As I am sitting at my desk, writing this very article, the phone rings. I had just finished referencing some recent medical journal articles (see below) which conclude the worthlessness of, and harm from, treating most childhood ear infections with antibiotics. There is a man on the line inquiring if I can help with his child’s ear infections. It seems his 14 month old daughter gets an ear infection about once per month. She has received multiple courses of antibiotics, all to no avail, and now their pediatrician wants to put her on a six month course! “This can’t be good for her,” he says to me. “So I am trying to find out if there is something else we can do.” These calls come all to often, usually after yet another failed antibiotic prescription or just after being told by the pediatrician that “If this doesn’t clear up soon we’ll need to do surgery to put tubes in Johnny’s ear.” Sound familiar? If not, yours is a very unusual child indeed. Earache is the single most common reason for bringing a child to a pediatrician. Three quarters of all children will have had at least one earache by the time they’re three years of age, and about a third will have had more than three episodes. Over the past 20 years the incidence of childhood ear infection has increased, occurring both more frequently and beginning at an earlier age.
Ear infections, or otitis (oto=ear, -itis=inflammation) can involve any part of the ear. Most commonly are infections of the outer ear or the ear canal called otitis externa, and the middle ear and ear drum, called otitis media. Of the two, otitis media is the more serious and the one most often referred to when your doctor diagnoses an “ear infection.” How the middle ear becomes infected is fairly straightforward. Why is not always so. There is a small tube, called the eustachian tube, which connects the middle ear and the throat. It’s purpose is twofold. One is to open and close to allow fluid produced in the ear to drain out and into the throat and prevent other fluids from backing up into the ear. It’s second function is also to open and close for the purpose of normalizing air pressure. When we travel to a higher altitude and our ears “clog.” Swallowing causes them to “pop” because that action opens the eustachian tube allowing the pressure inside and out to equalize. Ear infections may develop when the eustachian tube does not open and close properly, allowing germ-laden fluids from the throat, along with secretions produced in the nose, to back up into the middle ear and not drain out. Colds and allergies may produce inflammation in the area and can be another cause for the eustachian tube to not function properly. As the immune system does it’s job to fight the infection, dead bacteria and white blood cells form pus which puts pressure on the eardrum as it builds up. The eardrum, or tympanic membrane, bulges outward under this build up, becoming painful as it is stretched. An older child will be able to tell you that there is something going on with their ear. With younger children you may notice them tugging at the ear or behaving differently, becoming either particularly irritable or perhaps very clingy. Fever may or may not accompany an ear infection and can be low or quite high. Occasionally the thin tympanic membrane tears, producing an alternative route for the pus to drain out. If this happens you may notice a discharge coming out of the ear. Don’t become alarmed if this happens. The body has rid itself of unwanted infected material and a torn eardrum will usually heal by itself rather quickly.
But why do some children seem to have one ear infection after another and others not. As mentioned above, the inflammation produced by a cold may ultimately lead to an ear infection. The more colds a child gets the higher the risk of frequent ear infections. Allergic reactions, especially to certain foods, are also associated with an increased incidence of ear infections. The top offender seems to be milk, and dairy products in general. In addition to being a very common allergen, dairy also increases mucous production, making bodily secretions thicker and harder to drain away. Other commonly associated allergens are wheat, as well as other gluten-containing grains such as rye, oats and barley. Eggs, corn, oranges and nuts may also be suspect. Diets high in sugar and fruit juices should also be looked at.
Two interesting studies have implicated both pacifiers and second hand smoke. A Finnish study published in the September, 2000 issue of the journal Pediatrics implicated pacifier use with an increased risk of ear infection in infants, as well as higher rates of tooth decay and thrush. The study found that children who used pacifiers continuously had 33% more ear infections than did those who never used them or used them only when falling asleep. A report on a Canadian study in the February, 1998 issue of the Archives of Pediatrics & Adolescent Medicine showed that children residing with two smoking parents were 85% more likely to suffer from frequent ear infections than those who lived in smoke-free homes.
Another possible influence are childhood vaccinations. Although there is much controversy as to whether or not there is a direct relationship, a significant body of evidence suggests that there may be. From a homeopathic point of view, though, there are certain categories (called constitutional types) of people who, due to inherited influences, are more susceptible to vaccine reactions.
Serious complications of middle ear infections are rare but can and do occur. These include mastoiditis, an infection of the part of the skull bone just behind the ear, and meningitis, an infection of the covering of the brain and spinal cord. Symptoms of mastoiditis may include swelling, redness, pain and tenderness in the bony area behind the ear. Symptoms of meningitis are severe headache and stiff neck. Vomiting, mental dullness and mood changes may also be involved. If evidence of either of these two complications are seen, a doctor should be consulted immediately. By far the most common complication of middle ear infections are the chronic ear problems that often follow. Serous otitis media, commonly known as “glue ear,” is an accumulation of non-infectious fluid in the middle ear. It can cause problems with hearing as the fluid interferes with normal motion of the eardrum.
