While sitting at my desk writing this article, the phone rings. I just finished referring to some recent articles on medical journals (see below), which conclude the worthlessness and harms of treating ear infections in most children with antibiotics. There is a man on the line who asks if I can help with his child’s ear infections. It looks like his 14-month-old daughter is getting an ear infection approx. monthly. She has received several antibiotic courses, to no avail, and now their pediatrician will put her on a six month course! “This can’t be good for her,” he tells me. “So I’m trying to figure out if there’s anything else we can do.” These calls often come about, usually after another unsuccessful antibiotic prescription or just after being told by a pediatrician that “If this doesn’t resolve soon, we will have to undergo surgery to put a tube in Johnny’s ear.” Do you sound familiar? If not, your actually a very unusual child. Ear pain is the most common reason for bringing a child to a pediatrician. Three-quarters of all children will have had at least one ear grip when they are three years old, and about one-third will have had more than three episodes. Over the past 20 years, the incidence of ear infection in children 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 often, infections of the outer ear or ear canal are called otitis externa, and the middle ear and ear drum, called otitis media. Of the two, otitis media is the most severe and most commonly referred to when your doctor diagnoses an “ear inflammation.” How the middle ear gets infected is pretty straightforward. Why isn’t it always. There is a small tube, called the eustachian tube, which connects the middle ear and the neck. Its purpose is twofold. One is to open and close to allow fluid produced in the ear to drain out and into the throat, preventing other fluids from supporting the ear. The other function is also to open and close for the purpose of normalizing the air pressure. When we travel to a higher altitude and our ears are “clogged”. Swallowing causes them to “pop” because this action opens the eustachian tube so the pressure inside and out can be equalized. Ear infections can develop when the eustachian tube is not opened and closed properly, allowing germ-loaded fluids from the throat, along with secretions produced in the nose, to back up the middle ear and not run out. Colds and allergies can produce inflammation in the area and may be another reason why the eustachian tube is not functioning properly. As the immune system does the job of fighting the infection, dead bacteria and white blood cells create pus, which exerts pressure on the eardrum as it builds up. The eardrum or tympanic membrane bends outward during this build-up and becomes painful when stretched. An older child can tell you that something is happening to your ear. With younger children, you may notice that they pull in the ear or behave differently, become either particularly irritable or perhaps very clammy. Fever may not accompany an ear infection and may be low or quite high. Occasionally, the thin tympanic membrane tears, producing an alternative pathway for the pus to drain out. If this happens, you may notice a discharge coming out of your ear. Don’t be alarmed if this happens. The body has freed itself from unwanted infected material, and a torn eardrum will usually heal by itself fairly quickly.
But why do some children seem to have one ear infection after another and others do not. As mentioned above, the inflammation produced by a cold can eventually 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 mucus 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 can also be suspicious. Diet with sugar and fruit juice should also be looked at.
Two interesting studies have implicated both pacifier and second hand smoke. A Finnish study published in the September 2000 issue of the journal Pediatrics implicated the use of nappa with an increased risk of ear infection in infants, as well as higher frequencies of tooth decay and comfort. The study found that children who used dummy continuously had 33% more ear infections than those who never used them or used them only when they fell asleep. A report on a Canadian study in the February 1998 issue of Archives of Pediatrics & Adolescent Medicine found that children staying with two smoking parents were 85% more likely to suffer from frequent ear infections than those living in non-smoking homes.
Another possible influence is vaccinations against children. While there is much controversy over whether or not there is a direct relationship, significant evidence suggests there may be. However, from a homeopathic point of view, there are certain categories (called constitutional types) of people who, due to hereditary influences, are more susceptible to vaccine actions.
Serious complications of middle ear infections are rare, but can and do occur. These include mastoiditis, an infection of the part of the skull just behind the ear, and meningitis, an infection of the brain and spinal cord. Symptoms of mastoiditis can include swelling, redness, pain and tenderness in the bony area behind the ear. Symptoms of meningitis are severe headache and stiff neck. Vomiting, mental lethargy and mood swings may also be involved. If evidence of either of these two complications is seen, consult a physician immediately. The most common complication of middle ear infections is the chronic ear problems that often follow. Serous otitis media, commonly known as “lime ear”, is an accumulation of non-infectious fluid in the middle ear. It can cause hearing problems as the fluid interferes with normal movement of the eardrum.
