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By Jerry Hochman, D.C.

I want to share my experiences dealing with children with otitis media, and the successes that are likely under chiropractic care. I would like to convey information related to the mechanisms, whereby chiropractic care is likely to help these children.

I have observed many children with chronic or acute ear infections who have responded favorably to upper cervical and upper dorsal adjustments, and sometimes to S.O.T. cranial corrections. Sharing these observations may enable other practitioners to successfully help some children with ear infections.

My first experience with this problem came when a neighbor, who I had adjusted for headaches, brought her baby boy, age 6 months, to my home to see if I could do anything to keep him from having to get tubes in his ears.

Through evaluation, I determined he needed an atlas adjustment, which I gave with a thumb toggle. His mother reported that his ear infection completely cleared up by the next day. Tubes were never inserted.

In this informal case history, I describe events which occurred while I was adjusting two female children, ages 2 and 4 years, with chronic ear infections.

Both children exhibited indicators of upper respiratory dysfunction, both historically and on examination. Cervical, upper dorsal and cranial adjustments were applied in helping these cases. Chiropractic care was immediately successful, in that no more ear infections have occurred since the first visit.

The associated anatomy and physiology of the involved areas is discussed, as well as other aspects and treatments for this common childhood affliction.

Introduction

It is estimated that, by age 2, 33 percent of children have had three or more episodes of otitis media, and 66 percent have had at least one episode. Otitis media represents the single most common diagnosis made in practice after respiratory tract infection. In a general pediatric practice, 40-67 percent of children may be expected to have at least one episode of otitis media by their second birthday.

For these reasons, accurate diagnosis of otitis media is imperative. [1,2] The complications of acute otitis media and the morbidity associated with serous otitis media are often diagnostic and therapeutic dilemmas and contribute greatly to the health-care costs of children. [2]

Of kids with ear tubes, 75 percent will have another bout of ear infection with about nine months. [3]

Forty percent of OM cases have no bacterial or viral infection, just fluid buildup, but antibiotics are still routinely prescribed. [4] By some estimates, the incidence of OM is increasing, and antibiotic resistance may be partly responsible. [5]

Acute otitis media can cause earaches, hearing loss, fever, nausea and vomiting, and even diarrhea. On visual inspection, the tympanic membrane may appear bulged out, and pus or blood may be seen behind it. The cone of light often appears displaced. Serous otitis media shows retraction of the tympanic membrane, with the middle ear appearing amber-gray. The examiner may see an air-fluid level or bubbles through the membrane.

The medical treatment of otitis media consists primarily of antibiotics and ear tubes (tympanostomy tubes). Sometimes other drugs, such as ephedrine sulfate, are used and occasionally an incision in the eardrum is performed, without the insertion of tubes (myringotomy). Complications of untreated otitis media can result in mastoiditis, petrositis, facial paralysis, permanent hearing loss, intracranial meningitis, brain abscess, hydrocephalus or subdural empyema. [6]

Analysis and Adjustments

A mother brought her two daughters, ages 2 and 4, to my office for chiropractic care for chronic ear infections. Both had received numerous courses of antibiotics over at least two years, but they had shown no improvement. Their mother received a referral from a friend whose daughter had been relieved of chronic ear infections under my care. The mother did not want to continue either child on antibiotics, which had been medically recommended.

S.O.T. and Dynamic Spinal Analysis methods of chiropractic showed T3, C1 and temporal dysfunction in both children. C1 was adjusted with the Activator adjusting instrument; T3 was adjusted by hand using a Diversified approach; and the temporal bone was adjusted using sutural technique as taught in Sacro Occipital Technique.

After the first visit, the mother reported that both children were "doing much better." As of this report, I have seen both children four times, and no ear infections have been reported.

Analysis consisted of manual palpation, the use of S.O.T. palpatory indicators of trapezius and occipital fibers (Fig. 1 and Fig. 2 - trapezius and occipital fibers) and the use of challenge and leg checks from Dynamic Spinal Analysis. Adjustments were delivered by hand and utilizing the Activator adjusting instrument.

The parent noticed significant improvement in symptoms after the first visit, with no return of infections for three months following the first visit. Both girls have been adjusted six times over a three-month period. The younger girl continues to catch colds easily, and I have counseled the mother on replacing her large sugar intake with healthier alternatives.