So now that we know what it is and how it got there, what should be done about it? As is evident from the opening paragraph of this article, conventional western medicine treats this problem with antibiotics. And shouldn’t they? This is an infection, right? And infections have to be treated with antibiotics, don’t they? If not, who knows what could happen! This couldn’t be further from the truth. The purpose of this article is not to debate the pros and cons of antibiotics. No one argues that, used appropriately, they can save lives. But they have not been used properly. They have been over-prescribed and wrongly prescribed. So much so that an article in the New York Times on June 13, 2000, reported that “The World Health Organization, taking its first comprehensive look at drug-resistant diseases, concluded in a report released today that the effectiveness of antibiotics had been so eroded globally that some diseases that were once easily treatable are now often incurable. Misuse of antibiotics, including over prescribing, and their use to increase animal growth have made treating illnesses as diverse as ear infections, tuberculosis and malaria much more difficult, said the report from the health agency, part of the United Nations.”
A paper published in the July 23, 1997 issue of the British Medical Journal reproached doctors for prescribing antibiotics routinely for ear infections in their pediatric patients. It reported on an analysis of existing studies relating to such treatment and concluded that not only is the practice a waste of time and money, it appears to be harmful. Antibiotics don’t speed recovery (in fact, at least one previous study suggests that they lead to more recurrences) and promotes proliferation of stronger, drug-resistant bacteria. The British researchers estimate that 97 percent of physicians routinely prescribe antibiotics for ear infections. An editorial in the November 26, 1997 issue of the Journal of the American Medical Association, the largest medical journal in the world, citing this same study, encouraged physicians to stop all antibiotic use (except in very severe and recurrent cases) for this most commonly treated infection in childhood.
The RAND corporation’s Evidence-based Practice Center (EPC), conducting research for the Agency for Healthcare Research and Quality, discovered some interesting facts regarding the management of acute ear infections. They found that nearly two-thirds of children with uncomplicated ear infections are free of pain and fever within 24 hours of diagnosis without antibiotic treatment, and that over 80% recover completely within 1 to 7 days. 93% of children treated with antibiotics recover within that same 1 to 7 days. The researchers also found that the newer and more costly antibiotics, such as cefaclor, cefixime, azithromycin, or clarithromycin, provided no additional benefit to children than amoxicillin. Amoxicillin caused fewer side effects than the other antibiotics as well. The EPC also found no evidence that short-duration (5 days or less) versus long-duration therapy (7-10 days) made a difference in the clinical outcome for children over 2 years of age. More than 5 million cases of acute ear infections occur annually, costing about $3 billion. The report points out that in other countries otitis media is not treated with drugs at the first sign of infection. Rather, in children over the age of 2 years, the norm is to watch and see how the infection progresses over the course of a few days. The report notes that in the Netherlands the rate of bacterial resistance is only about 1%, compared with the US average of around 25%.
The conventional western medical treatment for children who develop chronic otitis media is a surgical procedure called a tympanostomy. This involves the insertion of small tubes into the ear drum to drain away the fluid build up. The rationale behind this approach is that the reduced hearing caused by the condition may lead to long-term speech and hearing problems, and even behavioral and intellectual impairments. What I often hear from parents is that they have been told their child will go deaf if the procedure is not performed. Again, the current research does not bear this out. A study published this year (April 19, 2001) in the New England Journal of Medicine showed that children with persistent otitis media who get the tubes inserted immediately do not show measurable improvements in developmental outcomes. And this procedure is, by no stretch of the imagination, without it’s risks. The editorial which accompanied the NEJM article stated that “The tubes often lead to long-term anatomical changes in the tympanic membrane, especially tympanosclerosis [hardening of the ear drum,] retraction, and changes in mobility. What happens, for example, to hearing and the mobility of the tympanic membrane in middle-aged persons who had tubes inserted in childhood?” Not to mention that in any procedure requiring anesthesia, there is always the possibility of death!
