Monthly Archives: March 2017

Treatment Options for Ear Infections: A Least Invasive to Most Invasive Approach

Ear infections (otitis media) are all too common among the pediatric population. And what is the status quo treatment? You probably didn’t even have to think twice on that answer. Antibiotics. There are different treatments of course, but antibiotics are the most common prescription for an ear infection. Why?
Antibiotics have been proven to have negative effects on our gut health due to their focus to destroy ALL bacteria, not just the bad bugs. And they are very effective at their job. Once they have kicked your ear infection to the curb, your gut is ready to rebuild with new bacteria. Bad gut bacteria are more than willing to step up and replenish the gut with bacteria that will feed a host of pathogens, fungi, and bacterial infections if not rebalanced by good bacteria. Maybe your gut will easily replenish the good-to-bad bacteria ratio. If you’re taking a high quality probiotic, avoiding processed foods, and getting plenty of direct sunlight daily, then your gut is likely headed to balance. If not, antibiotics have opened the door to a host of major issues. The CDC explains the issue,
“Ear infections will often get better on their own without antibiotic treatment.”
“Taking antibiotics when they are not needed can be harmful, and may lead to unwanted side effects like diarrhea, rashes, nausea, and stomach pain. More severe side effects may rarely occur; these include life-threatening allergic reactions, kidney toxicity, and severe skin reactions.”
“Each time you or your child takes an antibiotic, the bacteria that normally live in your body (on the skin, in the intestine, in the mouth and nose, etc.) are more likely to become resistant to antibiotics.”

pro-vs-anti-biotics

What’s a parent of a child with an ear infection to do?
Here is a hierarchy of treatments for Ear Infections. I am a parent, not a medical professional. Take any information learned here to your provider to create an individualized plan for your child that better reflects your wishes to use antibiotics as a last resort.

1. Prevention.
Well that seems simple and maybe irritating advice. Parents are thinking, “Don’t you think if I knew how to prevent ear infections I would?!” Well, have you tried these evidence-based otitis media preventers?
Risk factors: exposure to second hand smoke, bottle fed instead of breastfed, poor nutrition and wellness habits.

Mother nursing son

So, breastfeeding baby, keeping baby’s diet as organic and whole-food-based (i.e. not squeezy pouches), and avoiding exposures to well known toxins such as smoke will give you the leg up to maintaining baby’s wellness. Vitamin supplementation and probiotics have also been found to provide overall health benefit and reduce ear infection occurrences.

2. Treatment Options
The following have evidence-based literature to support their use in successful treatment of otitis media.
Homeopathy (This article can help you determine which remedy fits)
Osteopathic/Chiropractic manipulations
Xylitol
Probiotics
Acupuncture
Naturopathy

tug-in-ear So finding a good Bodyworker that will adjust your child at the first signs of ear tugging has research-proven benefits. Ask other parents which Alternative Medicine providers treat children regularly in your area.

More tried-and-true treatment options to look into:

onionwoman02Garlic Mullein Oil (excellent ear infection discussion and garlic Mullein info here)
Onion over the ear
Hydrogen Peroxide solution (sometimes referred to as Swimmer’s Ear– *for specific types of ear infections*)
Essential Oils (This article discusses which oils based on the research)
Colloidal Silver
Nambudripad Allergy Elimination Technique (NAET)

3. Managing Ear Pain
For a parent of a child with an ear infection, pain management is crucial because baby is miserable.

ear infection
“Treatment of the ear pain early in the course of [Acute Otitis Media] decreases both parental anxiety and the child’s discomfort and accelerates the healing process.”
This study concluded, “that in cases of ear pain caused by AOM in children in which active treatment, besides a simple 2- to 3-day waiting period, is needed, an herbal extract solution may be beneficial.” They found that the group randomly assigned to naturopathic ear drops had better pain management and resolution than the group assigned anesthetic ear drops with amoxicillin.
The Naturopathic Herbal Extract Ear Drops they used in their double-blind study contained “allium sativum, verbascum thapsus, calendula flores, hypericum perfoliatum, lavender, and vitamin E in olive oil. 5 drops 3 times daily.”
Other pain management options include essential oils, homeopathy, bodywork, and Garlic Mullein Oil.

