Ear Infections and Chiropractic

Many of us can identify with that screaming child in the night suffering with an ear ache. Your sympathy from holding this child wears thin through the night as there is not an easy non pharmaceutical approach to quell the discomfort. Eventually, an analgesic takes the edge off and you schedule a chiropractic appointment in the morning.

Since the last time we addressed otitis media and chiropractic, there have been some changes in the care and guidelines for acute and chronic otitis media in both the medical and chiropractic approaches. The prescriptions of antibiotics for acute otitis media have increased by 15%; according to the University of Minnesota, 8-10 million prescriptions for antibiotics for otitis media are written annually in the United States. It is also one of the top 10 reasons parents bring their children to the chiropractor at 11.3% of chiropractic pediatric clientele.

The American Academy of Pediatrics guidelines state that the preferred course of action for an acute otitis media (or middle ear infection) is to yield a “wait and see” approach. The guidelines in 2011 from the Agency for Healthcare Research and Quality found that 66% of Acute Otitis Media episodes will recover without antibiotic use within 24 hours, and 80% will recover after several days without
antibiotics. The AAP realized that pediatricians were not following this  recommendation and changed diagnostic criteria to try to reduce antibiotic excessive prescription in 2020. In 2024,studies of effectiveness in the Journal of Infectious Disease suggest longer antibiotic therapy approaches
showed even less effectiveness. So, why continue to prescribe antibiotic therapy for ear aches? The main concern is that an infection could spread. We know that any infection poses a risk of spreading, but the eustachian tube, behind the tympanic membrane, is closely related to the small and porous bones of the skull. So, monitoring becomes imperative to be sure the child is recovering
appropriately.

While antibiotic therapy is extremely common, parents realize the side effects of this therapeutic choice causes the destruction of fragile normal flora, or good bacteria in the gut and mucus tissue, that protects the child from infection. It can also result in antibiotic resistance. It is important to note the literature since 2020 is influencing vaccine implementation and breastfeeding for 6 months, as the preventative approach to AOM. If infections recur and it becomes a chronic issue (presently defined as 3 infections in a calendar year), the parents are instructed to consult with the ENT for surgical intervention of tympanostomy tubes.

Below is a photograph of gradually infected ear drumsA, Normal TM. B, TM with mild bulging. C, TM with moderate bulging. D, TM with severe bulging. Courtesy of Alejandro Hoberman, MD.
 
A normal appearance in an otoscopic evaluation reveals a reflex of light and identification of normal middle ear anatomy. As pressure builds up behind the eardrum in the eustachian tube, it changes to a mottled light reflex, can become red, fluid can be visualized, and then the bulging of the eardrum becomes progressive.
 
When health care providers adhere to the new 2020 guidelines, if effusion and bulging occurs without fever, the “wait and see” approach is encouraged over antibiotics. It is at this critical 24 to 72 hours that your chiropractor can assist the child's body in defeating this immunological challenge. As chiropractors, we are not in the business of treating infection. However, we are devoted to helping people pursue and maintain optimal health. We think it is imperative to  strengthen the immune system to defend against and conquer infection of any kind. We believe that the body has the best laboratory to come up with illness fighting agents. We do this by stimulating of the nervous system, circulatory system and lymphatic system with chiropractic adjustments. 
 
By detecting and removing mechanical interference at the joint and cranial sutures, we chiropractors help the body to expedite the healing process. In the case of ear infection, we simply stimulate the upper cervical spine and cranial motion. This will help the body to drain out fluid normally through the eustachian tube and thereby relieve that terrible pain and crying. Chiropractic research supports this philosophy for those suffering with ear infections. Remembering that 80% of children who do not use antibiotic therapy will recover from otitis media in a few days, let’s compare Roseann M Froehle’s study that touts that 93% of children who get adjusted are able to resolve an episode of otitis media
within a few days in an article submitted to JMPT. Joan M Fallon wrote extensive research for the Journal of Clinical Chiropractic Pediatrics. She studies 332 children who saw improvement via tympanography of ALL children within six days under chiropractic care. Van Breda reported in a “Comparative Study in the Health Status of Children Raised Under Chiropractic Models of Health
Care and Allopathic Models of Health Care” a statistically significant decrease in many childhood illnesses, specifically ear infections, in those children who were raised with chiropractic care.
 
