these
losses by drinking appropriate fluids, ingesting nutritious foods,
or taking
vitamin supplements.
Replacing water-soluble vitamins (chiefly C and Bs) makes sense. However,
during fevers, the body makes some minerals unavailable for a good
reason - bacteria need them to thrive. In terms of energy stores, our
bodies
switch from burning glucose (the favorite meal of bacteria) to burning
protein and fat.
This means a few days of poor appetite is probably adaptive. In other
words, don't cajole or coerce your children into eating during fevers
if they don't feel hungry; they will likely regain any lost weight
quickly after the illness ends. You do, however, need to encourage
fluids, because
dehydration alone can drive up fever.
Very high fevers - those above 106°F (41°C) - can harm the heart
and brain. Some authorities, however, say that fever is unlikely to cause
brain damage in a previously healthy child. During most infections, the
brain keeps body temperature at or below 104°F (40°C). So in
most - not all - cases, you don't need to be afraid that your child's
temperature is going to continue to rise above that point.
What About Febrile Seizures?
First, let's define them. These abnormal jerking movements occur in
children between the ages of three months and five years in association
with a
fever, but without evidence of infection of the nervous system. The
seizure lasts no longer than 15 minutes (usually five minutes or less)
and causes
twitching all over. About 3 percent of kids get febrile seizures.
The reason some children have this susceptibility isn't well understood.
Of those kids who have a first-time febrile seizure, about one-third
have a recurrence. Risks for recurrence go up with younger age at the
first seizure (16 months old or less) and a family history of febrile
seizures.
Frightening as these seizures are for parents, they're benign; once
they pass, the child continues to develop normally. Often pediatricians
can
help parents learn to block high temperatures by giving ibuprofen or
acetaminophen when fevers start. For the few children who have recurrent
febrile seizures, anticonvulsants or sedatives may be used.
What to Do If Your Child Has a Febrile Seizure
Try to stay calm. That's a tall order, but your child needs you to
be collected. Take a deep breath. Let it out. Tell yourself that the
seizure
will not last long (although it may seem like forever) and that your
child will likely be fine afterward.
Look at your watch to time the length of the seizure. This sounds like
a big demand, given the anxiety a parent naturally feels. However,
you will otherwise overestimate the time, and the duration of the seizure
is important information for the doctor. If it exceeds five minutes,
call 911.
• Turn your child on his side. This reduces his risk of gagging on or inhaling
secretions.
• Make sure the immediate environment is safe. Remove objects your child
might hit.
• Do not restrain your child.
After the seizure is over, comfort and reassure your child, then call
your doctor for an immediate appointment. He or she will want to evaluate
your child for any abnormalities (other than fever) that may have triggered
the seizure. If the seizure lasted longer than five minutes and/or
your child seems to be very sick, your physician may tell you to go to the
emergency room right away.
Over-the-Counter Medications for Fevers
It makes sense to us that if fever helps defend against infection,
giving fever-reducing medications may make things worse. In addition,
some fever
medications can have undesirable side effects. On the other hand, no
one likes to watch a child suffer. And fever can deplete a child's
energy. Here's a profile of over-the-counter medicines for reducing
fever and
discomfort.
Acetaminophen reduces fever and pain but not inflammation. Follow the
package instructions. Because of the risk of liver damage, do not dose
more frequently than every four to six hours or for more than five
consecutive days. There is no need to awaken your child to give her
a dose; sleep
will do far more good.
Ibuprofen (Children's Motrin, Pediaprofen, Advil) reduces fever, pain,
and inflammation. Follow the package instructions. Do not give more
often than every six hours unless your physician advises otherwise.
This medicine
can cause stomach upset.
Aspirin reduces fever, pain, and inflammation, but pediatricians rarely
recommend it.
Use of aspirin in children during viral illness has been linked to
Reye's syndrome, a disease characterized by severe liver dysfunction
and brain
swelling. Symptoms include effortless and repeated vomiting, then a
change in the level of consciousness (lethargy, stupor, combative behavior,
delirium, seizures, coma).
No one knows what the cause of Reye's is, but it seems to be linked
with aspirin use during viral illnesses. For this reason, authorities
have
recommended that children under 21 years with symptoms of viral respiratory
illness or chickenpox do not take aspirin. Sometimes herpes outbreaks
and viral gastroenteritis (marked by vomiting and/or diarrhea) are
included in the list of illnesses during which aspirin must be avoided.
Unfortunately, it is often difficult to be certain of the cause of
an illness when it starts. Aspirin is a component of many cold and
flu over-the-counter
medications, so avoiding it requires careful label reading on your
part.
Medications for fever can act as a screen. Here are some pros and cons
to giving your child over-the-counter medication to ease a fever.
Medication such as acetaminophen can help sort out whether your child
feels miserable because of a fever or because of an infection. Some
physicians use a trial of acetaminophen as a screen. If, after the
drug kicks in,
the child looks and acts better, it is less likely that he has a fever
or that his infection is a serious one.