4. Chronic Ear Infections
This beast deserves its own separate article. Please read Curing Recurrent Ear Infections to learn more.
An excerpt… “I keep treating my child, but their ear infections continue to reoccur.” The number one question that I believe gets missed too frequently and is critical to stopping chronic ear infections is: Why?
Your provider does a great job of identifying the ‘What’ –type and severity of ear illness. This article gives you resources to tackle ‘How’ to treat. But figuring out the ‘Why’ is going to require detective work on your part.
Chronic ear infections are caused by two things:
• structural abnormalities (i.e. babies with Down Syndrome or other genetic disorders have small ear structures that may be inverted and poorly move fluid out)
• environmental triggers that create inflammation resulting in increased fluid
Common environmental triggers include foods, pet dander, secondhand smoke exposure, and any other things that cause an increase in your individual body’s inflammatory response. An Audiologist and/or ENT would be the professional to diagnose structural abnormalities as a potential cause of recurrent ear infections.

 

“But my Pediatrician is strongly urging me to go with the antibiotics, what should I do?”

I can’t tell you what is best for your child, but this article can help you identify resources to give you confidence in your decision-making. Because it is ultimately your decision.
Does your child meet the *now stricter* guidelines set forth by the American Academy of Pediatrics to properly diagnose otitis media and avoid antibiotic overuse?
“The [2013 revised] guideline provides a specific, stringent definition of AOM [Acute Otitis Media]. It addresses pain management, initial observation versus antibiotic treatment, appropriate choices of antibiotic agents, and preventive measures.”
Additionally, “The American Academy of Otolaryngology-Head and Neck Surgery guidelines recommend topical medications as the first line of treatment for ear pain in the absence of systemic infection or serious underlying disease.”
Are you aware of the risks versus benefits of choosing antibiotics. I will repeat the CDC’s position statement:

“Ear infections will often get better on their own without antibiotic treatment.”
“Taking antibiotics when they are not needed can be harmful, and may lead to unwanted side effects like diarrhea, rashes, nausea, and stomach pain. More severe side effects may rarely occur; these include life-threatening allergic reactions, kidney toxicity, and severe skin reactions.”
“Each time you or your child takes an antibiotic, the bacteria that normally live in your body (on the skin, in the intestine, in the mouth and nose, etc.) are more likely to become resistant to antibiotics.”

Have you exhausted this hierarchy of treatment options?
Does your child show signs of a serious infection or illness that the ear infection is a part of?
The next step is Trust Your Doctor. You have followed the current best practice guidelines for ear infection treatment. Feel confident that you have done everything in your power to use antibiotics as a last resort. Some of you may get to the end of the list and need antibiotics. That’s what they were created for. Let them do their job, and feel confident and optimistic that you can replenish your child’s gut with good probiotic bacteria during and after antibiotics use.

Happy Healing!

Curing Recurrent Ear Infections

“I keep treating my child, but their ear infections continue to reoccur.”

The number one question that I believe gets missed too frequently and is critical to stopping chronic ear infections is: Why?
Your provider does a great job of identifying the ‘What’ –type and severity of ear illness. This article provides resources to tackle ‘How’ to treat, but figuring out the ‘Why’ is going to require detective work on your part.
Chronic ear infections are caused by two things:
•structural abnormalities (i.e. babies with Down Syndrome or other genetic disorders have small ear structures that may be inverted and poorly move fluid out)
•environmental triggers that create inflammation resulting in increased fluid
I am going to discuss environmental triggers. An Audiologist and/or ENT would be the professional to diagnose structural abnormalities as a potential cause of recurrent ear infections.
But how can a food allergy cause an ear infection?
Inflammation.
Eating an offending food will create inflammation in the body. One way inflammation is expressed is an increase of fluid and congestion. This can look like recurrent ear infections, puffy eyes, frequent runny nose, allergic shiners under eyes, excess phlegm, etc. snot bubble

“The middle and inner ear are immunologically responsive and this includes responsiveness to food hypersensitivities. Both chronic otitis media with effusion and Meniere’s disease can improve with treatment of food allergies.” ¹ Other common signs of inflammation include eczema, rashes, and asthma. Symptoms sounding familiar?
In a study that looked at the association between recurrent otitis media with effusion and its association to food allergies, “the most common food found to be associated was milk, egg, beans, citrus, and tomato.”²  They removed the food(s) for a few weeks; symptoms resolved. They added the suspected offending foods back in; symptoms returned. This practice is commonly referred to as an Elimination Diet.
So Milk and Eggs are top causes of recurrent ear infections in this study. They are also on the Top 8 Food Allergens list for the world.

topeight  Allergy to milk is THE most common food allergen in the entire world! This is not rare. So, why aren’t parents being advised to eliminate milk for 30 days as a Least Invasive, evidence-based approach to chronic otitis media?

