Doctors Urged to Delay Kids` Earache Drugs

The above headline comes from the June 6, 2003 edition of the Atlanta Journal Constitution (AJC). The article starts off by saying, "Doctors are being advised to withhold antibiotics for two to three days for many children with earaches in an effort to curb the growing problem of antibiotic resistance."  The Academy of Pediatrics is planning on initiating a campaign called, "watchful waiting" this fall in response to the growing problem.

According to the AJC article, about 10 million prescriptions for antibiotics are written every year for kids with ear infections. This number represents nearly half of all antibiotics used among preschoolers.  However the article notes that 81 percent of the ear problems go away without medication, according to the U.S. Agency for Healthcare Research and Quality, a division of the Department of Health and Human Services.

Dr. Richard Rosenfeld, a pediatric ear, nose and throat specialist at Long Island College Hospital in Brooklyn, says, "You're not getting a lot of bang for your antibiotic buck with this disease."  Dr. Rosenfeld spoke at a Centers for Disease Control and Prevention conference in Atlanta and is helping the Academy of Pediatrics finalize its guidelines. Those new guidelines tell pediatricians and family physicians to hold off on antibiotics for children older than 6 months if doctors aren't sure of a true ear infection. The new guidelines also suggest that antibiotics should be given for just five days, instead of seven to 10 days, for children older than 2.

The AJC article also noted that many earaches are viral and don't involve fluid in the middle ear, a sign of infection. Nearly 20 percent of true ear infections are caused by viruses for which antibiotics don't work. Dr. Gerald Reisman, with Dunwoody Pediatrics in Atlanta noted, "It may take a while for parents to accept the new approach away from routinely using antibiotics to treat their children.  Parents often have the expectation that their child is sick and needs an antibiotic to get well, and some really put the pressure on," he said. "But now we can say, "It's not just me. It's the CDC and the Academy of Pediatrics."

Dr. Rich Bessler, a CDC infectious disease specialist, noted that other countries in Europe have successfully implemented campaigns to delay antibiotic use for earaches. Dr. Rosenfeld closed the article by suggesting that parents need to realize that an earache, even though sometimes painful, is almost always harmless.

Ear infections can affect anyone, though children are particularly prone. The most common type affects the middle ear, the area behind the eardrum.

The ear

The outer ear includes the parts of the ear that can be seen on the side of the head, as well as the canal that leads into the head.

The middle ear contains three small bones (ossicles) that help sounds reach the eardrum. A narrow tube (called the Eustachian tube) connects the middle ear to the throat, and regulates the pressure in the ear. It is this middle part of the ear that most commonly becomes infected.

The inner ear includes the fluid-filled labyrinth and cochlea, where the fibres of the auditory nerve are found.

Middle ear infection

The medical term for middle ear infection is otitis media. It is very common in children under the age of eight, but people of any age can be affected, and it can affect one or both ears. You are more likely to get otitis media if someone in your family has had it, or if you live or work with people who smoke. Children who use a dummy have been shown to be at more risk.

There are three main types:

• acute otitis media
• chronic otitis media
• "glue ear" (secretory otitis media, also known otitis media with effusion).

 

Causes

Acute otitis media

This type of infection is often caused by bacteria from a cold or sore throat, which can travel up the Eustachian tube. The infection can cause pus and bleeding, and the eardrum may burst as a result of the pressure. In most cases, a burst eardrum heals by itself.

Chronic otitis media

If the eardrum does not heal completely, or if it has been punctured by a blow to the head, chronic otitis media is more likely. This is not as painful as acute otitis media, but it can last for longer and the infection can occur repeadedly. Chronic otitis media can also be caused by a condition called cholesteatoma, which causes an over-production of tissue in the middle ear.

Glue ear

This can develop if the Eustachian tube gets blocked. When this happens, the pressure inside the ear cannot be regulated. A sticky fluid builds up inside the middle ear and affects hearing.

Blockage of the Eustachian tube may be caused by an infection, an allergy, or by enlarged adenoids (tissue at the back of the throat which helps fight infections).

Children are particularly vulnerable to glue ear because they are less able than adults to fight off infections, and also because their Eustachian tubes are shorter, lie in a more horizontal position, and are more easily blocked. Children who get allergies and hay fever are more susceptible, too.

Symptoms

Acute otitis media

The symptoms of acute otitis media include:

• severe earache,
• a feeling of "fullness" in the ear,
• deafness,
• ringing in the ear,
• fever,
• a discharge of blood and pus if the ear drum ruptures,
• feeling generally unwell, with nausea, vomiting or diahorrea,
• children tugging at the ear or having trouble swallowing their food.

Chronic otitis media

The symptoms of chronic otitis media are much less severe than with acute otitis media. It is usually painless, but there is likely to be a discharge of thick, smelly pus, and hearing may be affected.

