Otitis Media

Dr. Weyrich's Naturopathic Functional Medicine Notebook

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Etiology

The proximal cause of otitis media is bacterial or viral infection. Various predisposing factors may represent the underlying cause, which should also be addressed to reduce the recurrence rate.

Bacterial infections such as Streptococcus pneumoniae (40%), Haemophilus influenza (20%), and Moraxella catarrhalis (10%). Note that these are normal flora in the mouth and nose. Many are resistant to common antibiotics [Barnett1995].
Viral infections.
Allergies [McMahan1981] [Nsouli1994].
Second-hand tobacco smoke (33%) [Strachan1989].
Eustachian tube dysfunction.

Differential Diagnosis

Bacterial otitis media.
Vial otitis media.
Immunodeficiency (consider if more than 4 infections a year).

Treatment

Watchful Waiting and Treatment of Symptoms

In uncomplicated cases the best course of action is to relieve pain with medicated ear-drops and (with proper medical supervision) allow the child's immune system to do its job.

Ear tubes (myringotomy, tympanotomy tubes)

The primary cause of pain in acute otitis media is pressure behind the eardrum. Myringotomy and tympanotomy tubes relieve this pressure and allow drainage.

Strengthen the Immune System

Homeopathy

Homeopathy has been reported to reduce the frequency of re-occurrence of acute otitis media as compared to antibiotic treatment [Friese1997]. This study lacked a watchful waiting control group, so it is not possible to comment on whether homeopathy out-performed antibiotics because of the effectiveness of homeopathy or because of the counterproductiveness of the antibiotics.

Antibiotics for Treatment of Otitis Media

While antibiotics may give a quick resolution of acute symptoms of bacterial otitis media, in the long run their use may be counterproductive, and predispose the child to developing chronic otitis media.

Antibiotics are not useful in treating viral infections, colds, and flues, although they are sometimes applicable as a prophylactic measure in compromised patients where there is a risk of secondary infection.

In one study [vanBuchem1981], three different interventions for treating acute otitis media were compared:

Antibiotics
Ear tubes (myringotomy, tympanotomy tubes)
Control group

The outcomes of the three treatment groups were similar [Shaw2008].

Another study found that the rate of reoccurrence of Otitis Media was higher in the treatment group receiving amoxicillin than in the control group [Cantekin1991].

Although a causal relationship has not been definitively established, increased use of oral antibiotics to treat Otitis Media is associated with increased incidence of autism, attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and childhood seizures [Shaw2008].

If antibiotics must be used, consider an injectable form such as rocephin or penicillin rather than oral forms, in order to minimize disruption of beneficial bacteria in the gut.

If oral antibiotics must be used, consider adding antifungals such as nystatin in order to control overgrowth of yeast in the gut due to disruption or beneficial bacteria in the gut. Various naturopathic antifungals may also be prescribed. Also re-inoculate with beneficial bacteria (probiotics) during and after oral antibiotic treatment.

Prevention

Strengthen the immune system.
Eliminate exposure to second-hand tobacco smoke.
Eliminate exposure to food and environmental allergens.
Breast-feed child as long as possible [Teele1989].
Prevent exposure to germs in daycare and preschool settings before the age of two years. [Shaw2008]. On the other hand, other practitioners suggest that childhood illnesses help develop the immune system.

ICD-9 Codes

ICD9-Code	Description	Comments

References

Unless specifically noted above, references used in the construction of this web page include the following:

[FDM] Lecture notes from Functional Medicine University.

[SCNM] Lecture notes from Southwest College of Naturopathic Medicine.

[UT] Lecture notes from the University of Tennessee graduate programs in Chemistry and Biochemistry.

[Shaw2008] Shaw W. Biological Treatments for Autism & PDD, Third Edition. (2008).

[vanBuchem1981] van Buchem FL, Dunk JH, van't Hof MA. Therapy of acute otitis media: myringotomy, antibiotics, or neither? A double-blind study in children. Lancet. 1981 Oct 24;2(8252):883-7.

[Cantekin1991] Cantekin EI, McGuire TW, Griffith TL. Antimicrobial therapy for otitis media with effusion ('secretory' otitis media). JAMA. 1991 Dec 18;266(23):3309-17.

[Strachan1989] Strachan DP, Jarvis MJ, Feyerabend C. Passive smoking, salivary cotinine concentrations, and middle ear effusion in 7 year old children. BMJ. 1989 Jun 10;298(6687):1549-52.

[McMahan1981] McMahan JT, Calenoff E, Croft DJ, Barenholtz L, Weber LD. Chronic otitis media with effusion and allergy: modified RAST analysis of 119 cases. Otolaryngol Head Neck Surg. 1981 May-Jun;89(3 Pt 1):427-31. No abstract available.

[Nsouli1994] Nsouli TM, Nsouli SM, Linde RE, O'Mara F, Scanlon RT, Bellanti JA. Role of food allergy in serous otitis media. Ann Allergy. 1994 Sep;73(3):215-9.

[Barnett1995] Barnett ED, Klein JO. The problem of resistant bacteria for the management of acute otitis media. Pediatr Clin North Am. 1995 Jun;42(3):509-17.

[Teele1989] Teele DW, Klein JO, Rosner B. Epidemiology of otitis media during the first seven years of life in children in greater Boston: a prospective, cohort study. J Infect Dis. 1989 Jul;160(1):83-94.

[Friese1997] Friese KH, Kruse S, Lüdtke R, Moeller H. The homoeopathic treatment of otitis media in children--comparisons with conventional therapy. Int J Clin Pharmacol Ther. 1997 Jul;35(7):296-301.

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