Treating Children's Ear Infections Without Drugs
By Dr. Mary Ann Block
Treating ear infections (acute otitis media) with antibiotics may actually cause the ear infection to last longer and recur more often. This may come as a surprise to some, but it is well documented in the medical literature. In the 1970s, one study examined records from 20 years earlier. In the 1950s, antibiotics were not prescribed as often as they are today. In the '50s, there were just as many children who did not receive antibiotics as there were who did.
The researchers actually found that the sooner these children were given antibiotics, the longer the infections lasted and the more recurrences they experienced. If the antibiotic was given on the first day of the infection, the frequency of recurrence was almost three times greater than those who received no antibiotics. If physicians waited at least eight days before prescribing the antibiotics, the ear infections resolved as quickly as in the children who had been given no antibiotic.
It is also well-documented in the medical literature that 80 to 90% of all ear infections will heal entirely on their own. It's important to understand why treating ear infections with antibiotics is no longer always the best option.
There is a great deal of conflict in the current medical literature about the effectiveness of antibiotics for the treatment of acute otitis media (AOM). One study says that amoxicillin is better than placebo, while others report that there is no difference between the drug and placebo. Still another study compared chronic antibiotic use with insertion of tubes and "doing nothing." There was no difference in outcome. A study published in JAMA indicated that only 11% of children taking antibiotics for ear infections showed improvement. Certainly, parents have been trained to expect and even demand a prescription when a child is ill. It is still up to the physician to decide whether a prescription is appropriate. Often, a physician can convince concerned parents to wait out the ear infection without antibiotics by just explaining that not all infections need a drug. Parents should also be told that antibiotics may have side effects, even when the medication is appropriately prescribed.
Physicians have been well-trained to prescribe medications. It is often easier and less time-consuming to write a prescription than to explain why you are not going to do it. Today, countless articles in the professional and lay literature tell us why we should not prescribe antibiotics so readily, even for problems they have been used for in the past. As physicians, it is impossible to be unaware of the dangers of over-prescribing antibiotics. Yet even with this knowledge, many physicians refuse to stop prescribing antibiotics for every ear and respiratory infection they diagnose. How can we continue to do this?
Let's review: 80% to 90% of all ear infections heal on their own, and children who do not receive antibiotics actually heal faster and have fewer recurrences. By treating every ear infection with antibiotics, we only succeed at increasing antibiotic-resistant bacteria.
Antibiotic resistance has become a tremendous problem. Some blame it directly on the overuse of antibiotics in the treatment of AOM.
At least one-fourth of all the antibiotic prescriptions written in the United States are for AOM. While amoxicillin is still considered the first-line drug, penicillin may no longer be efficacious for many strains of pneumococcus bacteria. Since this is the most common bacteria underlying ear infections, broader spectrum antibiotics are now being used frequently, often for first-line treatment. There appears to be a higher rate of antibiotic-resistant bacterial infections when one has taken more courses of antibiotics.
It is getting harder to treat bacterial infections with antibiotics. There are now bacteria in the environment that are no longer susceptible to any antibiotic now available. We cannot sit back and wait for the pharmaceutical companies to save us. There are no guarantees that they can develop a new, stronger, more broad-spectrum antibiotic for the next generation of resistant bacteria.
If we return to the pre-antibiotic age, we will have ourselves to blame. We have known since the l950s that antibiotic resistance was a real threat. Over the past 40-plus years, we have done nothing to curb the growth of antibiotic-resistant bacteria. We have actually encouraged their growth by prescribing antibiotics for viral infections, which do not respond to antibiotics. We have prescribed antibiotics for infections for which antibiotics are not necessary.
However, despite all these years of antibiotic abuse, it appears that it is not too late to turn the problem around. We can learn from doctors in Finland. Doctors there have decreased the use of certain antibiotics. At the same time, resistant bacteria were cut nearly in half. As physicians, we weigh the pros and cons of a medication before prescribing it. Bacterial resistance should be part of that decision. There are other options.
The osteopathic philosophy states that "the body has an inherent ability to heal itself." This concept is certainly not unique to the osteopathic profession. Hippocrates said it, too. Occasionally, the body needs some help. But generally speaking, if the body has the right nutrients, exercise, and healthy food and water, it will take care of itself. Even when the body does get sick, it can usually get itself well. We have a wonderful immune system that usually works quite well.
