Complementary and
Alternative Treatments for
Paediatric Otitis Media
LINDA MILLER CALANDRA MSN, CRNP, CORLN
TERRI GIORDANO DNP, CORLN
DIVISION OF OTOLARYNGOLOGY
CHILDREN’S HOSPITAL OF PHILADELPHIA
No Disclosures
ACUTE OTITIS MEDIA (AOM)

Usually preceded by URI

Pulling on ear

Fever

Cervical lymphadenopathy

Rhinorrhea

Decreased appetite

Tympanic membrane rupture
SOM

Often occurs after AOM

Can remain for 3 months or more

Impacts quality of life

Decreased hearing
FAMILY / PATIENT GOALS

Relieve pain

Back to school / work as quickly as possible

Minimize cost as much as possible
COMPLEMENTARY & ALTERNATIVE
MEDICINE (CAM)

Used alone or in conjunction with conventional medicine

Does not originate from evidence based scientific methods

< 5% of therapies tested in children
HOMEOPATHY

Developed in Germany end of 18th century

Supporter of homeopathy believe “like cures like”

Disease can be cured by using substances that produce same symptoms in healthy people

Supporters believe in low dose substances

https://nccih.nih.gov/health/homeopathy

National Health and Medical Research Council concluded there is no
good quality evidence to support claim that homeopathy is effective in
treating health conditions compared to placebo

https://www.nhmrc.gov.au/media/releases/2015/nhmrc-releasesstatement-and-advice-homeopathy
HOMEOPATHY



Belladonna

Ear pain and fever

Extract from poisonous plant of the nightshade family, used with caution
Chamomilla

Pain and irritability

Flowering top of German chamomile plant
Hepar sulphuris

Ear pain

Inner layer of oyster shells combined with flowers of sulfur
HOMEOPATHY

Hylands earache drops

ClearPop
 Subjects
4-12 years of age
 Contains
 Reported
no analgesics or antibiotics
decreased pain after 20 minutes
PHYTOTHERAPY vs. HERBALISM

Phytotherapy first described in 1914 as the medical use of plants

Herbalism dates to Paleolithic Age – 60,000 years ago

Similar but different
HERBALISM

WHO estimates herbals widely used around the world

Preparations come in many forms, but most common is liquid

Tinctures are extracts of herbs and are stronger than teas
HERBAL EAR REMEDIES

Garlic oil

Tea tree oil

Elderberry syrup
EAR CANDLING

Ear coning or thermal auricular therapy

Traditional healing practices of China, Greece, Egypt,
Tibet and North America

Place a hollow candle in the ear canal and lighting the
other end

Claims to purify the blood and heal children with OM
through cleaning the middle ear cleft by creating a
negative pressure
XYLITOL

5-carbon sugar alcohol naturally found in fruits and vegetables

Antibacterial properties suppressing growth of Streptococcus
mutans a major cause of dental caries

First described by Finnish researchers in 1996

Randomized controlled trial (RCT) by Uhari et al found that children who
chewed gum containing 1.7g of xylitol 5x/day had significantly fewer
episodes of AOM and less antibiotic use than controls

RCT by Vernacchio et al (2014) found a dose of 5g 3x/day for 12 weeks did
not reduce time to clinically diagnosed AOM, incidence of AOM or overall
antibiotic use
COCHRANE REVIEW

Xylitol for AOM prevention in children up to 12 years of age

5 clinical trials with 3,405 children

4 - Finland

1 - United States

Xylitol chewing gum, lozenges or syrup can reduce
occurrence of AOM in healthy children with no acute
respiratory infection from 30% to 22%

Not effective in reducing AOM among healthy children
during a respiratory infection or among otitis prone children
PROBIOTICS

Live microorganisms that offer health benefits

Oral or topical

Conflicting evidence

Hatakka et al (2001) randomized to receive milk with or without Lactobacillus
rhamnosus 3x/day, 5 days/week for 7 months

Hatakka et et al (2007) randomized to receive probiotic capsule or placebo
daily for 24 weeks

