Recurrent Ear Infections

Also indexed as: Glue Ear, Otitis Media

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Many children suffer recurrent infections of the middle ear, a condition also known as otitis media (OM).

Checklist for Recurrent Ear Infections

Rating Nutritional Supplements Herbs
1Star Vitamin C
Zinc		 Echinacea
Garlic
Linden
Mullein
St. John’s wort
See also:  Homeopathic Remedies for Recurrent Ear Infections
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of recurrent ear infections? Ear infections can cause irritability, difficulty sleeping, runny nose, fever, fluid draining from the ear, loss of balance, mild to severe ear pain, and hearing difficulty. Untreated infections can cause permanent hearing impairment and can also spread to other parts of the head, including the brain. Frequent or persistent ear infections in children can reduce their hearing when normal hearing is critical for speech and language development.

How is it treated? Conventional treatments for an active infection include prescription antibiotics and pain relievers. For chronic infections or persistent fluid in the ear, many doctors suggest myringotomy, an operation in which small “tympanostomy tubes” are inserted in the affected eardrums to equalize pressure and improve drainage of fluid from the middle ear. Enlarged or infected adenoids may be removed (adenoidectomy) at the same time the ear tubes are inserted.

Although antibiotics are frequently used, the benefit is often small for serous OM (a type of OM that involves accumulation of fluid in the eustachian tubes, which drain the middle ear into the back of the throat) and side effects or drug resistance may result.1 2 Likewise, myringotomy has not consistently demonstrated long-term efficacy for recurrent ear infections. 3

Dietary changes that may be helpful: The incidence of allergy among children with recurrent ear infections is much higher than among the general public.4 In one study, more than half of all children with recurrent ear infections were found to be allergic to foods. Removing those foods led to significant improvement in 86% of the allergic children tested.5 Other reports show similar results.6 7 In one preliminary study, children who were allergic to cow’s milk were almost twice as likely to have recurrent ear infections as were children without the allergy.8 People with recurrent ear infections should discuss allergy diagnosis and elimination with a doctor.

Although sugar intake has not been studied in relation to recurrent ear infections, eating sugar is known to impair immune function.9 10 Therefore, some doctors recommend that children with recurrent ear infections reduce or eliminate sugar from their diets.

Xylitol, a natural sugar found in some fruits, interferes with the growth of some bacteria that may cause ear infections. In double-blind research, children who chewed gum sweetened with xylitol had a reduced risk of ear infections.11 12

Lifestyle changes that may be helpful: When parents smoke, their children are more likely to have recurrent ear infections.13 It is important that children are not exposed to passive smoke.

Humidifiers are sometimes used to help children with recurrent ear infections, and animal research has supported this approach.14 Nonetheless, human research studying the effect of humidity on recurrent ear infections has yet to conclusively show that use of humidifiers is of significant benefit.

Use of pacifiers in infants increases the risk of ear infections.15 16 17

Nutritional supplements that may be helpful: Vitamin C supplementation has been reported to stimulate immune function.18 19 As a result, some doctors recommend between 500 mg and 1,000 mg of vitamin C per day for people with ear infections. Nonetheless, vitamin C supplementation has not been studied by itself in people with ear infections.

Zinc supplements have also been reported to increase immune function.20 21 As a result, some doctors recommend zinc supplements for people with recurrent ear infections, suggesting 25 mg per day for adults and lower amounts for children. For example, a 30-pound child might be given 5 mg of zinc per day while suffering from OM. Nonetheless, zinc supplementation has not been studied in people with ear infections.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Echinacea has been reported to support healthy short-term immune response. As a result, it has been suggested that some children with recurrent ear infections may benefit from 22 1–2 ml (depending on age) of echinacea tincture taken three times per day or more.23 Doctors who use echinacea suggest that supplementation be started as soon as symptoms start to appear and continued until a few days after they are gone. Nonetheless, research has not been done to determine whether echinacea supplementation either reduces symptoms or prevents recurrence of ear infections.

Ear drops with mullein, St. John’s wort, and garlic in an oil or glycerin base are traditional remedies used to alleviate symptoms, particularly pain, during acute ear infections. No clinical trials have investigated the effects of these herbs in people with ear infections. Moreover, oil preparations may obscure a physician’s view of the ear drum and should only be used with a healthcare professional’s directions.

