In January of 2010 a beautiful little 4 year old little girl named Raegan presented to my office. Her parents brought her in out of desperation. She had been dealing with chronic, recurring ear infections since she was a baby. It was always worse during the winter months when it was not uncommon for her to go on multiple rounds of antibiotics in an effort to ease her pain. This time her pediatrician was recommending myringotomy, a surgical procedure in which she would be put under general anesthesia and a small incision would be made in the eardrums. Tympanostomy tubes would then be inserted which would allow fluid to drain from the middle ear space into the ear canal and and prevent future ear infections. The tubes would stay in place until they fell out on their own. If the fluid and infections returned, another surgery would have to be scheduled. Raegan's parents wanted another option.
The diagnosis of otitis media is made based on the finding of an inflamed and bulging tympanic membrane (ear drum). The cause of the problem, however, is not as easily identified. Inflammation and fluid behind the eardrum may be due to bacterial invasion, but can also be due much more commonly to viral infection or even allergic reaction. This helps to explain why antibiotics are not always effective in the treatment of otitis media since viruses and allergies are unaffected by this form of treatment. The fluid that builds up behind the eardrum creates a rich medium for an infection to take hold in.
Fluid build-up in the middle ear from any of these causes may be responsible for the eventual rupture of the tympanic membrane. For this reason, the medical procedure of myringotomy is recommended when repeated antibiotic regimens don't work. The problem with myringotomy is that it does nothing for the actual cause of the fluid build up, it just allows the fluid to drain out of the middle ear which diminishes the chances of establishing an infection. After the tube falls out, the incision heals with scar tissue. Scar tissue does not have the same flexibility as the original tissue of the tympanic membrane. This loss of flexibility can lead to high frequency hearing loss, especially in those patients that have had repeated procedures.
The chiropractic management of otitis media is based on two models. First, a muscle called the tensor veli palatini plays a very important role in the proper functioning of the middle ear. It is responsible for the opening of the eustachian tube which connects the middle ear space to the back of the throat. This tube is the one you pop open when you yawn during altitude changes to equalize the pressure in your ears. This little muscle can lose its ability to do its job when the nerve that feeds it is irritated by structural problems in the cervical spine (the neck). Structural problems in the neck can occur in children as early as the birthing process or later as they learn to walk and, of course, fall. When the eustachian tube fails to open properly, fluid can build up in the space behind the eardrum (which normally is an air space) and contribute to the onset of an infection, viral or bacterial.
The second aspect of the chiropractic model has to do with the lymphatic drainage of the cervical and ear regions.Structural problems in the cervical region can cause restriction of the muscles in the side of the neck. Tight, restricted muscles can reduce the flow of the lymphatic system contributing to the build up of fluid in the area. The swollen cervical lymph nodes can often be felt from behind the ear, along the side of the neck towards the collarbone like a "string of pearls".
A chiropractor trained in the special needs of children can easily identify the structural problems in the cervical spine which include vertebrae that are out of alignment or stuck and fixated, tight muscles, irritated nerves and swollen cervical lymph nodes. Gentle cervical adjustments and lymphatic drainage massage techniques can be utilized to restore normal position and movement of the vertebrae, reduce irritation to the nerves and improve lymphatic drainage. When all of these are accomplished, there is much less likelihood that fluid will build up and set the stage for infectious processes to occur.
After explaining the chiropractic approach to treating otitis media, I started working with Raegan and after just 2 visits the fluid which had been constantly present behind her eardrums was cleared out. She made it through the rest of the winter without another ear infection! Her mother rushed her to the office at the first sign of any sniffle or cough for fear that the ear infection would be right behind. The infections never returned. Even as this year's cold and flu season began and is now in full swing, Raegan is still free of any ear infections. In fact, this year she's had no coughs or colds either! When Raegan comes to see me for her regular check-ups she still gives me big smiles and hugs of thanks (her parents do too!)