Marchisio et al (2015) randomized to intranasal S. salivarius 24SMB or placebo
twice daily for 5 days each month for 3 consecutive months
VITAMIN D

Immunomodulatory role by acting on cells of the innate immune system
to inhibit proinflammatory cytokine production and induce antimicrobial
peptide synthesis

Marchisio et al 2013 evaluate whether a deficit in Vitamin D is associated
with an increased risk of recurrent AOM

Children 1-5 years of age with history of recurrent AOM

Randomized to oral Vitamin D 1000 IU daily or placebo for 4 months

Found statistically significant reduction in incidence of new episodes of
uncomplicated AOM only in children whose serum 25(OH)D concentrations at
the end of the study were < 30mg/mL
CHIROPRACTICS

Believe disorders of the musculoskeletal system affect the general
health via the nervous system

Spinal manipulation therapy (SMT) mediates changes in
sympathetic and parasympathetic neural activity

Cervical SMT may reduce tension within hypertonic muscles
increasing both lymphatic drainage and Eustachian tube opening

Some concern over safety in paediatric population
OSTEOPATHY

Noninvasive manual medicine focuses on total body health by
treating and strengthening the musculoskeletal framework

Most common osteopathic manipulative treatment for OM are
Galbreath and Muncie/Modified Muncie

Galbreath


Movement of mandible aimed to indirectly generate a pumping action on
the Eustachian tube and allow fluid to drain
Muncie

Placement of fingertip on Rosenmuller’s fossa to open the Eustachian tube
ACUPUNCTURE

Body’s energy force, chi,
travel channels are blocked
and small needles are
inserted to correct flow of
energy
PREVENTION

Pneumococcal 13-valent conjugate vaccine

Breastfeeding

Influenza vaccine

Limit smoke exposure
REFERENCES

https://nccih.nih.gov/

https://www.nhmrc.gov.au/media/releases/2015/nhmrc-releasesstatement-and-advice-homeopathy

https://www.britannica.com/topic/phytotherapy#ref1184714

Vernacchio L, Corwin MJ, Vezina RM, Pelton SL, Feldman HA, CoyneBeasley, Mitchell AA. Xylitol syrup for the prevention of acute otitis media.
2014, Pediatrics 133(2) Feb.

Marom T, Marchisio P, Ovnat Tamir S, Torretta S, Gavriel H, Esposito S.
Complementary and alternative medicine treatment options for otitis
media: a systematic review. 2016, Medicine 95(6) Feb.
REFERENCES

Levi JR, Brody RM, McKe-Cole K, Pribitkin E, O’Reilly R. Complementary
and alternative medicine for pediatric otitis media. Int J Pediatr
Otorhinolaryngol 2013;77Z:926-931.

Taylor JA, Jacobs J. Homeopathic ear drops as an adjunct in reducing
antibiotic usage in children with acute otitis media. Glob Pediatr Health
Jan-Dec 2014:1-7.

Wahl RA, Aldous MB, Worden KA, Grant KL. Echinacea purpurea and
osteopathic manipulation treatment in children with recurrent otitis
media: a randomized controlled trial. BMC Complementary and
Alternative Medicine 2008;8(56).

Ciuman RR. Phytotherapeutic and naturopathic adjuvant therapies in
Otorhinorlaryngology. Eur Arch Otorhinolaryngol 2012 Feb;269(2):389-97.
REFERENCES

Azarpazhooh A, Lawrence HP, Shah PS. Xylitol for preventing acute
otitis media in children up to 12 years of age (review). Cochrane
Database of Systematic Reviews 2016, Issue 8.

Marchisio P, Consonni D, Baggi E, Zampiero A, Bianchini S,
Terranova L, Tirelli S, Esposito S, Principi N. Vitamin D
supplementation reduces the risk of acute otitis media in otitis
prone children. Pediatr Infect Dis J. 2013 Oct;32(10):1055-60.
Buerger Center for Advanced Pediatric Care