Fever medications can make your child feel better. He may be more likely
to drink fluids, nibble food, and sleep. All can help him recover.
Fever medications can mask symptoms. In other words, your child acts
as though his health has improved, but it really hasn't.
Fever medications may actually prolong the illness. This opinion of
some practitioners is backed by a few studies. Assuming the response
of the
body to illness (fever, inflammation, sleepiness) is adaptive, it seems
reasonable to assume that interfering with the process may do more
harm than good. The following are some examples that support this theory.
• A study of adults with colds found that aspirin and acetaminophen suppressed
production of antibodies and increased cold symptoms, with a trend toward
longer infectiousness.
• In a study of children with chickenpox, acetaminophen prolonged itching
and the time to scabbing compared to placebo treatment.
• In test-tube studies, therapeutic levels of aspirin suppressed the ability
of human white blood cells to destroy bacteria. Acetaminophen did not
have this effect. Another study found that a host of pain relievers,
including aspirin and ibuprofen, inhibited white-cell production of antibodies
by up to 50 percent.
The bottom line. Use these medicines sparingly when your child is in
pain or suffers discomfort from a fever over 102°F (38.8°C).
Ask yourself whether you are administering the fever-reducing medicine
to make your child more comfortable or to decrease your own anxiety.
Nondrug approaches can go a long way toward helping your child feel
better. If the situation does not seem urgent, you might want to consider
a trial
of herbal treatment before you pull out the acetaminophen.
Home Management of Fevers
Do give your child lots to drink. Fever increases fluid loss, and dehydration
can drive up your child's temperature. Kids with fever often do not
feel thirsty, or by the time they do, they're already dehydrated. So
keep
offering fluids.
Small, frequent sips are often best, especially if the child feels
nauseated. If necessary, use a plastic medicine dropper to gently insert
water into
your child's mouth. The type that holds several ounces is best to use.
Dress lightly or bundle? The answer depends on your children's perception
of temperature - follow her cues. If your child looks pale, shivers,
or complains of feeling chilled (things that tend to happen in the
early stages of fever), bundle her in breathable fabrics so that sweat
will
evaporate, but make sure she can easily remove the layers. If she is
comfortable and her fever is low, dress her snuggly and give warm liquids
to assist the body's fever production. If she sweats and complains
of heat, dress her lightly and let her throw off the covers. Older
kids
will take care of these needs themselves.
Don't push food. People with fevers generally don't have much appetite.
Let your child determine when and what she eats. Just bear in mind
that consumption of sugary foods could delay the natural immune response.
Call your local Chiropractor. The job of the chiropractor is to assist
the body's own inner healing mechanisms. Through gently adjustments
to the spine and the nervous system the immune system is boosted into
response.
Typically the fever is lowered to a more manageable level and the body
is able to fight off the infection on its own naturally.
Finally, Fewer Antibiotics for Children
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to top
Young children are being prescribed
fewer antibiotics than they were in 1995, a decrease that is in line
with recent public health messages
urging doctors to tone down their use of antibiotic prescriptions.
In 1995, close to 1,200 antibiotic prescriptions were written per
1,000 children, however in 1999 the number had declined some 41 percent
to
about 700 prescriptions per 1,000 children, according to a study of
children aged 4 years and younger.
Overuse, and frequent misuse, of antibiotics to treat ailments such
as the cold and flu, has allowed many bacteria to become resistant
to the
drugs, rendering the illnesses harder to treat.
In response to the increasing problem of antibiotic resistance, organizations
including the U.S. Centers for Disease Control and Prevention (CDC)
and the American Academy of Pediatrics published guidelines for the
appropriate
use of antibiotics. Other campaigns, targeting both doctors and parents,
were also launched.
The recent study, which investigated the effect of these campaigns
on antibiotic prescribing using data from 1993 to 1999, concluded that
the
campaigns are indeed making a difference.
Of the antibiotic prescriptions included in the study, close to half
were intended to treat otitis media (middle ear infections). Upper
respiratory infections, pharyngitis (throat inflammation), bronchitis
and sinusitis
also accounted for a large number of the antibiotic prescriptions.
Antibiotics were prescribed for upper respiratory infections even though
the drugs
are often ineffective against such illnesses, researchers said.
Data indicated that antibiotic prescriptions for middle ear infections
and upper respiratory infections both decreased during the study period,
which, researchers say, accounted for a large portion of overall reduction.
Decreasing antibiotic use may stop antibiotic resistance from spreading
in the short-term and may decrease resistance in the future, researchers
noted.
Pediatric Infectious Disease Journal December 2002;21:1023-1028
Antibiotics
linked to asthma, allergies in babies
Back
to top
For years, M.D.s have been warned not to indiscriminately give antibiotics
to patients, especially children. Many refuse to heed the warnings
and the result has been the creation of “super-bacteria” which
are resistant to antibiotics, and a deterioration of human immune systems.
