Kids with chronic ear infections given unproven therapies

More conservative strategy recommended since studies showed that chronic infections can pass without treatment.

By JUDY SIEGEL-ITZKOVICH
ear check 88 (photo credit: )
ear check 88
(photo credit: )
A majority of the children brought to a leading Tel Aviv hospital suffering from chronic middle-ear infection (otitis media) had previously been taken for non-medical complementary and alternative medicine (CAM) - even though such "therapy" has never been proven effective against this common pediatric condition. Drs. Michael Rotstein and Ari DeRowe of the Dana Children's Hospital at Tel Aviv's Sourasky Medical Center presented their study on "The Use of Complementary and Alternative Medicine among Children with Otitis Media" at the 21st annual meeting of the American Society of Pediatric Otolaryngology that ended in Chicago on Monday. Otolaryngology is the branch of medicine that specializes in the diagnosis and treatment of ear, nose, throat and head and neck disorders. Otitis media with effusion (OME) is a very common childhood condition, with 80 percent of four-year-olds having already had at least one bout. In rare cases, OME can cause a conductive hearing loss at a level of 25 to 30 decibels that may also affect language and speech impairment. Although physicians have long treated OME with decongestants, antihistamines or antibiotics, in recent years research has shown that since it usually goes away without any treatment, a more conservative strategy should be adopted. The recent research advises watchful waiting and only using antibiotics and surgical intervention - the insertion of tiny tubes to drain pus from the middle ear - for prolonged and difficult cases. Rotstein and DeRowes's study was conducted at the hospital's outpatient pediatric otolaryngology clinic between May 2003 and February 2004, and covered children who were referred to the clinic with a diagnosis of middle ear effusion for more than three months, or with a history of at least three episodes of AOM in the preceding six months or four episodes in the preceding year. The study found that 51.7% of the children had been treated with CAM, either by practitioners or by their parents. The most commonly used treatment was echinacea herbal preparations, followed by dietary modification, naturopathy, homeopathy and various other folk remedies. Other unproven CAM treatments for ear infections include: hopi candles, a method for removing earwax by burning a paper stick inserted into the external auditory canal; non-specific folk remedies such as inserting olive oil into the ear; acupuncture; reflexology; massage; biofeedback; yoga, hypnosis and other relaxation techniques; "energy healing," such as Reiki and magnet or crystal therapy; osteopathic, cranio-sacral or chiropractic manipulation; and religious approaches including prayers, blessing, spiritual healing or the use of religious artifacts. Paternal education level, country of origin and religious beliefs were not shown to influence treatment choices, but better-educated mothers were more likely to use CAM. Prof. Jonathan Halevy, the director-general of Shaare Zedek Hospital in Jerusalem, recently published an authoritative Hebrew-language book examining the efficacy of a variety of CAM techniques. He said his research found that no CAM therapies had any proven effect in reducing the extent and duration of otitis media infections. In most cases, he said, the condition goes away by itself. While the risks of using unproven CAM for ear infections, even chronic ones, could not be compared with the seriousness of going to such practitioners for cancer treatment instead of to physicians, Halevy said it was worthwhile for family health (tipat halav) centers to do a better job educating parents on what to do about ear infections and explaining that CAM had not been shown effective. Hadassah-University Hospital pediatrics chief David Branski said he was not surprised by the results. "I don't reject all CAM therapies; we ourselves have done a study with Dr. Menahem Oberbaum of Shaare Zedek on homeopathic medicine that was shown to help against damage to oral membranes in cancer patients." CAM studies on otitis media are problematic, he said, because they should compare cases in which no treatment is administered with intervention such as antibiotics. "We are planning a scientific study of homeopathic treatment for otitis media versus conventional therapy," he said.