Otitis+Media

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Definition:
Acute otitis media is a viral or bacterial infection of the middle ear, usually secondary to a URI. It is most common in children 6 to 36 months old and then again at 4-7 years old. It is the most frequent diagnosis of children in a clinical setting, and it is estimated that about 2 billion dollars are spent each year for conventional medical and surgical treatment of the condition. See "course/prognosis" for information on serous OM.

Etiology:
The Eustachian tube is the focal point of concern in most cases of acute otitis media. The eustachian tube protects the middle ear from nasopharyngeal secretions, regulates gas pressure in the middle ear, prevents bacteria and viruses from having easy access into the middle ear from the mouth and nasopharnyx, and clears secretions from the middle ear. In the child, the tube is at a horizontal level in the head (the tube becomes slightly vertical in the adult), making it easier for organisms to move from the nasopharynx into the middle ear. The tube opens during the act of swallowing due the contraction of the tensor veli palatini muscle. Obstruction of the tube and/or abnormal patency are the initiating factors causing acute otitis media. Obstruction may be: 1. Functional : Due to an abnormal opening mechanism and/or increased tubal compliance. 2. Mechanical: Due to abnormal hyperplasia of the tissues around the tubes opening into the nasopharynx or swelling of the tube itself. 3. From an infection or allergy affecting nearby tissues causing them to swell and occlude the tube.

In infants, the bacteria most involved are E. coli and S. aureus; in older children (but less than 8 years old), the most common bacteria are S. pneumonia, H. influenza, Group A-beta hemolytic streptococci, and S. aureus. Over 8 years of age H. influenza is less involved in infections of the ear and the other three bacteria are the main causes. OM usually begins when a viral URI or acute otitis media experiences secondary invasion by one of these bacterial organisms.

Causative factors involved in susceptibility include substituting early bottle feeding for breast feeding. Human breast milk seems to have a prophylactic effect on a baby, although the exact reason why is not understood: that is, whether it has more to do with an intolerance to the cow's milk or the natural immune boost provided by mother's milk, or a combination of both. A related factor to bottle feeding is that supine feeding with the bottle has been shown to cause regurgitation of the milk which then has a chance of entering the Eustachian tube. Another very common etiological factor in children is one or more food or inhalant allergies. Allergens may cause acute otitis media by causing mucus production and mucous membrane swelling. Once the allergens are discovered and removed from the child's environment or diet, health can greatly improve. Common food allergens in children include cow's milk, wheat, soy, corn, citrus, and egg, although other foods may be implicated on an individual basis. Inhalant allergies include molds, dust, animal dander, and hay fever.

Pre-teen OM seems to be related to true food allergies while OM in adults (20+) to be mostly food sensitivities. (Easley)

Nutrition:
eating principles: • Children's immune system's directly benefit from breast feeding while consumption of cow's milk may contribute to the incidence of ear infections. • eat as little as possible • increase Vitamin C foods, Vitamin A foods • increase fluids • a short fast is recommended during the acute phase, or a diet of steamed vegetables and fruit (see Fasting in materia medica)

» chronic: • elimination/rotation diet, rotation diet, rotation diet expanded

therapeutic foods: • increase foods that tonify the Kidney

specific remedies: • bake a whole potato, wrap it in a cloth and apply it behind the ear to provide heat and relief (especially good for young children) (Shefi) • grilled, baked, or sauteed onion poultice applied to ear (Shefi) • if eardrum is intact, drop 2 drops of warm olive oil in ear, then secure with cotton ball. Garlic oil made with olive oil may be substituted for older children and adults (Shefi) • make peppermint herb tea and place in a thermos. Let steam enter affected ear with head tilted (Shefi) • place walnut oil in ear canal (Yin-fang and Cheng-jun, p. 107)

avoid: • food intolerances of baby and, if breastfed, mother • dairy products, especially cow's milk; wheat, peanuts, eggs, oranges, tomatoes or other catarrh-producing foods, heavy protein foods, fats, meats, vinegars, shellfish, sugars (Juntti H, et al. Acta Otolaryngol (Stockh). 1999;119(8):867-873.)

