Chronic Ear Infections

A recent article in the May issue of Pediatrics titled ‘Effectiveness of Tympanostomy Tubes for Otitis Media: A Meta-analysis’ is a perfect lead-in to a discussion about chronic ear infections in children.

Acute otitis media is diagnosed when the middle ear is filled with pus. Treatment of ear infections accounts for the largest use of antibiotics in childhood in the United States. Most ear infections will resolve without antibiotics, but the fluid can persist after the bacteria or virus is gone. This fluid is gone in 90% of kids within 3 months, but when it persists, it is called chronic otitis media or serous otitis. Repeated ear infections are called recurrent otitis media. Persistent fluid can cause hearing impairment, usually short term. 30% of children under two years old with recurrent ear infections have some hearing impairment. Because this causes concern for associated language and academic success, physicians in the 1980’s and 90’s started recommending ear tubes. More than 650,000 tympanostomy operations are now performed each year.

Some factors that increase the risk of otitis media include exposure to lots of kids, formula feeding, no immunizations, smoke exposure, dairy exposure, allergens and low vitamin D levels.

Since most ear infections are self limited (resolve without antibiotics), it is important to look at other causes of persistent middle ear fluid. Colds, allergies and food sensitivities can all cause fluid in the ear.

The findings in the above-referenced article in Pediatrics suggests that there may be short term improvement in hearing after insertion of ear tubes, but the benefit is not sustained and there is no evidence of benefit by 12 – 24 months.

Integrative Pediatrics recommendations for otitis media:

PREVENTION:

1. Breast feed
2. Supplements – Omega 3 fatty acids, Vitamin D, Probiotics (Lactobacillus GG)
3. Consider food sensitivities, most commonly dairy, eggs, gluten
4. Avoid second hand smoke
5. Vaccinate (Pneumococcus, H flu, influenza are common causes of otitis)
6. Xylitol chewing gum for kids old enough to chew gum

TREATMENT:

1. Avoid antibiotics
2. European strategy of ‘wait and see’. Physician gives a prescription to parents for antibiotics only to be filled after 48-72 hours if symptoms do not improve.
3. Garlic, mullein, St John’s wort ear oil
4. Avoid dairy
5. Consider craniosacral therapy