Alternative Medicine: Otitis Media
Otitis media, sometimes referred to simply as an ear infection or inflammation, is the most common cause of earaches. Although this condition is a frequent cause of infant distress and is often associated with children, it can also affect adults. Otitis media is an infection of the middle ear, whose tiny bones pick up vibrations from the eardrum and pass them along to the inner ear. But very often, otitis media accompanies a common cold, the flu, or another type of respiratory infection. This is because the middle ear is connected to the upper respiratory tract by a pair of tiny conduits known as Eustachian tubes.
Most parents are frustratingly familiar with otitis media. Except for wellness baby visits, ear infections are the most common reason for trips to the pediatrician, accounting for 30 million doctor visits a year in the United States. Today, almost half of all antibiotic prescriptions written for children are for otitis media, and the cost of treating middle ear infections in the U.S. is estimated at $2 billion a year. Untreated, otitis media can lead to more serious complications, including mastoiditis (a rare inflammation of a bone adjacent to the ear), hearing loss, perforation of the eardrum, meningitis, facial nerve paralysis, and possibly Meniere's disease.
Cells in the middle ear manufacture a fluid that, among other things, helps keep out invading organisms. Normally, the fluid drains out through the Eustachian tube and into the throat. But if the Eustachian tube becomes swollen, the fluid can become trapped in the middle ear, causing the area to become inflamed and infected. This tube lies in a more horizontal position and is shorter in children, which may put them at even greater risk of infection. To the physician, the eardrum of an infected patient appears red and bulging.
The most common cause of otitis media is an upper respiratory viral infection, such as a cold or the flu. These disorders can make the Eustachian tube so swollen that middle ear fluid cannot escape. Allergies-to pollen, dust, animal dander, or food-can produce the same effect, as can smoke, fumes, as well as other environmental toxins. Bacteria can cause otitis media directly, but usually these organisms come on the heels of a viral infection or an allergic reaction, quickly finding their way into the warm, moist environment of the middle ear. Invading bacteria can wreak major havoc, turning inflammation into infection and provoking fevers. Among the bacteria most often found in infected middle ears are the same varieties responsible for sinusitis, pneumonia, and other upper respiratory infections. (Note: Flu shots do not offer protection from otitis media.) Otitis media occurs in various degrees of severity. A single, isolated case that is easily cured is called acute otitis media. If the condition clears up but comes back as many as three times in a six-month period (or four times in a single year), it is known as recurrent otitis media. If it continues for weeks without clearing up, it is called chronic otitis media. A fluid buildup in the ear without infection is termed serous otitis media.
In recent years, scientists have identified the characteristics of people most likely to suffer recurrent middle ear infections: males, individuals with a family history of ear infections, babies who are bottle-fed (breast-fed babies get fewer ear infections), children in day-care centers; Native Americans and Australian Aborigines, people living in households with tobacco smokers, and people with poor or damaged immune systems.
Diagnostic and Test Procedures
If you or your child has an earache accompanied by a stuffy or runny nose, sore throat, and fever, chances are good that the problem is otitis media. Your doctor will most likely examine the eardrum with an instrument called an otoscope for signs of infection - not an easy task if the patient is a fussy infant.
To check for a bacterial infection, the doctor may make an opening in the eardrum, draw out a sample of fluid from the affected middle ear, then culture the sample in a laboratory dish. This more extreme measure is usually used only for serious or particularly stubborn infections.
The goal of most doctors and therapists is to rid the middle ear of infection before more serious complications set in. Treatment usually involves eliminating the causes of otitis media, killing any invading bacteria, boosting the immune system, and reducing swelling in the Eustachian tubes.
Otitis media is typically caused by a viral infection, in which case the only relief doctors can offer is treatment of the symptoms. This may involve trying to reduce swelling in the Eustachian tubes with a decongestant, such as pseudoeph-edrine, and an antihistamine, possibly diphenhy-dramine. (Note: Antihistamines will not cure otitis media, and they may cause minor side effects, including drowsiness and nervousness.) To ease the pain, your doctor may recommend an analgesic, typically acetaminophen, which also helps reduce a fever. (Aspirin should be avoided in children because of the threat of Reye's syndrome.)
A controversy surrounds the use of antibiotics in treating bacterial middle ear infections. In En-gland, most physicians treat only the symptoms of otitis media, without the help of bacteria-killing drugs. Studies have shown that up to 88 percent of otitis media cases got better when treated this way. Other research, in fact, suggests that 80 per-cent of otitis media cases are viral in origin and therefore will not respond to antibiotics.
But many doctors, particularly in the U.S., are concerned that without antibiotics, bacteria lurking inside the middle ear can grow out of control, possibly causing a serious complication such as hearing loss or mastoiditis. After all, they point out, these complications have become rare, largely as a result of antibiotic therapy. To be on the safe side, many American physicians treat all otitis media cases as if bacteria were present.
Amoxicillin is the antibiotic of choice for treating bacterial otitis media. The drug is generally considered safe because it is less likely to cause allergic reactions than penicillin, from which it is derived. The drug is highly effective: A single course of amoxicillin can knock out an ear infection in 7 to 10 days, at little cost.
Lately, however, doctors have noticed trouble with this wonder drug. As it turns out, some types of bacteria have learned to make a defen sive protein that renders amoxicillin useless. Critics of routine antibiotic use in the U.S. charge that the millions of prescriptions of amoxicillin written for otitis media that had no bacterial element helped to create these resistant strains.
