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Ear Infections

Health Topics

earinfectionPeer Reviewed Journals:

1) Prevention and Therapy of Serous Otitis Media by Oral Decongestants. A Double- Blind Study in Pediatric Practice. Olson, AL; Klein SW; Charney E. MacWhinney JB Jr.,McInerny TK, Miller RL, Nazarian LF, Cunningham D.. et al Pediatrics Vol. 62, May 1978, 679-84.

Pharyngitis-57% of patients with phyaryngitis were treated on the first day of sore throat with spinal manipulative therapy and salt water gargle. All were symptom free the second day. Laryngitis- 100% of patients with laryngitis were treated on the first day of illness, with spinal manipulative therapy and voice function returned to normal within one day.

2) Characteristics of 217 children attending a chiropractic college teaching clinic. Nyiendo J. Olsen E. JMPT, 1988; 11(2):78084.

The authors found that pediatric patients at Western States Chiropractic College public clinic commonly had ordinary complaints of ear-infection, sinus problems, allergy, bedwetting, respiratory problems, and gastro-intestinal problems. Complete or substantial improvement had been noted in 61.6% of pediatric patients of their chief complaint, 60.6% received “maximum” level of improvement while only 56.7% of adult patients received “maximum” level of improvement.

3) Ear Infection: A Retrospective Study Examining Improvement from Chiropractic Care and analyzing influencing factors. Froehle RM J Manipulative Physiol Ther 19 (3): 169-177 (Mar 1996)

This was a study of forty-six children aged 5 years and under in a private practice in a Minneapolis suburb. All care was done by a single chiropractor, who adjusted the subluxations found and paid particular attention to the cervical vertebrae and occiput. Sacral Occipital Technique-style pelvic blocking and the doctorʼs own modified applied kinesiology were also used. Typical care was three adjustments per week for one week, then two adjustments per week for one week, then one adjustment per week. Interestingly, children with a history of past antibiotic use was associated with a less favorable outcome. From the abstract: “93% of all episodes improved, 75% in 10 days or fewer and 43% with only one or two treatments. Young age, no history of antibiotic use, initial episode (vs. recurrent) and designation of an episode as discomfort rather than ear infection were factors associated with improvement with the fewest treatments… Improvement was based on parental decision (they stated that the child had no fever, no signs of ear pain, and was totally asymptomatic), and/or the child seemed to be asymptomatic to the treating DC and/or the parent stated that the childʼs MD judged the child to be improved. Read the abstract

4)Allergy airway disease and otitis media in children. Todd NW, Feldman CM, Int J Pediatr Otorhinolaryngol 1985: 10(1):27-35.

Musculoskeletal eustachian tube dysfunction is an important etiological factor for otitis media. The eustachian tube dysfunction manifests primarily by poor ventilation from the nasopharynx to the middle ear, by allowing negative pressure in the middle ear.

5) Blocked atlantal nerve syndrome in babies and infants. Gutman G. Manuelle Medizin (1987) 25:5-10.

From the abstract: Three case reports are reviewed to illustrate a syndrome that has so far received far too little attention, which is caused and perpetuated in babies and infants by blocked nerve impulses at the atlas. Included in the clinical picture are lowered resistance to infections, especially to ear-,nose-, and throat infections.”

6) Infections of the ears, nose and throat. Blood HA. Osteopathic Annals 6:11 November 1978, p.46-48.

7) Diagnosis and treatment of TMJ, head, neck and asthmatic symptoms in children. Gillespie BR, Barnes JF, J of Craniomandibular Practice. Oct. 1990, Vol 8, No. 4. From the abstract: “Pathologic strain patterns in the soft tissues can be a primary cause of headaches, neck aches, throat infections, ear infections, sinus congestion, and asthma.”

8) Structural normalization in infants and children with particular reference to disturbances of the CNS. Woods RH JAOA, May 1973,72: pp.903-908. Post-traumatic epilepsy, allergic problems, otitis media and dizziness have been relieved by cranial manipulation

9) The role of the chiropractic adjustment in the care and treatment of 332 children with otitis media. Fallon, JM. Journal of Clinical Chiropractic Pediatrics Vol 2, No. 2 1997 p. 167-183.

From the abstract: This pilot study included children from 27 days old to five-years-old, was on the effects of chiropractic adjustments on children with otitis media used tympanography as an objective measure.