Glue ear

There are no obvious signs of glue ear. Children sometimes complain that their ear feels "bunged up" but the main symptom is deafness, which, in small children, is often mistaken for lack of attention.

Diagnosis

To diagnose otitis media, the doctor may:

• look into the ears with an instrument called an otoscope,
• take a sample of any discharge for laboratory analysis,
• take a sample of blood for testing to confirm the presence of infection,
• carry out some simple hearing tests,
• sometimes request an X-ray or a CT scan to discover whether the infection has spread from the middle ear.

Treatment

Left untreated, acute and chronic otitis media can lead to deafness or other serious complications. Glue ear rarely causes long term physical damage, but the temporary deafness can affect a child's educational and social development. For these reasons, it's important to see a doctor if you think your child has otitis media.

Acute otitis media is often given a chance to clear up on its own. If this does not happen, it may be treated with antibiotics. Sometimes, nasal drops or sprays are prescribed to help unblock the Eustachian tube. Eardrops or painkillers may also be prescribed.

If the eardrum is likely to burst, a specialist ear, nose and throat doctor (an otolaryngologist) may perform a procedure called a myringotomy. This involves making a tiny hole in the eardrum (under general anaesthetic) so the fluid can drain out. The eardrum should heal about a week after the infection has cleared.

Chronic otitis media may be treated with antibiotics to clear the infection. However, surgery provides a more permanent solution. An operation called a tympanoplasty can repair the perforated eardrum, as well as any damage done to the bones in the middle ear. Alternatively, if the condition is caused by cholesteatoma, the excess tissue can be surgically removed.

Glue ear may clear up without treatment, but may also be treated with antibiotics. When hearing loss is involved, some doctors recommend a myringotomy. A tiny tube called a grommet may be inserted. This lets the ear drain continually, and usually restores hearing.

If a child does have a grommet, an earplug should be used when swimming with the head underwater to prevent bacteria entering the ear. In addition, he or she should also be examined regularly by a doctor. The grommet usually falls out after eight months to a year, and the hole usually closes within another eight to nine months.

Not all doctors recommend grommets. The risks include permanent scarring or damage to the middle ear or eardrum, which, in rare cases, can cause some deafness.

Preventing otitis media

The correct treatment of colds, 'flu and sore throats, and of hay fever and other allergies may help. This means controlling the symptoms as much as possible, with medications such as decongestants like xylometazoline hydrochloride (eg. Tixycolds, which is suitable for children over two) and menthol capsules (eg. Karvol).

There is some evidence that breastfeeding babies during their first three months, and that feeding babies in an upright position, decreases the risk of glue ear.

Recurrent ear infection is strongly associated with early bottle feeding, whilst breastfeeding of at least six months has a protective effect. This is probably often due to the combination of breast-fed babies avoiding the cow's milk allergy, and also receiving natural immunity through the breast milk. Breast milk is also high in essential fatty acids which are anti-inflammatory.

It has been estimated that as many as 95%of all children have at least one ear infection by the time they are 6 years old.. There are several different types of ear infections.

Frequent middle ear infections, or recurrent otitis media, affects 30% or more of children under the age of six. This is the most frequent diagnosis in clinical medical practice.

 

 

 

How common is glue ear?

It is common. More than 7 in 10 children have at least one episode of glue ear before they are four years old. In most cases it only lasts a short while. Boys are more commonly affected than girls. It is more common in children who:

• live in homes where people smoke.
• were bottle fed rather than breast fed.
• have frequent coughs, colds, or ear infections.
• have a brother or sister who had glue ear.

 

 

Acute Otitis Media (Middle Ear Infection)

A child awakens suddenly at night crying because of intense ear pain. The probable cause is infection in the middle ear (the area between the eardrum and the skull) - a very painful condition called acute otitis media that is usually accompanied by fever with fluid coming out of the ear. Childhood ear infections often frighten parents partly because they tend to come on suddenly, often at night.

 

Antibiotics & Surgery

The most common treatments prescribed for ear infections in children are antibiotics, oral decongestants, tubes in the ears and surgery. The benefit of every one of these treatments is questionable.  

