Otitis Media

Introduction

What should I know about Otitis media?

Otitis media is more commonly referred to as an ear infection. As most parents know, ear infections demand attention. Otitis media can be classified as acute otitis media or as otitis media with effusion meaning that there is an accumulation of fluids. Acute otitis media is characterized by rapid onset of symptoms, and episodes are more frequent in the first 3 years of life. Acute otitis media is the most frequent diagnosis in infants and children who visit physicians because of illness. (1) Acute otitis media occurs in adults, but with much less frequency. Otitis media with effusion differs from acute otitis media in that signs and symptoms of acute infection are absent.

The middle ear is best described as an air-filled cavity that begins at the eardrum, also referred to as the tympanic membrane, and extends to the upper throat behind the nose, an area called the nasopharynx. Connecting these two areas is the eustachian tube. Its primary functions are the regulation of atmospheric pressure between both sides of the tympanic membrane, protection from nasopharyngeal secretions, and draining secretions from the middle ear into the nasopharynx. In the adult, the eustachian tube lies at a 45° angle from the horizontal plane. In children that angle is only 10°. This may indeed help explain the increased rate of infection in infants and children, since the degree of this important angle may cause improper drainage.

Several risk factors contribute to the higher incidence and frequency of otitis media. These include the season of the year, certain malformations, environmental factors, and the age of the child when the first episode occurred.

There are basically two situations which may occur with middle ear disturbances. First, a pathogen, such as bacteria, may get into the middle ear and, as it reproduces, fluid is unable to drain due to swelling and inflammation. Potential causes of this may include head trauma from birth or from an accident, or eustachian tubes congested from allergies or colds.

Secondly, some experts feel that chronic ear complaints may be initiated by food or environmental allergies. Allergies could cause a fluid buildup in the ear, which may create pain or pressure in the child, but this is not an infection. However, this buildup can become a ripe medium for pathogen invasion. The biggest food culprits are wheat, corn, and dairy. Other common problem foods include soy, eggs, citrus, and peanut butter. The bacteriology of middle ear infections has changed very little since the mid-1970's with the exception of emergence of some strains of bacteria which seem to be resistant to antibiotics.

Statistic

World Health Organization, 1996.

  • The prevalence of COM around the world ranges from 1%-46% in disadvantaged groups developing and developed countries.

  • A prevalence of chronic otitis media COM greater than 4% in a defined population of children is indicative of a massive public health problem requiring urgent attention.

The National Institute on Deafness and Other Communication Disorders, National Institutes of Health, 1999.

    It is estimated that medical costs and lost wages because of otitis media amount to $5 billion a year in the United States. Middle ear infections are the reason for up to 30% of pediatric office visits in American children. Otitis media is second in prevalence only to the common cold. About two thirds of children have at least one acute ear infection by the time they are three years old. About 17% of all children under two have recurrent ear infections, i.e., three or more episodes within a six-month period. Prevalence increased 44% between 1981 and 1988, with infants particularly affected. 38% of children with ear infections also had sinusitis. More than 70% of children received antibiotics before they were seven months old, and the most common reason for these medications was otitis media. 80% of children are cured by two weeks without any treatment at all; antibiotics cure about 95%.

Signs and Symptoms

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Not available

General

  • Pain in the ear, signaled by pulling on the ear in some infants
  • Fever
  • Eventual hearing loss
  • Irritability, tiredness, lack of appetite or vomiting may also occur, especially in young children
  • Usually occurs in children who have had an upper respiratory tract infection for several days

Treatment Options

Conventional

The goals of therapy include the control of pain, getting rid of the infection, preventing complications, and avoiding unnecessary antibiotics. (2) Providing supportive therapy such as mild pain medication or warm compresses may ease the pain and comfort the child. The most common treatment is the use of antibiotics. The physician selects the appropriate antibiotic based on the symptoms of the condition and characteristics of the child. Occasionally, Otitis media is treated by the insertion of tubes called tympanostomy tubes. This results in a longer period of time between infections and relieves the discomfort associated with the condition.

