Ear Infections

• Introduction
• Research
• TCM Clinical Trials
• Patient Form

Introduction

The medical term for ‘ear infection’ is acute otitis media, which is an inflammation of the middle ear behind the eardrum. While ear infections are the most common health ailment for children in the Western world, they are virtually unheard of among children in China. In the United States, ear infections are now responsible for 30 million doctor visits per year. This is a 300% increase since 1975 (Pediatric News, January 1998). These statistics are similar in other developed countries. Children get ear infections much more often than adults. The highest concentration of ear infections occur between the ages of 6 and 24 months old.

Main Symptoms of Ear Infections

1. Pain
2. Fluid in the Ear
3. Fullness or Decreased Hearing
4. Fever
5. Nasal congestion/runny nose

Ear infections are the most common reason that children make extra trips to the doctor, take antibiotics, or even have surgery. Antibiotics are given to children for ear infections more than any other health concern. Most doctors prescribe antibiotics for treatment of ear infections, but antibiotics are over-prescribed and cause many side-effects including a weakened immune system.

Current research reveals that 85-95% of the 10 million antibiotic prescriptions written last year for ear infections (in the US) showed no real benefit to the patient. Traditional Chinese Medicine (TCM) treats the condition with herbal remedies and the benefits of these remedies are almost immediate. TCM can effectively treat ear infections and strengthen your child’s immune system to prevent a further occurrence.

Ten Tips for Preventing Ear Infections

1. Breastfeed your child
2. Massage your child
3. Ensure proper nutrition, adequate sleep and decreased stress
4. Limit the size of the nursery your child attends
5. Stop giving your child a pacifier (i.e. dummy)!
6. Avoid germs
7. Provide opportunities for plenty of fresh air
8. Avoid passive exposure to cigarette smoke
9. Avoid having your child drink while lying down
10. Identify and treat allergies

For a more detailed discussion of these prevention tips please see ear infection patient form.

Success Stories

Maxwell

When our son Max was less than one year old, he had recurrent ear infections. Our doctor wanted to put him on repeated courses of antibiotics to solve this problem. We thought that sounded like a bit much for a child that was so young. A friend of mind recommended Robert, so we went to see him, and Maxwell has never had an ear infection since then (the last two years).

What we love about Robert is that he's always available to answer any concerns we have. Robert’s great with children because he is so easygoing and at the same time very caring.

Nash

Nash was suffering from recurring ear infections that were causing him a great deal of pain, preventing proper sleep and impacting his overall temperament. He was seeing our family doctor who continually prescribed antibiotics as treatment. Nash would show signs of improvement and then as soon as he had completed the allotted dosages, his ears would flare-up again. The only options presented to us by our doctor at that time were surgery or to simply put up with it. Neither option suited us and left us with no choice except to consider surgery as we could not continue as we were. After reading an article by Robert Helmer, we decided it was worth a shot to see if he could help us.

After a thorough assessment, Robert prescribed Chinese herbal treatments and massage techniques that were designed to boost his immune system. As well, he made us aware of dietary alterations to help with digestion issues. Nash has not had another ear infection since seeking treatment with Robert.

Robert solved a problem that was really stressful for both of us and for Nash. It was a simple process of monitoring his diet and administering the herbal treatments. Over the course of a few months, the problems were resolved. It was not a difficult process and his support and explanations put a mother’s worry at ease! I have continued to bring Nash to Robert as other issues come up and his treatments continue to work over modern medical treatments. I completely believe in the methodologies behind Chinese Medicine and am always ready to tell another desperate parent about how it worked for us.


Research

• Ear Drops
• Antihistamines and Ear Infections
• Reflux and Ear Infections?
• No Dummy?
• The Antibiotic Hoax
• Watch and Wait for Ear Infections?
• Ear Infections ‘linked to asthma’

Ear Drops

Study 1

Some doctors recommend that parents wait 48 hours to see if their child’s ear infection will improve on its own before prescribing antibiotics. This may be a wise course of action, meanwhile, the child may experience severe pain and sleepless nights. An article in the May 2001 issue of Infectious Diseases in Children has a remedy for this common situation – doctors can prescribe topical ear drops to ease the pain.

