Chiropractic and Ear Infections in kids

Factual Questions
1

I’ll start this by saying that I think chiropracters who say they can treat stuff like colds, asthma, etc. with manipulations are a bunch of hooey. Unfortunately (IMO), a mothers group I belong to is having a chiropracter come to speak about how she can treat ear infections in kids. From what I can find on the net, there have been a couple studies done by chiropracters that show great results from their treatment. What I can’t find is if there were control groups in the studies (how many kids out of 100 would get better without any treatment?), what their results are compared to conventional medicine and, basically, any challenging comment besides, “Yeah, studies were done, but results aren’t conclusive.” There are a lot of chiropractic sites that talk about the studies, but very few objective ones that I could find.

I’d like to be more knowledgeable about the subject so that I can ask some intelligent (polite) questions after the presentation and, if warranted, maybe help the “sales pitch” (which is what it is) not be quite so one-sided.

Can anyone help educate me?

2

A search of pubmed doesn’t turn up any studies with controls. There was just one controlled “feasibility study” with 20 patients that only reports that a full-scale randomly controlled trial could be done, but doesn’t say anything about actual results. There’s also a review article that looks at that study, plus others testing spinal manipulation for non-spinal ailments, and their conclusion was that there’s no evidence.

The review reference is: Ernst, E. Chiropractic manipulation for non-spinal pain–a systematic review.
N Z Med J. 2003 Aug 8;116(1179):U539. Review.

3

They already did a good double blind study. Chiropractic is useful for mild-moderate back pain. That’s it.

Any chiropractor that claims to cure ear infections is a quack.

Although they do have a tiny point- many times a childs minor ear infection goes away by itself.

4

I thought there were laws about practicing medicine without a license.

5

[QUOTE=DrDeth]
They already did a good double blind study. Chiropractic is useful for mild-moderate back pain. That’s it.

Any chiropractor that claims to cure ear infections is a quack.

Although they do have a tiny point- many times a childs minor ear infection goes away by itself.
[/QUOTE]

This is pretty much what I thought (and what I’ve read about chiropractic in general…at least from reputable sources). Any idea what the stats are for children’s recovery from ear infection without any treatment at all?

Now, I have to not be a wuss and ask this woman about what science she has to back up her claims. We’ll see if I get kicked out of the mothers group!

6

Thanks, cher3, for the name of that review. I’m going to read that this evening when I have a quiet house.

7

[QUOTE=C3]
This is pretty much what I thought (and what I’ve read about chiropractic in general…at least from reputable sources). Any idea what the stats are for children’s recovery from ear infection without any treatment at all?
!
[/QUOTE]

OK, prepare to have your Eyes glaze over. Do understand I am not an MD, and that “ear infection” is a very general term for several problems, but usually we are talking about “Acute otitis media”:

Some cites:

"*Contact your pediatrician if your child has any symptoms of an ear infection. Do not attempt to heal your child on your own with over-the-counter medications.

To treat a middle ear infection, your doctor may prescribe an antibiotic–usually amoxicillin. Be sure to stick to the prescribed dosage schedule, and complete the full course of treatment even if symptoms begin to subside. Stopping treatment too soon could allow the infection to take hold again. If after two days your child still has fever or ear pain, contact your pediatrician–a different antibiotic may need to be prescribed.

In addition to an antibiotic, your doctor may recommend a non-aspirin medication like acetaminophen or ear drops to alleviate pain. Don’t give your child aspirin, which has been linked with Reye syndrome, a disease that affects the liver and brain. For older kids, a pediatrician might suggest soothing pain by putting warm compresses against the ear or lessening pressure on the middle ear by keeping a child sitting up as much as possible. …Do Antibiotics Cure All Ear Infections? No. There are several types of ear infection. Most need antibiotics, but some do not. For instance, these drugs work for bacterial infections, but not viral infections. Doctors are concerned because indiscriminate use of antibiotics over the years has spawned new strains of bacteria that no longer respond to these life-saving drugs. The more antibiotics prescribed, the higher the chance that your child will be infected with resistant bacteria."*

http://aapnews.aappublications.org/cgi/content/abstract/9/5/22
*Child chiropractic care can lead to tragedy
TIMOTHY K. SMITH

A 5-year-old boy was delivered to the University of Iowa hospital last fall with a condition seldom seen since the advent of antibiotics: mastoiditis, an infection of the middle ear so advanced that it had invaded his skull.