Now, a study conducted at Henry Ford Hospital in Detroit adds more
bad news: Children who receive antibiotics within the first six months
of life increase their risk of developing by age seven allergies to
pets, ragweed, grass and dust mites and asthma.
The problem is a serious one, since nearly half of all children receive
antibiotics before they reach their seventh birthday – making them
two-and-a-half times as likely to have asthma, and one-and-a-half times
as likely to have allergies.
Researchers also found that if a child is breast-feeding, the mother’s
history of allergies adds to the risks of allergy for a child taking
antibiotics.
The study’s findings are believed to be the first of its kind in
the United States to find a link between antibiotics and allergies and
asthma in children.
Christine Cole Johnson, Ph.D., the study’s lead author and senior
research epidemiologist for Henry Ford’s Department of Biostatistics & Research
Epidemiology, presented the study at the European Respiratory Society’s
annual conference in Vienna.
Although she stopped short of suggesting that children not be given the
drug, she noted that “I believe we need to be more prudent in prescribing
them for children at such an early age. In the past, many of them were
prescribed unnecessarily, especially for viral infections like colds
and the flu when they would have no effect anyway.”
Dr. Johnson theorizes that use of antibiotics may affect the gastrointestinal
tract and alter the development of a child’s immune system.
The increasing use of antibiotics in children from 1977 to the early
1990s led to what federal health officials called a public health crisis
in antibiotic resistance. A national campaign commissioned by the U.S.
Centers for Disease Control and Prevention has sought to promote a more
judicious approach for prescribing antibiotics for children.
For the Henry Ford study, researchers followed 448 children from birth
to seven years. The children were evenly divided by gender.
Data was collected before the birth and at the first four birthdays until
the children were six and seven years old, when they underwent a clinical
evaluation by a board-certified allergist. The data included information
about all prescribed oral antibiotics; blood tests that measure the antibody
(immunoglobulin E) that causes allergies; and skin reaction tests that
show whether a person is hypersensitive to an allergen. Researchers also
collected data on all clinical visits and made home visits to collect
environmental samples.
Of the 448 children, 49% had received antibiotics in the first six months
of life. The most common antibiotic category prescribed was penicillin.
Among the findings…
By age seven, children given at least one antibiotic in the first six
months were 1.5 times more likely to develop allergies and 2.5 times
more likely to develop asthma than those who did not receive antibiotics.
Those who lived with fewer than two pets, were 1.7 times more likely
to develop allergies, and three times more likely to develop asthma.
And those whose mother had a history of allergies, were nearly twice
as likely to develop allergies.
SOURCE: Media Advisory, Henry Ford Health System, Sept. 30, 2003.
Chiropractic & Ear Infections
Back
to top
 Ear
infections (otitis media) are the most common cause of pediatric visits,
and subsequent antibiotic use during the first two years of a child's
life. In the US, the cost of the medical and surgical treatment of otitis
has been estimated to be between $3 billion and $4 billion annually.
According to medical doctors, Otitis media is a complication of the
common cold, sinusitis, or a sore throat, developing once normal resistance
to infection has been lost. Just as mental or emotional stress impairs
the immune function, physical stress on the central nervous system lowers
our resistance to disease.
Antibiotics have been shown to increase the risk of having more ear infections
It has been found that 93% of all episodes of otitis media treated
improved with chiropractic care. 75% of the cases improved in 10 days
or less, and 43% with only one or two adjustment (Froehle, 1996).
Chiropractic is by no means a treatment for ear infections or a substitute
for medical care. Chiropractors correct vertebral subluxations that damage
the nervous system and prevent the body from functioning properly. When the
damaging subluxation is corrected, and the body functions better, the above
mentioned results are not surprising. Regardless of how your child looks, acts
or feels, vertebral subluxations ALWAYS do damage. Have your children checked
for vertebral subluxations today to give them the chance they deserve to grow
up healthy and strong!
Otitis Media in Young Children
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to top
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]
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
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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
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1985; 10(1):37-46 / Medline ID: 86084756
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1985; 9(3):219-25 / Medline ID: 86032732
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Otol 1971; 85
Research on ear infections and chiropractic
Back
to top
 Chiropractic
has been shown to help with ear infections
Peer Reviewed Journals:
1) Chiropractic RX for Chronic Otitis Media With Effusion David Eisenberg,
MD This work is in progress under a grant from the Consortial Center for Chiropractic
Research and the National Institutes of Health (NIH) National Center for Complementary
and Alternative Medicine (NCCAM)
• The aim of the proposal is to examine whether chiropractic treatment
will reduce the likelihood of the persistence of effusion in children with otitis
media with effusion (OME) when compared to usual care.