Botanicals
• Allium sativum: external use (NCNM Botanicals) • Anemone pulsatilla (toxic): tinnitus, yellow discharge, creamy discharges (Harper-Shove, p. 46) • Atropa belladonna (toxic): throbbing, flushed, fast onset (Ellingwood, p. 184) • Calendula officinalis: inflammation (Harper-Shove, p. 45) • Chamomilla spp.: associated with colds (Felter, p. 476) • Echinacea spp. • Guaiacum officinalis: anti-inflammatory (Ellingwood, p. 397) • Hydrastis canadensis: mucopurulent discharge (Felter and Lloyd, p. 1027) • Phytolacca decandra (toxic): with hard swollen lymph glands • Verbascum thapsus (oil): purulent discharge, anodyne (Ellingwood, p. 397)

Chinese Formulae
• Minor Bupleurum C. (Xiao Chai Hu Tang): use first, during fever and chill stage (Flaws, p. 114, Hsu, 1980, p. 91; Yeung, p. 255; Dharmananda, 1986, p. 133; Bensky and Barolet, p. 136) • Astragalus C. (Huang Qi Jian Zhong Tang): use after drainage of pus; also for chronic, recalcitrant earaches in children (Flaws, p. 114-5, Hsu, 1980, p. 293; Yeung, p. 128; Bensky and Barolet, p. 224) • Shuang Liao Hou Feng San (Superior Sore Throat Powder Spray) (patent): topically (Zhu, p. 158) • Asarum 14 (patent): Fire Toxin, earache (Dharmananda, 1990, p. 37) • Huang Lian Shang Ching Pien (patent): Stomach Fire Blazing Upwards (Fratkin, p. 54) • Gentiana C. (Long Dan Xie Gan Wan) (available as patent); Gentiana 12 (patent): Liver and Gall Bladder Invaded by Damp-Heat. (Gentiana C.: Hsu, 1980, p. 181; Yeung, p. 154; Dharmananda, 1986, p. 229; Bensky and Barolet, p. 96; patent: Zhu, p. 172; Gentiana 12: Dharmananda, 1990, p. 69) • Niu Huang Shang Qing Wan (patent): Fire Toxin (Zhu, p. 154) • Gan Mao Dan (patent); Forsythia 18 (patent): Wind-Heat (Gan Mao: Zhu, p. 45; Forsythia: Dharmananda, 1990, p. 67) • Hoelen, Licorice and Schizandra C. (Gui Ling Wu Wei Gan Cao Tang): exudative otitis media, oliguria (Hsu, 1980, p. 496; Bensky and Barolet, p. 445) • Pueraria C. (Ge Gen Tang): Wind-Cold especially with shoulder/neck tension (Hsu, 1980, p. 51; Yeung, p. 105; Dharmananda, 1986, p. 125; Bensky and Barolet, p. 51)

Acupuncture
after assessing the person and palpating, consider these patterns: external: Wind-Heat; Wind-Cold; Dampness obstructing ear cavities; internal: Liver and Gall Bladder Invaded by Damp-Heat; Liver and Kidney Xu (Deficiency); Spleen Qi Xu (Deficiency); Phlegm-Dampness; Stomach Yin Xu (Deficiency); Stomach Fire Blazing Upwards; Liver Fire Blazing Upwards

» therapeutic note: • The increased sensitivity and immature digestion of children makes them especially susceptible to inflammation and the accumulation of Damp Phlegm, esp. when irritating or Cold and Damp foods, such as sugar, dairy products and refrigerated foods, are present in their diet. • repeated use of antibiotics can increase Dampness

» illustrative combinations: • SI-19, TW-17 and LI-4 for otitis media (Shanghai, p. 160) • TW-21, TW-17 and LI-4 for otitis media and ear pressure (Shanghai, p. 159) • TW-23, GB-1 and LI-4; TW-18, TW-19 and GB-20; TW-17 and GB-2; GB-41 and GB-3; SI-19, TW-21, SI-15 and St-36; SI-3 and TW-5 for otitis media (Mann, p. 139-140) • TW-21 and GB-2 open the ear; spread the Qi; benefit hearing (Flaws, 1989, p. 86; Finkelstein, p. 65) • GV-14, LI-11 and LI-4 (-) clear Heat, esp. Wind-Heat; resolve Stagnation • Lv-13, Sp-9 and GB-34 (-): transform Dampness; clear Damp-Heat