Whatever their origin, amoxicillin-resistant bacteria have shown up in a number of communities, prompting many doctors to prescribe other antibiotics for otitis media. Some of these sub-stitutes, which tend to be more expensive than amoxicillin, are taken from a class of medications called cephalosporins. Others are combination drugs-amoxicillin and clavulanate, for instance. For those allergic to amoxicillin, doctors may prescribe sulfamethoxazole and trimethoprim, or erythromycin mixed with a sulfa drug like sulfisoxazole. For patients at least two years of age with severe, recurrent otitis media, doctors can stimulate the immune system by using a special vaccine that causes the body's immune system to recognize and attack certain bacteria.
If a case of otitis media develops serious complications, physicians may suggest surgery to eliminate infection or drain the middle ear. One technique, called myringotomy, involves piercing the eardrum to release fluid from the middle ear. If the Eustachian tubes become completely closed off due to swelling, a surgeon may insert a ventilation tube inside to keep them open. However, this procedure - called tympanostomy - is often expensive and may lead to infection and scarring. If recurring infections in the adenoids or tonsils cause repeated episodes of otitis media, a physician may suggest having the glands removed.
Some alternative treatments for otitis media at-tempt to fight the viruses or bacteria responsible for the infection, while others try to relieve the symptoms or boost the immune system.
Lavender (Lavandula officinalis) essence may sometimes help to reduce the inflammation and pain of ear infections. Other oils used include chamomile (Matricaria recutita), cajuput, evening primrose oil (Oenothera biennis), fatty acid, flax oil, and borage.
To open and drain the Eustachian tubes, Ayurvedic physicians massage the lymph nodes outside the ears. The massage is complemented with a drink made with the herb amala, a source of vita-min C that also has antiviral and antibacterial properties. Amala is often given with raw honey. (CAUTION: Raw honey may contain the organism responsible for botulism and should not be given to infants or people with weak immune systems.)
Practitioners use certain herbs to help fight infection and open up ear passages. Mixtures might include skullcap (Scutellaria baicalensis), alisma (Alisma plantago-aquatica), plantain (Plantago major), bupleurum (Bupleurum chinense), and licorice (Glycyrrhiza uralensis). Contact a practitioner for exact recipes.
A number of herbs that help fortify the immune system - including echinacea (Echinacea spp.), chamomile (Matricaria recutita), and goldenseal (Hydrastis canadensis) - are available in oral tablets. Ear-drop solutions cannot penetrate the middle ear and should be reserved for outer ear infections.
In the early stages of an ear infection with sudden onset and feverish restlessness, use Aconite (30c every four to six hours). For throbbing and sharp pain accompanied by fever, intense heat, and flushing in the outer ear and along the side of the face, use Belladonna (30c every four to six hours). WARNING: Use extreme caution when treating with Belladonna, an extract from a poisonous plant of the nightshade family. Check dosages with your practitioner and follow label directions carefully. For children with otitis media who are very irritable, in great pain, and can't be con-soled, try Chamomilla (30c every four to six hours). When a child is weepy, clingy, feels better in the open air, and has a yellowish green discharge coming from the nose, use Pulsatilla (30c every four to six hours). For ear congestion without infection, try Kali muriaticum (30c every four to six hours). If there is no improvement after two days, try a different remedy or consult a homeopathic practitioner.
Nutrition and Diet
Although diet alone won't cure an ear infection, nutritionists suggest using the following vitamins and supplements to fight a viral infection:
- Beta carotene (vitamin A). Multiply your child's age times 20,000 IU for the daily dosage, with 200,000 as the maximum.
- Vitamin C. Daily dosage: Your child's age times 500 mg. (WARNING: High doses of vitamin C can cause diarrhea; it is important to spread the dose out evenly over the course of a day. Although for adults and adolescents there is no strict daily maximum, many people cannot tolerate more than 1,000 mg every two hours.)
- Zinc. Daily dosage: Your age times 2.5 mg. Do not take more than 50 mg per day without consulting a nutritionist.
- Bioflavonoids. Daily dosage: Your child's age times 50 mg, with 250 mg as the maximum.
Consult an osteopathic practitioner for therapies that may help drainage of the Eustachian tubes.
- You can provide a great deal of symptomatic relief for an infected ear at home. Many find that warmth, perhaps from a warm compress, brings comfort. Steam inhalations and hot footbaths may also help.
- If you take antihistamines, which may rob your body of moisture and dry out your throat and respiratory passages, try to replace lost fluids by drinking lots of water.
- Gargling with salt water helps soothe an aggravated throat and clear the Eustachian tubes.
- Holding your head erect also helps drain your middle ear.
- Some people find relief with over-the-counter nasal sprays, which act as decongestants. Used for more than three days, however, sprays can become habit-forming and lead to rebound congestion, or a worsening of your condition.
Because bottle-fed babies are more likely to get otitis media, it is better to breast-feed your infant, if possible, to prevent ear infections. (If you must bottle-feed, never lay your baby down and prop the bottle up.) Also, remove as many environ-mental pollutants from your home as you can, including dust, cleaning fluid and solvents, and tobacco smoke. Food allergies may play a role in otitis media, so if you or your child is susceptible to the disease, try cutting back on wheat products, corn products, and food additives, as these tend to be more allergenic than other foods.
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