• The innervation of the tensor veli palatini (tvp) muscle is through the
motor fibers of the mandibular branch of the trigeminal nerve. These fibers unite
to form portions of the superior cervical ganglion located between the C-1 and
C-4 nerve roots. Neurological compromise of this muscle by osseous or soft tissue
structures may contribute to the malfunction of the tvp muscle causing inadequate
patency of the tube resulting in the pathological response of OME. Chiropractic
therapy may improve the function of the TVP.
4) Ear Infection: A Retrospective Study Examining Improvement from Chiropractic
Care and analyzing influencing factors. Froehle RM J Manipulative Physiol Ther
1996 (Mar-Apr); 19 (3): 169-177
• This was a study of forty-six children aged 5 years and under in a private
practice in a Minneapolis suburb. All care was done by a single chiropractor,
who adjusted the subluxations found and paid particular attention to the cervical
vertebrae and occiput. Sacral Occipital Technique-style pelvic blocking and the
doctor's own modified applied kinesiology were also used. Typical care was three
adjustments per week for one week, then two adjustments per week for one week,
then one adjustment per week. Interestingly, children with a history of past
antibiotic use was associated with a less favorable outcome. From the abstract: "93%
of all episodes improved, 75% in 10 days or fewer and 43% with only one or two
treatments. Young age, no history of antibiotic use, initial episode (vs. recurrent)
and designation of an episode as discomfort rather than ear infection were factors
associated with improvement with the fewest treatments. Improvement was based
on parental decision (they stated that the child had no fever, no signs of ear
pain, and was totally asymptomatic), and/or the child seemed to be asymptomatic
to the treating DC and/or the parent stated that the child's MD judged the child
to be improved.
5) Allergy airway disease and otitis media in children. Todd NW, Feldman
CM, Int J Pediatr Otorhinolaryngol 1985 (Oct); 10 (1): 27-35
• 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 negative
pressure in the middle ear.
6) A feasibility study of chiropractic spinal manipulation versus sham
spinal manipulation for chronic otitis media with effusion in children.
Sawyer CE, Evans RL, Boline PD, Branson R, Spicer A. J Manipulative Physiol
Ther 1999 (Jun); 22 (5): 292-298
• A pilot study was undertaken for the purpose of assessing the
feasibility of conducting a full-scale randomized clinical trial investigating
the efficacy of chiropractic spinal manipulative therapy (SMT) for children
with chronic otitis media with effusion.
• Recruitment for a randomized controlled trial is feasible and could be
enhanced by medical collaboration. Patients and parents are able and willing
to participate in a study comparing active SMT and placebo SMT. Parents were
extremely compliant with the daily diaries, suggesting that similar quality-of-life
and functional status measures can be successfully used in a larger trial. We
found the objective outcomes assessment involving tympanometry and otoscopy extremely
challenging and should be performed by experienced examiners in future studies.
7) Blocked atlantal nerve syndrome in babies and infants. Gutman G.
Manuelle Medizin (1987) 25: 5-10
• From the abstract: Three case reports are reviewed to illustrate a syndrome
that has so far received far too little attention, which is caused and perpetuated
in babies and infants by blocked nerve impulses at the atlas. Included in the
clinical picture are lowered resistance to infections, especially to ear-,nose-,
and throat infections."
8) Diagnosis and treatment of TMJ, head, neck and asthmatic symptoms
in children. Gillespie BR, Barnes JF, Cranio. 1990 (Oct); 8 (4): 342-349
• From the abstract: "Pathologic strain patterns in the soft tissues
can be a primary cause of headaches, neck aches, throat infections, ear infections,
sinus congestion, and asthma."
9) Structural normalization in infants and children with particular
reference to disturbances of the CNS. Woods RH J Am Osteopath Assoc.
1973 (May); 72 (9): 903-908
• Post-traumatic epilepsy, allergic problems, otitis media and dizziness
have been relieved by cranial manipulation
10) The role of the chiropractic adjustment in the care and treatment
of 332 children with otitis media. Fallon, JM. Journal of Clinical Chiropractic
Pediatrics Vol 2, No. 2 1997 p.167-183.
• From the abstract: This pilot study included children from 27 days old
to five-years-old, was on the effects of chiropractic adjustments on children
with otitis media used tympanography as an objective measure.
• Results: the average number of adjustments administered by types of otitis
media were as follows: acute otitis media (127 children) 4 adjustments; chronic/serous
otitis media (104 children) 5 adjustments; for mixed type of bilateral otitis
media (10 children) 5.3 adjustments; where no otitis was initially detected (74
children) 5.88 adjustments. The number of days it took to normalize the otoscopic
examination was for acute 6.67, chronic/serous 8.57 and mixed 8.3. the number
of days it took to normalize the tympanographic examination was acute: 8.35,
chronic/serous 10.18 and mixed 10.9 days. The overall recurrence rate over a
six month period from initial presentation in the office was for acute 11.02%,
chronic/serous 16.34%, for mixed 30% and for none present 17.56%.