This is how I observe it usually play out…
Ear infections begin around age 1. Round(s) of antibiotics resolves. Next month, new ear infection occurs. Repeat same antibiotics treatment. Following month, same thing again. Professional assures you that if it happens again your child is a candidate for PE Tubes (Do they expect us to start cheering?). Next month, guess what? Yep, ear infection again. PE Tube surgery is scheduled and completed under general anesthesia. You are relieved that this is over… Unless you have one of the thousands of children that go on to have continued drainage issues sometimes resulting in the surgically-placed tube falling out. No problem. They will surgically put the tube right back in under general anesthesia. Repeat the cycle of most invasive, symptom-focused treatment…
This story is far too common. As an early interventionist and a Hearing Specialist I can tell you that this same story is told to me monthly. Every time I ask the parent, “What did the professional say is CAUSING the ear infections?” ***crickets***
“They never talked about a cause…”

So I begin asking basic, non-medical questions.

Me: You said ear infections began monthly around age 1. What else changed around age 1?
Parent: I can’t think of anything. She wasn’t in daycare yet, no illnesses.
Me: What did she eat or drink around that time?
Parent: We switched her over from Breastmilk/formula to cow’s milk after her 12 month checkup. **ding ding ding**
Me: Does anyone in the family have food reactions?
Parent: Well I am lactose intolerant, but she hasn’t showed any negative reactions to dairy thankfully.

And this is the problem. Intelligent, well-intentioned, loving parents have ZERO clue that the #1 Allergen in the whole wide world can CAUSE ear infections. And they are led on a journey of pharmaceutical and surgical interventions, many times without any discussion of there being a  cheap, easy, and less invasive solution for the vast majority. And all the literature that clearly demonstrates the association is never discussed even with high risk families such as parents with a history of food intolerances.

Here is what I wish would occur…
12 month check up:
Pediatrician: Many kids start cow’s milk at age 1. Do you or anyone in your immediate family have a history of food allergies/intolerances, eczema, allergies, or asthma?
Parent: Yes, I am lactose intolerant, have asthma and allergies. My other child has eczema and allergies.
Ped: Well, dairy is the #1 Allergen and with your family history you may want to either wait to introduce dairy or observe for the following signs that a reaction is occurring…

Ear Infection Appointment:pediatrician-2
Pediatrician: Here is a list of Ear Infection treatment options. If there are no signs of other infections in the body, let’s pursue a Least Invasive to Most Invasive approach. This means we will save antibiotics as a last resort.

 

Recurrent Ear Infection Appointment:
Pediatrician: What new foods or environmental triggers has your child been exposed to?
Let’s try 6 weeks of an Elimination Diet of the Top Allergens to see if food is a factor. Let’s also review the treatment options so we can pursue a Least Invasive to Most Invasive treatment path. Read my other article, Treatment Options for Ear Infections: A Least Invasive to Most Invasive Approach.

I used examples citing cow’s milk as the culprit because it is the most common. However, any food can cause an inflammatory response. We are all individuals with individual responses. There are a variety of ways to identify food culprits. To read about Why and How to do an Elimination Diet to identify food triggers read Dr. Axe’s article.
Remember to assess your child’s environment for other environmental triggers as well. The Top 6 Environmental Allergies list.
Check products that you put on your child by using an app like Skin Deep to see the Environmental Working Group’s toxicity rating on skin products, foods, cleaning products, and more.

The most important focus of this article is empowering parents to ask Why questions and Cause questions. These are the questions that will Heal Our Little Ones.

  1. The role of food allergy in otolaryngology disorders. Ramakrishnan, JB. Curr Opin Otolaryngol Head Neck Surg. 2010 Jun;18(3):195-9. http://www.ncbi.nlm.nih.gov/pubmed/20168232?log$=activity
  2.  Recurrent otitis media with effusion and food allergy in pediatric patients.  Arroyave CM. Rev Alerg Mex. 2001 Sep-Oct;48(5):141-4. http://www.ncbi.nlm.nih.gov/pubmed/11759256