So now that we know what it is and how it got there, what should be done about it? As the introduction to this article shows, conventional Western medicine addresses this problem with antibiotics. And shouldn’t they? This is an infection, right? And infections need to be treated with antibiotics, right? If not, who knows what could happen! This could not be further from the truth. The purpose of this article is not to discuss the pros and cons of antibiotics. No one argues that if used properly, they can save lives. But they have not been used properly. They have been prescribed and incorrectly prescribed. So much so that a New York Times article on June 13, 2000, reported that “The World Health Organization, which took its first comprehensive look at drug-resistant diseases, concluded in a report published today that the effectiveness of antibiotics had been so eroded globally that some diseases that were once easily treatable are now often incurable. much more difficult, says the Health Agency report, part of the United Nations. “
A paper published in the July 23, 1997 issue of the British Medical Journal blamed doctors for routinely prescribing antibiotics for ear infections in their pediatric patients. It reported on an analysis of existing studies relating to such treatment and concluded that the practice is not only a waste of time and money, it appears to be harmful. Antibiotics do not accelerate recovery (at least at least one previous study suggests they lead to more relapses) and promote the spread of stronger, drug-resistant bacteria. British researchers estimate that 97 per cent of doctors 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, urged doctors to stop all antibiotic use (except in very severe and recurrent cases) for this most commonly treated infection in childhood.
The RAND Company’s Evidence-Based Practice Center (EPC), which conducts research for the Agency’s Research and Quality Agency, discovered some interesting facts about managing acute ear infections. They found that almost two-thirds of children with uncomplicated ear infections are free from pain and fever within 24 hours of being diagnosed without antibiotic therapy, and that over 80% fully recover within 1 to 7 days. 93% of children treated with antibiotics recover within the same 1 to 7 days. The researchers also found that the newer and more expensive antibiotics, such as cefaclor, cefixime, azithromycin or clarithromycin, did not offer any additional benefit to children than amoxicillin. Amoxicillin also caused fewer side effects than the other antibiotics. The EPC also found no evidence that short-term (5 days or less) versus long-term therapy (7-10 days) made a difference in the clinical outcome for children over 2 years. More than 5 million cases of acute ear infections occur annually, costing about $ 3 billion. The report points out that otitis media in other countries is not treated with drugs at the first sign of infection. Instead of children over 2 years of age, the norm is to watch and see how the infection progresses over a few days. The report notes that in the Netherlands the bacterial resistance is only approx. 1% compared to the US average of approx. 25%.
The traditional Western medical treatment for children who develop chronic otitis media is a surgical procedure called a tympanostomy. This involves inserting small tubes into the eardrum to drain away the fluid buildup. The rationale behind this approach is that the impaired hearing caused by the condition can lead to longstanding speech and hearing problems and even behavioral and intellectual disabilities. What I often hear from parents is that they have been told that their child will be deaf if the procedure is not performed. Again, current research does not highlight this. A study published this year (April 19, 2001) in the New England Journal of Medicine found that children with persistent otitis media immediately inserting the tubes do not show measurable improvements in developmental outcomes. And this procedure is by no means the fantasy, without it there are risks. Editors who accompanied the NEJM article said that “The tubes often lead to long-term anatomical changes in the tympanic membrane, especially tympanosclerosis [hardening of the ear drum,] withdrawal and changes in mobility. For example, what happens to hearing and the mobility of the tympanic membrane of middle-aged people who had inserted tubes in childhood? “Not to mention that in any procedure that requires anesthesia, there is always the possibility of death!
