Otitis Media - Exploring all Treatment Options

Written by David M. Wall, MD

Fortunately, Brandon never did require ear tubes and his mother later told me that he never had any further infections in his ears.

I'm sure you must be asking yourself what is this "magic treatment program" that we concocted for Brandon. The truth is there is no magic at all. There is, though, well thought-out, credible medical and nutritional approaches for chronic, recurrent ear problems of which you should be aware.

Otitis media is the medical term used for inflammation of the middle ear. Otitis media is the most common reason that children are seen in the office of a physician right after well baby check ups. Otitis media is further divided into acute and serous. Acute otitis media refers to a syndrome of pain in the ear associated with a bulging, red eardrum or drainage of pus from the ear. Children are often irritable, with fever, and present pulling on the ear. Bacteria are generally the culprits of acute otitis media. These bacteria are the same as those found in the nasal passages. Typically, therefore, doctors treat acute ear infections with antibiotics. The use of antibiotics for the first episode of acute otitis media is certainly reasonable therapy as over 75 percent of these infections are believed to be bacterial origin. There is increasing evidence that short term ( 5 day) treatment is as effective as longer treatment and results in less incidence of the development of bacterial resistance. Antibiotics, though, are not the only proven treatment for acute otitis media. Homeopathic products have undergone study and have demonstrated statistically significant improvement in symptoms with their use. Additionally, there are anecdotal reports of the use of garlic oil applied by drops into the ear with benefit. As garlic has known anti-bacterial properties, this may not be as implausible as it initially appears, although clinical studies are lacking. Unfortunately, regardless of treatment, many children have repeat episodes of these ear infections. This has led may doctors to prescribe antibiotic prophylaxis ( daily continued use) to prevent recurrent otitis media. This practice is now being questioned because prolonged antibiotic use may increase the development of bacteria which are resistant to our usual antibiotics. This can lead to serious consequences. Additionally, recent studies suggest no difference between patients who underwent antibiotic prophylaxis and placebo( sugar pill) for reducing the incidence of recurrent infections. Individuals should therefore consider all other options prior to the daily use of long term or prophylactic antibiotics.

Serous otitis media or otitis media with effusion (OME) refers to fluid in the middle ear without signs or symptoms of infection. This is an extremely common problem occurring in approximately 20 percent of children age two years. Antibiotics do not appear to be the answer in this situation as only one out of six children who have this problem treated with antibiotics will benefit. Even in these children who do benefit from antibiotics, the effects are short lived ( about one month) and a long-term benefit of antibiotics for OME has not been shown. Physicians will therefore often recommend surgery. Surgical treatment of children with chronic OME is extremely controversial. The surgery is known as myringotomy with placement of PE tubes. These tubes allow the pressure to equilibrate on both sides of the eardrum, thus improving hearing and preventing problems with speech development. Again, though, the results have been inconsistent. Recent evidence has shown that the hearing improvement lasts only six months and that the long term effects of PE tubes may actually result in hearing loss in some children. Additionally, complications can occur with myringotomy and PE tube placement including tympanosclerosis ( scarring of the ear drum) and permanent perforation of the drum.

Given all of these facts, it's prudent to explore other options for children with recurrent acute ear infections or chronic ear fluid. Fortunately, there are safe nutritional approaches that are often effective. It is these following approaches that worked so well in the young child Brandon cited above. The most important intervention that we have with our young children with recurrent ear conditions is changing their diet. Food allergy is probably the most important and most overlooked factor in these children. In fact, our experience is that 80% of children who strictly follow the prescribed dietary restrictions have significant improvement in symptoms. The typical diet recommended avoids diary products, corn, wheat, and eggs. While these are the most common food allergies across the board, the specific foods to avoid may differ from individual to individual. The diagnosis of food allergies remains controversial in many medical circles, especially among allergists. Unfortunately, that is because allergists often utilize the type of testing that fails to diagnose these allergies. Routine skin testing, in our experience, often fails to accurately diagnose these children's true food sensitivities. The doctors in our office utilize ELISA testing, a form of testing for circulating antibodies within the blood against various foods and preservatives. It has been our experience that this testing is accurate ( about 80%) for determining the allergenic foods. When these foods are eliminated, symptoms often resolve. A study published in the Annals of Allergy 1994 confirmed this position. One hundred and four children with OME were tested for allergies. 78% tested positive for food allergies ( with a similar type of testing as mentioned above). 70 of 81 children who excluded these foods from their diet had improvement. Rechallenging the children to these foods led to a recurrence of the otitis media in 66 out of 70 of them. This study confirms our own experience that eliminating major food allergens decreases and even eliminates symptoms of otitis media in most children. Additionally, it should be mentioned that sugar may also be problematic in these young individuals. Sugar is known to decrease the immune system functioning. Some children may also be allergic to sugar containing foods as well. We therefore encourage every effort to decrease high sugar foods ( candies, cakes, etc.) in children with these conditions. In children still breast feeding, we strongly encourage continued breast feeding and ask the mother to reduce the intake of major allergenic foods as described above.

Lastly, a good nutritional program including proper supplementation is imperative to enhance immune system functioning. It is, of course, a child's immune system that is pre-programmed to fight and rid the body of infections. An optimally functioning immune system is the best defense against recurrent infections. The immune system, as in all of the body's systems, requires the basic essential fatty acids, essential proteins, vitamins and minerals for optimal working. Probably the most important of these in this specific issue is Vitamin C, Vitamin A and Zinc. Vitamin C helps the white blood cells of the immune system to destroy germs better. Vitamin A has demonstrated reduction in recurrence of ear infections. Zinc is one of the most important minerals for an active and strong immune system. As Vitamin A and Zinc can have toxic effects if given in excessive doses it is important to check with a knowledgeable physician to assure proper dosages if you are using over the counter supplements. There are a number of herbal products that have demonstrated improved immune functioning that may assist in these conditions also. Again, an experienced practitioner can assist with this information.

In summary, clinical experience and scientific research have demonstrated the benefits and safety of dietary and nutritional approaches in addition to specific pharmaceutical approaches in children with otitis media. It has been our experience that antibiotics, while effective in specific limited situations, are over prescribed with little scientific merit to their continued use. Surgery, and its potential complications, can also be avoided in most circumstances. It is important to explore all options before proceeding with any invasive or potentially toxic treatments. The nutritional approaches discussed provide parents safe, reasonable options for the care of their children.

Bibliography:

DowellSF,Butler JC, Giebink Gs et al: Acute otitis media: management and surveillance in an era of pneumococcal resistance - a report from the Drug-Resistant Streptococcus Pneumonia Therapeutic Working Group. Pediatr Infect Dis J 1999; 18:1-9.

Culpepper L, FroomJ; Otitis media with effusion in young children: treatment in search of a problem? J Am Board Fam Pract 1995; 8:305-316.

Bellioni P, Cantani A, SalvinelliF. Allergy: a leading role in otitis media with effusion. Allergol Immunopahtol 1987;15: 205-208.

Nsouli TM,et al. Role of food allergy in serous otitis media. Ann Allergy 1994,73:215-219.

Stoff J, The Use of Biomune OSF for Otitis Media, Townsend Letter April 2000, 64-67.

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