ear infections
New AAP Guidelines on Ear Infections take a "Watch
and Wait" approach: http://www.aap.org/advocacy/releases/aomqa.htm
A Welcome Revolution in Ear Infection Treatment! http://www.drgreene.com/21_1767.html
Early Ear Treatment Doesn't Help Children at School, Study
Says
A child's early educational development isn't affected by a delay in treating
inner-ear infections, according to a study in the New England Journal of Medicine.
Inserting
tubes to drain fluid from the ears of children younger than 3 years old doesn't
improve their performance at school by the age of 6, the study by researchers
at Children's Hospital of Pittsburgh and the University of Pittsburgh found.
The study appears in the Aug. 11, 2005issue of the New England
Journal of Medicine.
Read the entire article here: http://www.bloomberg.com/apps/news?pid=10000087&sid=aaOcLJT6WaAg&refer=top_world_news
Read additional articles here: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16036440&query_hl=5
Natural Ear Drops as Effective as Medicated Drops
Naturopathic eardrops are an effective alternative
to traditional medicated drops, say researchers. The study
followed 103 youngsters with acute otitis media. All subjects
suffered from ear pain and were aged 6 to 18 years.
Half of the subjects were given Otikon eardrops, a naturopathic
herbal extract containing garlic, mullein, calendula and
St. John's wort in olive oil. The other group received anesthetic
drops containing ametocaine and phenazone in glycerin. Drops
were administered three times each day. Both groups showed
similar improvement in pain scores over three days, as evidenced by visual
analog scores. "Otikon, an ear drop formulation of naturopathic origin, is
as effective as anesthetic ear drops and was proven appropriate for the management
of acute otitis media associated ear pain," conclude the study's authors.
Sarrell EM, Mandelberg A, Cohen HA Efficacy
of naturopathic extracts in the management of ear pain associated with acute
otitis media Arch Pediatr Adolesc Med 2001 (Jul); 155
(7): 796-799
There have been numerous studies in the medical
literature reporting the ineffectiveness of antibiotics
as treatment for ear infections
Recent evidence has thrown into question
the use of antibiotics and the length of treatment, if prescribed.
The growing worldwide development of multidrug-resistant
bacteria, the uncertainty of diagnosis, and that up to one
third of cases of AOM are viral in origin 12 have made popular
a wait-and-see approach to the initial prescription of antibiotics,
especially in many European countries. In several randomized
clinical trials, antibiotics provided only a small benefit.
13-15 In a meta-analysis of more than 2000 children with
AOM, ear pain resolved spontaneously without antibiotics
in two thirds by 24 hours and in 80% by day 7.
William F. Miser, MD To
Treat or Not to Treat Otitis Media-That's Just One of the Questions J
Am Board Fam Pract 2001 (Nov); 14 (6): 474-476
Clinical Evidence Shows Limited Effect of Antibiotic
Treatment on Children With Acute Otitis Media
A study conducted by the Southern California/RAND
Evidence-based Practice Center (EPC) and sponsored by the
Agency for Healthcare Research and Quality reveals that nearly
two-thirds of children with uncomplicated acute otitis media
recover from pain and fever within 24 hours of diagnosis
without treatment with antibiotics. And, over 80% recover
within 1-7 days. When treated with antibiotics, up to 93%
of children recover during the first week.
Investigators found no evidence that children with acute otitis media treated
with amoxicillin fared any differently from those treated with newer, more
aggressive antibiotics - which are more expensive and more likely to provoke
side effects.
Press Release, August 9, 2000 Clinical
Evidence Shows Limited Effect of Antibiotic Treatment on Children With Acute
Otitis Media Agency for Healthcare Research and Quality,
Rockville, MD.
Antibiotic treatment of otitis media is no more
effective than placebo, and increases the risks of reoccurrence
Nine studies of antibiotic prophylaxis of
recurrent otitis media with 958 subjects had an RD of 0.11
(95% confidence interval [Cl], 0.03 to 0.19) favoring antibiotic
treatment. Twelve studies of short-term patient outcomes
of OME with 1697 subjects had an RD favoring antibiotics
of 0.16 (95% Cl, 0.03 to 0.29), while eight studies using
the ear as the outcome measure with 2052 ears studied had
an RD of 0.25 (95% Cl, 0.10 to 0.40). No significant difference
was shown between placebo and antibiotics (RD, 0.06; 95%
Cl, -0.03 to 0.14) in the eight studies of longer-term outcome
of OME.
Cantekin EI Use
of antibiotics in preventing recurrent acute otitis media and in treating otitis
media with effusion. A meta-analytic attempt to resolve the brouhaha JAMA.
1993 (Sep 15); 270 (11): 1344-1351
Are antibiotics indicated as initial treatment for
children with acute otitis media?