Results: the average number of adjustments administered by types of otitis media were as follows: acute otitis media (127 children) 4 adjustments; chronic/serous otitis media (104 children) 5 adjustments; for mixed type of bilateral otitis media (10 children) 5.3 adjustments; where no otitis was initially detected (74 children) 5.88 adjustments. The number of days it took to normalize the otoscopic examination was for acute 6.67, chronic/serous 8.57 and mixed 8.3. the number of days it took to normalize the tympanographic examination was acute: 8.35, chronic/serous 10.18 and mixed 10.9 days. The overall recurrence rate over a six month period from initial presentation in the office was for acute 11.02%, chronic/serous 16.34%, for mixed 30% and for none present 17.56%.

Conclusion: The results indicate that there is a strong correlation between the chiropractic adjustment and the resolution of otitis media for the children in this study. Note: 311 of the 332 had a history of prior antibiotic use. 53.7% of the children had their first bout of otitis media between the ages of 6 months and 1 year and a total of 69.9% of the subjects in the study had their first bout of OM under a year of age. This is consistent with the findings of others

10.) Chiropractic correction of congenital muscular torticollis. (Child also presented with repeated ear infections)

A 7-month-old male infant with significant head tilt since birth was brought to a chiropractic physician for evaluation. The infant’s history included ear infections, facial asymmetry and regurgitation. Significant spasm of the left sternocleidomastoid and trapezius muscles, a left lateral atlas and suboccipital joint dysfunctions were present upon examination. A diagnosis of congenital muscular torticollis was made. INTERVENTION AND OUTCOME: Treatments included chiropractic manipulation, trigger point therapy, specific stretches, pillow positioning and exercises. Excellent results were obtained.

CONCLUSION: Suggests that chiropractic intervention is a viable treatment option for congenital muscular torticollis. Further studies should be performed to compare the effectiveness of other treatment options.

J Manipulative Physiol Ther 1993 Oct;16(8):556-9

More Studies Needed!

A feasibility study of chiropractic spinal manipulation versus sham spinal manipulation for chronic otitis media with effusion in children.

A pilot study was undertaken for the purpose of assessing the feasibility of conducting a full-scale randomized clinical trial investigating the efficacy of chiropractic spinal manipulative therapy (SMT) for children with chronic otitis media with effusion. Recruitment for a randomized controlled trial is feasible and could be enhanced by medical collaboration. Patients and parents are able and willing to participate in a study comparing active SMT and placebo SMT. Parents were extremely compliant with the daily diaries, suggesting that similar quality-of-life and functional status measures can be successfully used in a larger trial. We found the objective outcomes assessment involving tympanometry and otoscopy extremely challenging and should be performed by experienced examiners in future studies.

J Manipulative Physiol Ther 1999 Jun;22(5):292-8

Case Studies:

1) The atlas fixation syndrome in the baby and infant. Gutmann G. Manuelle Medizin 1987 25:5-10, Trans. Peters RE.

18-month-old boy, recurring tonsillitis, frequent enteritis, therapy resistant conjunctivitis, suffered from colds, rhinitis, ear infections and sleep disturbances. “Immediately after (spinal adjustment) the child demanded to be put to bed and for the first time slept peace-fully to the next morning. Previously disturbed appetite normalized completely. Conjunctivitis cleared completely.”

2) Chiropractic results with a child with recurring otitis media accompanied by effusion. Chiropractic Pediatrics, 1996;2:8-10.

Authorʼs Abstract (Abridged) : A case study of five year old male with recurring otitis media is reviewed. Chiropractic Biophysics spinal analysis methods and adjusting procedures were applied over a six month period. During the six months of adjustments, the child had only one middle ear infection with mild effusion. In the previous year, the child had recurring middle ear infections with effusion approximately every three to six weeks.

Note: Newer studies in the effectiveness of antibiotics for middle ear infections in child are reporting that child treated with antibiotics are more likely to have recurrences. Antibiotics are known to weaken resistance to disease and that is probably why children are so affected by their use.

3) The response of a patient with otitis media to chiropractic care. Thill L, Curtis J, Magallances S, Neuray P. Life Work, 1995; 3: 23-28.

