Naturally Healing Ear Infections - Do Children Need Antibiotics?

According to the NHS, earache is cited as the most common reason for a parent to call a doctor out of hours for their child. It will often be the result of a middle ear infection (otitis media).

Many still believe antibiotics to be essential, I once read a comment on a parenting forum that infection could easily spread to the brain and so it should always be promptly treated.  Yikes right!

So firstly, when to call the doc (according to NHS):

• you or your child has a high temperature (fever) of 38ºC (100.4ºF) or above
• you or your child has other symptoms, such as dizziness, a severe headache, or swelling around the ear
• the earache does not improve within 24-48 hours

I'm not entirely sure about the temperature thing as I personally wouldn't panic over a 38 degree temperature in an older child compared to a very young baby, however you are responsible for the well being of your child and this blog is not intended as medical advice ie it's your call.

As for treatment, NHS current guidance is:

Most cases of middle ear infection (otitis media) will clear up within 72 hours without the need for treatment.

The routine use of antibiotics to treat ear infection is not recommended because:

• there is no evidence they speed up the healing process

• many middle ear infections are caused by viral infections so antibiotics are often ineffective 

• every time you use antibiotics to treat a non-serious infection it increases the likelihood of bacteria becoming resistant to it, meaning more serious infections could become untreatable.

Antibiotics are usually only recommended if:

• your child has a serious health condition that makes them more vulnerable to infection such as cystic fibrosis or congenital heart disease 

• your child is under the age of three months 

• your child’s symptoms show no signs of improvement after four days

You can relieve your child’s symptoms of earache and high temperature using over-the-counter painkillers such as ibuprofen and paracetamol.
Aspirin should not be given to children under 16 years of age.
Placing a warm flannel or washcloth over the affected ear may also help relieve pain. 

Why? 

The first question I think should be, why is the child catching ear infections?  This probably sounds bizarre to some who believe it's common to suffer these childhood illnesses,  ie just because we get exposed to bacteria, we get an infection.  Of course a child's immune system isn't mature until around the age of 6, which is why breastfeeding as long as possible to assist their defenses is recommended.  But some children are plagued by recurrent infections, whilst others don't suffer at all - so there is clearly more to it than inevitability.

Bacteria don't grow well anywhere and everywhere, conditions have to be suitable.  Some environments help good bacteria to flourish, whilst others make it difficult for them to survive allowing more harmful, opportunistic bacteria to move in and thrive.  We know the gut flora ie the profile of bacteria that resides in our body, directly impacts on the immune system.

Gut health is rather like a game of draughts (or checkers if you're over t'other side of the pond) when you've

lost too many of your pieces, it's easy for the other team to quickly take over, including fungus like (but not limited to) candida.

Lots of different things can weaken the defenses of good bacteria - antibiotics and many if not most other medications, nutritional imbalances, environmental toxins, food intolerances ie things that create inflammation.

In some cases the good guys don't even get to start with a full team; colonisation is disrupted from birth during cesarean sections, early antibiotics or by formula and you have to ask, where are the good bacteria even supposed to come from?

We also need to remember the body is linked from top to toe, like a network of pipes if something is working ineffectively at the top - problems may occur further down.

Birth can be an interesting time for babies, rapid, long, intense, or even straight forward and calm but perhaps a larger baby snuggled into a smaller mum. At birth the skull isn't fully fused, instead membranes separate the cranial bones, these create the fontanelles or "soft spots" that can be felt on new babies. These areas allow some movement between the bones, so that the developing skull is partially compressible and can slightly change shape, enabling them to pass through the birth canal more easily.

This is an interesting case study outlining how one mum resolve her daughter's case of severe recurrent ear infections with osteopathy, and this study also shows promising results.  Other studies that also show improved outcome can be found here and here.  It's worth noting this study did not note improvement - but I haven't delved into the paper.

Dealing with the current infection

Again a study suggests osteopathy or chiropractic treatment may be worth exploring, beyond that the first important guideline is:

"Eardrops or olive oil drops should not be used if the eardrum has burst."

Natural Alternatives

Heat 

NHS recommends a flannel, but many find heat packs are much more effective.  I find these intended for eyes are easier for children to hold over a specific area than a big heavy bag, but if both ears are sore, something like this could be used to cover both sides at the same time. 

You can also make heat compresses with various household things (according to the internet)  ranging from onion to ginger crushed and wrapped in cloths.  Some I'm sure would be easier to convince children about than others.

Breastmilk

If you have some, always worth a try.

Herbs

1.  Shop bought:

• Hear No Evil, containing Mullein, Scullcap, Goldenseal Root, Black Cohosh, Blue Cohosh, Yarrow and Rosemary combined with essential oils of Garlic, Tea Tree and Peppermint (kosher,vegan, wheat free etc)  Suggested use is in or around the ear. (these are pretty pricey as they're imported)


• Herbs for kids ear drops, containing garlic and willow oil.