In this study of 88 children, antibiotics were avoided and the ear infections went away with pain treatment alone in 89% of the children (ages 2-18) who received the ear drops. Three of the children who did not initially receive antibiotics did have complications from spreading infection (pneumonia, perforated ear drum, bleeding), but all recovered without problems. Among the children who did receive antibiotics initially, 95% had their ear infections go away while they were on the antibiotics. Two of the children in the antibiotic group had complications (rash and diarrhea); but they recovered as well.

Study 2

A study in the July 2001 issue of the Archives of Pediatrics and Adolescent Medicine evaluated prescription anesthetic ear drops versus an herbal product from Israel. Otikon Otic Solution is olive oil augmented by herbal extracts including garlic, mullein, and St. John’s wort. In this study of about 100 children, the herbal drops seemed to work as well as the prescription drops. This study demonstrated that local treatment is effective in treating ear infections. Although the above medicinal ear drops were not Chinese herbs, there are many different ear drop formulas a doctor of Chinese medicine may choose from to relieve the pain of acute otits media. From my perspective, because this is an acute illness, local treatment can be very effective and ear drops of can play a role in the management of ear infections. Many ear infections can be relieved with ear drops and together with the internal administration treatment of Chinese medicine can relieve the pain and fight off infection. Generally, ear drops are used for symptomatic relief (of pain) and are usually not used for longer than 48 hours. If pain is not decreased at this time, the patient’s condition should be reevaluated and a different herbal formula should be given.

Antihistamines and Ear Infections

The use of antihistamines in the treatment of ear infections is increasing as antibibiotic use is decreasing. Almost one in five doctors will prescribe a child an antihistamine or an antihistamine-containing cold medicine to aid in the treatment of ear infections. Some parents often give over-counter antihistamines without consulting their doctor. The idea is that antihistamines should decrease congestion and unplug the Eustachian tubes, allowing the fluid in the ear to be cleared. These medications are also known to make individuals (and children) taking them drowsy and sleepy. The September 2003 issue of the Journal of Pediatrics contained a study that concluded that antihistamines make ear infections worse. In this study, it was shown that the time it takes the ear infection to go away increased by the use of antihistamines.

Reflux and Ear Infections?

A study published in the February 9, 2002 issue of The Lancet suggests a dramatic new approach to dealing with ear infections. The researchers analyzed the fluid in the ears of 54 children with ear infections (OME). The researchers were surprised to find many of these children had digestive enzymes from the stomach (pepsin and pepsinogen) at concentrations 1000 times higher than expected. It appears that when a young child is lying in his back, the acidic liquid from the stomach can flow to the back of his throat and then drip into the Eustachian tube. This would cause irritation and swelling, thus setting up an ear infection.

No Dummy?

Study 1

University researchers from Finland have published a study of 845 children attending daycare. They followed the children for fifteen months, keeping track of behaviors which might influence the number of ear infections. These included breastfeeding, parental smoking, thumb sucking, bottle use, and social class. The strongest association identified in this study was with use of a dummy (i.e. pacifier). The use of a dummy increased the frequency of ear infections by 50%. In children less than two years of age, pacifier use increased the average number of annual ear infections from 3.6 to 5.4 episodes. In children between two and three years of age, pacifier use increased the number from 1.9 to 2.7 ear infections per year. Presumably, either the sucking motion associated with pacifier use hinders proper eustachian tube function (which normally keeps the middle ear open and clean), or - particularly in daycare - the pacifiers act as fomites (germ covered objects that spread infection). The authors suggest that pacifiers be used only during the first ten months of life when the need for sucking is strongest and episodes of ear infections are relatively uncommon.

Study 2

A more recent study in children less than 2 years old demonstrated a similar association between pacifier use and ear infections. Researchers found a 33% reduction in the rate of ear infections when pacifier use was limited. The authors recommend that pacifier use be reduced to moments when falling asleep after 6 months of age and discontinued altogether after 10 months of age.

The Antibiotic Hoax

Study 1

Most parents are taught to think that if an antibiotic is given to their child for an ear infection, the medicine will help the child to recover. Not necessarily! Of the 10 million annual antibiotic prescriptions for ear infections in the United States, it is estimated somewhere between 8.5 million and 9.5 million prescriptions didn’t actually help the children. These finding are according to the best medical research (and according to the American Academy of Pediatrics). In other words, between 7 and 20 children would need to be treated with antibiotics for ear infections before one child would benefit.