Too often, people view the symptoms of an illness as the illness itself. Fever, cough, and a runny nose are not illnesses. They are the body's efforts to heal itself. Prescribing antibiotics for an infection may actually interfere with the body's abilities to heal on its own. If we allow the antibiotic to do all the work, the immune system may never learn how to fight an infection by itself.
Exposure to bacterial and viral infections allows our immune systems to develop the antibodies that fight off future infections. Antibiotics may interfere with this process, leaving the body vulnerable to future infections. Could this be why we are seeing an increase in ear infections at the same time antibiotic use is on the rise?
Bacteria is not really the problem.
When a child has chronic ear infections or chronic fluid in the ear, he or she is often referred to the otolaryngologist to place tubes in the ear. The reasoning here is that the child's recurring ear infections are due to fluid in the middle ear canal. This fluid is unable to drain down the eustachian tube. If the fluid could drain, the bacteria would not be able to grow and cause an infection. It would seem, then, that giving antibiotics to kill the bacteria in the ear is not enough.
No wonder children continue to have ear infections when all they are given is an antibiotic. The antibiotic may kill the bacteria, but it does nothing to help the fluid drain down the eustachian tube. This is why doctors put tubes in the ear, to allow the fluid to drain.
Unfortunately, this procedure also puts a hole in the child's ear. Furthermore, inserting a tympanostomy tube can permanently scar the tympanic membrane, which can lead to hearing and learning problems. Instead, we need to find a way to prevent the fluid from entering the middle ear, and a way to help drain the fluid more naturally through the eustachian tube. We need an alternative to surgically putting a hole in the child's ear. Preventive medicine.
Putting a hole in a child's ear may help drain the fluids, but it is not a very physiological way to deal with the problem. There are several things parents can do to protect against ear infections. Remedies should be as non-invasive as possible, and more helpful than harmful. The best line of care would prevent eustachian tube swelling before fluid becomes trapped in the ear.
Breast-feeding rather than formula-feeding is one important preventive measure. Studies show that breast-feeding for at least four months cuts the number of ear infections in half. Even supplementing with formula while breast-feeding increased the number of ear infections. The American Academy of Pediatrics recommends exclusive breast-feeding for at least four to six months. If bottle-feeding is used for either formula or breast milk, the caretaker should not allow the infant to lie on her back while feeding. The head should always be elevated so the fluids from the mouth do not flow upward through the eustachian tube into the ears.
Pacifiers can also increase the incidence of ear infections. It is not understood whether this is because pacifiers are not properly cleaned, or because the sucking motion causes bacteria to flow upward into the eustachian tube.
Smoking is another factor that raises the risk of ear infections. Tobacco smoke can irritate the mucous membranes in the nasal passages, causing them to swell. This increases the likelihood of fluid getting trapped in the middle ear. Even fragrances, colognes, and air fresheners can irritate the mucous membranes.
Allergies and sensitivities also contribute to ear infections. One hundred and four children with recurrent ear infections were evaluated for food allergies. Seventy-eight percent were found positive for food allergies. When the offending food(s) were removed from the diet, 86% had resolution of their symptoms. When the foods were reinstated in the diet, 94% experienced a recurrence. The most common allergy-causing foods were cow's milk, wheat, egg, peanut, soy, and corn. Treating the problem.
It is always best to prevent ear infections with breast-feeding, no smoking, no pacifiers, no fragrances, and eliminating or treating allergies. Even if the child has not had the benefit of these preventive tools, it is not too late to use them now. If breast-feeding was impossible or is no longer occurring, an infant could switch from cow's milk formula to soy. However, soy is one of the other top allergens, so allergy to soy may occur.
One effective option is to rotate the type of formula the infant receives. A cow's milk formula may still be tolerated if it is not consumed every day. I recommend changing the type of formula every day for four days, then starting the formulas over again. Try cow's milk on day one, soy on day two, a hypoallergenic formula on day three, and goat's milk on day four.
If the infant is sensitive to soy, the problem may be complicated by the fact that most formulas have soy oil in them. With an older child who is eating table food, an elimination diet may determine if any of the common food allergens are affecting the child.
