Ear infection: a retrospective study examining improvement from chiropractic care and analyzing for influencing factors.
The aims of this study were to determine (a) if the patients improved while under chiropractic care; (b) how many treatments were needed to reach improvement; and (c) which factors were associated with early improvement.
Cohort, nonrandomized retrospective study.
Private chiropractic practice in a Minneapolis suburb.
Forty-six children aged 5 yr and under.
All treatments were done by a single chiropractor, who adjusted the subluxations found and paid particular attention to the cervical vertebrae and occiput. Sacral Occipital Technique-style pelvic blocking and the doctor’s own modified applied kinesiology were also used. Typical treatment regimen was three treatments per week for 1 wk, then two treatments per week for 1 wk, then one treatment per week. However, treatment regimen was terminated when there was improvement.
Improvement was based on parental decision (they stated that the child had no fever, no signs of ear pain, and was totally asymptomatic), and/or the child seemed to be asymptomatic to the treating DC and/or the parent stated that the child’s MD judged the child to be improved. A data abstraction form was used to determine number of treatments used and presence of factors possibly associated with early improvement.
93% of all episodes improved, 75% in 10 days or fewer and 43% with only one or two treatments. Young age, no history on antibiotic use, initial episode (vs. recurrent) and designation of an episode as discomfort rather than ear infection were factors associated with improvement with the fewest treatments.
Although there were several limitations to this study (mostly because of its retrospection but also, significantly, because very little data was found regarding the natural course of ear infections), this study’s data indicate that limitation of medical intervention and the addition of chiropractic care may decrease the symptoms of ear infection in young children.
PMID: 8728460 [PubMed – indexed for MEDLINE]
CHIROPRACTIC APPROACH TO CHILDHOOD EAR INFECTIONS
Chiropractic Approach to Childhood Ear Infections
Dr. Brenda Trudell
Children in the US are getting more ear infections then ever, and with the rise in complications from antibiotic-resistant bacteria due to overuse of antibiotics, many parents are searching for safer alternatives for treatment and prevention. In the US, there are 10 million new cases of Otitis Media (OM) diagnosed each year, accounting for 35% of all pediatrician visits, or 25 million office visits. This costs around 3 billion dollars a year, but that number is closer to 6 billion when factoring in parents’ time off work to treat a sick child.
It is estimated that 62% of American children will have an ear infection before the age of one, and 80% will be diagnosed by three. Studies show that the earlier the first infection, the likelihood for repeat infections increases, along with repeated anti-biotic use. OM is also the most common reason for antibiotics in children, although the majority are caused by viral infections, not bacterial. Inserting tubes into the ears is the second most common reason for surgery in children under the age of two, behind circumcision. But unlike circumcision, general anesthesia must be administered, which can have serious consequences itself. The surgery must be repeated in 20-30% of cases.
What causes OM and why does it affect more children today? There are many factors that can cause ear infections in children. These include allergies, infection, mechanical obstruction, nutritional deficiency, birth trauma, not breast feeding, pacifier use, and iatrogenic or medical causes.
In Childhood Ear Infections, Dr. Michael Schmidt discusses 16 studies that show chronic ear infections may be caused by food and airborne allergies. Allergies cause inflammation and increased mucous, leading to pressure changes in the middle ear and obstruction of the Eustachian tube (ET). The most common food allergies linked to OM include pasteurized cow’s milk and dairy, wheat, corn, soy, sugar and yeast, with dairy being the number one contributor. Raw, organic milk, on the contrary, has the opposite effect, and actually helps to build a child’s immune system.
Infection occurs when a child’s immune system has been lowered for any reason. OM often occurs after a child has been recently ill, such as with a cold or flu, as bacteria and viruses can make their way into the middle ear. Mechanical obstruction results when there is a blockage due to misalignments of structures around the ear and ET, such as the bones of the jaw, skull and cervical spine. When small bones in the head and neck area can’t move properly, fluid can get built up in and around the eardrum and ET, giving microbes a place to grow and cause problems.
Nutritional deficiency is especially important, as healthy immune systems are determined by our nutritional status. Children who have a healthy diet low in sugars and processed foods, and high in essential fats, vitamin and minerals have a decreased risk of getting OM. A weak immune system can set a child up for years of chronic ear infections, antibiotic use and possible surgery.
