• Middle Ear Infection, Otitis Media
• Avoiding Passive Smoke Inhalation,
Acute otitis media (AOM) is a painful infection of the middle ear, the portion of the ear behind the eardrum. (Another form of ear infection, otitis externa or swimmer's ear, is entirely different and is not covered here.)
AOM often follows a cold, sore throat, or other respiratory illness. Although it can affect adults, this occurs primarily in infants and young children. It's estimated that by age 7, up to 95% of all children in the US will have experienced at least one bout of AOM—it's the most common reason parents take a child to the doctor.
When the Eustachian tube connecting the upper part of the throat to the middle ear is blocked by a cold's mucus and swelling, fluids pool behind the eardrum, providing an ideal place for bacteria to grow; an infection may set in, generating even more fluid. The pressure this exerts on the eardrum can be intensely painful. The eardrum turns red and bulges. Children too young to explain their discomfort cry, fuss, and pull at their ears. They might also appear unresponsive because they can't hear well—fluid buildup in the middle ear prevents the eardrum and small bones in the ear from moving, causing temporary hearing loss.
In addition, a complication called secretory otitis media (fluid build-up in the middle ear) may develop and cause continuous hearing loss for months. Other possible, though rare, complications of AOM include mastoiditis (an infection of the bone behind the ear) and spinal meningitis.
Without treatment, most middle ear infections resolve on their own, often through a harmless rupture of the eardrum.
US doctors, however, tend to initiate treatment early. This practice has been criticized on several grounds. First, aggressive antibiotic treatment has not been found effective in preventing complications, such as serous otitis,
In addition, antibiotic treatment does not even appear to help AOM itself very much. For example, a
In other published reviews, the benefits of antibiotics for AOM have also been found less than impressive. A review of 33 randomized trials involving 5,400 children concluded that antibiotics modestly improved the rate of recovery.
However, the claim (often made in alternative medicine circles) that early antibiotic treatment causes an increased rate of ear infection recurrence does not appear to be correct.
Note : Despite the issues raised above, simply withholding antibiotic treatment can be dangerous. Any child who appears to have an ear infection should be seen by a physician.
When ear infections do reoccur frequently, a physician may insert a tube into the infected ear to drain fluids and relieve pressure, a procedure called tympanostomy. Nearly one million American children undergo this procedure each year; however, its usefulness is somewhat controversial.
Principal Proposed Natural Treatments
Although there is as yet no natural treatment for AOM, there are several promising approaches parents can take that may help prevent children from developing ear infections or reduce symptoms.
A natural sugar found in plums, strawberries, and raspberries, xylitol is used as a sweetener in some "sugarless" gums and candies. One of its advantages is that it inhibits the growth of
a type of bacteria that causes dental cavities.
Xylitol also inhibits the growth of a related bacteria species,
implicated in ear infections.
Based on this evidence, xylitol has been tried as a preventive treatment for middle ear infections with some success. Two well-designed studies enrolling a total of 1,163 children found that when taken 5 times daily throughout a large portion of the cold season, chewing gum and syrup sweetened with xylitol helped prevent middle ear infections. However, xylitol has not proved effective when taken 3 times daily rather than 5 times daily, nor when it is used only after the onset of a respiratory infection.
In one of the positive studies, 857 children were given either placebo or xylitol 5 times daily in the form of chewing gum, syrup, or lozenges.
Similarly positive results had been seen in an earlier three-month, double-blind study by the same researchers, evaluating about 300 children, and again using a dosing schedule requiring use of xylitol 5 times daily.
However, taking xylitol 5 times daily requires a great deal of effort. Other researchers set out to discover whether it would still work if taken only 3 times daily. Unfortunately, in their 3-month, double-blind, placebo-controlled study of 663 children, no benefits were seen.
Another study, this one enrolling 1,277 children, took a different approach to simplifying the use of xylitol: they used the original dosage schedule, but began treatment only after a respiratory infection had begun, rather than over a period of many months.
