Otitis Media

Otitis Media


Otitis Media is an inflammation of the middle ear, or middle ear infection. Otitis media occurs in the area between the ear drum (the end of the outer ear) and the inner ear, including a duct known as the Eustachian tube. It is one of the two categories of ear inflammation that can underlie what is commonly called an earache, the other being otitis externa (or an external ear infection). Otitis media can be caused by a bacteria, a virus, a fungus or may be associated with sterile (non-infected) fluid. Most cases of otitis media are caused by viruses, and the most common virus found in this association is Respiratory Syncytial Virus (RSV). (i)

Seventy-five percent of children will experience at least one episode of otitis media by their third birthday. Almost half of these children will have three or more episodes in their first 3 years of life. According to the National Institutes of Health and the Centers for Disease Control, medical costs and lost wages due to otitis media amount to over $5 billion annually in the United States.

Although otitis media is primarily a disease of infants and young children, it affects all ages. Symptoms of otitis media may include pain, irritability, insomnia, tugging or pulling at one, or both ears, fever, fluid drainage, temporary loss of hearing and balance.  Several serious complications can result from improperly treated or neglected otitis media.  These can include mastoiditis (an infection of the mastoid bone) and brain involvement.

According to researchers at The Children’s Hospital of Pittsburgh the hearing loss associated with most middle-ear infections is only temporary and should not raise any concern about the effects of speech and language delays on children (ii). Mismanaged cases of otitis media can lead to permanent hearing impairment.  Persistent fluid in the middle ear (Serous Otitis Media) and chronic otitis media can reduce a child's hearing at a time that is critical for speech and language development. Children who have early hearing impairment from frequent ear infections are likely to have speech and language disabilities.

Conventional allopathic treatment of otitis media includes the use of analgesics, decongestants and antibiotics.  Several studies suggest that this treatment is excessive and unnecessary (iii) since at least 81% of patients with otitis media will experience an uneventful recovery without any pharmacologic intervention at all (iv). This is probably be due to the fact that most ear infections are viral and do not respond to antibiotics. 

Researchers at the Cochrane Institute have concluded that the use of antibiotics in otitis media is not only unhelpful, but it does not produce significant change in disease activity (v).   Over use of antibiotics can lead to antibiotic resistance, bowel dysbiosis and more frequent recurrence of infection. Some state agencies have recommended that physicians strongly discourage the use of unnecessary treatment, including antibiotics, and adopting a course of watchful waiting (vi).

Homeopathy can be particularly useful in the non-pharmacologic management of otitis media. It is important to remember that there are no homeopathic medicines specifically for otitis media, only remedies for patients who suffer from it. Because patients can have completely different symptoms of otitis media and even be completely asymptomatic, their treatment depends upon the particular symptoms that each of them experience. For example, one person might have sharp pain, while another might experience irritability; another might feel better from applied heat and third might feel better outdoors. It is imperative to remember that each patient must be treated as a unique individual.  An experienced practitioner who will consider the totality of the symptoms and perform a focused physical exam may need to be consulted.

In one study, 230 children with otitis media were treated with either homeopathy or placebo. The homeopathy group achieved pain control in 72% of patients after 12 hours.  This was 2.4 times faster than the placebo controls. There were no complications observed in the homeopathic  treated group, and when compared to conventional treatment the approach was 14% less expensive (vii).

Another study looked at 75 children ages 18 months to 6 years old with otitis media in a private pediatric practice. They were randomly given an individualized homeopathic medicine or placebo administered orally three times daily for five days.  The homeopathic group experienced fewer treatment failures and noted faster resolution of symptoms than the placebo group (viii).

A third, prospective observational study looked at 131 children between the ages of 6 months and 11 years treated by one homeopathic practitioner and 4 Otolaryngologists.  The homeopathically treated group experienced a more rapid reduction of symptoms, a shorter courses of therapy, and fewer recurrences up to one year later, than the antibiotic treated group (ix).

Both researchers and clinicians have concluded that homeopathy is useful and effective in the treatment of otitis media. The clinician must weigh the risks and the benefits of a homeopathic intervention against the risks of no intervention or conventional treatment.  It behooves the practitioner to consider that each case of otitis media reflects a unique and new set of conditions and circumstances.  The pros and cons of treatment should also be discussed in detail with patient and their care-givers in an informed and open atmosphere of exploration. The practice of informed consent should always be observed.

References:

i) NEJM 1999;340:260-64.

ii) Paradise JL; Dollaghan, Christine A. Language, Speech Sound Production, and Cognition in 3-Year-Old Children in Relation to Otitis Media in Their First 3 Years of Life. Ped Research. Volume 45(4) PART 2 OF 2, April 1999, p 129A

iii) Nyquist A-C, Gonzales R, Steiner JF, et al. Antibiotic prescribing for children with colds, upper respiratory tract infections, and bronchitis.  JAMA. 1998;279:875-877.

iv) Del Mar C, Glasziou P, Hayem M. Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis. BMJ. 1997;314:1526-1529.

v) Eaton CB. Should We Prescribe Antibiotics for Acute Otitis Media?  Am Fam Phys. Aug 1, 2001,64(3):469-70.

vi) Ear Infections In Children. The Capitol Region Otitis Media Project 1998-99.  Albany Chapter, New York State Academy of Family Practice. Capitol District Pediatric Society, Capitol District Physicians Health Plan, Kaiser Permanente/Community Health Plan, Mohawk Valley Physicians Health Plan, New York State Department of Health. #4815, 8/00.

vii) Frei H, Thurneysen A. Homeopathy in acute otitis media in children: treatment effect or spontaneous resolution?Br Homeopath J. 2001 Oct;90(4):178-9.

viii) Jacobs J, Springer DA, Crothers D. Homeopathic treatment of acute otitis media in children: a preliminary randomized placebo-controlled trial. Pediatr Infect Dis J. 2001 Feb;20(2):177-83.
ix) Friese KH, Kruse S, Lüdtke R, Moeller H. The homoeopathic treatment of otitis media in children--comparisons with conventional therapy. Int J Clin Pharmacol Ther. 1997 Jul;35(7):296-301