Pediatric+Ear+Infections

=Ear infections – Otitis= -Acute otitis media Decongestants and/or antihistamines not recommended for acute otitis media in children Ear Check Middle Ear Monitor (Med Lett Drugs Ther 2008 Jul 14) Description: middle ear infection presents with symptoms of acute illness, middle ear effusion, and signs of middle ear inflammation

Definitions: presence of middle ear effusion - indicated by any of bulging of tympanic membrane limited or absent mobility of tympanic membrane air-fluid level behind tympanic membrane otorrhea signs or symptoms of middle ear inflammation, either distinct erythema of tympanic membrane distinct otalgia that interferes with normal activity or sleep
 * acute otitis media (AOM)** - diagnosis requires all 3 of history of acute onset of signs and symptoms

chronic suppurative otitis media - continuing inflammation of middle ear for at least 6 weeks, leading to perforated tympanic membrane and otorrhea Who is most affected: children, especially infants peak incidence age 6-15 months, second peak at school entry, decreased incidence after age 7
 * otitis media with effusion(OME)** - inflammation of middle ear with clear pale yellow-colored transudate, may be sequela of acute otitis media or due to many other causes such as allergies, treatment of OME usually unnecessary

viruses detected in most cases of acute otitis media bacteria isolated from patients with acute otitis media (both?) most common organisms: Streptococcus pneumoniae (S. pneumoniae is the most common bacterial organism identified), non-typeable Haemophilus influenzae (H. flu identified primarily in children < 5, but reduced with routine immunization), Moraxella (Branhamella) catarrhalis microbiology may be changing due to heptavalent pneumococcal vaccine (decrease in S. pneumoniae and increase in H. influenzae) decrease in S. pneumoniae and increase in H. influenzae, especially beta-lactamase-producing H. influenzae and non-typeable H. influenzae

Likely risk factors: risk factors include formula feeding, young age, day-care attendance, family history of otitis media, upper respiratory tract infection, gastroenteritis, passive smoking and in-utero maternal smoking seasonal - peak in winter, least in summer

eustachian tube-middle ear-mastoid cell system Who is most affected: childhood mastoid pneumatization is most active at age 5-10 (may be halted or reversed) however intermittent aural discharge in children most likely due to recurrent acute otitis media most common in developing countries, certain high risk populations in developed countries, and children with tympanostomy tubes (Int J Pediatr Otorhinolaryngol 1998 Jan;42(3):207)
 * Chronic suppurative otitis media**

Likely risk factors: poor eustachian tube function (chronic or recurrent nose and throat infection, anatomic obstruction, scarring, thickened mucosa, polyps, granulation tissue, tympanosclerosis) ear disease in early childhood, persistent tympanic membrane perforation, squamous metaplasia of middle ear, virulent otitis media (scarlet fever, measles), areas of sequestration or persistent osteomyelitis in mastoid allergy, debility, immunosuppression

Antibiotics not effective for ear infections
Ear infections usually clear up spontaneously without drugs and they respond faster under chiropractic care. Scientific studies repeatedly show that antibiotics are not indicated for otitis media with effusion (middle ear infection). In fact, two-thirds of children with middle ear infection recover from pain and fever within 24 hours of diagnosis without antibiotics, and over 80% recover within 1-7 days. Antibiotics actually slow healing. This analysis was sponsored by the Agency for Healthcare Research and Quality (AHRQ). Management of Acute Otitis Media Summary, Evidence Report/Technology Assessment. 15. Southern California/RAND Evidence-based Practice Center (EPC) http://www.ahrq.gov/clinic/epc/socalepc.htm

HomeopathicTreatments:
Belladonna, Pulsatilla or chamomille

Wind heat –
fever, sore throat, nasal congestion & runny nose, ears blocked, then pounding or throbbing pain T: Red tongue, thin yellow coat. P: Floating and rapid Shu Feng Qing Re tang Jia Jian: Jing Jie, Fang Feng, Jin Yin Hua, Lian Qiao, Gan Cao, Jie Geng, Sang Ye, Bo He, Huang Qin, Cang Er Zi

Liver - GB Fire:
Sudden onset, crying, and restless, poor appetite, possible high fever, dry mouth, Bitter taste, dry stool, or constipation T: Red, yellow coat P: Wiry and rapid Long Dan Xie Gan Tang: Long Dan Cao, Huang Qin, Chai Hu, Zhu Zi, Sheng Di, Shi Gao, Ye Ju Hua, Pu Gong Ying, Da Huang

