It offers a number of folk remedies for ear infections of varying advisability, misrepresents the only source cited, sows fear, uncertainty and doubt against antibiotics and includes nonsensical concepts drawn from pre-scientific superstitious medical systems. The author recommends allowing the eardrum to rupture rather than taking antibiotics.
Otitis mediaW is a very common childhood ailment. 80% of cases resolve spontaneously. Complications can include perforated eardrum, acute pain and occasionally permanent hearing loss. The advice in this article is a little worse than useless.
Treating ear infections naturally
If your child is prone to this condition, these home remedies are Annemarie’s favourites
Inflammation of the middle ear (on the other side of the eardrum), also known as ‘otitis media’, is a veritable epidemic among our children. Although the condition is commonly treated with antibiotics, despite the use of drugs it will recur time and time again. A recent review of 11 trials of antibiotics compared with a placebo or watchful waiting in children with acute otitis media found that, although the drugs were better at dealing with symptoms, the otherwise small difference overall did not outweigh the safety issues associated with antibiotic use.1
Reference 1: J Antimicrob Chemother, 2009; 64: 16– Antibiotics versus placebo or watchful waiting for acute otitis media: a meta-analysis of randomized controlled trials. Vouloumanou EK, Karageorgopoulos DE, Kazantzi MS, Kapaskelis AM, Falagas ME.
|What WDDTY told you||What the source actually said|
|A recent review of 11 trials of antibiotics compared with a placebo or watchful waiting in children with acute otitis media found that, although the drugs were better at dealing with symptoms, the otherwise small difference overall did not outweigh the safety issues associated with antibiotic use.||Antibiotic treatment is associated with a more favourable clinical course in children with AOM, compared with placebo, and also compared with watchful waiting. However, safety issues and the rather small treatment effect difference render the consideration of additional factors necessary in relevant clinical decision making.|
As you see, the claim misrepresents the source. In fact the results show a very different picture from how it’s represented by WDDTY:
We identified seven trials comparing antibiotic treatment with placebo (all double-blinded) and four trials comparing antibiotic treatment with watchful waiting (two investigator-blinded and two open-label) trials, all of which involved children (6 months to 12 years). Clinical success was more likely with antibiotics than comparator treatment in: placebo-controlled trials [seven RCTs, 1405 patients, risk ratio (RR) = 1.11, 95% confidence interval (CI) = 1.05-1.18]; watchful waiting trials (four RCTs, 915 patients, RR = 1.18, 95% CI = 1.07-1.32); and all trials combined (11 RCTs, 2320 patients, RR = 1.13, 95% CI = 1.08-1.19). Similarly, persistence of symptoms 2-4 days after treatment initiation was less likely with antibiotics in: placebo-controlled trials (four RCTs, 1014 patients, RR = 0.75, 95% CI = 0.64-0.88) and all trials combined (five RCTs, 1299 patients, RR = 0.68, 95% CI = 0.54-0.85). Diarrhoea was more likely with antibiotics (seven RCTs, 1807 patients, RR = 1.50, 95% CI = 1.16-1.95). No differences between the compared treatments were found regarding other effectiveness and safety outcomes.
In other words, antibiotics work but you should wait and see if it resolves on its own first.
The current standard of care is to monitor for up to three days for signs of resolution and if the infection remains or is getting worse, the first-line treatment is amoxicillinW, a well tolerated moderate-spectrum antibiotic. Standard of care already takes account of the likelihood of spontaneous resolution and reserves antibiotic treatment for acute cases that are not resolving. In these cases, antibiotics are the most appropriate treatment.Recurrence does not mitigate against use of antibiotics where indicated.
Given the substantial data available on the damaging adverse effects seen with antibiotics, it could be said that, in the case of ear infections, antibiotics may do little good and much harm. In fact, the Center for Healthcare Policy and Research at the University of California at Davis recommends ‘watchful waiting’ instead of antibiotics as the first step in the treatment of non-acute middle-ear infection.
The “damaging adverse effects” are rare; they are due to a well-known allergic reaction. Other side effects are typically transient and less distressing than the pain caused by the condition.This is a great reason for delaying antibiotic treatment in case the condition resolves spontaneously, and a terrible reason for substituting ineffective alternatives.However, there is some suggestion that a few individuals prescribe long-term antibiotics for recurrent cases. The prevalence of this is unclear. It does not appear on the face of it to be related to the usual long-term antibiotic crank targets such as “chronic Lyme disease”. There is no sound evidence long-term antibiotics are effective for this indication, and numerous good reason not to do it. Chronic suppurative otitis media should be referred to an ENT specialist.