About 80 percent of ear infections will resolve easily without antibiotics. For those cases that do not resolve easily, often the antibiotic would not have helped either. However, research shows in 5 to 14 percent of children, antibiotics will take one day off the length of the ear infection. But by comparison, up to 15 percent of children who take antibiotics will develop diarrhea and up to 5 percent will have allergic reactions, some of which may be quite serious.

Study 2

A recent study at Children's Hospital Los Angeles questioned the need to treat uncomplicated ear infections with antibiotics. Doctors reviewed 74 research trials done between 1966 and 1999. After reviewing all the data, they concluded that 78% of children in the studies would have experienced resolution of their ear infections within 4 to 7 days if not treated with antibiotics. It is common practice in the Netherlands and some other European countries to not treat ear infections with antibiotics unless symptoms persists or worsen after 24 to 48 hours. The study also pointed out the risks of side effects from antibiotics such as allergic reactions and diarrhea. Avoiding overuse of antibiotics will also slow down the growing problem of resistant bacteria.

Watch and Wait for Ear Infections?

Avoiding complications from spreading bacteria is a primary reason for treating ear infections with antibiotics. Mastoiditis, an infection of the skull bone behind the ear, is the most common serious complication. A major study published in the August 2001 issue of the Pediatric Infectious Disease Journal compared children in the US, UK, Canada, and Australia (where more than 96% of acute ear infections in children are treated with antibiotics) with children in the Netherlands, Denmark, and Norway (where only 31% to 76% of acute ear infections are treated with antibiotics). Complications are indeed more common when people 'watch and wait' before treating many ear infections -- but the increased complications only totaled 2 extra cases of mastoiditis per 100,000 children per year. Adverse reactions to antibiotics can be a bigger problem than spreading ear infections.

Ear Infections ‘linked to asthma’

Children who suffer from recurrent ear infections may have an increased risk of asthma, a study suggests. Doctors in the United States examined the medical records of 7,538 children between the ages of two and 11. They discovered that children with a history of ear infections were twice as likely to develop asthma compared to those who had never had an infection. This study also acknowledged the need for more research to see if there really is a link. As many as 150 million people around the world have asthma and the numbers are increasing every day. It causes 180,000 deaths each year. Though scientists do not know why so many people are becoming asthmatic, a link has been found between the incidence of childhood illness (with a focus on ear infections) and the development of asthma. Researchers at the University of Illinois in Chicago found that 72% of the children with asthma they looked at had suffered at least one ear infection. Children with three or more infections were twice as likely to have asthma compared to those who had never had an infection. The researchers involved in the study believe it is possible that specific viruses or bacteria that cause recurrent ear infections may play a major role in the development of asthma and that antibiotics use increases the risk of asthma.


TCM Clinical Trials

Study 1

This study included 32 children with acute, purulent otitis media (i.e. ear infection). This study was published by Yuan Gui-fang in the Jilin Journal of Chinese Medicine and Medicinals, #2, 1993. The author’s formula consisted of equal portions of the Chinese herbs Xian Ren Zhang and Pu Gong Ying. These medicinals were macerated to obtain their juice. This medicinal liquid was then introduced by a dropper into the affected ear two to three times each day. Nineteen of the 32 cases were cured in two days, 11 were cured in two to four days and two cases were cured in 4-5 days.

Study 2

A summary of data collected in a clinical audit using Chinese Herbal Medicine to treat children with acute ear infections appeared in the 9th edition of the Sichuan Journal of Chinese Medicine in 1996. All patients had middle ear infections with fever and purulent secretions discharged externally from their ear(s). Yin Long Tang (Lonicera and Gentiana) was the base formula used by the doctor in this study. This formula was taken internally and was combined with herbal ear drops composed of seven different Chinese herbs. Using this treatment method all 42 cases were healed and all their symptoms disappeared within two to ten days. Thus the amelioriation rate of this trial was 100%.

Study 3

In issue #9, 1996 of the Journal of Chinese Medicine, the results were reported of a clinical trial using Chinese herbal ear drops to treat 136 children with purulent ear infections. The herbal ear drops were composed of the Chinese herb Zi Cao and sesame oil. Three to four drops of this medicinal oil were introduced into the ear, four to five times each day. All patients were cured using this treatment. Typically, pus stopped after one to two days and the condition was cured in three to seven days.


Patient Form

This printable handout is to inform current patients how they can assist in the healing process by offering helpful tips and suggestions.