• Conclusion: The results indicate that there is a strong correlation between
the chiropractic adjustment and the resolution of otitis media for the children
in this study. Note: 311 of the 332 had a history of prior antibiotic use. 53.7%
of the children had their first bout of otitis media between the ages of 6 months
and 1 year and a total of 69.9% of the subjects in the study had their first
bout of OM under a year of age. This is consistent with the findings of others
11) Chiropractic correction of congenital muscular torticollis. (Child
also presented with repeated ear infections) Toto BJ. J Manipulative
Physiol Ther 1993 (Oct); 16 (8): 556-559
• A 7-month-old male infant with significant head tilt since birth was
brought to a chiropractic physician for evaluation. The infant's history included
ear infections, facial asymmetry and regurgitation. Significant spasm of the
left sternocleidomastoid and trapezius muscles, a left lateral atlas and suboccipital
joint dysfunctions were present upon examination. A diagnosis of congenital muscular
torticollis was made. INTERVENTION AND OUTCOME: Treatments included chiropractic
manipulation, trigger point therapy, specific stretches, pillow positioning and
exercises. Excellent results were obtained.
• CONCLUSION: Suggests that chiropractic intervention is a viable treatment
option for congenital muscular torticollis. Further studies should be performed
to compare the effectiveness of other treatment options.
12) Correlation between clinical course and otitis media purulenta chronica
and tonicity of autonomic nervous system. Muminov AI, Karimov KhIa, Khakimov
AM, Arifov SS. [Article in Russian] Vestn Otorinolaringol. 1999; (3):
33-34
• The study of the autonomic status of the body in 38 patients with different
forms of chronic purulent otitis media (CPOM) has demonstrated that patients
with exacerbation or complication of CPOM were for the most part sympathotonics
and normotonics. The former had more persistent disease with more frequent recurrences.
13) Infections of the ears, nose and throat. Blood HA. Osteopathic Annals
1978 (Nov): 6 (11): 46-48
Case Studies:
1) The atlas fixation syndrome in the baby and infant. Gutmann G. Manuelle
Medizin 1987 25:5-10, Trans. Peters RE.
• 18-month-old boy, recurring tonsillitis, frequent enteritis, therapy
resistant conjunctivitis, suffered from colds, rhinitis, ear infections and sleep
disturbances. "Immediately after (spinal adjustment) the child demanded
to be put to bed and for the first time slept peace-fully to the next morning.
Previously disturbed appetite normalized completely. Conjunctivitis cleared completely."
2) Chiropractic results with a child with recurring otitis media accompanied
by effusion. Chiropractic Pediatrics, 1996;2:8-10.
• Author's Abstract (Abridged) : A case study of five year old male with
recurring otitis media is reviewed. Chiropractic Biophysics spinal analysis methods
and adjusting procedures were applied over a six month period. During the six
months of adjustments, the child had only one middle ear infection with mild
effusion. In the previous year, the child had recurring middle ear infections
with effusion approximately every three to six weeks.
Note: Newer studies in the effectiveness of antibiotics for middle ear
infections in child are reporting that child treated with antibiotics
are more likely to have recurrences. Antibiotics are known to weaken
resistance to disease and that is probably why children are so affected
by their use.
3) The response of a patient with otitis media to chiropractic care.
Thill L, Curtis J, Magallances S, Neuray P. Life Work, 1995; 3: 23-28.
• Authors' Abstract: This paper discusses the case of a nineteen month
old female with a chronic history of acute episodes of suppurative otitis media.
Treatment consisted of four series of antibiotics over a six month period with
no improvement; antibiotics were stopped and then began a four week course of
intensive chiropractic care, with complete resolution at two weeks.
4) Vertebral subluxation and otitis media: a case study. Phillips, NJ.
Chiropractic: The Journal of Chiropractic Research and Clinical Investigation.
Jul 1992, Vol: 8(2), pp.38-9.
• Author's abstract: This is the case of a 23-month-old female with chronic
otitis media who had orthodox medical treatment with no relief of symptoms. She
had sustained improvement with chiropractic care. A mechanism for the etiology
of chronic otitis media is suggested. From the paper: "Conventional medical
treatment had been administered, including numerous regimens of broad-spectrum
antibiotics. Six months before having been seen, bilateral myringotomies with
tympanostomy tube placement were performed. The tubes were still in place on
presentation." Three days after initial adjustment (at C-1) the patient's
ear drainage and pain were notice-ably reduced. Child was soon free of all symptoms.
5) Chronic otitis media: a case report. Hobbs DA, Rasmussen SA. ACA
J of Chiropractic, Feb 1991; 28:67-68.
• This is a case study of a 38-year-old female. She had previously suffered
from headaches and colitis and they resolved after earlier chiropractic care.