Birth trauma is an important cause of OM. Infants with traumatic births, interventions such as forceps and vacuum, or pulling on the neck are at a higher risk due to spinal cord and cranial injury. C-sections also increase the risk because the baby isn’t exposed to the beneficial bacteria in the vaginal canal that builds up an infant’s immune system. With a C-section rate of 35% in the US, this alone could be a major contributing factor to the rise in ear infections. Drugs used during delivery can also weaken the immune system or make infants groggy so they are unable to breastfeed. Breastfeeding is extremely important for building up an infant’s immune system. Mother’s breast milk provides antibodies, probiotics, vitamins, minerals and essential fatty acids that all act to protect the infant from disease. Plus, the areola around the nipple contains receptors that react to proteins in the infant’s saliva. If the baby is fighting off an infection, its body will communicate with the mother and tell her exactly what she needs to produce in her milk to help the baby.
According to a Dutch study, pacifiers have been shown to increase risk of OM by 50%, especially in children over 10 months. Some feel that the sucking mechanism for pacifiers is different than for breastfeeding, and that, along with continuous sucking, may allow the tubes to stay open longer, allowing more fluid from the nose and throat to enter the middle ear. Others feel that the pacifier itself may be covered in germs, and that exposure may get the child sick.
There is some new research showing that overuse of antibiotics and vaccines could contribute to OM as well. Antibiotics given early in life, or with the first ear infection may alter infants’ immune systems in such a way that they are unable to fight off infections on their own. Some vaccines are known to lower immunity for a period of time, which can make an infant more susceptible to viral or bacterial infections. And six childhood vaccines, including Hib, have “Otitis Media” listed as a common adverse reaction, meaning the vaccine itself is a known cause of ear infections. With vaccines given at birth, 2,4,6 and12 months, it may be a reason why 62% of children are diagnosed under the age of one. A large study in New Zealand showed that vaccinated children were 3 times as likely to get OM than unvaccinated children.
Let’s discuss anatomy and physiology of the Eustachian tube. It is a small tube that connects the middle ear to the throat and helps drain fluid from the middle ear out to the nasal passage in order to equalize pressure between the ear and the outside environment. If the tube is blocked, fluid builds up and puts pressure on the eardrum, which can rupture if the pressure is too strong. In a child, the ET is short, narrow and horizontal, making it easy for fluid and microbes to remain trapped in it, especially if structures around it are compressing it. In an adult, is it wider and angled down to allow gravity to assist in drainage. Besides bones, there are muscles surrounding the ET. Levator palatini and tensor veli palatine muscles both assist in active dilation. The nerves that supply these muscles originate from cranial and cervical nerves (brain and neck), so if there is birth injury to these areas, the nerves may affect how the muscles work. If the muscles cannot dilate the ET properly, this may cause an obstruction and lead to fluid buildup.
This is where chiropractic can help. Chiropractic adjustments remove interference within the nervous system by correcting misalignments in the spinal column, jaw and possibly cranial bones, without the use of drugs or surgery. Correcting misalignments also reduces muscle tension, decreases inflammation, increases mobility, and establishes proper blood flow & lymph drainage, all of which can affect the function of the middle ear and Eustachian tube. According to Dr. Joan Fallon, author of a study published in the Journal of Clinical Chiropractic Pediatrics, “Chiropractic mobilizes drainage of the ear in children, and if they can drain without a buildup of fluid and subsequent infection, they build their own antibodies and recover faster.” Dr. Fallon focuses on the upper cervical area on children with OM, concentrating on the occiput (base of the skull), and upper two vertebrae in the neck, and she states that close to 80% of the 332 children in the study did not experience another ear infection within a 6-month period. Pediatrician Dr. Spears even states on his website, “I firmly believe that chiropractic adjustments to the skull and neck can improve middle ear drainage and decrease ear infections.”
There are some other things parents can do to prevent and treat childhood ear infections. Natural ear drops containing warm olive and garlic oil (do NOT use any drops if the ear drum is ruptured), warm compress with lavender oil, massaging head and neck to promote drainage, tea tree oil massaged into mastoid (bump behind ear), craniosacral therapy, fish oil, probiotics, vitamin D (1000-2000 IU’s for babies, can get it through breast milk if mom’s levels are high enough), vitamin C, and coconut oil can all be added to fight infections. Breastfeeding is especially important, and mom may need to eliminate some things from her diet, such as dairy, sugar, processed grains, and high fructose corn syrup if ear infections reoccur. Do not have your child vaccinated if he or she is showing signs of illness or has a fever, as these symptoms indicate their immune system is already fighting something else, and they may be more susceptible to getting an ear infection. A wait-and-see approach for 4 days may also be prudent, and adding some of the things listed above will provide some relief while the child’s body learns to heal itself.
Dr. Brenda Trudell is a chiropractor and owner of New Beginnings Chiropractic in Mount Horeb and Sauk City. The clinic focuses on natural health, especially for women, pregnancy and children through chiropractic, acupuncture, massage, reiki, nutrition and more. For more information, visit newbeginningschiropractic.net.