Homeopathy
• Aconitum napellus: rapid onset, after a shock or after getting chilled especially by a cold wind; high fever, sharp pains with bright red ears; pains cause moaning or crying out; after exposure to cold, dry winds; burning thirst, very anxious and restless; wakes with severe, distressing pains, around midnight, after having gone to bed feeling fine; primarily effective during initial 24 hours of infection. • Apis mellifica: burning, stinging pains; pain can be hot with swollen sensation and is characteristically worse form heat or hot applications; both patient and ear better from cold drinks or applications; usually worse in the right ear, though can begin on the right and shift to the left; often accompanied by a sore throat; averse to being covered up or touched, unlike Pulsatilla which often looks similar; weepy, clingy, thirstless and restless (more restless than Puls.). • Belladonna: sudden onset of severe pain and fever, with throbbing of carotids; child cries out in sleep; high temperatures with heat radiating from the ears to the face and neck; flushed face; often angry, irritable; fever has dry, burning character and is often accompanied by delerium and dilated pupils; little thirst, anxiety or fear; no thirst with fever; tongue red with white spots, like a strawberry. • Calcarea carbonica: stitching and throbbing/pulsating pain in ear with a mucopurulent discharge and enlarged glands; often report noises in the ear; profuse sour discharges (sweat, breath, stools); child ususally sweaty, especially head and the back of the neck, worse at night; takes cold easily and is sensitive to cold around face and neck. • Capsicum: redness; otitis with rupture of the membrane; tenderness and soreness of the mastoid, abscess of mastoid; chronic discharge; often strong element of home-sickness, consider with childcare separation situation. • Chamomilla: ears red hot, violent pain which makes them irritable and prone to screaming; child wants to be held, wants to be put down and held again; inconsolable pain, which often is difficult to sympathize with given their irritability and anger (in contrast to Pulsatilla) ; impossible to satisfy: asks for things and then refuses or throws them down; sensitive to cold wind on ears; one cheek red and the other pale • Ferrum phosphoricum (Ferrum Phos): first stages, before exudate; from wet and cold; pulsating and throbbing pain; high fevers, membrane is red and bulging; not thirsty • Hepar sulphur: often begins in left ear and goes to right; splinter-like or stitching pain, covers ear due to not wanting draft or wind exposure; chilly, oversensitive; sweat easily, with smelly and profuse perspiration; pain better from heat, hot drinks or warm applications; swollen glands; become morose and irritable when ill; want to be wrapped up but averse to being touched. • Kali Muriaticum: ears snap, crackle and pop after an infection; often there is hearing loss after an earache. • Lycopodium: thick, yellow, offensive discharge; humming and roaring with deafness; craves warm things, irritable and sensitive and averse to being alone; better 4-8 p.m. • Magnesia phosphorica (Mag Phos): right-sided pains, usually shooting and spasmodic, which radiate to the face and are worse frm rotating the head; onset often after exposure to a cold wind or getting chilled; generally indicated with any pain that is worse from cold and better from heat and firm pressure, especially warm compresses. • Mercurius solubilis (Merc sol), aka Mercurius viv. (Merc viv): patient is chilly with burning thirst, bad breath and a moist mouth, often drools on pillow; fever with heat alternating with chills and profuse, smelly perspiration; sensitive to both heat and cold; characteristically swollen glands; discharge from ear is thick, yellow-green, bloody, is fetid and foul in odor; often suited to serous otitous media after a cold or earache where odorous discharge from the ear continues. • Pulsatilla: copious, thick, yellow or yellow-green discharge, especially if eardrum bursts; earache has sensation of pressure from the catarrh pressing on the eardrum, often accompanied by noises in the ear or hearing loss; symptoms constantly change, patient is thirstless and craves the cool air; these children may be clingy, whine and want to be cuddled, carried and constantly attended to, but they also evoke sympathy (as opposed to Chamomilla); sensitive to pain and weeping easily from it; can be emotionally pathetic and constantly needing reassurance; often a good remedy to give at 2nd or 3rd stages. • Silicea: roaring sound in ears, sensitive to the pain, noise; profuse sweats; thirsty; condition is slow to develop and resolve; often occurs after a vaccination. • Tellurium: rupture of the membrane with a thin, acrid and profuse discharge which lasts a long time, smell of pickles; discharge is excoriating. • Sulphur: left-sided infections with swollen glands; generally aggravated by heat; redness of ears with localized painful throbbing; ringing and/or roaring in ear; thirsty and restless; fever with sweating and shivering; hot head but cold feet; ill effects of suppression of a discharge; lack of reaction; emotionally irritable and sluggish; generally averse to washing or bathing.

