Healthy children contract colds, sore throats, coughs and even earaches. This is a normal part of childhood. Sometimes a simple cold can develop into an ear infection after a few days. At other times ear infections can occur suddenly without warning. They may manifest with a fever and ear pain or they may have no signs that suggest ear involvement unless the eardrum is examined. An ear infection is usually diagnosed by observing a red, inflamed eardrum. These simple ear infections can be managed easily and usually go away in a few days on their own. Often the only treatment necessary is to relieve the discomfort and promote healing. If antibiotics are given they may alleviate symptoms by killing off bacteria and allowing the body to heal itself. In many cases, however, antibiotics will do no more than the body would if left to heal the problem on its own. It is important to watch an ear infection closely because it can develop into a more serious infection, but that is an unusual event.
Parents usually seek homeopathic care for their child after ear infections have recurred again and again. These children have developed a chronic problem. They have a lowered resistance to infections that may manifest in the ears or other respiratory symptoms. These parents are often frustrated with repeated courses of antibiotics, discouraged by hearing problems and frightened at the prospect of surgery. Homeopathy offers an alternative approach to the management of ear problems and the prevention of recurrent infections.
Repeated ear infections
Let us look at a typical course of events for a child with repeated ear infections. During the normal process of growing up, a child will develop cold symptoms and fever. There may also be a pain in the ear. The paediatrician will see a red eardrum on examination and prescribe antibiotics. This is the beginning of the problem, repeated infections and antibiotics. If the body does not fight off the bacteria on its own, then the immune system may not build resistance to the organisms involved. At the next exposure the growth of bacteria (or viruses) will be more likely to recur. It is not unusual for antibiotics to prevent this natural immunity and cause recurrent ear infections. Some children may be on antibiotics most of the winter because each time they are taken off the drug the infection returns.
Fluid in the middle ear
This chain of events has several effects on the body. One effect is a lowered resistance to bacteria and viruses associated with ear infections and respiratory infections. Another possible effect is the accumulation of fluid in the problem ear. This becomes evident to parents if hearing is impaired due to fluid in the middle ear pressing against the eardrum. Fluid accumulates because the Eustachian tube (auditory tube) does not perform its usual function of draining mucus from the middle ear into the throat. This type of hearing problem (conductive hearing loss) is temporary. Most children with fluid in their middle ear recover without any treatment.
In some cases fluid collection will persist for an extended period of time. During the time that hearing is impaired a child may show a temporary delay in language or cognitive development. It must be remembered that hearing problems may be slight, moderate or severe and this will have an influence on development. In addition, no studies confirm the relationship between the accumulation of fluid in the child’s ears with temporarily decreased hearing and any long-term developmental delays.
Why does fluid accumulate in the middle ear and how does this influence hearing? The eardrum separates the external ear and the air outside the body from the middle ear cavity. The eardrum is a flexible membrane that helps to transmit sound waves from the air to the bones of the middle ear and then to the nerves of the inner ear. The middle ear apparatus functions best when the air pressure is the same on both sides of the eardrum. The auditory tube connects the middle ear cavity to the air passages in the throat, thus maintaining adequate air pressure on the inner side of the eardrum. The middle ear is lined with mucous-producing cells. If for some reason the auditory tube is blocked, then it cannot drain mucus produced in the middle ear during a cold or ear infection. The mucus presses against the eardrum preventing it from moving freely. In this condition it will not conduct sound well. In addition, if fluid remains in the middle ear it can be a breeding ground for bacteria. This may lead to future infections.
The auditory tube may be blocked by swollen tissues in the respiratory tract or by a structural problem in the tube itself. In young children the auditory tube lies in a more nearly horizontal position than it does in adults, which lessens the tendency of fluid to drain down into the throat. Any of these problems may contribute to fluid accumulation. As a child grows, the position of the auditory tube gradually changes and fluid in the ear drains more effectively.
Extension of ear infections
The middle ear communicates with several other structures including the inner ear and air cavities in the skull (mastoid). It is possible, although unusual, for an infection to spread to these structures. It is therefore important to carefully monitor ear conditions. Permanent hearing impairment can result from infections in the inner ear, but the anatomy of the ear discourages the extension of disease to this region. Permanent hearing loss from this cause is quite rare.
Treatment of chronic ear problems
The goal in treating chronic ear problems is the prevention of recurrent infections and the drainage of fluid in the middle ear. Homeopathy offers a method of treating the underlying cause of the problem. Allopathic medicine treats the resulting condition with surgery or long-term antibiotics.
Homeopathy treats the body as a whole, not just the ear condition. The intent of homeopathic treatment is to strengthen the immune system and encourage its ability to react to normal physical symptoms. Homeopathy stimulates a healing reaction. It does not kill bacteria or treat infections directly. It treats the cause underlying the problem ear. The cycle of repeated ear problems can only be broken by strengthening the body’s resistance.