Nutritional Suplementation


Vitamin C

Vitamin C is a nutrient that is critical for proper functioning of the immune system. One small study reported that some positive results could be achieved in children with recurrent middle-ear infections with the use of vitamin C therapy. (3) Another study reported using a combination of antioxidants, including vitamin C, vitamin E, and vitamin A, in children with middle ear inflammation with good results. (4) The dosing is variable depending on the age and weight of the patient. To date, no large-scale studies have examined vitamin C’s usefulness for otitis media.


Zinc

Zinc is a nutrient that plays critical roles in the proper functioning of the immune system. In an investigation of 28 children aged 10 months to 10 years with undue susceptibility to upper respiratory and/or inner ear infections, zinc and iron were the two minerals that were found to be most frequently deficient in these children. (5)

Herbal Suplementation


Echinacea

Echinacea is one of the most popular herbs in the world. It has non-specific stimulatory effects on the immune system. (6) Research has indicated that echinacea stimulates the alternate and complementary pathway, activating white blood cells to scavenge for bacteria and cellular debris. (7) It has been used to improve wound healing (8) and to help in the treatment of colds and flu. (9) Two recent studies were performed using echinacea products in colds and influenza. One study reported no significant advantage when using echinacea in management of colds and influenza. (10) The investigators used an alcohol extract (polysaccharides are precipitated in alcohol). The other study (randomized, double-blind, placebo controlled) reported positive benefits in managing colds and influenza when using echinacea (using the succus product). (11) Echinacea is reported to have a wide level of antimicrobial activity on bacteria, fungi, and viruses. (12) It has been used externally for a wound wash, eczema, burns, herpes, canker sores, and abscesses, as well as other conditions. (13)


Astragalus

Astragalus has been valued by the Chinese for centuries for its immune-enhancing and adaptogenic properties. As an adaptogen, it may modify and improve the body’s response to stress through action on the adrenal cortex. (14) , (15) Experiments have reported that astragalus promotes regeneration of cells in the bronchi after viral infection.


Larch Arabinogalactan

Because of the immune-enhancing properties, LA is receiving increased attention as a clinically useful immunomodulating agent. (16) LA may be a good therapeutic choice for individuals with recurrent immune system problems, including colds and influenza, chronic fatigue, and viral hepatitis among others. LA has also been used with positive success in children, specifically in otitis media. (17)


Olive Leaf

Olive leaf extract has been reported to be an effective antimicrobial agent against a wide variety of pathogens, including Salmonella typhi, Vibrio parahaemolyticus and Staphylococcus aureus (including penicillin-resistant strains), Klebsiella pneumonia and Escherichia coli, causal agents of intestinal or respiratory tract infections in man. (18) The component usually associated with olive leaf’s antimicrobial properties is oleuropein. (19) , (20)

Diet & Lifestyle

Allergy to milk and dairy products: Some children with recurrent otitis media infections are found to have food allergies. In one study of children between the ages of 1.5 to 9 years of age, 81 of 104 (78 percent) were found to have food allergies. An elimination diet led to a significant amelioration of serous otitis media in 70/81 (86 percent) of patients as assessed by clinical evaluation and tympanometry. The challenge diet with the suspected offending food(s) provoked a recurrence of serous otitis media in 66/70 patients (94 percent). (21) One of the most common conditions is an allergy to milk and dairy products. (22)