Now that we understand what is causing this all-too-common problem and know how not to deal with it, let’s talk about what to do. As with any illness, first and foremost is prevention. And the best prevention for any infection is a strong immune system. For infants and young children, breastfeeding is the best way to build their immune system. 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 may or may not care, I refer the reader to Sally Fallon’s wonderful book, Nourishing Tradition, 1999, New Trends Publishing, Washington, D.C. Of course, prevention also means avoiding the various risk factors already discussed, such as giving your child a smoky living environment, limiting the use of pacifier, identifying and removing food allergies, limiting or removing sugar and fruit juices from the diet. If your child has already taken antibiotics, using probiotics or “friendly bacteria” is very important. Antibiotics not only destroy the “bad bacteria” but also the good ones that live in our gut. These bacteria are an important part of our body’s natural defenses. A study published in the January 2001 issue of the British Medical Journal found that adding probiotics reduced both the number of recurrences and complications from otitis media.
Now, for the active treatment of acute otitis media. A well-known alternative medicine and columnist, Dr. Joseph Mercola, agrees to put a few drops of breast milk (your own or, if you are not breastfeeding, someone else’s) into your ear every few hours. He claims this will remedy most ear infections within 24-48 hours. Although the idea of clearing a case of otitis media in one to two days with only breast milk may sound good, to me this is still far too long for a child to suffer. The well-chosen homeopathic remedy will work gently and very quickly, often within minutes (see case below.) But there are so many homeopathic remedies that are useful for treating ear infections. In fact, a search of my repertory (the book Homeopaths, showing all the symptoms and remedies associated with them) shows under ear pain, 326 remedies, 114 specifically for middle ear pain and another 65 during inflammation of the middle ear. Of course, different remedies are needed to treat the same symptoms in different people. For the average person, choosing the right remedy on this list can be a daunting task. An important point to understand is that homeopathic remedies must be taken at a time. Taking multiple remedies at once (as found in combination remedies sold in stores for this disorder or that) can be confusing to the body and is not recommended. If you do not know which remedy to take, it is better to consult an experienced homeopath who will know how to obtain the necessary information to make an appropriate remedy for choice. If your child has already been prescribed a constitutional remedy (a remedy that covers your general constitution and not just the symptoms of a particular disease), it will be you as the first and best remedy for choice in any emergency, ear problems or other. For chronic problems, including chronic otitis, a constitutional remedy becomes a necessity. However, it has been my experience that just remembering “ABC” for most cases of acute, uncomplicated middle ear infections. “ABC” stands for the homeopathic remedies aconitum, belladonna and chamomilla. The following is a brief description of each.
Fear and anxiety are the most important feature of aconitum. The Aconitum ear canal is remarkable because it suddenly begins, often brought on by exposure to the elements, especially a cold, dry wind. The pain is intense and there can be a high fever. The baby will be restless and thirsty and the ear may look bright red.
The belladonna ear grip is in severe pain. The ear will be red, hot and throbbing, just like the eardrum, as seen with an otoscope. More often than not, the belladonna breath will be right-sided and worse at night. These can be brought on by temperature changes where the baby gets chilled or overheated.
With chamomilla-type ear grips, the pain seems unbearable in a child who is already the hypersensitive type, especially for 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 voicemail. “She has a terrible earache. She continues to pull on her ear. I don’t know what to give her. ” (The mother, one of my patients, had a well-equipped homeopathic medicine kit.) “Oh, we’re going for a 15-minute vacation.” When I returned the call a few minutes later I got their machine. Hoping they weren’t back yet I asked more questions. A few minutes later, another message came 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 phone brand game. “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 in the car. Within five minutes she stopped crying and the redness and heat left her ear. She has been sleeping since then.”
A.B., a 3 year old boy was brought in by his parents. I had a persistent ear infection in both ears. He had already been on three different antibiotics. An ear specialist put him on steroids, but still the tympanogram (a design that measures the mobility of the eardrum) showed little improvement. The specialist suggested “the pipes.” On examination, his left eardrum did not look so bad, the right was red and swelling from behind with fluid. A homeopathic consultation with a child, this young person, requires not only 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 strength to be given daily with some probiotic products. I also performed a special cranial procedure to open the eustachian tubes and help the buildup of fluid run out of the middle ear. He was symptom free the next morning. When I saw him five days later, both ears were perfectly clear, with no redness or signs of fluid at all. A follow-up tympanogram by the specialist a few days later was normal.
Homeopathy and childhood infections
by Stuart H. Garber, D.C., Ph.D.