In addition, children should be encouraged to eat a variety of fruits and vegetables, and to decrease their consumption of "junk foods."
If the child has already received antibiotics for ear infections, the medicine has probably killed much of the normal flora in the gastrointestinal tract. Supplementation with Lactobacillus acidophilus and bifidus will help recolonize the gut. This, in turn, may enhance the immune system.
Parents need to quit smoking altogether for their own health benefit. If they are unwilling to do this, they should- at the very least-eliminate smoking in the house and car. But even if they smoke away from the child, their clothing and belongings will carry the smell around the child. This may continue to irritate the mucous membranes. One child of a smoking mother was tested for allergy to tobacco smoke in my office. When the mother saw how the smoke affected her child's behavior, she quit immediately with the help of a nicotine patch. In addition to her child's behavior improving, she reported that both of her young children were free of ear and respiratory infections the following winter.
Homeopathy has demonstrated success in treating ear infections. In a study comparing homeopathic treatment with traditional treatment, the children who used the homeopathic treatments had less pain, shorter duration of therapy, and more improvement just three hours after starting treatment. Furthermore, a greater percentage of the homeopathic group experienced no recurrences after one year. The homeopathic remedies used were Aconitum, Apis, Belladonna, Capsicum, Chamomilla, Kalium bichromicum, Lachesis, Lycvpodium, Mercurius, Okoubaka, Pulsatilla, and Silicea.
It would be preferable if we could all eat only organically grown foods. Studies indicate different levels of nutrients in organic foods than in regular grocery-store foods.
I no longer think it is possible to obtain adequate amounts of nutrients through diet only. Supplementation is necessary. Vitamin C has long been studied for its impact on the immune system. Vitamin A has also been shown to increase the number of immune cells in children. In addition, I recommend zinc lozenges for children old enough to handle them. They are not suitable for young children, who could choke on a lozenge. A comprehensive multivitamin/mineral formula is a good idea, since people who take supplements tend to have fewer infections than those who do not.
Another aspect of my treatment of ear infections without antibiotics is osteopathic manipulation. I use gentle manipulation modalities that help drain the fluid in the ears and enhance the immune system. In my office, I have measured ear fluid with a tympanogram and then treated the patient with manipulation alone. A recheck of the ears with the tympanogram immediately after the treatment has revealed some dramatic improvements in fluid levels in the ears.
I teach parents how to do this treatment at home on their children. Parents often feel they should be doing something for the child when ear problems start. If their doctor has decided to avoid antibiotics, this manipulation treatment gives parents something they can do to help. It is immediate, effective, and the parents know they're doing something positive for their child. In the managed care environment, it is also a valuable tool, often enabling the family to treat the problem at home. After they recognize the benefits of this treatment, they may not even need to visit the doctor. A videotape from The Block Center instructs parents how to use this treatment.
Eighty to 90 percent of all ear infections will heal entirely on their own. Treating them with antibiotics can cause the infections to last longer and recur more often. Antibiotic-resistant bacteria is a serious threat to our lives. It is time to stop misusing antibiotics and utilize other, safer, more effective treatments for ear infections. Physicians and patients must join together to ensure that antibiotics will be available in the future for serious and life-threatening illnesses. We need to stop using them to treat problems-such as ear infections-that can heal on their own.
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4. Charnow J: Doctors compelled to overuse antibiotics. Medical Tribune 38(16), September 18, 1997.
5. Duncan B, Ey J, Holberg C, et al: Exclusive breast-feeding for at least four months protects against otitis media.
Pediatrics9l(5), May 1993.
6. Niemela M: Use of pacifiers linked with babies' acute otitis media. Pediatrics 96:884-888, 1995.
7. Nsouli T, Nsouli M, Linde R, et al: Role of food allergy in serious otitis media. Annals of Allergy 73(3):215-219, September 1994.
8. Friese K, Kruse S, et al: The homeopathic treatment of otitis media in children: comparisons with conventional treatment. International Journal of Clinical Pharmacology and Therapeutics 35(7):296-301, November 7, 1997.
Reprinted with permission from
The American Journal of Natural Medicine VOL. 5, NO. 4 MAY 1998
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