* Note from the author: This is an advanced post intended for healthcare practitioners *

Acute Otitis media (AOM) is one of the most common childhood infections and is the leading cause of doctor visits by children (1), and in the absence of penicillin allergy Amoxicillin is the antibiotic of choice as treatment. To provide perspective, the microbes that typically cause otitis media are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis and they are developing resistance to it. There can be a viral etiology where Rhinovirus and Respiratory Syncytial Virus can be the cause or adding to the infection (2). Antibiotic resistance is real and many physicians are seeking ways to address bacterial infections without antibiotics in order to decrease their contribution to it. We will talk about herbal approaches that have been used by Eclectic Physicians, Functional Medicine oriented Medical Practitioners, and Naturopathic Physicians. There is also a neuroanatomical model explaining the possible role spinal manipulation can play in co-managing AOM, performed by a Doctor of Chiropractic or Osteopathy. How? Spinal Manipulations can promote better ventilation of the Eustachian tube, possibly aiding in preventing the infection and aiding in it’s resolution if there is one. Citations will follow.

In the context of the middle ear, the eustachian tube has three main functions: protection, clearance, and most importantly, ventilation (2). It’s also wise to remember that the eustachian tube is underdeveloped in children, deeming it more horizontal, shorter, and less compliant. (2) The most probable sequence of events that leads to AOM is:

~ Edema of the Adenoid and the lymphoid mucosa
~ Blockage of the Eustachian tube
~ Infiltration of opportunistic bacteria into the nasopharynx
~ Sneezing, coughing and/or sniffing forces bacteria up the Eustachian tube
~ Accumulation of serous or purulent exudates

Edema in the adenoid and lymphoid mucosa is an intelligent response to some sort of immune assault…my first question is: what foods are irritating the child’s gastrointestinal system? The swelling could very well be pathogen-mediated, but with the neoantigens in our food system, like modern-day gluten, it is wise to investigate because the average American doesn’t only eat 3 times a day. Before I expand on food sensitivities I want to share that I’ve probably had over 15 ear infections as a child. I eventually had a tube put in my ear and things got better, but was that another band-aide approach?

Food sensitivity testing is probably the second wisest test you can get when you are dealing with chronic ear infections, second to an ear exam. I’m going to talk about antiallergy herbs in later sections, but a sensitivity (IgG mediated) is different than an allergy (IgE mediated). The issue with food sensitivities is that the body doesn’t always provide feedback to you about how offensive a food was to your gut and nervous system, but the common feedback that is present is bloating and brain fog. The most objective measurement is testing it and I’m not paid to say this, but I like and use US Biotek: an in-house fingerpick test. Healing the gut by temporary removal (possibly best permanent FOR SOME foods) is therapeutic and may prevent another ear infection from starting. You can get over 100 foods screened at one time; the following image is an example of what the test looks like.

The following are the herbal approaches to addressing AOM. Speak with your doctor before trying any of these! The dose and the severity of your condition matters! Antiallergic herbs (a substance that tones down the allergic response, often by stabilizing mast cells) such as Albizia and Baical Skullcap are indicated for AOM in the herbal medical literature. Upper respiratory anticatarrhal herbs (substances that reduce the formation of phlegm) such as Eyebright, Golden rod, Golden seal, Ribwort (natural and whole vitamin C source), Elder flowers, and Ground ivy are also indicated for AOM. A depurative herb (substances that improve detoxification and aids elimination to reduce the metabolic waste products within the body) indicated for AOM is Clivers. Immune enhancing herbs such as Echinacea and Andrographis are typically prescribed for most infections. Diaphoretic herbs (substances that control a fever by promoting sweating) like Elder flowers and Peppermint are ideally suited also. Once again, speak with your Primary Care Physicians before trying any of these.

Chiropractic and Osteopathic manipulations’ possible role in the prevention and pivotal co-management role in Acute Otitis Media came to me from an article in the Journal of Tinnitus and a neuroanatomy chapter in an Atlas of Anatomy. In both places it mentions the trigeminal nerve innervates 12 muscles (6 found on both sides of the face), and the one muscle of clinical significance is Tensor Veli Palltini (TVP). Recall how I said earlier that the most significant role of the eustachian tube is ventilation? TVP does that. In order for any muscle to activate, it needs the neuruochemical inputs to contract and relax. There are higher brain centers in the cortex that modulate this. To learn more about the emerging branch in healthcare called Chiropractic Neurology, check out Dr. Fredrick Carrick’s work at the Carrick Institute. The general summary of his Institute is when the body moves symmetrically in the respective planes of joint motion, it promotes symmetry in the central and peripheral nervous system

TVP is a muscle affected via the dentato-rubro-trigeminal projection from spinal manipulation integration in the cerebellum, and my theory is that regular Chiropractic care promotes symmetrical tone of the TVP. In an article in the International Tinnitus Journal it states “unquestionably, the upper cervical spine, the TMJ, the eustachian tube, and the autonomic nervous system can contribute to the global symptom complex of Meniere’s disease.” (3)  Research needs to be done for AOM outcomes and prevention, but I have very little doubt based on the way our neurological infrastructure is set up that Chiropractors and Osteopaths CAN play a major role in the prevention and co-management of Acute Otitis Media.

In summary, we spoke about antibiotic resistance, the purpose of the eustachian tube, the probable way infections begin, the anatomical differences of the eustachian tube in children compared to adults, traditional herbal therapies, and the neuroanatomical explanation of spinal manipulation.

Now the turn in yours! Based on the images and citations provided, what’s your take on this? I’m inviting us to remain focused on the antimicrobial effect of antibiotics on their gut microbiome, which has unfavorable lasting metabolic consequences. (4) Should we try food sensitivity testing, herbal therapy, herbal liquid ear drops, and spinal manipulations to prevent and co-manage AOM?

Direct Every Angle,

Dr. WP

(1) Freid VM, Makuc DM, Rooks RN. Ambulatory health care visits by children: principal diagnosis and place of visit. National Center for Health Statistics. Vital Health Stat 13(137). 1998.

(2) Maroeska M Rovers, Anne GM Schilder, Gerhard A Zielhuis, Richard M Rosenfeld. Otitis media. The Lancet, Volume 363, Issue 9414, 27 March 2004.

(3) Franz B1, Anderson C. The potential role of joint injury and eustachian tube dysfunction in the genesis of secondary Ménière’s disease. Int Tinnitus J. 2007;13(2):132-7.

(4) Cox LM, Yamanishi S, Sohn J, et al. Altering the intestinal microbiota during a critical developmental window has lasting metabolic consequences. Cell. 2014;158(4):705‐721. doi:10.1016/j.cell.2014.05.052

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