A few days later, when doctors had got the infection under control, the boy’s 4-year-old sister was admitted with a similar crisis. Her mastoiditis was so severe that her face was partly paralyzed and pus was pressing against her brain.

Hospital officials, alarmed by the reappearance of a once-common childhood scourge, interviewed the parents and discovered that they had been using a chiropractor as the family’s primary-care doctor.
*

http://www.health.state.ny.us/nysdoh/antibiotic/4815.htm
*Until recently, all children with ear infections were given antibiotics. New research suggests that many children with ear infections will get better without antibiotics, and with no ill effects. This is called the “observation option.” This option reduces the use of unnecessary antibiotics, and limits the child’s exposure to the side effects of antibiotics. It also reduces the chance that “super bacteria” — bacteria that cannot be killed by antibiotics — will develop.

Your child’s health caregiver may offer this option if your child is over age 2, does not have pus draining from the ear, has not had an ear infection in more than three months, is otherwise healthy, and will have medical follow-up within 48 hours. If your health caregiver does not discuss it, you may want to ask if this is an option for your child.
*

But here is a study that may show that Chiropratic may possibly work:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8728460&dopt=Citation
CONCLUSION: Although there were several limitations to this study (mostly because of its retrospection but also, significantly, because very little data was found regarding the natural course of ear infections), this study’s data indicate that limitation of medical intervention and the addition of chiropractic care may decrease the symptoms of ear infection in young children.

Here’s another that sez it can be studied but with difficulty:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10395431&dopt=Citation
B*ACKGROUND: Pediatric otitis media with effusion is a common and costly condition. Although chiropractors have anecdotally claimed success in treating otitis media, there is little research to support their claims…CONCLUSION: Recruitment for a randomized controlled trial is feasible and could be enhanced by medical collaboration. Patients and parents are able and willing to participate in a study comparing active SMT and placebo SMT. Parents were extremely compliant with the daily diaries, suggesting that similar quality-of-life and functional status measures can be successfully used in a larger trial. We found the objective outcomes assessment involving tympanometry and otoscopy extremely challenging and should be performed by experienced examiners in future studies."
*

Here’s a study that read the above study but concluded it was not useful for AOM:
http://www.nzma.org.nz/journal/116-1179/539/
*Sawyer et al published a pilot study of spinal manipulation versus sham spinal manipulation for children with otitis media.22 The sham intervention involved manual handling of the spine for diagnostic purposes without the high-velocity thrust performed in the experimental group. The authors do not reveal any results that suggest real spinal manipulation to be superior to sham treatment. They do, however, state that controlled trials of sham spinal manipulation are feasible.
*

http://www.journals.uchicago.edu/JID/journal/issues/v184n4/010089/010089.text.html?erFrom=4110824470745046617Guest

Have fun.

8

From day one I’ve had problems with my ears. Tons of infections, eustation tube issues, surgey,. I’ve seen it all.

Not long ago I was in a car crash and I’ve been advised to see a chiropractor to help with my back and neck (which, after 7-8 sessions I’m considering stopping treatment because of increased pain - I’m going to see what my doctor thinks)

One thing I have noticed since starting chiropractic treatment is my left ear seems to pop by itself more than normal. The more it pops, the more it feels like the tube is staying open.

So, in my case, chiropractic treatments might help avoid an infection. But I’d never replace it for a trip to the doctor if my ear were infected.

9

Anyone have any speculation or data as to HOW chiropractics would help an ear infection?

I grew up with constant ear infections, then as a young adult was diagnosed with TMJD. Nowadays I can’t hardly tell an ear infection from TMJD symptoms.

Does the chiro adjust the kids jaw and hope that the kid is mistaking TMJD for an earache or something?

10

This gives a little overview of what they do. Apparently, they do adjustments to the cervical vertabrae (which are theoretically out of alignment due to the birthing process*) in order to take pressure off the eustachian tubes, thus allowing them to drain.