• Herb Pharm ear drops, containing mullein garlic compound

2.  Home made 

• Instructions to make garlic oil here.
• Instructions to make mullein garlic oil here.

Consulting a medical herbalist for a custom made remedy is often recommended.

Homeopathy

Highlands infant earache drops containing  Belladonna, Calcarea, Carbonica, Chamomilla, Lycopodium, Pulsatilla, Sulphur - they have a picture of a baby on the box, new packaging shows a child and lists as suitable for 3 and under.

Highlands earache drops are listed as suitable for 2 and over.  According to their website "they've been clinically shown to reduce earache symptoms during the first 48 hours of the episode", but I haven't delved into the research.

Consulting a homeopath for a custom made remedy is often recommended.

Propolis

Propolis is made from resins gathered by the oldest bees, once brought back to the hive they are mixed with some wax and salivary secretions before using to sterilize the hive against infection.  There is some evidence here and here suggesting it may be useful to treat and prevent recurrent infections.

You can buy propolis in a number of forms.  In its sticky raw state here (it's quite hard to source in the UK, apart from the link eBay seem to have regular listings), or as a tincture,

For the treatment of ears, two methods are commonly listed:

1.  10% alcohol tincture mixed 1:2 with olive (or other good quality vegetable) oil, if you have a stronger propolis dilute accordingly.  A piece of gauze is soaked in the emulsion and place in the ear for 2-3 hours before changing.  A typical course suggested is 10-15 applications is depending on severity.  Always check the ingredients of ticture as it should be simply propolis and alcohol.  Some cheaper varieties contain Mono Propylene Glycol

  

2.  A propolis oil used as you would olive oil ie a few drops in each ear.

Propolis oil is difficult to buy in the UK but there are instructions of how to make your own, plus your own tincture if feeling adventurous are given here.

For older children you can also buy propolis capsules to be taken as directed rather than applied topically.

Can topical/alternative treatments help infection?

The NHS says:

"Ear drops or olive oil drops should not be used if the eardrum has burst, and they will not help an ear infection."

This is echoed by may other sources including this page belonging to ENT consultants who state using ear drops of any kind is ineffective as they cannot get behind the eardrum to where the infection is located.

The ear drum is a membrane, made up of thin connective tissues, skin and mucosa.  So whilst something can't run freely into the ear, is it true nothing can make it through?

Given a 2006 study found middle ear infections actually responded better to antibiotic ear drops than when taken orally - it would seem not.

"That’s in line with previous research and other findings that support increased use of topical antibiotics over oral antibiotics in other cases involving middle ear infections, one of the most common childhood afflictions", said Dr. Roland, who heads the Clinical Center for Auditory, Vestibular and Facial Nerve Disorders at UT Southwestern and who is also chief of pediatric otology at Children’s Medical Center Dallas. 

A 2003 study handily compared a herbal remedy to oral antibiotics. They found:

"Patients who were given ear drops alone had a better response than patients who were given ear drops together with amoxicillin."

Because ear infections usually self resolve within a few days, researchers cautioned this could explain the results.  However they significantly also added:

"Because no evidence was found that systemic antibiotics alone improved treatment outcome, if antibiotics do not change the natural course of otitis media, then the main goal of treatment, as in the present study, should be to alleviate the ear pain. The alternative, naturopathic herbal extract medications, may offer many new possibilities in the management of ear pain associated with AOM."

"They are also well-absorbed with good penetration into the tissue surrounding the tympanic membrane. They have been found to enhance local immunologic activity. Finally, herbal extracts are well-tolerated (owing to their long elimination time), easy to administer, and less expensive than the new antibiotics. There are no documented side effects."

Recurrent Infections:

A 2006 study found that chronic middle ear infections were linked to resistant biofilm Bacteria - ie a heap of bad guys moved in that aren't killed by antibiotics.

Garth Ehrlich, Ph.D., principal investigator and executive director of the ASRI Center for Genomic Sciences, co-author of the study said:

It appears that in many cases recurrent disease stems not from re-infection as was previously thought and which forms the basis for conventional treatment, but from a persistent biofilm,"
"Given that bacteria living in biofilms are metabolically resistant to antibiotics, this study makes a definitive, scientifically-based statement against the use of these drugs to treat children with chronic ear infections. It simply does not help the child and increases the risk of breeding more resistant strains of bacteria."

Oral supplementation of good bacteria, in particular S.salivarius K12 has been shown to be helpful in dealing with recurrent otitis media.

Ruptured Eardrum:

How can I tell if an eardrum is ruptured and is it serious? According to Dr Internet:

"Infection of the middle ear sometimes causes the eardrum to burst and this may result in a yellowy-green discharge, sometimes blood-stained, to ooze out of the affected ear.
The eardrum usually heals over again and although some scarring of the eardrum may occur this doesn't usually cause any significant long-term problems with hearing.
There may be some temporary hearing loss for a few weeks after a burst eardrum but this should gradually return to normal."

What are your favourite remedies?