For example, in a double-blind study of 171 children with acute otitis media (239 affected ears), the children were divided into four groups. One group was treated with surgery, a second group was given antibiotics. In the third group, both surgery and antibiotics were given. The fourth group received no treatment at all. According to the authors, "There were no significant differences (in) pain, temperature, duration of discharge, otoscopic appearances, audiography, (or) recurrence rates between the four groups."1 In other words, recovery time was about the same for all of the children whether medical treatments were done or nothing was done at all. Another medical study showed that "88% of patients with acute otitis media never need antibiotics. In those treated with antibiotics, risk of recurrence is high.antibiotics does not imply shortening of the disease."2

 

Tubes in Ears (Tympanostomy)

Over a million operations for tubes in the ears are done in the United States each year to treat recurrent ear infections. Do they work? In controlled studies performed in Europe, children with bilateral chronic ear infections had a tube placed in one ear, with the other serving as a control. The results for both ears were just about the same: "No benefit from the placement of tubes.and actually created some complications such as scarring and permanent perforation." 3

 The late Dr. Robert S. Mendelsohn, a leading paediatrician, stated, "In the future, we doctors may have to consider whether the entire panoply of therapy for simple ear infections (antibiotics, antihistamines, insertion of tubes, tonsillectomy) does not represent overkill for a condition that, except in malnourished children, is almost always self-limited." 4 (In accordance with his philosophy of always choosing the most conservative option first, Dr. Mendelsohn would prescribe heated olive oil dropped into the ear canal, and whiskey (by mouth) to alleviate the pain and allow everyone, patient included, to get some sleep while the infection cleared up all by itself.)

Cause of Ear Infections?

Why are ear infections so common today? As Harris L. Coulter Ph.D. explains in his landmark book Vaccination, Social Violence and Criminality, the cause may be childhood vaccinations. Otitis, with consequent hearing loss, is one of the most common effects of vaccination. Today the United States is experiencing a true plague of this condition. At least half of all U.S. children have had an episode of "glue ear" by their first birthday. By the age of six, 90 percent have had such an episode, and they account for thirty million visits to physicians each year. 5

 

Conditions associated with vaccine damage, including ear infections, asthma and various behaviour problems such as hyperactivity and attention deficit disorder, have increased greatly since the start of mass vaccination programs. This increase is not across the board, however, as Coulter describes: "Conditions not associated with vaccine damage.remained stationary during this time or actually declined." 6

 

The Chiropractic Approach

Chiropractic care is one of the best things you can give a child suffering from an ear infection. Chiropractic is not a treatment for ear infections, yet doctors of chiropractic have noticed chiropractic's profound effect on ears and hearing. Restoring the spine to its proper alignment through chiropractic care should result in the return of normal nerve supply. 7

 

  Clinical Observations

Of 1,250 babies examined five days after birth, 211 suffered from vomiting, hyperactivity and sleeplessness. Of these 211, spinal abnormalities were found in 95%. Chiropractic spinal adjustment frequently resulted in the immediate cessation of crying, muscular relaxation and sleepiness. The authors stated that an unhealthy spine "causes many clinical features from central motor impairment to lower resistance to infections - especially ear, nose and throat infections."

 The authors, who were M.D.'s assert that all new-borns should have their spines checked by chiropractors. 8  

Among many chiropractic case histories, those of T.& P. Roger, males, aged 6 and 9 (from the records of Arno Burnier, D.C.) are common. Both children were medically diagnosed with chronic ear infections and had been on antibiotics for years. "Both children have been free of medication and over-the-counter drugs for the three years since their first spinal adjustment." 9

 Dr G. Thomas Kovacs (D.C.) described a 4 ½-year-old girl with chronic ear infections, a 50% right ear hearing loss and adenoiditis. "After six weeks of chiropractic care, a follow-up visit was made to her paediatrician and ENT specialist. Not only was there absolutely no sigh of ear infection or inflammation, her adenoids, which were the worst the ENT had ever seen, were perfectly normal and healthy.the family was told to continue chiropractic care because it had obviously worked." 10

 

It is essential that anyone with ear infection consider a chiropractic check-up. Chiropractic care may make the difference. Keeping your child's spine free from spinal subluxation will help your child's natural defences against disease. This will help you avoid drugs with all their side effects. Give your child the great advantage of this safer, more natural, non-drug form of health care.

1. Van Buchem, F.L., Dunk, J.H.M. & Van't Hof, M.A. Therapy of acute otitis media: Myringotomy antibiotics, or neither? Lancet , October 24, 1981, pp. 883-887.

2. Diamant, M. & Diamant, B. Abuse and timing of use of antibiotics in acute otitis media. Archives of Otolaryngology , 1974, 100 , pp. 226-232.

3. The People's Doctor, A Medical Newsletter for Consumers, 1981, 9 (5), pp. 1-4.4. Ibid.

5. Coulter, H.L., Vaccination, social violence and criminality, Berkeley, CA: North Atlantic Books, 1990, p. 116

6. Ibid, p. 258

7. Hendricks, C.L., & Thier, S.M. Otitis media in young children. Chiropractic , 1989, 2 (1), pp.9-13.

8. Gutman, G. Blocked atlantal nerve syndrome in babies and infants. Manuelle Med. , 1987, 25 , pp 5-10.

9. Burnier, A. Chiropractic Pediatrics, 1995, 1 (4).

  10. Kovacs, G.T. Int'l Chiropractic Paediatric Association Newsletter, July 1995.