For more information, including dosage and safety issues, see the full
Breastfeeding may help prevent AOM. Numerous studies tracking ear infection frequency in large groups of infants found that the infants who were breastfed exclusively had significantly fewer middle ear infections than those fed formula.
Researchers aren't sure how breast milk might protect infants from ear infections. Studies attempting to determine if breast milk inhibits bacteria associated with AOM have yielded mixed results.
Avoidance of Cigarette Smoke
Environmental conditions may predispose a child to middle ear infections. A study of 132 daycare students found that the 45 children exposed to cigarette smoke at home had a 38% higher risk of middle ear infections than the 87 children whose parents didn't smoke.
Herbal Ear Drops
The herbs mullein and garlic are traditionally combined with other herbs in oily ear drops designed to reduce the pain of ear infections. One study supports this use. Two double-blind trials enrolling a total of more than 250 children with eardrum pain caused by middle ear infection compared the effectiveness of an herbal preparation containing mullein, garlic, St. John’s wort, and calendula against a standard anesthetic ear drop product (ametocaine and phenazone).
However, due to the strong placebo response in pain conditions, this study would have needed a placebo group to provide truly dependable evidence that the herbs were effective.
Keep in mind that while herbal eardrop products may relieve pain, the actual infection is on the other side of the eardrum, and it is not immediately clear how the herbs can get to where they could do any good. There is some evidence, however, that
Note : Garlic and its oil are too harsh to instill into the ear. Herbal drops that contain garlic use much milder extracts of the herb.
Other Proposed Natural Treatments
Allergies may contribute to ear infections, possibly by increasing the amount of fluid in the middle ear. There is some evidence that children allergic to pollens, dust, molds, and foods may be more likely to develop AOM.
Weak evidence suggests that a
Other Herbs and Supplements
Numerous natural products have been proposed for preventing or treating ear infections. These include all herbs and supplements used for
This topic is also discussed in the
1. Rosenfeld RM, Vertrees JE, Carr J, et al. Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials. J Pediatr. 1994;124:355-367.
2. Rosenfeld RM, Vertrees JE, Carr J, et al. Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials. J Pediatr. 1994;124:355-367.
4. Rothrock SG, Harper MB, Green SM, et al. Do oral antibiotics prevent meningitis and serious bacterial infections in children with Streptococcus pneumoniae occult bacteremia? A meta-analysis. Pediatrics. 1997;99:438-444.
5. Damoiseaux RA, van Balen FA, Hoes AW, et al. Primary care based randomized, double blind trial of amoxicillin versus placebo for acute otitis media in children aged under 2 years. BMJ. 2000;320:350-354.
6. Rosenfeld RM, Vertrees JE, Carr J, et al. Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials. J Pediatr. 1994;124:355-367.
25. Hurst DS. Association of otitis media with effusion and allergy as demonstrated by intradermal skin testing and eosinophil cationic protein levels in both middle ear effusions and mucosal biopsies. Laryngoscope. 1996;106:1128-1137.
33. Butler CC, Van Der Linden MK, MacMillan HL, et al. Should children be screened to undergo early treatment for otitis media with effusion? A systematic review of randomized trials. Child Care Health Dev. 2003;29:425-432.
34. Aldous MB, Wahl R, Worden K, Grant KL. A randomized, controlled trial of cranial osteopathic manipulative treatment and echinacea in children with recurrent otitis media [abstract 1062]. 2003 Pediatric Academic Societies' Annual Meeting; May 3-6, 2003; Seattle, WA.
37. Hatakka K, Blomgren K, Pohjavuori S, et al. Treatment of acute otitis media with probiotics in otitis-prone children: a double-blind, placebo-controlled randomised study. Clin Nutr. 2007 Mar 10. [Epub ahead of print]
40. Wahl RA, Aldous MB, Worden KA, et al. Echinacea purpurea and osteopathic manipulative treatment in children with recurrent otitis media: a randomized controlled trial. BMC Complement Altern Med. 2008;8:56.
Last reviewed April 2009 by EBSCO CAM Review Board
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