Otitis media can lead to complications, but there are alternative treatments to antibiotics.
What is Otitis Media?
Simply put, otitis media (OM) refers to “any inflammation of the middle ear”. This is a common childhood issue. There are a few subtypes of OM, including otitis media with effusion (OME), adhesive otitis media, acute otitis media (AOM), and chronic suppurative otitis media. AOM has a rapid onset, often with symptoms such as otorrhea, otalgia, fever, headache, irritability, vomiting, loss of appetite, and diarrhea. After acute otitis media, OME may occur, with such complications are vertigo, otalgia, hearing loss, or tinnitus. Chronic suppurative OM is a condition in which there is “a persistent ear infection that results in tearing or perforation of the eardrum”. Adhesive OM is a situation in which “a thin retracted ear drum becomes sucked into the middle ear space and stuck”. There is no benefit to taking antibiotics for otitis media with effusion, so healthcare providers need to be able to tell the difference between a normal middle ear and one with AOM or OME. Just giving antibiotics is potentially harmful because it can lead to bacterial resistance if it is prescribed when not necessary.1
Causes and Frequency
It is thought that acute otitis media is “related to childhood anatomy and immune function”. Viruses or bacteria may be involved, and risk factors include pacifier use, daycare, allergies, and smoke exposure. Those with Down syndrome or who are Native American get AOM more often. Across the world, AOM affects “11% of people a year”, with about half being “less than five years of age” and it is “more common among males”. To reduce the risk of OM, parents should consider giving their children the flu and pneumococcal vaccines, breastfeed for the first 6 months after the baby is born, and avoid smoking. Antibiotics may be recommended for serious otitis media or patients under the age of two. For others, antibiotics may be suggested if the patient does not improve after a few days.2
For patients suspected of having OM, “pneumatic otoscopy” is the standard exam. Doctors should also examine the tympanic membrane (TM) and external ear as well as the neck and head. The TM needs to be evaluated for color, position, mobility, and perforation. A normal tympanic membrane will be “translucent pale gray”. If it is “opaque yellow or blue”, that is likely indicative of a middle ear effusion (MEE). The TM will bulge in patients with AOM, but for those with OME, the tympanic membrane is retracted or neutral. There will be impaired mobility of the TM in patients with OME. It is common for there to be a single perforation in the tympanic membrane of patients with otitis media. Another screening test is called “tympanometry, which measures changes in acoustic impedance of the TM/middle ear system”. Air pressure changes and acoustic reflectometry are used to measure reflected sound. The louder the sound, the more likes there is MEE.3
Otitis Media Treatment and Prevention
Antibiotics are an issue because they may not help to prevent “long-term outcomes such as hearing loss” and their overuse is “associated with the emergence of antibiotic-resistant otitic bacteria”. The pneumococcal vaccine reduces the rate of AOM by 6-7%, and the flu vaccine is also recommended, annually, by doctors. If using daycare, parents should consider facilities with fewer children. Smoking should be ceased in the home as well. In addition, breastfeeding is encouraged, but pacifier use is discouraged. Unless a patient has marasmus or some other malnutrition, zine supplementation is not recommended. For the most part, patients are given topical and oral pain killers. Generally, steroids, antihistamines, and decongestants are not given, due to side effects. Half of the OM cases in children resolve in 3 days and most are gone in a week. Some patients, with recurrent episodes of OM, will be prescribed “tympanostomy tubes”. There is a risk, though, of “otorrhea, which is a discharge from the ear”.4
There are some alternative treatments for OM, such as breathing in steam with essential oils, making a garlic paste, hot compresses, Mullein drops, and breastmilk drops.5 In one study, Eustachian tube rehabilitation was used for OME as an alternative treatment. ETR was developed decades ago in France using methods such as “improved nasal hygiene and breathing, muscle strengthening exercises and auto-insufflation”. Mouth breathing is a common issue in patients with OME, and there are abnormalities in swallowing as well. ETR may be considered a useful tool for managing OME to avoid the need for surgery.6 Some chiropractors offer manipulation for ear infections, as well as craniosacral therapy and soft tissue modalities (for example, endonasal procedure, lymphatic drainage). They may recommend herbal ear drops and immune support supplements such as Echinacea, elderberry, and homeopathic options. In addition, probiotics and prebiotics may also be recommended, especially for children who have taken antibiotics. Other vitamins and nutritional education may be suggested as well.7