Authorsʼ Abstract: This paper discusses the case of a nineteen month old female with a chronic history of acute episodes of suppurative otitis media. Treatment consisted of four series of antibiotics over a six month period with no improvement; antibiotics were stopped and then began a four week course of intensive chiropractic care, with complete resolution at two weeks.

4) Vertebral subluxation and otitis media: a case study. Phillips, NJ. Chiropractic: The Journal of Chiropractic Research and Clinical Investigation. Jul 1992, Vol: 8(2), pp.38-9. Authorʼs abstract: This is the case of a 23-month-old female with chronic otitis media who had orthodox medical treatment with no relief of symptoms. She had sustained improvement with chiropractic care. A mechanism for the etiology of chronic otitis media is suggested. From the paper: “Conventional medical treatment had been administered, including numerous regimens of broad-spectrum antibiotics. Six months before having been seen, bilateral myringotomies with tympanostomy tube placement were performed. The tubes were still in place on presentation.” Three days after initial adjustment (at C-1) the patientʼs ear drainage and pain were notice-ably reduced. Child was soon free of all symptoms.

5) Chronic otitis media: a case report. Hobbs DA, Rasmussen SA. ACA J of Chiropractic, Feb 1991; 28:67-68.

This is a case study of a 38-year-old female. She had previously suffered from headaches and colitis and they resolved after earlier chiropractic care. Her hearing loss and chronic otitis media symptoms subsided and hearing was restored through chiropractic care with an emphasis on cranial adjustments. (Note from Neurological Fitness Magazine V.1 No.4, July 1992: “Recently, Dr. Peter Fysh (Proceedings of the National Conference on Chiropractic and Pediatrics (ICA), 1991;37-45 hypothesized that cervical adjustments relieve blockage to lymphatic drainage from the ears.)

6) Aerotitis Media: A Case Report. Doyle EP, Dreifus LI, Dreifus GL. Chiropractic Sports Medicine, 1995; 9: 89-93.

Authorsʼ Abstract: the objective of this report is to determine if spinal manipulation affects symptoms associated with aerotis media (barotitis), which commonly affects underwater divers and airplane travels. This study involves a recreational scuba diver that has a history of eustachian tube blockage that is exacerbated by diving.

7) From Neurological Fitness Vol. V, No. 2 Jan 1996:

The 33-year-old male patient presented with a feeling of fullness in his ears, hearing loss, and tinnitus: these problems were not relieved by a course of antihistamines (patient had a history of eustachian tube blockage since childhood). Following Diversified adjusting (primarily C2, C5) audiometry and tympanometry findings normalized. The patientʼs subjective complaints were alleviated as well.

8) Chronic ear infections, strep throat, 50% right ear hearing loss, adenoiditis and asthma. Case history by G. Thomas Kovacs, D.C. International Chiropractic Pediatric Association Newsletter. July 1995.

4 1/2 year old female with chronic ear infections, strep throat, (on and off for 4 years) 50% right ear hearing loss, adenoiditis and asthma. Had been on antibiotics (Ceclor), developed pneumonia, on bronchodilators and anti-inflammatory for asthma. Also given steroids. ENT diagnosed child with enlarged adenoids. Surgery to remove childʼs adenoids and to put tubes in her ears was scheduled. Chiropractic history: cervical (C2) and thoracic (T3) and right sacroiliac subluxation. Numerous enlarged lymph nodes and muscle spasm. Chiropractic care of 2x/week for 6 weeks scheduled. After 3 or 4 adjustments mother noticed “a changed child, she has life in her body again...acting like a little girl again for the first time in 4 years.” After 6 weeks, pediatrician and ENT noticed no sign of ear infection or inflammation, “Her adenoids, which were the worst the ENT has ever seen, were perfectly normal and healthy. Hearing tests revealed no hearing loss. Family told M.D.s ʻall medication was stopped 6 weeks ago when chiropractic care started.ʼ Shocked and confused by this answer, the family was told to continue chiropractic care because it had obviously worked.ʼ”

9) Chronic ear infections The side-effects of the chiropractic adjustment. Arno Burnier, D.C. Chiropractic Pediatrics Vol. 1 No. 4 May 1995.