Spleen deficiency
Recurrent earaches, possible clear or white pus, increase earwax, poor appetite, tired, sallow, yellow complexion, loose stool or diarrhea, T: Pale P: Thin, moderate, might be slippery Tuo Li Xiao Du San: Huang Qi, Zao Jiao Ci Honeylocust, Jin Yin Hua, Zhi Gan Cao, Jie Geng, Bai Zhi -Angelica, Chuan Xiong, Dang Gui, Bai Shao Yao, Bai Zhu, Fu Ling, Dan Shen

Kidney Yin Xu:
Ear Pain comes and goes, with small amount pus which is smelly, a long course without healing, decreased hearing, fatigue, lassitude, night sweats, dry mouth T: red with scanty coat P: Thin and rapid Zhi Bai Di Huang Wan - This formula comes from Qin Jing-ming’s Qing dynasty Zheng Yin Mai Zhi (Patterns, Causes, Pulses & Treatments) published in 1702 CE. Shu di huang (Rehmannia, - nourishes blood, enriches essence,Shan zhu yu (Cornus officinalis) - tonifies qi, Shan yao (Dioscorea) Ze xie (Alisma - promotes urination, Mu dan pi (peony tree root-bark) - clears heat, cools blood, Fu ling (Poria cocos fungus/mushroom filaments) - provides tranquility; relaxes muscles, Huang bai (Phellodendron - drains damp heat, reduces pain/swelling, Zhi mu (Anemarrhena ) - reduces heat and irritability Liu Wei Di Huang Wan Si 5 (or3), SJ17, GB20, GB2, GB34, Li4, Li11 Manipulation, Tuinah

The Consequences of Antibiotics –creates Qi Xu and can cause Qi stagnation, dampness and damp heat, and eventually yin xu Wind-heat, clear heat and resolve toxin. Yin Qiao San (Wu Ju Tang, 1798) Pathogenic wind is trapped in the interior, heat toxins accumulate, and cold quickly turns to heat, "half-interior/half-exterior" shaoyang Xiao Chai Hu Tang (Zhang Zhongjing, 220)

Nasal and eustachian tube area: dispel wind, clear heat, and transform phlegm Bi Min Gan Wan (Pe Men Kan Wan) -Heat and cold clearing herbs: Bupleurum -Chai Hu, Chrysanthemum -Ju Hua, Angelica -Bai Zhi, and Zingiberis -Sheng Jiang.  herbs to transform phlegm to make it more watery, and herbs to drain this damp downwards out of the body- Fritillaria -Zhe Bei Mu, Pinellia -Ban Xia, Peucedanum -Qian Hu, Agastache -Huo Xia, Poria -Fu Ling, Vitex -Man Jing Zi, which drains damp and dispels wind, and which conveniently leads the formula to the inner ear and sinus. - clear heat and resolve toxins: Forsythia -Lian Qiao and Coptis -Huang Lian. The former is effective against upper respiratory virus, and the latter against bacteria. Plus -Paeonia -Chi Shao to circulate blood to relieve pain.

Acute Otitis Formula: This comes from Golden Flower as CHILDREN'S EAR FORMULA. It comes as a powder (prepared by KPC in Taiwan) Agastache -Huo Xiang 10 % Poria -Fu Ling 10 Chrysanthemum -Ju Hua 8 Coptis -Huang Lian 8 Forsythia -Lian Qiao 8 Paeonia -Chi Shao 8 Peucedanum -Qian Hu 8 Angelica -Bai Zhi 7 Bupleurum -Chai Hu 7 Fritillaria -Zhe Bei Mu 7 Pinellia -Ban Xia 7 Vitex -Man Jing Zi 7 Zingiberis -Sheng Jiang 5

CHILDREN'S EAR FORMULA. Add the powder to a bowl, and add a little boiling water, enough to make it thick but not too thick. (Or use the empty bottle: fill with boiling water, and add that to the bowl of powder). Stir well. It is best to have a pediatric syringe, calculated in ml (or cc, which is the same). Give 1 ml of herb plus 1 ml for each year of the child. An infant would get 1 ml; a one year old would get 2 ml, etc, up to 5 or 6 ml as a maximum dose. If you don't have a pediatric syringe, use the eyedropper enclosed with the bottle. One eyedropper squeeze (about half the dropper) equals 1ml.