Discussion

The Eustachian (auditory) tube runs from the anterior wall of the tympanic cavity, inferiorly and medially to the nasopharynx. The Eustachian tube lies more horizontally in children, due to incomplete cranial development, resulting in the nasopharynx and middle ear being closer vertically than in adults. The purpose of the Eustachian tube is to transmit atmospheric pressure to the inside of the tympanic membrane, thereby equalizing pressure on both sides of the membrane. Infections may travel from the throat to the middle ear through the Eustachian tube. [7] Fig. 2 - Eustachian Tube)

Proposed Mechanism

Various theories have been offered regarding the modus operandi of upper cervical results in a variety of diverse problems. Indeed, the amazing results obtained in strict upper cervical practices leave much room for explanation. This is definitely a case of, "We’re not sure how it works, but it sure does work."

Theories abound regarding the dentate ligament-cord distortion hypothesis, [8] the proximity of important neural ganglia to the atlas and axis, [9] and the Meric relationship of T3 to the lungs and respiratory system. The old Meric chart may be old, but it certainly appears to be as valid today as it was 100 years ago.

DeJarnette [10] found spasm of the trapezius and sternocleidomastoid (SCM) musculature to be easily palpable in certain discrete areas in the presence of subluxation of specific spinal segments, and especially when such subluxations were associated with an active viscero-somatic reflex subluxation.

Edelman and Fallon, in a study in 1997 and 1998, found that chiropractic care consisting of vertebral and occipital adjusting showed resolution of otitis media in most children studied, with objective changes shown by tympanography. [11,12]

Carol Phillips found that cranial compression and distraction might be implicated in otitis media, [13] and Hobbs and Rasmussen found that S.O.T. cranial work was effective in alleviating chronic otitis and hearing loss in an adult patient. [14]

This is a case history, not a controlled clinical study. It is, therefore, difficult to determine which segments were most responsible for the results obtained. In fact, the large intake of sugar by one of the patients may have been the major cause of the subluxation complex. I have found repeatedly that a purely mechanical approach to spinal dysfunction is often inadequate in obtaining the desired results clinically. This has forced me to incorporate nutritional protocol into my office procedures.

Leg Length Inequality Theories

In a small study by Brown and Hinson on supine leg length check reliability,[15] intra-class agreement among examiners was high, as was intra-examiner reliability. The pilot study indicates that functional leg length inequality is a stable clinical entity, showing great conservation across a variety of test conditions when the measuring apparatus is designed to optimize the detection of a functional short leg.

Cooperstein and Jansen, in two separate studies, showed that leg length analysis reliability is greatly enhanced by the use of a special table that reduces error created by friction between the patient and the table.[16,17] A study done on the Thompson leg checks in 1988 showed inter- and intra-observer reliability to less than 3mm. [18] Good agreement among examiners was indicated as well by significant intra-class correlation in two of the three possible examiner combinations. These results argue strongly for the reality of the leg length inequality phenomenon and also that it can be reliably measured. [19]

Manello, in a literature review in 1992, states that there is a lack of agreement about the incidence, classification and clinical significance of leg checks, and that much work needs to be done to establish reliability. [20]

Sutural Ranges of Motion

In a study of parietal bone mobility, it was found that head compression caused closure of the sagittal suture and changes in intraventricular pressure. [21] Adams and Heisey, using a cranial motion measuring device, were able to establish cranial sutural motion. [22]

Conclusion

My assumptions are that:

1. Chiropractic care can control ear infections in some children;

2. Temporal bone fixation may be an issue in otitis media; and

3. C1, C2 and T3 are often to be found by independent chiropractic indicator systems in the presence of ear infections or respiratory difficulties.

Many children and some adults suffer from acute or chronic ear infections, with or without serous fluid. The medical treatment has been shown, by medical research, to be limited.

Clinical chiropractic findings have shown cervical adjusting to be effective in many medically non-responsive cases. The use of cranial mobilization techniques is promising and further studies are warranted. A comparison of results using cervical adjusting only, cranial adjusting only, cervical and cranial adjusting, upper dorsal adjusting and upper dorsal adjusting combined with cervical and cervical/cranial adjusting may be worthwhile.

About the author: Jerry Hochman, D.C., has taught chiropractic for 17 years and has been in private practice for 18 years. He is vice president of the Sacro Occipital Research Society International (SORSI), and he has developed and taught Dynamic Spinal Analysis for four years. He can be reached by E-mail at jhochman@life.edu.