Subtle Support
• So (Gardner, p. 93, 99); La (Gardner, p. 103, 109)

• notes: A#, B, C, D#, E, G, G#

• chords: diminished 8th, C Major, D# Major, G# Major (Gimbel, p. 116)

Mind/Body
• Anger; not wanting to hear; too much turmoil; parents arguing. (Hay, 1988, p. 29) • Chronic ear infections associated with fear, poor kidney function, and a posture which may be expressed as a stooped walk and hunched shoulders. (Harrison, p. 75) • Our capacity for hearing is a bodily expression of how obedient and submissive we are. Those who are hard of hearing are people who will not listen to that which they do not want to hear, revealing a certain egocentricity and lack of submissiveness. (Dethlefsen, p. 153)

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; provides the nourishing and stabilizing qualities of Yin and Water that balance the Yang and the Fiery qualities; carries the constitutional endowment from the parents; manifests through the ears; and displays the effects of extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. As always, chronic Yin Xu (Deficiency) predisposes to Empty Heat and/or acute inflammation. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).
 * Chinese psychophysiology:**

• Spleen ~ Pi governs digestion; transforms food into Qi and Xue (Blood); resolves Dampness and Phlegm; maintains upbearing; and relates to the ability to assimilate, stabilize, and feel centered and balanced. » Healthy expressions are fairness, openness, deep thinking, and reminiscence. » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; and muscular weakness. Unresolved Spleen Xu (Deficiency) predisposes to Spleen Shi (Excess), particularly accumulation of Dampness and Phlegm, as the Spleen's functioning declines. The Heat produced by Liver Stagnation may then transform the Dampness into Damp-Heat. » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen. This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and Cold foods will also deplete the Spleen. Environmentally, the Spleen is highly susceptible to attack from external Dampness and Cold.

Integrative Therapies
Otitis Media is a bacterial or viral infection in the middle ear. The middle ear can not be seen without using medical equipment. It is an air-filled space which opens into the inner ear. Otitis media often can occur after an upper respiratory infection like, for example, the common cold. While it can occur at any age, otitis media is most common in young children, particularly aged 3 months to 3 years. The peak age of problems occurs at 6 months of age.

The child usually has an earache or irritability as well as possible chills and fever. The pain may be sharp, stabbing, dull, or throbbing. The pain is due to inflammation, swelling, or infection in the middle ear. This can be a chronic (ongoing) problem or an acute (short term) problem.

The cause is usually due to problems with the eustachian tube (a tube that goes from the middle ear to the throat). When this tube is blocked for any reason, otitis media can result due to a buildup of pressure. The fluid, which normally drains through the tube, backs up because of blockage and creates pressure.

Ear infections can be quite serious. Because the ear drum may break, hearing problems may result, or the infection may spread, consult your physician.

REGARDING THE PROPER DIET FOR OTITIS MEDIA: 1. For infants, breast feeding is important for many reasons. First of all, if the infant is not breastfed, he or she may have problems digesting the formulas used, no matter what the source. Cow milk, soy, and corn, which are the basic ingredients in many formulas, may not be easily digested. The baby may even develop an allergy to the formula. The irritation and inflammation that result can cause or aggravate otitis media. Breast milk is the most natural food source for an infant. It is protective because it de-creases inflammation, is rich in nutrients, and is easily digested. A minimum of 6 months of breast feeding is recommended.