The homeopathic approach to chronic ear problems usually involves two types of medicines. The first is the prescription of a constitutional remedy which stimulates a healing process within the body. This is a long-acting medicine. Its effects may come on gradually, but will persist for a period of months or years. In order to find the correct constitutional medicine for any individual, it is necessary to take a complete history. It usually takes an hour or more to gain a thorough understanding of the individual child and his or her problems. The interview will consist of questions related to the child’s symptoms, reactions to stresses, behaviour, development, food cravings, and many other areas. The symptoms of the acute infections and other ear problems are important considerations, but a wide range of general information must also be gathered in order to find the correct medicine. A physical exam is performed as well. The prescription of the constitutional remedy is based on the total symptom picture. The appropriate medicine is given in a single dose. Its effects are then observed at periodic office visits over the next few months. At these visits the original symptoms are reviewed and any acute illnesses are carefully monitored. The constitutional medicine may be repeated or changed, if necessary, at infrequent intervals depending on the changes in symptoms.
During the course of constitutional treatment it is not unusual for another acute bout of respiratory symptoms to occur. This is the body’s method of developing its own resistance and antibodies. It may be necessary to prescribe a short-acting homeopathic medicine at these times. This is the second type of remedy that may be needed. It will encourage the body’s healing mechanisms during the acute illness and help the body to resolve these symptoms. It is important to evaluate acute episodes of symptoms from a homeopathic perspective because they may have significance within the overall progress of a child’s constitutional case.
The expectation for homeopathic treatment is that recurrences of respiratory problems will be mild, ear symptoms will not be bothersome, and fluid will drain from the ear. These changes should be evident from physical exams and the follow-up history. In addition, an overall increased level of health should be attained. This is the most important indication that homeopathic treatment has been effective for the individual child. Homeopathy effects the whole child and not just one symptom or part of the body. The child’s general energy and emotional state should improve under the action of a constitutional remedy. The evaluation of improvement should include the severity and frequency of ear problems as well as the overall quality of physical and mental health over the year following the initiation of treatment.
The primary approach to repeated ear infections in orthodox practice is to let the child grow out of them. When infections occur, antibiotics are repeated as needed. If fluid accumulates in the middle ear, then the only effective intervention is the placement of tiny plastic tubes in the eardrum. These will drain fluid into the external ear canal and help equalise air pressure on both sides of the drum. Decongestants, antihistamines or steroids are not effective in relieving fluid collection in the middle ear. Similarly, several studies demonstrate that surgical removal of adenoids has no favourable effect on fluid accumulation or infections in the ear.
Ventilating tubes are placed in the eardrum under general anaesthetic. They remain embedded in the drum until they fall out on their own (usually by the fourth to sixth month after insertion) or they are removed. Tubes are effective for temporary improvement of hearing. When they fall out, the fluid collection and hearing problem sometimes return, requiring insertion of a second tube in approximately one-third of cases. Tubes have no long-term effect on hearing.
Several side effects are observed when tubes have been placed in an eardrum. The eardrum often develops permanent scar tissue, which can lead to chronic middle ear disease. The tubes themselves frequently cause infections and fluid drainage from the ear. In a study which placed a tube in one ear and left the other ear undisturbed, 25% of the ears with tubes developed infections compared to a disease-free ear on the opposite side. And finally, tubes often become blocked by the fluid they are intended to drain, rendering them ineffective. These side-effects are not severe, but they indicate that a conservative approach to tube placement is warranted. Certainly they should not be inserted routinely for recurrent infections.
Both antibiotics and ventilating tubes are measures that treat the results of the ear problem. They kill overgrown bacteria and drain collections of fluid. They may be necessary at some point in the course of an individual child’s life, but they are not intended to cure the underlying problem which is a lowered resistance and susceptibility to this condition. They are stopgap measures used with the expectation that the problem will resolve on its own. Homeopathy, by contrast, is intended to treat the cause of the problem ear, thereby preventing recurrences of ear symptoms.
Parents of children with recurrent ear infections have two main concerns the discomfort of repeated acute illnesses and hearing loss. There is no evidence that fluid itself, thick or thin, is damaging to the structures of the middle ear. Fluid may impair hearing and this may slow speech development in young children. Whether this temporary situation has any long-term effects on development is open to question. In preschool children a hearing loss may go unnoticed. There are cases of permanent hearing loss from chronic ear infections, but these may depend on the presence of active infection.
When is it important to pursue treatment for recurrent ear problems? Homeopathic treatment can be started at any time. It has no side effects and can only help to strengthen the system. If fluid in the middle ear and hearing loss persist, then the child should be evaluated by an ear specialist. The period of time to wait depends on the degree of hearing loss and the appearance of the ears on examination. Some conditions of the middle ear which are associated with repeated infections warrant prompt attention by a surgeon. These are rare, but they are apparent on examination and they must be considered when deciding on a treatment plan. The course of treatment for children with recurrent ear problems involves a clinical judgement which can only be made on an individual basis.
The following are important points to remember:
• Acute ear problems can usually be managed with supportive measures and homeopathic remedies. Any child with ear pain or fever that persists should be examined. Ear infections need to be followed carefully, though they rarely lead to complications or serious illness.
• Fluid accumulation in the middle ear is not dangerous, though it may cause temporary hearing loss.
• Antibiotics can treat an ear infection, but they may promote recurrent ear problems. They have no effect on fluid in the ears.
• A treatment plan should consider the long-term effects of an intervention, not just the short-term relief of symptoms. Treat the underlying susceptibility and lowered resistance, not just the ears.
© Randall Neustaedter