The contention is also out of line with the only source cited directly.
Ear problems may be dry, congestive and painful or they may be moist, when the eardrum may break open and allow the inflammation to drain naturally. Once the process is over, the eardrum will heal on its own.
A perforated eardrum is painful (sometimes acutely so) and while it does usually heal over a couple of months (as opposed to the week of a course of antibiotics), it can leave scarring. Repeated perforation can, and does, permanently affect hearing. In some cases the eardrum may need to be surgically repaired. So, this is not a life threatening incident but neither is it trivial.
When natural drainage doesn’t happen, the medical treatment technique calls for placing tubes through the eardrum to allow pus to drain. This procedure (called ‘myringotomy’) is associated with permanent eardrum perforation in about 1 per cent of the ears treated, so further surgery is then required to repair the hole.
Also, as much as 70 per cent of the ears studied suffered recurring infections throughout the ear-tube treatment.
This is rare and is not related to antibiotic use. Arguing for allowing the infection to progress to rupture of the eardrum in order to avoid a complication that should be largely avoidable, sounds like very poor advice. Surely the author cannot be suggesting this? It would be irrational.TympanostomyW reduces recurrence in the six months following the procedure, and has little effect on long-term hearing, so may be recommended for those who have numerous infections (more than 3 in a 6-month period, or more than 4 with effusion in a year).
From my observations, infections may be to do with regular use of cow’s milk products in the diet of both the mother while expecting and the child itself once born. If the mother eats a lot of milk products and cheese while pregnant, her child may discharge the mucus caused by excess dairy through the ears after birth. Let’s remember that milk is a high-nutrient food intended by nature for the baby, not the mother, and that the nutrients in cow’s milk are excessive for humans.
And from the observations of actual doctors, it is usually the result of an upper respiratory tract infection causing inflammation and blockage of the Eustachian tubes.There is some association of chronic otitis media with effusion (“glue ear”), and allergy. Evidence suggests that this allergy may be present in up to a third of children with glue ear. There is weak evidence that this condition may be mitigated by a dairy-free diet, but no consensus that this is generally true for otitis media, even in chronic cases. It is best to seek advice from a specialist since dairy-free diets are not without complications and their routine use on the grounds that some children might benefit is clearly not indicated.
This relationship was made clear to me by painful personal experience. When I was pregnant with my youngest daughter, I craved lots of melted cheese and ate it daily on English muffins and pizza. After she was born, I stopped, so she and I both had what I consider a ‘dairy discharge’ when she was about five months old. She developed a dramatic ear infection with plenty of mucus. I wasn’t seriously worried because I believed I understood the cause, which had been my diet.
These terms are made up. This is not a finding with any basis in the literature. As usual in the alternative world, a single personal experience is all the evidence cited.
I treated her with herb teas, washing out her ears with tea and honey (a natural antiseptic), and putting a small cold compress behind her ears (to keep the infection from spreading) and a warm compress over her kidneys at the back of her waist. The latter technique is based on the Chinese concept that the ears and kidneys are linked, so that any problem with the ears also indicates a problem with the kidneys. When the kidneys are attempting to clear away the byproducts of dairy metabolism, they may sometimes become overstressed, and the ears may reflect that stress in the form of inflammation. Placing a hot compress on the kidneys stimulates them to increase their detoxifying activities.
The issue here is that the weak natural antibiotic properties of honey, cannot cross the tympanic membrane. The Chinese idea that the ears and kidneys are linked in this way is abject nonsense so not a useful principle on which to base treatment or diagnosis. The documented link between some cases of chronic otitis media and dairy allergy has no provable connection tot he kidneys.The kidneys process creatine and nitrogen generated by the breakdown of all proteins. As always, a balanced diet is the best recommendation.
As I was breastfeeding my daughter at the time, I made sure to eat a low-fat diet and plenty of vegetable soups. Every time I put the compresses on her, she nursed well, slept for hours and didn’t seem to be in pain, so I felt that healing was happening.
A warm compress is well documented as temporarily reducing pain in otitis media. Expectation effects, placebo effects and other factors are also in play. I can’t find any credible evidence that the magic nature of the constituents of the compress has any effect beyond that experienced with a warm flannel.