2. With children, teenagers, and adults there are other considerations. Certain foods seem to be more likely to cause or aggravate ear infections. Eliminating these foods from the diet is a good way to determine if one or several of them are responsible for the problem. The main problem foods are dairy products (including milk, cheese, ice cream), eggs, wheat, corn, and sugar.

After eliminating all of those foods from the diet, and the symptoms have gone away, 1 food at a time can be reintroduced to see if the symptoms reoccur. A new food would be introduced each week. If you need more information, refer to the artiocle on food allergies.

THE FOLLOWING SUPPLEMENTS CAN BE TAKEN UNTIL SYMPTOMS IMPROVE: 1. Vitamin A – 5,000 Units a day times the age (with a 50,000 Unit maximum in one day). Pregnant women (or women who may become pregnant) should not take more than 10,000 units per day of vitamin A. 2. Vitamin C – 250 milligrams times age per day, given in 3 or 4 divided doses. 3. Zinc picolinate – 2.5 milligrams times age per day (with a 15 milligram maximum in one day) 4. Bioflavonoids – 50 milligrams times age per day. (250 milligram maximum in one day) 5. Evening Primrose oil – 1 capsule per day for an infant and up to 3 capsules for an adult. 6. Thymus extract – Age times 50 milligrams per day, up to 1,000 milligrams. Do not use supplements for more than 2 weeks without consulting your physician.

HERBS USED FOR OTITIS MEDIA: Ear drops should only be administered if the ear drum is intact. These may be used in oil form or as a tincture, which is a liquid herbal extract. Only in cases when the ear drum is undamaged, the following applications are used: 1. An ear drop tincture that contains 4 parts Verbascum (also called Mullein) and 4 parts Golden Seal – 3 to 4 drops are put in the ear at night or as needed. Consult your doctor if symptoms persist. 2. Ear oils – with equal parts of Garlic, Mullein, and St. John's Wort in olive oil. Two to 3 drops are put in the ear 3 times a day. Commercial preparations of this mixture are readily available in health food stores. 3. A tincture of 2 parts Echinacea, 2 parts Golden Seal, and 1 part Poke Root – 5 drops times the age per day, given with a small amount of juice or water every 2 hours.

AN ADDITIONAL MEASURE FOR OTITIS MEDIA: Heat application – A warm towel or a hot water bottle wrapped in a towel is placed over the ear. Check the ear after the first couple of minutes to make sure the towel is not too hot. Children may not be able to judge this due to pain.

HOMEOPATHY From the following homeopathic medicines, the one that best matches the symptoms is chosen. Dissolve 3 pellets under the tongue. These can be given every hour or 2 for the first 6 hours, then 2 to 3 times a day until all symptoms are gone. • Aconite 12C: For sudden onset, particularly when the right ear is affected and especially if the earache occurred after being exposed to the wind. • Belladonna 12C: For sudden onset, particularly when the right ear is affected. The face is dry, flushed. The skin may feel dry and burning. There is restlessness and lack of thirst. • Chamomile 12C: For the child who is overly sensitive and intolerant of pain, which makes for extreme irritability and even rudeness. The person needing this remedy is never calm. Sometimes one cheek is red and hot, the other pale and cold. Pain is worse from warm applications. • Ferrum phos 12C: This is the most commonly indicated remedy for the early stages of an earache with inflammation and infection. • Hepar sulph 12C: For the person who is worse with any draft and wants to be well covered, is irritable, complains of stitching pains, and is sensitive to touch. • Mercurius 12C: For an earache during damp or changeable weather, worse at night. The person is sweaty and smells sick. A large, flabby tongue shows imprint of teeth on the edges; there is excess saliva and bad breath. • Pulsatilla 12C: For redness and swelling in the external ear. There may be severe throbbing pains, and the ears feel as if they are stopped up. The condition is worse from warmth and from becoming overheated, worse in the evening and at night. People responding to Pulsatilla often crave fresh air and feel weepy. Note: A wide range of homeopathic medicines can be helpful for children with chronic or recurrent ear infections. Consultation with a health care professional trained in homeopathic prescribing will usually be the best way to select the correct medicine.