Her hearing loss and chronic otitis media symptoms subsided and hearing was restored
through chiropractic care with an emphasis on cranial adjustments. (Note from
Neurological Fitness Magazine V.1 No.4, July 1992: "Recently, Dr. Peter
Fysh (Proceedings of the National Conference on Chiropractic and Pediatrics (ICA),
1991;37-45 hypothesized that cervical adjustments relieve blockage to lymphatic
drainage from the ears.)
6) Aerotitis Media: A Case Report. Doyle EP, Dreifus LI, Dreifus GL.
Chiropractic Sports Medicine, 1995; 9: 89-93.
• Authors' Abstract: the objective of this report is to determine if spinal
manipulation affects symptoms associated with aerotis media (barotitis), which
commonly affects underwater divers and airplane travels. This study involves
a recreational scuba diver that has a history of eustachian tube blockage that
is exacerbated by diving.
7) From Neurological Fitness Vol. V, No. 2 Jan 1996:
• The 33-year-old male patient presented with a feeling of fullness in
his ears, hearing loss, and tinnitus: these problems were not relieved by a course
of antihistamines (patient had a history of eustachian tube blockage since childhood).
Following Diversified adjusting (primarily C2, C5) audiometry and tympanometry
findings normalized. The patient's subjective complaints were alleviated as well.
8) Chronic ear infections, strep throat, 50% right ear hearing loss,
adenoiditis and asthma. Case history G. Thomas Kovacs, D.C. International
Chiropractic Pediatric Association Newsletter. July 1995.
• 4 1/2 year old female with chronic ear infections, strep throat, (on
and off for 4 years) 50% right ear hearing loss, adenoiditis and asthma. Had
been on antibiotics (Ceclor), developed pneumonia, on bronchodilators and anti-inflammatory
for asthma. Also given steroids. ENT diagnosed child with enlarged adenoids.
Surgery to remove child's adenoids and to put tubes in her ears was scheduled.
Chiropractic history: cervical (C2)and thoracic (T3) and right sacroiliac subluxation.
Numerous enlarged lymph nodes and muscle spasm. Chiropractic care of 2x/week
for 6 weeks scheduled. After 3 or 4 adjustments mother noticed "a changed
child, she has life in her body again...acting like a little girl again for the
first time in 4 years." After 6 weeks, pediatrician and ENT noticed no sign
of ear infection or inflammation, "Her adenoids, which were the worst the
ENT has ever seen, were perfectly normal and healthy. Hearing tests revealed
no hearing loss. Family told M.D.s 'all medication was stopped 6 weeks ago when
chiropractic care started.' Shocked and confused by this answer, the family was
told to continue chiropractic care because it had obviously worked.'"
9) Chronic ear infections The side-effects of the chiropractic adjustment.
Arno Burnier, D.C. Chiropractic PediatricsVol. 1 No. 4 May 1995.
• This is a case history of T & P Roger, males, ages 6 and 9, from
the records of Dr. Arno Burnier of Yardley, PA. Medical Diagnosis: Chronic ear
infections. Medication: Multiple course of Ceclor antibiotic, Nebulizer. Chiropractic
result: Both children have been free of medication and over-the-counter drugs
for the past three years since the onset of care. Presenting Vertebral Subluxation:
Tim C2, C3, D12/L1 Patrick Oc/C1, Sacrum.
10) Ear Infections:A Case Study Harley Bofshever D.C. International
Chiropractic Pediatric Association Newsletter Nov-Dec, 1999.
• HISTORY: An upset father presented to my office on 4-30-99, with his
9 year old son, who has been having chronic ear infections, Patient's father
states that his son has had ear infections for the past 6 years and are progressively
getting worse- He states that his son has been on and off antibiotics, Amoxycillin
and Biaxin on a regular basis at least every 6 weeks for the past 6 years. It
is noted that this patient has had prior surgery when tubes were put in his ears,
approximately 5 years ago. The tube in his left ear recently fell out. Upon the
patient's last visit to his EENT, another surgery to remove the remaining tube
and reinsert new tubes in both ears was suggested. Additionally it was suggested
to remove his tonsils and adenoids at that time. At exam, the patient was scheduled
to have this surgery in 3 weeks. History of the mother's pregnancy and birth
were unobtainable due to a divorce and father did not recollect much about the
delivery. It is noted that this patient is a heavy dairy consumer. At this time,
I have discussed with the father the benefits of chiropractic care for his child
and he has agreed to postpone the surgery for 6 weeks and give chiropractic a
chance.
• EXAMINATION: An in depth chiropractic examination was performed, which
revealed bilateral effusion and scar tissue in both ears. Patient has submandibular
glandular swelling as well as tonsillitis and redness of the throat. There is
also swelling of the posterior cervical musculature, with inflammation bilaterally
at the splenius capitus and splenius cervicus. Range of motion to the cervical
spine is within normal limits. There is a positive foraminal compression test.
