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

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