References

1. Hendricks C.L., Larkin-Their, S.M., "Otitis Media in Young Children," Chiropractic, 1989; 2(1):9-13.

2. Musci, M., Santucci, T., "Pneumatic Otoscopy in the Diagnosis of Otitis Media," Osteopathic Annals, Aug., 1982, 10(8):55-59.

3. Hendricks, C.L., Larkin-Their, S.M., "Otitis Media in Young Children," Chiropractic, 1989; 2(1):9-13.

4. Van Cauwenberg, P., "The Long-Term Results of the Treatment With Transtympanic Ventilation Tubes in Children With Chronic Secretory Otitis Media," Int J Pediatr Otorhinolaryngol, 1979; 1:109-116.

5. McCaig, L.F., Hughs, J.M., "Trends in Antimicrobial Drug Prescribing Among Office-Based Physicians in the United States," JAMA 1995; 273:214-219.

6. Merck Manual Online, http://www.merck.com/pubs/mmanual.

7. Tortora, G.J., Anagnostakos, N.P., Principles of Anatomy and Physiology, 5th ed., New York: Harper and Row, 1987.

8. Grostic, J., "Dentate Ligament-Cord Distortion Hypothesis," Chiropractic Research Journal, 1988, 1(1):47-55.

9. Snell, R.S., Clinical Anatomy for Medical Students, 3rd ed., Boston: Little, Brown and Co., 1986, pp. 843-852.

10. DeJarnette, M.B., Sacro Occipital Technique 1981, Major Bertrand DeJarnette, D.C., Nebraska City, Neb., pp. 417 and 427.

11. Edelman, M.J., Fallon, J., "Chiropractic Care of 401 Children With Otitis Media: A Pilot Study," Alternative Therapies In Health and Medicine, March, 1998, 4(2):93.

12. Fallon, J.M., "The Role of the Chiropractic Adjustment in the Care and Treatment of 332 Children with Otitis Media," Journal of Clinical Chiropractic Pediatrics, Oct., 1997, 2(2): 167-183.

13. Phillips, C., "Chiropractic and Pediatrics: Cranial Compression and Distraction – A Possible Implication in Otitis Media," Proceedings of the International Conference on Spinal Manipulation, June, 1994, pp. 136-139 .

14. Hobbs, D., Rasmussen, S., "Chronic Otitis Media: A Case Report," Journal of Chiropractic Technique, Feb., 1991, 28(2):67-68.

15. Brown, S.H., Hinson, R., "Supine Leg Length Differential Estimation: An Inter- and Intra-Examiner Reliability Study," Chiropractic Research Journal, Spring, 1998, 1:17-22.

16. Cooperstein, R., Jansen, R., "Technology Description: The Friction-Reduced Segmented Table," Chiropractic Technique, Aug., 1996, 8(3):107-111.

17. Bricker, D., Cooperstein, R., Jansen, R., "Confirmation of Leg Length Inequality as a Stable, Objectively-Measured Entity: The Construction and Implementation of a Friction-Reduced, Segmented Table," Conference Proceedings of the Chiropractic Centennial, July, 1995, pp. 325-326.

18. Fanselow, D., Anselow, D., Sclafani, L., Shambaugh, P.; "Reliability of the Derifield-Thompson Test for Leg Length Inequality, and Use of the Test to Demonstrate Cervical Adjusting Efficacy," Journal of Manipulative and Physiological Therapeutics, Oct., 1988, 11(5):396-399.

19. Deboer, K., Harmon, R., Savoie, S., Tuttle, C., "Inter- and Intra-examiner Reliability of Leg-Length Differential Measurement: A Preliminary Study," Journal of Manipulative and Physiological Therapeutics, June, 1983, 6(2):61-66.

20. Mannello, D., "Leg Length Inequality," Journal of Manipulative and Physiological Therapeutics Nov. 15, 1992; 15(9):576-590.

21. Adams, T., Briner, B., Heisey, R., Smith, M., "Parietal Bone Mobility in the Anesthetized Cat," Journal of American Osteopathic Assn., May, 1992, 92(5): 599-622.

22. Adams, T., Heisey, S., "Effect of Cranial Bone Mobility on Cranial Compliance," Journal of American Osteopathic Assn., Oct., 1992, 92(10):1284.