Static and motion palpation examination reveals evidence of C2 and C6 subluxation
complexes. Postural analysis showed a left head tilt with a high right shoulder.
• CARE PLAN: Recommendations were made for adjustments 3 times a week for
6 weeks at which time he will be reevaluated and a new care plan will be determined.
Nutritional recommendations were made. I have recommended discontinuing the use
of all dairy products at this point. Due to the heavy antibiotic usage, I have
also advised this patient to take acidopholus and lactovasic acid to help replenish
the normal flora in the gastrointestinal tract.
• PATIENT'S PROGRESS: The patient has shown vast signs of improvement after
his second adjustment. His father stated that his son is much more alert, is
concentrating better in school. The teachers have actually noted the improvement
the last 2 days. The father also states that his son has not complained about
his ears bothering him since the first adjustment. It is also noted that his
throat pain had begun to clear up after his second visit. At the end of the 6-week
program, the patient was reevaluated. There was no more effusion in either ear.
Rhinnes and Weber test were within normal limits. Tonsils and adenoids were back
to their normal size. The father stated that surgery was no longer indicated
by the EENT. The patient was advised to continue care plan of 1 time a week for
the next 6 weeks to and will continue to be monitored. After that time, he may
be put on a wellness care plan of 1 time a month for chiropractic evaluations.
• DISCUSSION: To this date is has been approximately 5 months since the
patient's first visit to our office. He has had no bouts of ear infections up
to this time, no sore throats, no colds, no flu's and has been on no medication.
He is back on dairy, however his consumption is much less than previously consumed.
This patient is now back to a normal lifestyle and patient's father has also
reported that his grades are up since he started his chiropractic care. This
patient will continue a once a month chiropractic evaluation program and since
his son has done so well, the father has decided to have his other son put under
chiropractic care because of a learning disability due to a hearing problem.
Additional Publications:
1) Treatment protocols for the chiropractic care of common pediatric
conditions: otitis media and asthma. Vallone S and Fallon JM Journal
of Clinical Chiropractic Pediatrics Vol 2, No.1 1997. P. 113-115
• This paper's purpose presents the results of a survey of chiropractors
enrolled in the first year of a three year postgraduate course in chiropractic
pediatrics. The survey sought to establish if consensus existed with respect
to the modalities these doctors used to treat two of the most common childhood
disorders seen by chiropractors: otitis media and asthma. Thirty-three doctors
of chiropractic participated in the survey. "Of the primary therapeutic
modalities employed by the chiropractor, spinal adjusting was the most commonly
used for both asthma and otitis media. Certain areas of the spine were addressed
most frequently for each of the two conditions.
2) Cause of Eustachian tube constriction during swallowing in patients
with otitis media with effusion. Takahashi H; Miura M, Honjo I, Fujita
A. Ann Otol Rhinol Laryngol. 1996 (Sep);105 (9): 724-728
• 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.
3) Chronic recurrent otitis media: case series of five patients with
recommendations for case management. Fysh PN, Journal of Clinical Chiropractic
Pediatrics Vol. 1, No. 2 1996.
• The author has presented a case series of five patients (ages 0 to 5)
with chronic otitis media who had previously been under regular medical pediatric
care for this condition. These children all underwent a program of chiropractic
case management, including specific spinal adjustments. All patients had excellent
outcomes with no residual morbidity or complications. All had five adjustments
to the spine. Of the five, 3 had an atlas subluxation, one had an occipital subluxation
and one had an atlas and axis subluxations. These children were adjusted full
spine as well. Hypothetical mechanisms for the putative effects of spinal adjustments
at areas exhibiting signs of subluxation, in patients with otitis media, are
presented in the paper.
4) From Neurological Fitness Vol. V, No. 2 Jan 1996:
• Reviewer's Synopsis: This patient presented with glassy eyes, a runny
nose, and apparent discomfort evidenced by continually tugging at both her ears.
The mother reported that the child had been like this consistently over the previous
six months. In addition to the antibiotic therapy noted in the abstract, medical
treatment also included weekly steroid injections and inhalants to control asthma...no
improvement had been noticed by the mother and several emergency room visits
had been required due to asthmatic attacks. Diversified adjusting at C1, T1 and
right sacroiliac joint every day for two weeks. Pulling at the ears, runny nose,
and glassy eyes were resolved by the second visit.
5) Sore throat, difficulty in swallowing, nausea, vomiting, poor appetite,
and alternating diarrhea and constipation From Neurological Fitness Vol.
V, No. 2 Jan 1996:
• Patient presented with a history of sore throat, difficulty in swallowing,
nausea, vomiting, poor appetite, and alternating diarrhea and constipation. She
was also suffering from ear pain and ear discharge related to chronic otitis
media of 17 months duration. This condition had resisted several regimens of
antibiotics as well as surgery to insert tympanostomy tubes. Three days after
this first adjustment, the ear pain and discharge were substantially reduced.
