John K Maltby II, D.C.
No one likes ear infections.
Otitis Media is the technical term for an ear infection. There is Acute Otitis Media and Chronic Otitis Media. The difference between acute and chronic is the length of time between reoccurring infections, it can also refer how long the specific infection lasts. Typically, under three weeks is considered acute, whereas over three weeks is considered chronic. Regardless of an ear infection being acute or chronic it still sucks.
Otitis Media is an inflammation of the middle ear, usually due to an infection. The eustachian tube runs from the front wall of the middle ear to the side wall of the nasopharynx. (Picture Below)
Its main purpose is to keep air pressure equal on both side of the eardrum, drain secretions from the middle ear, and help protect the middle ear from infections by being able to freely drain the middle ear. This tube is closed most of the time. It opens when you yawn, swallow, or with changes in air pressure to allow air to flow back and forth from the ear canal to the middle ear. This tube is more horizontal in children than in adults. This is why it is so important to make sure that kids eustachian tubes are functioning properly, and why they seem to get ear infections more than adults.
In order for this tube to function properly it needs to be free of any debris and there should be nothing keeping it closed. The most common treatment for ear infections are antibiotics. There are some homeopathic ear drops that are used and I have even seen kids with cotton or wax shoved in their ears. Often the ear infection is reoccurring and in the same ear. The person is told to not swim (this has never made sense to me, wouldn’t both ears be infected if the culprit was the pool?), or at least to keep it dry. Usually, the round of antibiotics works at clearing up the infection and the ear is better. The only issue is that the rate of reoccurrence after a round of antibiotics is extremely high.
In fact, one study involving 3,660 children in nine countries concluded, “Antibiotic treatment did no improve the rate of recovery of patients in this study,” and “patients who did not take antibiotics had a higher rate of recovery than those who did..”(1)
In one review of literature from 1939 to 1991 they found “poor evidence to support the routine use of antibiotic therapy.” (2)
After antibiotic therapy is unsuccessful the next step is to put holes (tympanostomy tubes) in the eardrums (tympanic membrane). These have a risk of causing total hearing loss (up to 25% of the time ). These tubes are not usually done until many rounds of antibiotics are tired first. There are risk involved in over use of antibiotics as well, one study found that children given more than 10 round of antibiotics during childhood have an 80% higher risk of developing non-Hodgkins Lymphoma later in life (4). There has been more research into the over prescription of antibiotics for a long time now, one study followed 21,825 patients treated for infection (pneumonia, UTI) and they found that 49.1% were over prescribed and had overused antibiotics after they were discharged from the hospital (5). They have been studying the phenomenon of antibiotic resistance since 1945 and in the last ten years alone (2012-2022) there has been over 100,000 peer-reviewed papers on this subject.
The obvious question is what should be done when a child that gets an ear infection? It should probably obvious that I would say to take them to a Chiropractor to get adjusted. But what evidence is there that a visit to the Chiropractor will do any good or better? Let’s look at what there is.
One study looked at 332 children ages 27 days to 5 years who had ear infections. All were adjusted by Chiropractors, the average adjustments needed were around 5 and it took 6 – 8 days for the tympanic membrane to normalize. (6)
A pilot study involving 401 children ages 27 days to 5 years who had presented with ear infections were also all adjusted by a Chiropractor. The average number of adjustments was 4 and it took an average of 9 days for all to present with normal tympanic membranes. (7)
Another study with 46 children aged 5 years were seen by a Chiropractor who focused on the upper cervical spine. All presented with otitis media and 75% of the cases were clearing up in under 10 days. 43% responded with only one or two adjustments, and all eventually cleared up. (8) This study had also surveyed a double-blind study involving 171 children who were diagnosed with acute otitis media. They were placed in four different treatment groups; antibiotics only; myringotomy (small incision in the tympanic membrane) only; both antibiotics and myringotomy; or neither antibiotics and myringotomy. The data showed no significant differences among the four groups with respect to otoscope findings, fever, relapses, complications, and hearing loos after 1 month.
When a child come in to my office with an ear infection I need to find the reason that the body is unable to fight the infection. I do this by identifying the vertebrae that is slightly out of alignment or not moving correctly. When a vertebra of the upper cervical spine is subluxated one of these ways it is putting pressure on the nerves that control the small muscles of the neck. This causes abnormal tension and pressure on the lymphatic ducts which can result in inadequate drainage through the eustachian tube. This subluxation could be due to many things that kids do everyday in their overly active little lives.
I do detailed and thorough evaluations of the upper cervical spine and the adjustment is very gentle and easy. Most kids enjoy getting adjusted and often are excited when it is there turn. It is better to have kids get adjusted before the infection and fever get too bad. Signs that your child might need an adjustment are: pulling on one or both ears, changing in sleeping patterns, or change in apatite.
1. Froom J, Culpepper L, Grob P, et al: "Diagnosis and antibiotic treatment of acute otitis media: a report from the International Primary Care Network." BMJ (1990) 300(6724):582.
2. Lehnert T: "Acute otitis media in children." Role of antibiotic therapy. Can Fam Physician (1993) 39:2157.
3. Stangerup SE, Tos M: "Etiologic role of suppurative otitis media in chronic secretory otitis." Am J Otol (1985) 6:126.
4. American Journal of Epidemiology 2015
5. Vaughn VM, Gandhi TN, Chopra V, Petty LA, Giesler DL, Malani AN, Bernstein SJ, Hsaiky LM, Pogue JM, Dumkow L, Ratz D, McLaughlin ES, Flanders SA. Antibiotic Overuse After Hospital Discharge: A Multi-hospital Cohort Study. Clin Infect Dis. 2021 Dec 6;73(11):e4499-e4506. doi: 10.1093/cid/ciaa1372. PMID: 32918077; PMCID: PMC7947015.
6. Fallon JM. The Role of the Chiropractic Adjustment in the Care and Treatment of 332 Children with Otitis Media. Journal of Clinical Chiropractic in Pediatrics, 1997; 2(2):167-182
7. Fallon JM. Chiropractic Care of 401 Children with Otitis Media: A Pilot Study. Alternative Therapies, 1998; 4(2): 93.
8. Froehle RM. Ear Infection: A Retrospective Study Examining the Improvement from Chiropractic Care and Analyzing for Influencing Factors. Journal of Manipulat