Written by Patrick B. Massey, M.D., Ph.D. Gentle osteopathic manipulations are a safe alternative for the early treatment of otitis media.
The past 15 years has seen an increase in ear infections in children.
Otitis media is the most frequent reason for young children to visit their physicians. Since almost all children experience one or more ear infections before age 6, it is accepted as a part of growing up. Studies from osteopathic medicine may change that.
In the U.S., almost all physicians use antibiotics to treat otitis media. However, in Europe, antibiotics are used 25 to 30 percent of the time.
Since, almost 80 percent of ear infections will spontaneously resolve, it has been estimated that 15 children must be treated in order to see one case of reduced pain after two days. There seems room for debate on the benefit of antibiotics.
Side effects of antibiotic therapy include stomach upset and skin rashes; rare anaphylactic, hematological, cardiovascular, central nervous system, endocrine, renal, hepatic, and respiratory problems can occur. Microbial resistance will develop with continuous use.
Some children with chronic ear infections are helped by a surgical procedure called myringotomy (making a hole in the ear drum) with or without the insertion of tubes. Like all surgery, there are risks. The most common complication is acute otitis media, which occurs in 21 percent of cases.
Other risks include tympanosclerosis (formation of hard, dense tissue around the bones of the middle ear); localized foreign body reaction; scar formation; hearing loss; persistent eardrum perforation, and dislocation of tube into the middle ear cavity. There is also a risk from the anesthetic (one death per 5,000 to 10,000 procedures).
Can we do better for our children? The answer is yes.
A recent blinded, placebo-controlled study reported in the Archives of Pediatrics and Adolescent Medicine examined the effect of osteopathic manipulation on the rate of recurrence and surgical referral. The results were impressive.
The children who received osteopathic manipulation had almost a 50 percent reduction in recurrence and a 90 percent reduction in referrals for surgery. Children get ear infections because their heads are smaller than adults’. Drainage of fluid from the ear and lymphatic system is more easily compromised, leading to otitis media. Stimulation of the tissues by osteopathic manipulation probably enhances the drainage of fluid and minimizes fluid retention and infection.
The osteopathic therapies used were not the ballistic cracking of the neck and spine we commonly associate with manipulation. They consisted of stretching and gentle/slow twisting movements in the head, neck and torso.
Practitioners of gentle, manipulative therapies have claimed for years that massage and manipulation are beneficial in the treatment and prevention of otitis media. However, there were limited medical studies supporting these claims. The interest in nontraditional medicine has resulted in an increase in good quality medical studies, with very interesting results.
The osteopathic manipulations used in this study were like gentle massage therapies, and very safe. Given the lack of complications and the potential benefits, I recommend this as part of the early treatment of otitis media.
However, I highly discourage the use of hard manipulation, or “cracking” of the neck, especially in young children.
