Chiropractic Management Of Otitis media-middle ear infection
What Is Otitis Media (OM)?
Otitis media is one of the most common prevalent conditions of childhood. The inflammation and infection of the middle ear normally occur after upper respiratory tract infection.
AOM can cause ear pain, trouble hearing and sleeping. Young children always tug or pull at their affected ears. Chronic OM can eventually result in hearing loss. There are different types of OM that list below:
Types of OM:
- Acute Otitis media (AOM)
- OM with effusion (OME)
- Chronic suppurative OM with or without cholesteatoma
Based on the types of OM, several medical interventions can be used, including antibiotic use, tympanostomy tube insertion and chiropractic treatment.
Antibiotic use for OM
In clinical practice guidelines for AOM, the majority of AOM cases in children will spontaneously resolve and antibiotics are not recommended. However, if symptoms are not improved at 48 hours, first-line antibiotics – amoxycillin is used for AOM. Antibiotic prescription for AOM in Australia for 1 to 4 years old between 2011 and 2015 accounts for 80%.
Although some data show that antibiotics may be useful for children who are younger than 2 years old with AOM, adverse effects of antibiotic use including diarrhoea, vomiting, oral thrush or skin rash should take into account. Also, the use of antibiotics leads to antibiotic resistant bacteria.
Tympanostomy tube (also known as Grommet)
A tympanostomy tube (TT) is used for a patient with a history of chronic otitis media in order to reduce the frequency of middle ear infections and improve hearing. TT is placed in the tympanic membrane for fluid drainage in the middle ear. Different shapes, materials and sizes of TT are selected according to particular pathology.
Surgical treatment is provided as an option if patients have a history of at least 3 episodes of AOM in the last 6 months or 4 episodes in the last year. For children who are over 4 years old, concomitant adenoidectomy is recommended with TT insertion.
TT placement may not benefit all children with chronic otitis media. A study has found that the watchful waiting strategy is an effective treatment for those who have recurrent AOM and TTinsertion is not necessary. Furthermore, more research has revealed patients with TT insertion had a higher risk of future surgery for chronic ear diseases compared to those without grommet insertion.
Chiropractic management of OM
Chiropractic care is safe, effective and has no adverse effect on OM compared to the use of antibiotics and TT placement. Paediatric chiropractors use pneumatic otoscopy, which is an instrument to examine the mobility of the tympanic membrane, to confirm the diagnosis and stage of OM. Bulging and inflamed tympanic membrane can be normally seen and reduced mobility of the tympanic membrane with pneumatic otoscopy
Physical examination such as checking liver size is vital to distinguish the type of infection (bacterial infection or viral infection) and monitor the progress of OM. In general, OM caused by viral infection leads to an enlarged liver.
Tensor veli palatini is a muscle to assist the eustachian tube opening when swallowing or yawning to equalize the pressure between the tympanic cavity and the atmospheric pressure. A negative pressure is developed and the fluid is built up in the middle ear when the dysfunction of the eustachian tube persists due to OM.
Spinal manipulation can correct cervical subluxation which repairs the function of tensor veli palatini muscle to encourage the opening of the eustachian tube. It can improve the drainage of fluid retention and the equalization of air pressure in the tympanic cavity.
Paediatric chiropractors will also recommend some supplements to boost the immune system function of children with OM. Patients will have a lower risk of recurrent OM and much faster recovery.
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