Me or my child has an acute Otitis media, acute earache

Patient information

Introduction

Acute earache is very common, especially in young children. There are two main reasons for acute earache:

  • Acute Otitis media (AOM)
  • Acute Inflammation of the ear canal  

The latter (acute inflammation of the ear canal) is relatively common after swimming in a pool (“swimming pool otitis”) in the summer time and warm countries and is not in the scope of this paper. Acute otitis media (AOM) is more frequent in cold seasons, in toddlers and patients may show symptoms of an upper airway infection (e.g. sniff) and (in childhood) fever. AOM is the focus of this paper.

What are the symptoms of an acute otitis media?

  • Sudden acute pain of the ear/the ears is the main symptom.

In children those symptoms may occur at the same time:

  • fever
  • irritability
  • whimpering, restlessness (especially at night)
  • sensitivity to touch (ears and head)
  • hearing loss
  • loss of appetite
  • cold, cough.
  • In case of perforation, the pain decreases significantly.

AOM should be taken particularly seriously in early childhood if there is a significant impairment in the general condition of the child. This should be accompanied by a doctor.

In adulthood the following symptoms are clearly indicative:

  • earaches
  • headaches
  • hearing loss

What is important to know?

  • Poor ventilation of the middle ear with restricted nasal breathing can lead to inflammation.
  • Noticeable symptoms usually last 3-4 days.
  • Complementary medicines and  external treatment are an efficient and safe therapy of AOM.
  • Most of AOM cases are caused by viruses, antibiotics are indicated in case of bacterial complications.

When should you visit a doctor?

  • The child with AOM is less than 1 year.
  • The general condition is impaired or getting worse.
  • Liquid runs out of the ear canal.
  • Despite therapy, there is no improvement within 3 days.

Follow-up

After 3-4 weeks, a follow-up otoscopic examination of the middle ear and control of middle ear pneumatization is recommended, with a hearing test (at least a bilateral whisper-test).

What is an acute otitis media?

Toddlers and young children are particularly susceptible to the development of AOM for anatomical reasons. After birth, the middle ear is gradually ventilated via the Eustachian tube. This process is very individual.

In most cases, the blockage of the Eustachian tube is preceded by swelling of the nasal mucosa. In infants and young children, this is usually the result of hypothermia or a respiratory infection. With increasing age, allergic inflammation of the airways plays a role.

The disposition for AOM is increased especially with adenoids and tonsil hypertrophy.

Risk factors include pacifiers, premature birth, passive smoking, food intolerance, low humidity, allergies. Breastfeeding is preventive.

Zu den Risikofaktoren zählen Schnuller, Frühgeburt, Passivrauchen, niedrige Luftfeuchtigkeit und Temperatur, Allergien und Nahrungsmittelunverträglichkeiten. Stillen dagegen wirkt vorbeugend.

Otitis media from the Anthroposophic Medicine point of view

After the first breath at birth, the middle ear and parts of the bone behind it (mastoid) are increasingly ventilated and pneumatized. Pneuma is also an expression of soul.

A disturbed nasal breathing and every long runny nose jeopardize the correct ventilation of the middle ear. This can also reduce hearing, which is necessary for language development and mental development of the child.

The initial ventilation of the middle ear has to be achieved again and again in infancy and toddler age. This process should be completed by puberty.

A chronic effusion in the middle ear corresponds to a fall back to the earlier stage of development when the middle ear was not yet sufficiently pneumatized. In this state, viruses and bacteria can spread more easily. In acute inflammation, the organism tries to overcome the foreign through its own activity.

Holistic therapy always aims to support people in their own activity, with AOM it is primarily the process of ventilation. Maintaining the warmth organism and responsible fever management is essential.

Therapy

Conventional therapy

If the course of the illness is uncomplicated, then conventional treatment is limited to observant waiting, nasal hygiene and pain relief with antiphlogistics. 

A perforation of the eardrum has to be observed by a physician, but usually heals without further complications.    