Now that we have an understanding of what causes this all too common problem and know how not to treat it, let’s talk about what to do. As with any illness, first and foremost is prevention. And the best preventative for any infection is a strong immune system. For infants and small children, the best way to build their immune system is breast feeding. Breast milk is by far the most nutritious food for your child. For a more detailed discussion of this, and for alternatives for women who cannot or will not nurse, I refer the reader to Sally Fallon’s wonderful book, Nourishing Traditions, 1999, New Trends Publishing, Washington, D.C. Of course, prevention also means avoiding the various risk factors already discussed, such as providing your child with a smoke-free living environment, limiting the use of pacifiers, identifying and eliminating food allergies, limiting or removing sugar and fruit juices from the diet. If your child has already taken antibiotics, the use of probiotics, or “friendly bacteria,” is essential. Antibiotics destroy not only the “bad germs,” but also the good ones which reside in our gut. These bacteria are an important part of our body’s natural defense. A study published in the January, 2001 issue of the British Medical Journal showed that the addition of probiotics reduced both the number of recurrences of, and complications from, otitis media.
Now, to the active treatment of acute otitis media. A well known alternative medicine practitioner and columnist, Dr. Joseph Mercola, advocates putting a few drops of breast milk (your own or, if you’re not lactating, someone else’s) into the ear every few hours. He claims that this will clear up most ear infections within 24-48 hours. While the thought of clearing up a case of otitis media in one to two days using only breast milk may sound great, for me this is still way too long for a child to suffer. The well selected homeopathic remedy will act gently and very quickly, often within minutes (see cases below.) But there are so many homeopathic remedies that are useful in treating ear infections. In fact, a search in my repertory (the book homeopaths use which list all symptoms and which remedies are associated with them) under ear pain shows 326 remedies, 114 specifically under middle ear pain and another 65 under inflammation of the middle ear. Obviously then, different remedies are needed to treat the same symptoms in different people. For the average person, choosing the right remedy from this list can seem a daunting task. An important point to understand is that homeopathic remedies should be taken one at a time. Taking several remedies at once (as is found in combination remedies sold in stores for this ailment or that) can be confusing to the body and is not recommended. If you don’t know what remedy to take it is better to consult with an experienced homeopath, who will know how to elicit the necessary information in order to make an appropriate remedy choice. If your child has already been prescribed a constitutional remedy (a remedy which covers your general constitution and not just the symptoms of a particular illness) that will be you first and best remedy choice in any acute situation, earache or otherwise. For chronic problems, including chronic otitis, a constitutional remedy becomes a necessity. However, it has been my experience that for most cases of acute, uncomplicated middle ear infections, just remember “ABC.” “ABC” stands for the homeopathic remedies aconitum, belladonna and chamomilla. Following is a brief description of each.
Fear and anxiety are the main feature of aconitum. The aconitum earache is notable for it’s sudden onset, often being brought on by exposure to the elements, especially a cold, dry wind. The pain is intense and there may be a high fever. The child will be restless and thirsty, and the ear may appear bright red.
The belladonna earache has severe pain. The ear will be red, hot and throbbing, as will be the eardrum, as seen with an otoscope. More often than not, the belladonna earache will be right-sided and worse at night. These may be brought on by changes in temperature, with the child getting chilled or becoming overheated.
With the chamomilla type earache, the pain seems unbearable in a child who is already the oversensitive type, especially to pain. The child who will respond well to chamomilla will be quite irritable and seemingly inconsolable, except when held or carried.
D.W., a 2 year old girl, could be heard screaming in the background of the message her mother left on my answering machine. “She’s got a terrible ear ache. She keeps tugging at her ear. I don’t know what to give her.” (The mother, a patient of mine, had a well supplied homeopathic medicine kit.) “Oh, we’re supposed to leave for vacation in 15 minutes.” When I returned the call a few minutes later I got their machine. Hoping they hadn’t left yet I asked several questions. A few minutes later there was another message back with the answers. “Right ear, red and hot to the touch.” I called back, only to get the answering machine again. A very frustrating game of phone tag. “Belladonna,” I said. About an hour later I received a call, this time from the car phone. There was silence in the background. “I gave her the belladonna just before we got into the car. Within five minutes she stopped crying and the redness and heat left her ear. She’s been sleeping ever since.”
A.B., a 3 year old boy was brought in by his parents. He had a persistent ear infection in both ears. He had already been on three different antibiotics. A ear specialist put him on steroids, but still the tympanogram ( a devise that measures the mobility of the ear drum) showed little improvement. The specialist suggested “the tubes.” On examination his left ear drum was looking not too bad, the right was red and bulging from behind with fluid. A homeopathic consultation with a child this young not only requires finding out as much as possible about the child, but also about the parents. I prescribed chamomilla ( which seemed to be his constitutional type) in a liquid potency to be given on a daily basis, along with some probiotic products. I also performed a special cranial procedure to open the eustachian tubes and help the built up fluid to drain out of the middle ear. He was symptom free by the next morning. When I saw him five days later both ears were perfectly clear, with no redness or sign of fluid at all. A follow-up tympanogram by the specialist a few days later was normal.
Homeopathy and Childhood Ear Infections
by Stuart H. Garber, D.C., Ph.D.