Continued correction of C1 eventually resulted in both ears being clear of exudate.
At the time of this report, the patient has been symptom-free for approximately
four years.
6) A comparative study of the health status of children raised under
the health care models of chiropractic and allopathic medicine. Van Breda,
Wendy M. and Juan M. Journal of Chiropractic Research Summer 1989.
• More than 80% of the medical children suffered from at least one bout
of otitis media while only 31% of the chiropractic children were so reported.
Review more articles on Otitis media at Chiro.Org
References from Koren Publications' brochure: Ear Infections and Chiropractic
Van Buchem F.L., Dunk J.H.M., and Van't Hof M.A. Therapy of Acute Otitis Media:
Myringotomy, Antibiot-ics, or Neither? Lancet, October 24, 1981, pp. 883-887.
Diamant, M., M.D. and Diamant B, M.D. Abuse and Timing of Use of Antibiotics
in Acute Otitis Media.
Archives of Otolaryngology Vol 100, Sept 1974, pp. 226-232.
Olson, A. L. et al Prevention and Therapy of Serous Otitis Media by
Oral Decongestants. A Double-Blind
Study in Pediatric Practice. Pediatrics Vol. 62, May 1978, 679-84.
The People's Doctor, A Medical Newsletter for Consumers, Vol. 9, No.5.
August 1981. pp.1-4.
Hendricks, C.L., D.C. Thier, S.M., D.C. Otitis Media in Young Children,
Chiropractic Jan. 1989 Vol 2 No.1 pp. 9-13.
Gutman G, Blocked Atlantal Nerve Syndrome in Babies and Infants, Manuelle
Medizin (1987) 25:5-10.
Purse F.M. Manipulative Therapy of Upper Respiratory Infections In Children.
Journal of the American
Osteopathic Association. 65: pp 964-971, 1966
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
.
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
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.
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
Only 1 in 8 children with ear infections benefit from antibiotics according
to a report in the New England Journal of Medicine. In the study, researchers
found that most subjects who received placebo recovered just as quickly as
subjects taking prescription antibiotics. Within one week 81% of placebo subjects
and 94% of antibiotic recipients had recuperated. Lead author, Dr. J. Owen
Hendley, shares the same concerns about prescription side effects and antibiotic
resistance that chiropractors and other holistic health-care professionals
have worried about for decades. He advises physicians to prescribe antibiotics
for ear infections sparingly. He suggests practitioners wait 48 to 72 hours
before administering drugs as ear infections often mend on their own.
Hendley JO. Clinical practice. Otitis media. N Engl J Med 2002; 347(15): 1169-74
/ Medline ID: 12374878
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.
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
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.
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
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.
Todd NW, Feldman CM. Allergic airway disease and otitis media in children.
Int J Pediatr Otorhinolaryngol 1985: 10(1):27-35 / Medline ID: 86084755
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.
Lehnert T, Acute otitis media in children. Role of antibiotic therapy., Can
Fam Physician 1993; 39: 2157-62. / Medline ID: 94034451
Tympanostomy treatment in cases of chronic otitis media does not eliminate
the dysfunction of the eustachian tube, but only serves to substitute tubal
function.
Virtanen H. Eustachian tube function in children with secretory otitis media.
Int J Pediatr Otorhinolaryngol 1983; 5(1):11-7 / Medline ID: 83184994
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.
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
Myringotomy and tympanostomy with tube implantation are frequently both ineffective
and expensive.
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
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
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.
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
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.
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
Medical treatment failures probably already surpass eustachian tube dysfunction
as the most common reason for tympanostomy tube insertion.
Poole MD; Otitis media complications and treatment failures: implications of
pneumococcal resistance. Pediatr Infect Dis J 1995; 4(14):S23-6 / Medline ID:
95312350
Antibiotic treatment of otitis media is no more effective than placebo, and
increases the risks of reoccurrence.
Cantekin EI. Antibiotics to prevent acute otitis media and to treat otitis
media with effusion. JAMA 1994; 272(3):203-4 / Medline ID: 94293436
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.
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
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.
Grote JJ; Antibiotics in otitis media with effusion. Ned Tijdschr Geneeskd
1997;141(2):76-7 / Medline ID: 97166702
Antibiotics are not the best treatment for middle ear infections (otitis media)
and doctors should stop routinely prescribing drugs for them.
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
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.
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
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. 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
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.
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
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.
Berman S; Management of acute and chronic otitis media in pediatric practice.
Curr Opin Pediatr 1995; 7(5):513-22 / Medline ID: 96120875
Oral decongestants are ineffective in treatment, or prevention, of otitis media
in children.
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
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.
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
Amoxicillin with and without decongestant-antihistamine combination is not
effective for the treatment of persistent asymptomatic middle ear effusions
in infants and children.
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
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.
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
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.
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
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