To determine the effect of antibiotic treatment
for acute otitis media in children six studies of children
aged 7 months to 15 years were reviewed. 60% of placebo treated
children were pain free within 24 hours of presentation,
and antibiotics did not influence this. Antibiotics seemed
to have no influence on subsequent attacks of otitis media
or deafness at one month. Antibiotics were associated with
a near doubling of the risk of vomiting, diarrhoea, and/or
rashes. Early use of antibiotics provides only modest benefit
for acute otitis media: to prevent one child from experiencing
pain by 2-7 days after presentation.
Del Mar C, Glasziou P, Hayem M Are
antibiotics indicated as initial treatment for children with acute otitis media?
A meta-analysis BMJ. 1997 (May 24); 314 (7093): 1526-1529
Antibiotics not effective for otitis media with
effusion
Otitis media with effusion usually resolves
spontaneously. The literature indicates that antibiotic treatment
has at most a short-term effect. Therefore it is not indicated
for the treatment of otitis media with effusion.
Grote JJ Antibiotics
in otitis media with effusion Ned Tijdschr Geneeskd. 1997
(Jan 11); 141 (2): 76-77
Antibiotics are not the best treatment for middle
ear infections
This study shows the ineffectiveness of
antibiotics for otitis media and suggests that doctors should
stop routinely prescribing drugs for them.
Froom J; Culpepper L; Jacobs M; DeMelker RA; Green LA et.
al. Antimicrobials
for acute otitis media? A review from the International Primary Care Network Brit
Med Journal 1997 (Jul 12); 315 (7100): 98-102
Treatment with Antibiotics made no difference in
outcome than in no treatment
Records from 2,089 otitis media patients
were examined to determine incidence and treatment success.
There was no difference in success rates between antibiotic
and no antibiotic therapies.
Tilyard MW; Dovey SM; Walker SA Otitis
media treatment in New Zealand general practice N Z Med
J. 1997 (Apr 25); 110 (1042): 143-145
No Difference of Effectiveness in Various Antibiotics
Most clinical trials comparing the efficacy
of different antibiotics have failed to show differences
in clinical efficacy. To date, no definitive trials of bacteriologic
efficacy in children have been published.
Cohen R The
antibiotic treatment of acute otitis media and sinusitis in children Diagn
Microbiol Infect Dis 1997 (Jan); 27 (1-2): 35-39
Limited Evidence to Justify Antibiotic Usage for
Acute Ear Infections
In a review and critical appraisal of the
literature on antibiotic therapy for acute otitis media in
children between 1939 and 1991, poor evidence supported the
routine use of antibiotic therapy. This approach cannot be
recommended for children 2 years and younger because this
age group has been excluded from most studies.
Fysh PN Chronic recurrent otitis media: Case series of five
patients with recommendations for case management J Clin Chiro
Ped 1996; 1(2)
Antibiotic Treatment for Ear Infections Remains
Controversial
Few issues in clinical medicine are as controversial
as the efficacy and risks associated with antibiotic treatment
of otitis media. Recent studies document the emergence and
rapid spread of drug-resistant streptococcus pneumoniae in
acute and unresponsive otitis as well as persistent effusions
and chronic suppurative otitis. It is best to avoid the antibiotic
treatment dilemma as much as possible by not over diagnosing
otitis media.
Berman S Management
of acute and chronic otitis media in pediatric practice Curr
Opin Pediatr 1995 (Oct); 7 (5): 513-522
Oral decongestants are ineffective in treatment,
or prevention, of otitis media in children
There were no significant differences between
the two groups, except that males developed SOM significantly
more often than did females. Use of decongestant and placebo
was continued in 78 patients with SOM for up to four more
weeks. Again, there were no siginificant differences between
the treatment groups except that patients with an allergic
history did significantly worse using a decongestant. Overall
there was no benefit from pseudoephedrine in either the prevention
or treatment of SOM.
Olson AL, Klein SW, Charney E, et al. Prevention
and therapy of serous otitis media by oral decongestant: a double-blind study
in pediatric practice Pediatrics 1978 (May); 61
(5): 679-684
Placebo fares as well as Amoxicillin
While once-a-day dosing was equivalent to
twice-a-day dosing for amoxicillin prophylaxis, there was
no benefit of amoxicillin prophylaxis compared with a placebo
control in preventing new acute otitis media episodes. Because
of the potential of excessive antibiotic use to promote the
acquisition of resistant pneumococci and the lack of effectiveness
in this trial, routine use of amoxicillin prophylaxis should
be discouraged.
Roark R; Berman S Continuous
twice daily or once daily amoxicillin prophylaxis compared with placebo for
children with recurrent acute otitis media Pediatr Infect
Dis J. 1997 (Apr); 16 (4): 376-381
Amoxicillin with and without decongestant-antihistamine
combination is not effective for the treatment of persistent
asymptomatic middle ear effusions in infants and children
Cantekin
EI; McGuire TW; Griffith TL Antimicrobial
therapy for otitis media with effusion ('secretory' otitis
media) JAMA 1991 (Dec 18); 266
(23): 3309-3317
Homeopathy for Ear Infections: Minimal Relapses,
No Side Effects
Within a prospective group study of five
practicing otorhinolaryngologists, conventional therapy of
acute otitis media in children was compared with homeopathic
treatments. Group A (103 children) was primarily treated
with homeopathic single remedies. Group B (28 children) was
treated by decongestant nose-drops, antibiotics, secretolytics
and/or antipyretics. Comparisons were done by symptoms, physical
findings, and duration of therapy and number of relapses.
