Otitis media (OM), also known as middle ear infection, cases are constantly on the rise. In the United States, nearly 10 million cases of OM are diagnosed each year, accounting for 35% of all pediatrician visits. Ear infections account for around 3 billion dollars in health care costs and another 3 billion dollars in lost wages when taking time off work to care for little ones who are suffering. With more and more complications related to antibiotic overuse and high failure rate of surgically placed tubes, parents are seeking alternatives.

First, let’s be clear... chiropractic treatment will not cure otitis media. There is much debate about the role of a chiropractor in the treatment of OM, and much of it is attributed to the claim of a cure. So, for clarity’s sake, chiropractic treatment will not cure ear infections.

However – and that is a big however – this is not to say that chiropractic care does not help to relieve the pain or reduce the recurrence of OM, because it can. Before we travel down that road, it is important to first understand the basic anatomy of the ear and the basic pathology of ear infections.

Anatomy

The ear is put into three anatomical categories: the outer ear, the middle ear, and the inner ear. The inner ear consists of the vestibule, the semicircular canals, and the cochlea. These parts are responsible for balance, proprioception, and hearing. The outer ear is comprised of the pinna, or lobe portion, and the external auditory meatus with the ear canal. The tympanic membrane, also know as the ear drum, separates the outer ear from the middle ear. The middle ear is made up of three tiny bones – the malleus, incus, and stapes – and an empty cavity that leads to the Eustachian or auditory tube. This tube connects the middle ear to the nasopharynx, or the upper most part of the back of the throat. Around the Eustachian tube is a muscle, known as the tensor veli palatini (TVP). This muscle helps to regulate pressure in the tube by opening it during swallowing and yawning. The regulation of pressure prevents damage to the tympanic membrane/ear drum. 

In relation to OM and for the purpose of this post, the focus is on the middle ear and the Eustachian tube.

Pathophysiology 

Otitis media is the general term for middle ear infections. Within this broad category, there are several types of ear infections with a range of symptoms, causes, and severity. The two main types of OM are acute otitis media (AOM) and otitis media with effusion (OME). AOM has an abrupt and painful onset and is caused by a bacteria, virus, or combination of both. OME is a non-infectious fluid build up in the middle ear due to Eustachian tube dysfunction.

Recent research has shown that the most common cause of AOM is a combination of bacterial and viral infections. While antibiotics can treat the bacterial component, the viral infection must run its course. More than this, it is not possible to easily, non-invasively tell if an infection is bacterial, viral, or both. Because of this and because of an increase in antibiotic resistant bugs, the American Academy of Pediatrics now recommends a “wait and see” approach for the treatment of OM. Moreover, surgical implantation of tympanostomy tubes (“T-tubes”) that are placed under general anesthesia are being reserved as a last line of defense and are to be used only in severe cases.

Both bacterial and viral infections can create inflammation and effusion, or fluid buildup. Often during the initial OM infection, inflammation causes the tensor veli palatini to become hypertonic and tighten around a tube, trapping fluid and creating a perfect medium for reinfection. While antibiotics or waiting for the infection to clear may kill the bug, they do nothing to relax the muscle or release the fluid that is trapped in the tube. Without resolution of these two factors, reinfection is common.

How can Chiropractic Help?

Dr. Sears, MD states that he “firmly believe[s] that chiropractic adjustments to the skull and neck can improve middle ear drainage and decrease ear infections.”

Image used with permission of patient's mother.

Ear infections are one of the top reasons that children visit a chiropractor. The basis of chiropractic care is to treat neuromusculoskeletal dysfunction. Once evaluated by a family physician, a chiropractor can help to naturally relive painful symptoms of ear infections and can help to reduce recurrence. Gentle mobilization of the neck, outer ear, and jaw (to effect the middle ear) help to stretch and relax the TVP, “reset” nerve pathways to the TVP to keep it from returning to a hypertonic state, drain the Eustachian tube, and ensure optimal structural alignment. Homecare tips and exercises for preventing future infections are also a key part of treatment. Holistic chiropractic care may also include nutritional support for children recently prescribed antibiotics as well as to reduce symptoms.

**Note: some cases of otitis media can be very serious and, when mishandled, can result in serious, long-term sequela. It is critical that a chiropractor know and understand his or her limits when co-treating conditions, such as ear infections. Our North Shore chiropractors are well trained and knowledgeable about when and how to refer. 

For any questions, please contact our North Vancouver chiropractor, Dr. Sarah Visconti, for any questions or concerns.