The process took three weeks, but she had no other ear infections after that for years, except for a mild earache about once a year that was easily handled by a hot compress on the ear. When she was eight she had another ear infection with drainage. At first I treated her with juices, the ‘expansive’ vitamin C approach (yin foods in Chinese medicine), but it didn’t help, so I switched to the salty ‘contractive’ (yang) remedies and gave her miso soup (see page 67), as well as a hot compress on the kidneys: she rallied within a day.
Three weeks is about as long as you’d expect untreated otitis media to last. Recurrence is the luck of the draw. Some children get recurrent infections, others don’t. It’s quite likely down to the physiology of the individual child, especially the Eustachian tubes.Yin and yang are nonsense.
For children prone to ear infections, I find the best policy is to remove all milk products, sugar and, in some cases, wheat products from their diet – WDDTY
These are nutritionists’ favourite bogeymen. There is weak evidence of association between recurrent otitis media and dairy allergy (up to 1/3 of chronic cases), no good evidence of a link with gluten intolerance. Exclusion diets should be pursued only under supervision of qualified practitioners (doctors or dieticians).
For children prone to ear infections, I find the best policy is to remove all milk products, sugar and, in some cases, wheat products from their diet. The problem will then usually abate within two or three months after the body goes through one last clean out, which is best treated naturally—without antibiotics.
Dairy intolerance is reasonably common, and there’s some crossover with recurrent ear infections, and even some evidence that this is causal, but to advocate large-scale use of dairy-free diets, with all the additional complications that brings, is not a rational approach. Dairy (and gluten) are common bogeymen in alternative nutrition circles.The philosophical rejection of antibiotics in favour of bogus concepts such as yin and yang, is not a rational approach to treating childhood ailments. Basically what the author advocates is rolling back the clock a few thousand years. All well and good, but life expectancy at birth back then was under 40 years.
Chronic otitis media does decline as the child ages. Attributing this to random changes in diet, of course, risks the post-hoc fallacy.
Gluten intolerance may be indicative of coeliac disease, there are simple and objective tests which rule this in or out. The majority of what you read about gluten on alternative health websites is nonsense.
Alexa Fleckenstein, MD, a Boston-based specialist in European natural medicine, strongly suggests drinking plenty of warm water and rinsing out the nostrils with salt water to help with the drainage. Sezelle Gereau-Haddon, a paediatric otolaryngologist at Columbia Presbyterian Medical Center in New York, recommends homeopathy for treating ear infections. Here are some other home remedies you can apply, which have worked well for me.
Drinking water is good. Washing the nasal cavities out with salt water might open the Eustachian tubes, but is rather unpleasant. Homeopathy is compete bollocks.
For dry painful earaches, try:
- Cold socks. Take a pair of cotton socks, wet with cold tap water, wring out and put on the feet, then add a pair of dry socks on top of the wet ones. Do this before bedtime and sleep with the socks on.
- A hot compress. To reduce ear pain, fold a washcloth in four, wet under hot tap water, wring out and place on the ear as hot as you (or the patient) can stand; put on a woolen cap to keep it in place. Use this only for dry earaches; for wet, draining earaches, use the hot compress on the kidneys.
- Keeping the ears warm and covered.
- Warm olive oil drops. Warm a bit of olive oil until a test drop on the wrist feels pleasant, and place two or three drops in each ear, followed by a cottonball to keep the oil from running out too soon.
- Food and drink. As with all inflammatory conditions, it’s best to keep away from sweets, milk, cheese, yoghurt and ice cream, and instead have plenty of warm liquids like teas and soups, soft grain dishes like oatmeal, polenta or soft barley, and cooked vegetables like carrots, squash or zucchini (courgettes). Go easy on protein foods until the condition subsides.
- Cold socks: Nonsense.
- Warm compress on ears: Relieves pain temporarily. Warm should be sufficient, though: some risk of scalding with the suggested approach.
- Warm compress on kidneys: Nonsense
- Keeping the ears warm and covered: good when outside, reduces pain. No obvious evidence of clinical effect though.
- Warm olive oil: May work for symptomatic relief as per warm compress.
- Foods: A mish-mash of superstition and normal advice. Overall, enough nonsense to make this ignorable.
There’s nothing wrong with eating a good healthy diet, this of course is not remotely alternative.
If the home remedies don’t help, if the earache lasts more than three days or if there is fever with listlessness, neck pain or any other worrisome symptoms, visit a health professional.
Which is how the article should have begun, and if the health professional recommends antibiotics, then use them. They work.
Because it’s bad advice that causes unnecessary suffering to your child.