While the pharmaceutical management of earaches varies, it is a welcome sight to know chiropractic is available to help resolve the fluid build up. The “wait and see” approach can be frustrating to the one holding a crying child. Chiropractic is a safe and effective enrichment for these families. Did you know that Coulter touted the risk of a negative side effect from chiropractic adjustments to the neck at 6.39 in 10 million and to the low back 1 in a hundred million? I think you will find that pain relievers and antibiotic use would struggle to compete with these numbers, and certainly the risk for a child undergoing anesthesia to have a tube insertion is quite a bit more daunting.
 
Hopefully, this article has sparked your interest in helping generations of families pursue optimal health with chiropractic. Always remember the tenants of health care that we espouse and educate families with every day: get enough sleep, drink enough water, exercise, eat your vegetables, pursue  your purpose in life and get adjusted regularly. If you have further interest or questions regarding the
specifics of chiropractic care and ear infections, please don’t hesitate to call our office. We are here to serve you and those you love.
 
References:
Trends in the incidence and burden of otitis media in children: a global analysis from 1990 to 2021 Lingkang Dong , Yuchen Jin , Wenqi Dong , Yumeng Jiang , Zhuangzhuang Li , Kaiming Su, Dongzhen Yu
 
PMCID: PMC12122604 PMID: 39719471 March 2013, VOLUME 131 / ISSUE 3 From the American Academy of Pediatrics Clinical Practice Guideline Durations of Antibiotic Treatment for Acute Otitis Media and Variability in Prescribed Durations Across Two Large Academic Health Systems Sophie E Katz, Timothy C Jenkins, Amy B Stein, Gale Thomas, Nancy Koenig, Gary Lucas Starnes, Jason G Newland, Ritu Banerjee, Holly M Frost Journal of the Pediatric Infectious Diseases Society, Volume 13, Issue 9, September 2024, Pages 455–465, https://doi.org/10.1093/jpids/piae073 Acute mastoiditis in children Pasquale Cassano 1 , Giorgio Ciprandi 2 , Desiderio Passali PMCID: PMC7947742 PMID: 32073562
 
Otitis Media: Rapid Evidence Review HEIDI L. GADDEY, MD, MATTHEW THOMAS WRIGHT, DO, AND TRACY N. NELSON, MD Am Fam Physician. 2019;100(6):350-356 Otitis media: recent advances in otitis media vaccine development and model systems Ayesha Zahid 1 , Jennifer C Wilson 2 , I Darren
Grice 1,2,* , Ian R Peak 1,2,* PMCID: PMC10847372 PMID: 38328427 Acute Otitis Media Caroline R. Paul, MD 1 ; Megan A Moreno, MD, MSEd, MPH 1 JAMA Pediatr Published Online: January 27, 2020 2020;174;(3):308. doi:10.1001/jamapediatrics.2019.5664 Fallon JM. The Role of the Chiropractic Adjustment in the Care and Treatment of 332 Children with Otitis Media. Journal of Clinical Chiropractic Pediatrics. 1997; Volume 2, No. 2:167-183.Coulter ID. Efficacy and Risks of Chiropractic Manipulation: What Does the Evidence Suggest? Integrative Medicine 1998;1:61-66 Tal Marom,1 Johanna Nokso-Koivisto,2 and Tasnee Chonmaitree1 Viral–Bacterial Interactions in Acute Otitis Media Curr Allergy Asthma Rep. 2012 Dec; 12(6): 551–558.doi: 10.1007/s11882-012-0303-2PMCID: PMC3493715NIHMSID: NIHMS407352 Fysh, Peter Top 10 Pediatric Conditions Treated by Chiropractors http://www.discoverfamilychiropractic.com/peds-topten.html 

Alaina Rowswell-Kulikowski, DC, DICCP