Otitis Media Manual Therapy by Osteopaths

Otitis Media

Otitis media is one of the most common infections in children. It has been estimated that, in the United States, there are more than 20 million physician visits annually for otitis media in the pediatric population.1 By 3 months of age, approximately 10% of infants will have had an episode of acute otitis media (AOM). By 3 years of age, 50% of children will have had more than three episodes of AOM (Degenhardt and Kuchera, 2006).

Between 6 and 8 years of age, most children “outgrow” persistent otitis media with effusion (OME) or recurrent episodes of AOM (Degenhardt and Kuchera, 2006).

The most common complication of AOM is persistent middle ear effusion (MEE), which is associated with short-term hearing loss, impaired language acquisition, and behavior problems (Steele et al. 2014).

The Eustachian Tube

Eustachian tube dysfunction, considered by some researchers as the most important factor underlying the etiology of middle ear infections, may be the key to why otitis media is primarily a disease of childhood.10,24 Anatomic variation between the adult and pediatric cranium demonstrates some interesting differences. The adult eustachian tube has a crosssectional area 2.25 to 2.75 times larger than is found in a 2-year old child  (Steele et al. 2014).

The intrinsic characteristics of the eustachian tube in early childhood appear to make it especially vulnerable to dysfunction, causes for eustachian tube dysfunction may also result from the interplay of other unique pediatric structural features. The cranium in the human infant is quite different from that of the mature adult in that it is made up of thin, single-layered, isolated bony tissue surrounded and interconnected by flexible membranous and more rigid cartilaginous connective tissue. Individual bones in the mature cranium are divided in the fetus to allow for compliance during the demands of delivery and the rapid growth of the brain in the first few years of life. For example, during infancy, the frontal, sphenoid, and temporal bones consist of two bony segments, while the occiput consists of four (Steele et al. 2014).

Goal of Treatment

The goals of treating patients with recurrent otitis media are to reduce the frequency of pain and fever; minimize hearing loss; reduce the cost of physician visits, surgery, and medications; reduce patient and parental anxiety; and prevent longterm sequelae

Treatment Protocol (Steele et al. 2014):

  1. Treatment of the sacroiliac joints bilaterally using BLT
  2. Treatment of thoracolumbar junction and diaphragm using MFR
  3. Treatment of the rib cage using MFR or Treatment of the rib cage using BLT
  4. Treatment of cervico-thoracic area (thoracic inlet) using MFR
  5. Treatment of cervical area using BLT
  6. Treatment of cranio-cervical junction using suboccipital inhibition
  7. Venous sinus drainage technique
  8. Occipital decompression technique
  9. Sphenobasilar symphysis decompression technique

Conclusion

A standard OMT protocol administered adjunctively with standard care for patients with AOM resulted in faster resolution of MEE at 2 weeks than standard care alone. These results support the clinical observation that OMT is an effective, nonpharmaceutical, nonsurgical, adjunctive treatment for young children with MEE. Larger studies with a sham treatment group are needed to confirm these results (Steele et al. 2014).

Osteopathic evaluation and treatment was shown to be beneficial in treating 5 (63%) of 8 subjects in this cohort with documented recurrent otitis media. After three weekly sessions of OMT, at least 50% of those subjects who experienced their first episode of otitis media during their first 6 months of life had resolution of their symptoms at 1-year follow-up (Degenhardt and Kuchera, 2006).

Is Treatment Effective?

We are unsure if treatment is effective for everyone and there is currently not enough research that explores the effectivness of Osteopathic treatment for Otitis Media. Though it would be interesting area of research to explore in the future.

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Reference List

Degenhardt BF, Kuchera ML (2006). Osteopathic Evaluation and Manipulative Treatment in Reducing the Morbidity of Otitis Media: A Pilot Study. The Journal of the American Osteopathic Association, June, Vol. 106, 327-334

Steele KM, Carreiro JE; Viola JH, Conte JA, Ridpath LC (2014). Effect of Osteopathic Manipulative Treatment on Middle Ear Effusion Following Acute Otitis Media in Young Children: A Pilot Study. The Journal of the American Osteopathic Association, June Vol. 114, 436-447.

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