Give a dose every 2 hours until pain is relieved. It will also reduce accompanying fever. Usually, the child will need one to three doses to control the event. (In some cases, the pain may last several days. In this case, give one dose every 3 or 4 hours.) Throw out the bottle once one episode is over. If giving to an infant or toddler, have them lie flat on their back. Squirt a little into the back of the throat several times, allowing them to swallow. They may make a bad face, but they recover immediately after swallowing. Follow with nursing or a little sweet juice to take the taste away, if necessary.

The formula is safe for newborns. In any child, the parent may notice loose stool or diarrhea; this is the process by which the body expels turbid phlegm. If the patient's case is complicated by cough or high fever, you will need to use other formulas in conjunction.

1. Heat in the Lung -Main Symptoms and Signs: The patient has intermittent otopyorrhea which may be recurrent due to a cold. The pus is white and as sticky as nasal mucus. Deafness is sometimes serious and sometimes mild. Perforation of membrana tensa occurs. The pus from it looks like sticky silk thread if smeared. These symptoms may be accompanied with stuffy nose and rhinorrhea. The fur of the tongue is thin and white and the pulse is slippery.

Therapeutic Principle: Purging lung-heat, removing turbidity and promoting the flow of qi to clear away obstruction from the upper orifices. - Magnolia Decoction for Purging Lung-Heat with additional herbs magnolia flower scutellaria root rhizome of anemarrhena cimicifuga rhizome xanthium capejasmine fruit ophiopogon root white tribulus fruit lily bulb loquat leaf gypsum dahurian angelica root licorice root All the above herbs are to be decocted in water for oral administration.

2) Dampness Retention due to Hypo-Function of the Spleen Main Symptoms and Signs: There is continuous pyorrhea flowing out from the ear. The discharge is thin and clear. A big perforation of membrana tensa and hypoacusis occur, accompanied by dizziness, a heavy sensation in the head and poor appetite. The fur of the tongue is thin and white and the pulse soft and moderate.

-Invigorating the function of the spleen to remove pathogenic dampness and reinforcing qi and blood to discharge pus. Powder of Ginseng, Poria and White Atractylodes - ginseng, white atractylodes rhizome, pulp of lotus seed, poria, licorice root, amomum fruit, platycodon root, Chinese yam, coix seed, white hyacinth bean All the above herbs are to be decocted in water for oral administration.

3) The Type of the Deficiency of the Kidneys There is a little but continuous otopyorrhea which is dirty and smells stinking. Hearing is distinctively worsened. Perforation of membrana tensa or Shrapnel's membrane occurs and granulation may be seen, accompanied by soreness of waist, dizziness, insomnia and palpitation, red tongue, with thin and white fur and thready and rapid pulse.

-Reinforcing the kidney and purging pathogenic fire to eliminate pus. Pill of Anemarrhena, Phellodendron and Rehmannia with additional ingredients, anemarrhena, yellow corktree bark -Huang Bai, pulp of dogwood fruit, prepared rehmannia root, poria, oriental water plantain rhizome, moutan bark, spike, Chinese yam All the above herbs are to be decocted in water for oral administration.

For those with yellow and thick pus, add 9 grams of scutellaria root, 6 grams of coptis root and 9 grams of bupleurum root. For those with thin pus, add 15 grams of plantain seed which is to be wrapped in a piece of cloth ,and 15 grams of coix seed. For those who have lot of pus which comes out continuously, add 9 grams of flavescent sophora root, 9 grams of xanthium and 9 grams of dahurian angelica root.

2. External Treatment 1) Clean the external auditory canal. Do this with white vinegar solution (white vinegar mixed with the same amount of water for injection), three times a day. 2) Drip ear drops into the ear. Do this with Ear Drops of Coptis (the same as used for acute suppurative otitis media), three times a day. 3) Other treatments. If there is granulation in the ear, it can be removed with snare. When otopyorrhea ceases to come out and inflammation is healed, and operation to restore hearing can be considered. If x-ray photograph indicates any destruction of the bones an operational treatment should be carried out. Slide 297 Jake Fratkin