The children of the study were between 1 and 11 years of
age. The median duration of pain in group A was 2 days and
in group B 3 days. Median therapy in group A lasted 4 days
and in group B 10 days. Antibiotics were given over a period
of 8-10 days, while homeopathic treatments were stopped after
healing. In group A 70.7% of the patients were free of relapses
within 1 years and 29.3% had a maximum of three relapses.
Group B had 56.5% without relapses and 43.5% a maximum of
six relapses. Of 103 subjects 98 (95.1%) responded solely
to homeopathic treatments. No side effects of treatment were
found.
Friese KH; Kruse S; Moeller H Acute
otitis media in children. Comparison between conventional and homeopathic therapy HNO
1996 (Aug); 44 (8): 462-466
Mom's who Smoke Increase Child's Risk of Ear Infection
Previous studies revealed an association
between second-hand smoke and risk of ear infection. Now,
scientists in Australia have discovered a link between in
utero exposure to smoke and this common childhood disorder.
The researchers pooled data on 8,556 women and their offspring. At age five,
children whose mothers had smoked 1-9 cigarettes per day during pregnancy were
60% more likely to have had a middle ear infection, compared with children
of nonsmokers. Mothers who smoked 10 to 19 cigarettes per day upped their children's
risk of ear infection by 2.6 times; mothers who smoked over 20 cigarettes per
day more than tripled their children's likelihood of ear infection. In addition,
offspring of heavy smokers were nearly three times as likely to undergo ear
surgery than children of nonsmokers, say researchers.
Stathis SL, O'Callaghan M, Williams GM, Najman JM, Andersen MJ, Bor W Maternal
cigarette smoking during pregnancy is an independent predictor for symptoms
of middle ear disease at five years' postdelivery Pediatrics
1999 (Aug); 104 (2): e16
Allergy Tied to Otitis Media
A new study by the University
of North Carolina supports evidence linking Otitis Media with allergy.. researchers
demonstrated that allergy "dynamically and functionally" inhibits
drainage of the ear canal. Allergy causes inflammation of
the Eustachian tubee, leading to restricted flow and stasis
of effusion, according to researchers. The study
was presented at the American Academy of Otolaryngology's
annual conference in San Antonio.
Otitis Media Linked to Secondhand Smoke
Researchers state that environmental tobacco
smoke (secondhand smoke) is an important risk factor for
middle ear disease in urban preschool-age children, even
in a relatively affluent population.
Adair-Bischoff CE; Sauve RS Environmental
tobacco smoke and middle ear disease in preschool-age children Arch
Pediatr Adolesc Med 1998 (Feb); 152 (2): 127-133
Ear Infections on the Rise
Over a seven year period, there was a 44%
increase in recurrent ear infections among preschool children
says the Journal of American Academy of Pediatrics. The increase
was especially pronounced among infants.
Otitis Media Complication of other Childhood Disorders
A misconception is that otitis media is
a primary disease entity; more accurately it is a complication
of other childhood complaints such as the common cold, sinusitis,
and sore throats.
Ballantyne J The
ear in paediatric practice Practitioner 1985 (Sep); 229
(1407): 809-12
Does swimming decrease the incidence of otitis media?
Based on these findings, the authors conclude
that there appears to be no basis to the commonly held belief
that swimming may induce or exacerbate otitis media. In fact,
the converse may be true.
Robertson LM; Marino RV; Namjoshi S. J Am Osteopath Assoc 1997; 97(3):150-2
Additional Articles on Ear Infections
ICPA's Research
on Chiropractic and Ear Infections
The
Otitis Media Page @ Chiro.Org
Parents
Sending Kids to the Chiropractor
Find a
Doctor of Chiropractic for Your Child
A Welcome Revolution in Ear
Infection Treatment!
A Story Goes with
It: Otitis Media and the Sanctity of Medical Guidelines
The
Role of the Chiropractic Adjuctment in the Care and Treatment of 332 Children
with Otitis Media.
Chiropractic & Children:
A Natural Approach to Ear Infections and Other Childhood Problems
Chiropractic
Helps in Prevention of Recurring Ear Infections
Chiropractic and
Otitis Media
Otitis Media: "The
Miracle Cure"
Are Antibiotics
Indicated as Initial Treatment for Children with Acute Otitis Media? A Meta-analysis
Evaluation of Children
with Ear Aches
Resources
to help you understand about ear infections
Additional Websites and Resources
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