This is a case history of T & P Roger, males, ages 6 and 9, from the records of Dr. Arno Burnier of Yardley, PA. Medical Diagnosis: Chronic ear infections. Medication: Multiple course of Ceclor antibiotic, Nebulizer. Chiropractic result: Both children have been free of medication and over-the-counter drugs for the past three years since the onset of care. Presenting Vertebral Subluxation: Tim C2, C3, D12/L1 Patrick Oc/C1, Sacrum.

10) Ear Infections: A Case Study by Harley Bofshever D.C. International Chiropractic Pediatric Association Newsletter Nov-Dec, 1999.

HISTORY: An upset father presented to my office on 4-30-99, with his 9 year old son, who has been having chronic ear infections, Patient’s father states that his son has had ear infections for the past 6 years and are progressively getting worse- He states that his son has been on and off antibiotics, Amoxycillin and Biaxin on a regular basis at least every 6 weeks for the past 6 years. It is noted that this patient has had prior surgery when tubes were put in his ears, approximately 5 years ago. The tube in his left ear recently fell out. Upon the patient’s last visit to his EENT, another surgery to remove the remaining tube and reinsert new tubes in both ears was suggested. Additionally it was suggested to remove his tonsils and adenoids at that time. At exam, the patient was scheduled to have this surgery in 3 weeks. History of the motherʼs pregnancy and birth were unobtainable due to a divorce and father did not recollect much about the delivery. It is noted that this patient is a heavy dairy consumer. At this time, I have discussed with the father the benefits of chiropractic care for his child and he has agreed to postpone the surgery for 6 weeks and give chiropractic a chance.

EXAMINATION: An in depth chiropractic examination was performed, which revealed bilateral effusion and scar tissue in both ears. Patient has submandibular glandular swelling as well as tonsillitis and redness of the throat. There is also swelling of the posterior cervical musculature, with inflammation bilaterally at the splenius capitus and splenius cervicus. Range of motion to the cervical spine is within normal limits. There is a positive foraminal compression test. Static and motion palpation examination reveals evidence of C2 and C6 subluxation complexes. Postural analysis showed a left head tilt with a high right shoulder.

CARE PLAN: Recommendations were made for adjustments 3 times a week for 6 weeks at which time he will be reevaluated and a new care plan will be determined. Nutritional recommendations were made. I have recommended discontinuing the use of all dairy products at this point. Due to the heavy antibiotic usage, I have also advised this patient to take acidopholus and lactovasic acid to help replenish the normal flora in the gastrointestinal tract.

PATIENT’S PROGRESS: The patient has shown vast signs of improvement after his second adjustment. His father stated that his son is much more alert, is concentrating better in school. The teachers have actually noted the improvement the last 2 days. The father also states that his son has not complained about his ears bothering him since the first adjustment. It is also noted that his throat pain had begun to clear up after his second visit. At the end of the 6-week program, the patient was reevaluated. There was no more effusion in either ear. Rhinnes and Weber test were within normal limits. Tonsils and adenoids were back to their normal size. The father stated that surgery was no longer indicated by the EENT. The patient was advised to continue care plan of 1 time a week for the next 6 weeks to and will continue to be monitored. After that time, he may be put on a wellness care plan of 1 time a month for chiropractic evaluations.

DISCUSSION: To this date is has been approximately 5 months since the patient’s first visit to our office. He has had no bouts of ear infections up to this time, no sore throats, no colds, no flu’s and has been on no medication. He is back on dairy, however his consumption is much less than previously consumed. This patient is now back to a normal lifestyle and patient’s father has also reported that his grades are up since he started his chiropractic care. This patient will continue a once a month chiropractic evaluation program and since his son has done so well, the father has decided to have his other son put under chiropractic care because of a learning disability due to a hearing problem.

Additional Publications:

1) Treatment protocols for the chiropractic care of common pediatric conditions: otitis media and asthma. Vallone S and Fallon JM Journal of Clinical Chiropractic Pediatrics Vol 2, No.1 1997. P. 113-115

This paperʼs purpose presents the results of a survey of chiropractors enrolled in the first year of a three year postgraduate course in chiropractic pediatrics. The survey sought to establish if consensus existed with respect to the modalities these doctors used to treat two of the most common childhood disorders seen by chiropractors: otitis media and asthma. Thirty-three doctors of chiropractic participated in the survey. “Of the primary therapeutic modalities employed by the chiropractor, spinal adjusting was the most commonly used for both asthma and otitis media. Certain areas of the spine were addressed most frequently for each of the two conditions.