An unpublished clinical trial of children with colds found that linden tea, aspirin, and bed rest were more effective than antibiotics at speeding recovery and reducing complications such as ear infection.24 (Aspirin is no longer given to children due to the threat of Reye’s syndrome.) However, no research has yet confirmed the use of linden for preventing ear infections.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

References:

1. Del Mar C, Glasziou P, Hayem M. Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis. BMJ 1997;314:1526–9.

2. Kozyrskyj AL, Hildes-Ripstein GE, Longstaffe SE, et al. Treatment of acute otitis media with a shortened course of antibiotics: a meta-analysis. JAMA 1998;279:1736–42.

3. Le CT, Freeman DW, Fireman BH. Evaluation of ventilating tubes and myringotomy in the treatment of recurrent or persistent otitis media. Pediatr Infect Dis J 1991;10:2–11.

4. McMahan JT, Calenoff E, Croft J, et al. Chronic otitis media with effusion and allergy: modified RAST analysis of 119 cases. Otolaryngol Head Neck Surg 1981;89:427–31.

5. Nsouli TM, Nsouli SM, Linde RE, et al. Role of food allergy in serous otitis media. Ann Allerg 1994;73:215–9.

6. McGovern JP, Haywood TH, Fernandez AA. Allergy and secretory otitis media. JAMA 1967;200:134–8.

7. Roukonen J, Pagnaus A, Lehti H. Elimination diets in the treatment of secretory otitis media. Internat J Pediatr Otorhinolaryngol 1982;4:39–46.

8. Juntti H, Tikkanen S, Kokkonen J, et al. Cow’s milk allergy is associated with recurrent otitis media during childhood. Acta Otolaryngol 1999;119:867–73.

9. Sanchez A, Reeser JL, Lau HS, et al. Role of sugars in human neutrophilic phagocytosis. Am J Clin Nutr 1973;26:1180–4.

10. Bernstein J, Alert S, Anus KM, Suspend R. Depression of lymphocyte transformation following oral glucose ingestion. Am J Clin Nutr 1977;30:613 [abstract].

11. Uhari M, Kontiokari T, Koskela M, Niemela M. Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ 1996;313:1180–4.

12. Uhari M, Kontiokari T, Niemela M. A novel use of xylitol sugar in preventing acute otitis media. Pediatr 1998;102:879–84.

13. Ethel RA, Pattishall EN, Haley NJ, et al. Passive smoking and middle ear effusion among children in day care. Pediatr 1992;90:228–32.

14. Ross A, Collins M, Sanders C. Upper respiratory tract infection in children, domestic temperatures, and humidity. J Epidemiol Community Health 1990;44:142–6.

15. Jackson JM, Mourino AP. Pacifier use and otitis media in infants twelve months of age or younger. Pediatr Dent 1999;21:256–61.

16. Niemela M, Uhari M, Hannuksela A. Pacifiers and dental structure as risk factors for otitis media. Int J Pediatr Otorhinolaryngol 1994;29:121–7.

17. Niemela M, Uhari M, Mottonen M. A pacifier increases the risk of recurrent acute otitis media in children in daycare centers. Pediatrics 1995;96:884–8.

18. Leibovitz B, Siegel BV. Ascorbic acid, neutrophil function, and the immune response. Int J Vitam Nutr Res 1978;48:159–64.

19. Vojdani A, Ghoneum M. In vivo effect of ascorbic acid on enhancement of human natural killer cell activity. Nutr Res 1993;13:753–64.

20. Duchateau J, Delespesse G, Vereecke P. Influence of oral zinc supplementation on the lymphocyte response to mitogens of normal subjects. Am J Clin Nutr 1981;34:88–93.

21. Fraker PJ, Gershwin ME, Good RA, Prasad A. Interrelationships between zinc and immune function. Fed Proc 1986;45:1474–9.

22. Brown DJ. Herbal Prescriptions for Better Health. Rocklin, CA: Prima Publishing, 1996, 213–4 [review].

23. Schilcher H. Phytotherapy in Paediatrics: Handbook for Physicians and Pharmacists. Stuttgart: Medpharm Scientific Publishers, 1997, 43–5.

24. Weiss RF. Herbal Medicine. Gothenburg, Sweden: Ab Arcanum and Beaconsfield, UK: Beaconsfield Publishers, 1985, 227–8.