References

  1. Infante-Rivard C, Fernandez A. Otitis media in children: Frequency, risk factors, and research avenues. Epidemiol Rev 1993;15:444-465.
  2. Richer M, Deschenes M. Upper Respiratory Tract Infections, In: DiPiro et al. eds Pharmacotherapy, A Pathophysiologic Approach, 4th ed. Stamford, CT: Appleton & Lange; 1999:1671-1675.
  3. View Abstract: Patrone F, et al. Disorders of neutrophil function in children with recurrent pyogenic infections. Med Microbiol Immunol (Berl). 1982;171(2):113-22.
  4. View Abstract: Karabaev KE, et al. Pathogenetic validation of optimal antioxidant therapy in suppurative inflammatory otic diseases in children. Vestn Otorinolaringol. 1997;(1):5-7.
  5. View Abstract: Bondestam M, et al. Subclinical trace element deficiency in children with undue susceptibility to infections. Acta Paediatr Scand. Jul1985;74(4):515-20.
  6. Snow JM. Echinacea (Moench) spp. Asteraceae. Protocol Journal of Botanical Medicine. 1996;2(2):18-23.
  7. View Abstract: Vomel VT. The Effect of a Nonspecific Immunostimulant on the Phagocytosis of Erythrocytes and Ink by the Reticulohistiocyte System in the Isolated, Perfused Liver of Rats of Various Ages. Arzneim- Forsch/Drug Res. 1984;34:691-95.
  8. View Abstract: Dorsch W. Clinical Application of Extracts of Echinacea purpurea or Echinacea pallida. Critical Evaluation of Controlled Clinical Studies. Z Arztl Fortbild (Jena). 1996;90(2):117-22.
  9. View Abstract: See DM, et al. In Vitro Effects of Echinacea and Ginseng on Natural Killer and Antibody-dependent Cell Cytotoxicity in Healthy Subjects and Chronic Fatigue Syndrome or Acquired Immunodeficiency Syndrome Patients. Immunopharmacology. 1997;35(3):229-35.
  10. View Abstract: Grimm W, et al. A Randomized Controlled Trial of the Effect of Fluid Extract of Echinacea purpurea on the Incidence and Severity of Colds and Respiratory Infections. Am J Med. Feb1999;106(2):138-43.
  11. View Abstract: Brinkeborn RM, et al. Echinaforce and Other Echinacea Fresh Plant Preparations in the Treatment of the Common Cold. A Randomized, Placebo Controlled, Double-blind Clinical Trial. Phytomedicine. Mar1999;6(1):1-6.
  12. Wichtl M, in NA Bisset, ed. Herbal Drugs and Phytopharmaceuticals. Stuttgart: Scientific Press; 1994:182-84.
  13. View Abstract: Melchart D, et al. Results of Five Randomized Studies on the Immunomodulatory Activity of Preparations of Echinacea. J Altern Complement Med. 1995;1(2):145-60.
  14. Chang CY, et al. Effects of Astragalus membranaceus on Enhancement of Mouse Natural Killer Cell Activity. Chung Kuo I Hsueh Ko Hsueh Yuan Hsueh Pao. Aug1983;5(4):231-34.
  15. Zhao KS, et al. Positive Modulating Action of Shengmaisan with Astragalus membranaceus on Anti-tumor Activity of LAK Cells. Immunopharmacology. Nov1990;20(3):471.
  16. View Abstract: Hauer J, et al. Mechanism of Stimulation of Human Natural Killer Cytotoxicity by Arabinogalactan from Larix occidentalis. Cancer Immunol Immunother. 1993;36(4):237-44.
  17. View Abstract: Kelly G. Larch Arabinogalactan: Clinical Relevance of a Novel Immune-Enhancing Polysaccharide. Altern Med Rev. 1999;4(2):96-103.
  18. View Abstract: Bisignano G, et al. On the in-vitro antimicrobial activity of oleuropein and hydroxytyrosol. J Pharm Pharmacol. Aug1999;51(8):971-4.
  19. View Abstract: Bisignano G, Tomaino A, Lo Cascio R, Crisafi G, Uccella N, Saija A. On the in-vitro antimicrobial activity of oleuropein and hydroxytyrosol. J Pharm Pharmacol. Aug1999;51:971-4.
  20. View Abstract: Coni E, Di Benedetto R, Di Pasquale M, et al. Protective effect of oleuropein, an olive oil biophenol, on low density lipoprotein oxidizability in rabbits. Lipids. Jan2000;35:45-54.
  21. View Abstract: Nsouli TM, et al. Role of food allergy in serous otitis media. Ann Allergy. Sep1994;73(3):215-9.
  22. View Abstract: Juntti H, et al. Cow's milk allergy is associated with recurrent otitis media during childhood. Acta Otolaryngol. 1999;119(8):867-73.