Otitis media is usually not caused by bacteria, especially in children. Antibiotics that are not indicated weaken the vital process of the organism and impair the natural maturation of the microbiome and the child's immune system, especially in the first years of life.

How can you help yourself

Local pain therapy

  • Onion bags on both ears

This measure is a tried and tested household remedy for uncomplicated middle ear inflammation. The effect is rapid; failure indicates a more severe inflammation. For instructions, see https://www.pflege-vademecum.de/zsohr.php?locale=en    

  • Skin stimulation therapy by placing a cut garlic clove in the opposite elbow for 1 – 2 minutes 3 – 4 x daily has also proven itself.

Anti-inflammatory and pain relief effects of onions are well known.

  • Aconit ear drops WALA: 3 – 5 x daily at body temperature drip into the ear canal


Interventions to ensure warm feet

  • Ginger footbath especially for patients with cold lower extremities.
    For instructions, see https://www.pflege-vademecum.de/ingwerfussbad.php?locale=en

  • Warm footbath with water or 1% NaCl solution and rising temperatures (37 to 40°C or 98.6 to 104°F).

  • Lavender 10% oil or Solum oil WALA or Mallow oil WALA (synon. Malvenöl) for mild cases and small children < 4 years coat the whole body, especially before sleep.

  • Copper ointment 0,4 % WELEDA or Red Copper Ointment WALA (synon. Kupfer Salbe rot): 1 – 2 x per day on the soles of the feet.

Care of the heat is important. Avoid cold airflow in winter or air conditioning in summer. Complement this approach with loving care, a healthy diet, appropriate clothing, and responsible fever management (see also www.feverfriend.eu).


Promoting pneumatization of the middle ear (see below)

  • Nasal sprays with physiological saline solution or similar 

  • Gencydo® 1% Gencydo 1% Nasal Spray WELEDA (similar to Heuschnupfenspray WELEDA): 1 – 2 bursts 3 x daily.

Experts recommend the following medication

In case of acute otitis media, frequent administration of medication initially proves effective, in the case of severe pain initially up to 4 x per hour. A widely proven basic medication for uncomplicated AOM:

  • Apis/Levisticum II pillules WALA

Start with 3 – 5 pillules every 15 – 30 minutes, then less frequently after this has started to have an effect. Pain-relieving and decongestant for the eardrum and the middle ear. Promotes ventilation of the middle ear.

This is usefully augmented with

  • Silicea comp. pillules WALA: 5 pillules 3 x daily

Includes Quartz D21, Argentum nitricum D 20 and Atropa Belladonna ex herba D14. Silicea comp. is a basic remedy for acute inflammatory diseases in the paranasal sinuses and the middle ear, especially during the advancing pneumatization of this area.

  • Erysidoron® 1 WELEDA or Apis/Belladonna pillules WALA: initially every two hours, then less often: 2 drops (< 2 years old), 3-5 drops (2 – 6 years), 5 – 8 drops (> 6 years), or 3 pill. (< 2 years), 5 pill. (2 – 6 years), 7-10 pill. (> 6 years).

Suppositories have proven to be effective for more progressive forms of AOM, impaired general condition, recurrent AOM and constitutional weakness of the immune system, among others:

  • Echinacea/Mercurius comp. suppositories/suppositories for children WALA: 1 suppository for children (< 7 years) 1 – 3 x daily.  

For AOM with increasing pain in the evening and at night, fever, pronounced restlessness, especially for toddlers in the teething age, the following are suitable:

  • Fever and teething suppositories WELEDA (synon. Fieber- und Zahnungszäpfchen): 1 suppository 1-3x/d for toddlers. For infants < 12 months off label use. In the first year of life, esp. for infections or susceptibility to infection because of teething. Broad positive experience with this age group.


Otitis media with perforation of the eardrum, otorrhea:

  • Needs medical attention.

 

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Pilot study  on the clinical effect of yarrow liver compresses  
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https://doi.org/10.1177/15347354221081253


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