11

[QUOTE=C3]
This gives a little overview of what they do. Apparently, they do adjustments to the cervical vertabrae (which are theoretically out of alignment due to the birthing process*) in order to take pressure off the eustachian tubes, thus allowing them to drain.
[/QUOTE]

Is there any reliable medical evidence that supports the “theory of vertebral subluxations” used to justify these treatments?

12

My grandfather’s cure for ear infections, according to my dad- put kettle on. Roll up newspaper. Steam clean ear canal.

13

[QUOTE=Great Dave]
My grandfather’s cure for ear infections, according to my dad- put kettle on. Roll up newspaper. Steam clean ear canal.
[/QUOTE]

Wouldn’t that cause burns?

14

The rolled newspaper serves both as a mist delivery system and as a steam cooler. By the time it gets to the ear the steam is no longer a hot and invisible gas and has cooled to a warm mist.

15

When my daughter was little she had repeated ear infections. We tracked them, and she was on amoxycillin for 80% of the year. Our pediatrician said that the cause of these was that at her stage of growth the ear didn’t drain, letting fluid accumulate and fostering the growth of bacteria. She underwent the then common operation of having a tiny tube inserted so the fluid would drain, which did fix the problem. I’m not sure if this is still a recommended fix.

Given that, I don’t see how chiropractic could do any good.

16

[QUOTE=mks57]
Is there any reliable medical evidence that supports the “theory of vertebral subluxations” used to justify these treatments?
[/QUOTE]

No. It’s pure quackery.

Note that there is very little evidence that adjustments can *decrease the symptoms * of an ear infection, and none on how. My WAG is the “caring caregiver with a placebo”. A caregiver with a good bedside manner can make *you *want to get better to please them. There is also the fact that we have very little info on what AOM does when left on it’s own without treatment- from one of my cites below:“…*because very little data was found regarding the natural course of ear infections…”
*
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8728460&dopt=Citation
That study was not double blind and in fact had no contol at all, what’s worse is that the Parents were in charge of deciding whether or not their kids were better “OUTCOME MEASURE: Improvement was based on parental decision (they stated that the child had no fever, no signs of ear pain, and was totally asymptomatic),…”

Really it was a very bad study, but I included it for the sake of fairness.

17

[QUOTE=Voyager]
When my daughter was little she had repeated ear infections. We tracked them, and she was on amoxycillin for 80% of the year. Our pediatrician said that the cause of these was that at her stage of growth the ear didn’t drain, letting fluid accumulate and fostering the growth of bacteria. She underwent the then common operation of having a tiny tube inserted so the fluid would drain, which did fix the problem. I’m not sure if this is still a recommended fix.

Given that, I don’t see how chiropractic could do any good.
[/QUOTE]

Yes, the tubes are still common. My son had them about 5 years ago, and they worked well for us, too.

18

[QUOTE=C3]
This gives a little overview of what they do. Apparently, they do adjustments to the cervical vertabrae (which are theoretically out of alignment due to the birthing process*) in order to take pressure off the eustachian tubes, thus allowing them to drain.
[/QUOTE]
This is utter quackery.

There is no evidence that “the birthing process” causes any pathologic misalignment of cervical vertebrae (nonsensical claims about “birth trauma” are fundamental only to the ludicrous chiro practice of adjusting newborns). Even if there was a problem with cervical vertebrae, there’s no evidence chiro adjustments would affect it. Furthermore, any manual procedure on the cervical spine forceful enough to affect nerve function (shudder) would have no effect on the Eustachian tube.* Unfortunately, chiropractic claims and techniques resonate with parents leery of antibiotics and ear tubes. They sound gentler, even though they’re useless.

Ask the chiropractor speaking to the group (and the other moms) if they are willing to take responsibility for potential hearing loss and developmental delays
associated with inadequate treatment of ear infections. Ask her if an unproven treatment is worth the risk of stroke and paralysis (seen in a small number of neck manipulations).
*and if you really want to sandbag the chiro, ask her what nerves innervate the Eustachian tube, and how “adjusting” the neck would affect those nerves.

19

Further info on the risks involved in chiropractic cervical manipulation (“neck cracking”) for middle ear infections or any other reason: check out this recent article in Self magazine.