Ear Infection (Otitis Media)
Peer Reviewed Journals: Chiropractic RX for Chronic Otitis Media With Effusion David Eisenberg, MD This work is in progress under a grant from the Consortial Center for Chiropractic Research and the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM)
- The aim of the proposal is to examine whether chiropractic treatment will reduce the likelihood of the persistence of effusion in children with otitis media with effusion (OME) when compared to usual care.
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The innervation of the tensor veli palatini (tvp)
muscle is through the motor fibers of the mandibular branch of
the trigeminal nerve. These fibers unite to form portions of the
superior cervical ganglion located between the C-1 and C-4 nerve
roots. Neurological compromise of this muscle by osseous or soft
tissue structures may contribute to the malfunction of the tvp
muscle causing inadequate patency of the tube resulting in the
pathological response of OME. Chiropractic therapy may improve
the function of the TVP.
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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.
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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.
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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
doctor's 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 child's MD
judged the child to be improved.
- 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
A feasibility study of chiropractic spinal manipulation versus sham spinal manipulation for chronic otitis media with effusion in children. Sawyer CE, Evans RL, Boline PD, Branson R, Spicer A. J Manipulative Physiol Ther 1999 (Jun); 22 (5): 292-298
- 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.
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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.
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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."
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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."
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Post-traumatic epilepsy, allergic problems, otitis
media and dizziness have been relieved by cranial manipulation
- 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%.
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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
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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.
- The study of the autonomic status of the body in 38 patients with different forms of chronic purulent otitis media (CPOM) has demonstrated that patients with exacerbation or complication of CPOM were for the most part sympathotonics and normotonics. The former had more persistent disease with more frequent recurrences
Case Studies:
The atlas fixation syndrome in the baby and infant. Gutmann G. Manuelle Medizin 1987 25:5-10, Trans. Peters RE.
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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."
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Author's 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.
- A case study of a 38-year-old female with chronic otitis media and loss is presented. The symptoms subsided and hearing was restored through chiropractic care with an emphasis on cranial adjustments. Chiropractic treatment of chronic otitis media of adults and children as an alternative to tympanotomy and ventilation tubes is discussed.
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Authors' 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.
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Author's 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 patient's ear drainage and pain
were notice-ably reduced. Child was soon free of all symptoms.
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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.)
- Authors' 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.
From Neurological Fitness Vol. V, No. 2 Jan 1996:
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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 patient's subjective complaints were alleviated
as well.
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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 child's 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 'all medication was stopped 6 weeks ago when chiropractic
care started.' Shocked and confused by this answer, the family
was told to continue chiropractic care because it had obviously
worked.'"
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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.
- 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 mother's 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:
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
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This paper's 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.
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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.
- 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.
From Neurological Fitness Vol. V, No. 2 Jan 1996:
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Reviewer's 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.
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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.
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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.
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