2) Cause of Eustachian tube constriction during swallowing in patients with otitis media with effusion. Takahashi H; Miura M, Honjo I, Fujita A. AnnOtol Rhinol Laryngol 1996; 105(9);724-8.

Inflammation in the nasopharynx and the pharyngeal portion of the Eustachian tube was considered to be closely related to the tubal constriction, which represents a considerable part of the cause of tubal ventilatory dysfunction in otitis media with effusion.

3) Chronic recurrent otitis media: case series of five patients with recommendations for case management. Fysh PN, Journal of Clinical Chiropractic Pediatrics Vol. 1, No. 2 1996.

The author has presented a case series of five patients (ages 0 to 5) with chronic otitis media who had previously been under regular medical pediatric care for this condition. These children all underwent a program of chiropractic case management, including specific spinal adjustments. All patients had excellent outcomes with no residual morbidity or complications. All had five adjustments to the spine. Of the five, 3 had an atlas subluxation, one had an occipital subluxation and one had an atlas and axis subluxations. These children were adjusted full spine as well. Hypothetical mechanisms for the putative effects of spinal adjustments at areas exhibiting signs of subluxation, in patients with otitis media, are presented in the paper.

4) From Neurological Fitness Vol. V, No. 2 Jan 1996:

Reviewerʼs Synopsis: This patient presented with glassy eyes, a runny nose, and apparent discomfort evidenced by continually tugging at both her ears. The mother reported that the child had been like this consistently over the previous six months. In addition to the antibiotic therapy noted in the abstract, medical treatment also included weekly steroid injections and inhalants to control asthma...no improvement had been noticed by the mother and several emergency room visits had been required due to asthmatic attacks. Diversified adjusting at C1, T1 and right sacroiliac joint every day for two weeks. Pulling at the ears, runny nose, and glassy eyes were resolved by the second visit.

5) Sore throat, difficulty in swallowing, nausea, vomiting, poor appetite, and alternating diarrhea and constipation From Neurological Fitness Vol. V, No. 2 Jan 1996: Patient presented with a history of sore throat, difficulty in swallowing, nausea, vomiting, poor appetite, and alternating diarrhea and constipation. She was also suffering from ear pain and ear discharge related to chronic otitis media of 17 months duration. This condition had resisted several regimens of antibiotics as well as surgery to insert tympanostomy tubes. Three days after this first adjustment, the ear pain and discharge were substantially reduced. Continued correction of C1 eventually resulted in both ears being clear of exudate. At the time of this report, the patient has been symptom-free for approximately four years.

6) A comparative study of the health status of children raised under the health care models of chiropractic and allopathic medicine. Van Breda, Wendy M. and Juan M. Journal of Chiropractic Research Summer 1989. More than 80% of the medical children suffered from at least one bout of otitis media while only 31% of the chiropractic children were so reported.

Read additional articles on Ear Infections:

1) Otitis Media -Dr Claudia Anrig References from Koren Publicationsʼ brochure: Ear Infections and Chiropractic Van Buchem F.L., Dunk J.H.M., and Vanʼt Hof M.A. Therapy of Acute Otitis Media: Myringotomy, Antibiot-ics, or Neither? Lancet, October 24, 1981, pp. 883-887. Diamant, M., M.D. and Diamant B, M.D. Abuse and Timing of Use of Antibiotics in Acute Otitis Media.

Archives of Otolaryngology Vol 100, Sept 1974, pp. 226-232. Olson, A. L. et al Prevention and Therapy of Serous Otitis Media by Oral Decongestants. A Double-Blind

Study in Pediatric Practice. Pediatrics Vol. 62, May 1978, 679-84. The Peopleʼs Doctor, A Medical Newsletter for Consumers, Vol. 9, No.5. August 1981. pp.1-4.

Hendricks, C.L., D.C. Thier, S.M., D.C. Otitis Media in Young Children, Chiropractic Jan. 1989 Vol 2 No.1 pp. 9-13.

Gutman G, Blocked Atlantal Nerve Syndrome in Babies and Infants, Manuelle Medizin (1987) 25:5-10.

Purse F.M. Manipulative Therapy of Upper Respiratory Infections In Children. Journal of the American Osteopathic Association. 65: pp 964-971, 1966