Treating Otitis Media in Children and Infants Suzanne Catty, RNHP, CAHP, CR, BA, author

Abstract:
Otitis media (OM) or middle ear infection, is a common condition in children and infants and can manifest from birth, with the peak incidence of infections occurring in children aged 3-18 months. The standard medical approach is antibiotics. In some cases a topical cortisone cream or cortisone/corticosteroid eardrops may also be used for pain and inflammation amelioration.

Four bacteria, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes, are responsible for the bulk of OM infections in children over 6 weeks of age. Other bacteria that may cause OM or cause secondary infections in tissue affected by OM include Staphylococcus aureus, Streptococcus viridans, and Pseudomonas aeruginosa.

In the wholistic treatment of OM in children we will look for causes, predisposing factors, and health history of both child and family. The World Health Organization (WHO) has reports on OM in a number of countries and different ethnic as well as socioeconomic populations. WHO data has suggested that OM is a disease of poverty and suggest that a Chronic Suppurative Otitis Media (CSOM) rate of greater than 4% in a defined population of children is indicative of a massive public health problem requiring urgent attention but when we consider that current estimates of CSOM infection in children in the USA is 48% of children by 6 months of age and 98% of children by 2 years of age, we must acknowledge that we have a global problem that traverses any distinction of ethnicity, class, or economic status. This problem is compounded by the anti-biotic resistance of many of the involved pathogens, the knowledge that combinations of virii and bacteria are commonly present, and the frequency of reoccurrence especially in children at day-care facilities.

Of the four bacteria that are found most frequently, two are gram-positive and two are gram-negative making the choice of antibiotics or, in this case, essential oils, more difficult. Many doctors will now prescribe two or more antibiotics for sequential administration to effect the complete eradication of the involved pathogens. However, few doctors will also suggest that pro-biotic treatment is undertaken following anti-biotic treatment and there is plenty of evidence from numerous sources to show that re-population of the body with healthy flora is vitally important to the proper functioning of the immune system and one must wonder what role extensive anti-biotic treatment has in creating an environment that allows the reoccurrence of OM in treated children. Current estimates from the CDC suggest that S. pneumonia alone causes at least 7,000,000 cases of OM in children each year. That is only one of the four most common bacterial causes.

CAUSES
OM can occur anytime after birth and The Merck Manual lists the peak age range as 6-18 months of age. The symptoms can include pain, inflammation of the tympanic membrane and ear canal, fever, nausea, vomiting, lethargy and infections of the upper respiratory tract (URTI’s). For an infant aged 6 months or less this is a painful experience and the quick amelioration of symptoms will be of prime concern.

URTI’s are a common cause of OM and the development of nose, throat or chest infections in young children should be watched and treated so as to avoid the spread of infection to the ear. If there are several children in the household, or if the child attends day-care where coughs, colds and other infections spread rapidly through the group, prophylactic treatment may be used. In the family, keeping family members with URTI’s away from close contact with predisposed children may also help prevent the spread of infection. Aerial diffusion of essential oils in the house offers an excellent environmental prophylaxis and treatment option. Streptococcus pneumonia and Haemophilus influenza are the most common causes of sinus and chest infections as well as being the most commonly found bacteria in OM cases.

Breast milk also plays an interesting role in OM. While some studies show that exclusively breast-feeding up to 6 months of age reduces the likelihood of OM (and other infections) by the support and building of the immune system, I have recently encountered a number of practitioners and doctors who feel as though breast-milk that remains in the infants mouth after feeding and when the infant falls asleep may be implicated in the cause of OM. The theory is that the sugar and protein rich breast-milk remaining in the child’s mouth may drain into the Eustachian tube on the side of the head on which the infant is sleeping, creating a warm, rich environment for bacteria to flourish. While this is certainly possible I believe that the presence of breast milk in the mouth, nasal passage, throat or Eustachian tube would only be problematic if the bacteria were already present in the body, the breast-milk then offering the final element necessary for infection to manifest. Breast-milk is naturally anti-biotic and I have known mother’s who put breast-milk in their infants eyes, nose and ears to clear up infections, all of which worked remarkably well, so implicating breast-milk as a causative agent seems counter evidential.

Family health history and environment will certainly be a factor. Streptococcus and Staphylococcus can live in the body for long periods, forever in some cases. Any member of the family with a history of chronic sinus infections, URTI’s, OM, boils or other infections related to the long-term presence of bacterial pathogens should be considered a possible source for OM in infants and children. Treatment of all family members can be undertaken with essential oil therapy without the use of pharmaceutical antibiotics, and in a manner that is pleasant and relatively easy to facilitate. The use of an aerial diffuser and the addition of essential oils to cleaning products can go along way to creating a relatively pathogen-free environment both in vivo and in enviro. Additionally the use of a diffuser allows essential oils of a more broad-spectrum anti-infectious nature to be used than one can apply to children, especially infants.

TREATMENTS
The first problem that most practitioners will deal with in cases of OM in children is one of a philosophical nature. Virtually every book, teacher, and course in the use of aromatics for healing begins with the dictate that you must never use essential oils on children. That puts the bulk of practitioners in a quandary from which there is no escape. However, as someone who has used essential oils and hydrosols on children from birth, for over a decade of practice I can assure you that much of the warning are based on repetition and theory not practice. I can also assure you that the dozens of aroma-kids out there have taught me that children can self-medicate and have a deeper understanding of the physiologic effect of essential oils and hydrosols than do virtually all adults. Children do not need to overcome rules, they only need to overcome what ails them and even before they are verbal they will clearly direct practitioners and parents in their treatment if we are willing to pay attention. The same is also true for animals.

Because the symptoms of OM can differ so widely it is necessary for the person who will be treating the child, usually the parent, to monitor symptoms and pay attention to what ameliorates and what aggravates the condition. For instance the application of a compress to the external ear and temporal/mandibular areas of the skull can offer great relief form pain, swelling and inflammation and also facilitate the draining of fluid and infection. However in some children the application of a cool compress will help and for other children a warm compress will help. Attention must be paid to ensure that treatment offers benefits but again the child will usually be quite clear about what works and doesn’t work.

In all cases of OM in children and infants the primary oil and hydrosol for topical treatment has been Monarda fistulosa (Purple Bee Balm, Bee Balm). M. fistulosa is just one of several Monarda’s that produce essential oil and hydrosol. M. didyma, and M. citriodora contain high levels of carvacrol (up to 35%) and moderate levels of thymol (10-15%) and are far too aggressive for pediatric use. M. fistulosa on the other hand contains a well-balanced mix of monoterpene alcohols, primarily gernaiol (up to 92%), and linalool, as well as monoterpenes and sesquiterpenes. In French clinical aromatherapy the most common choice for pediatric use is Thymus vulgaris CT thujanol (Thyme thujanol) and I have explored this option but my own clinical experience has shown Thyme thujanol more effective in teens and adults than in children and infants and I wonder if changes in body chemistry make this oil more effective after puberty.

For aerial use in the environment there are a range of essential oils that can be used in a number of ways. Unlike commercial anti-bacterial soaps and cleaning agents or air-purifiers, essential oils are known to target pathogenic bacteria and virii and to leave non-pathogenic or healthy flora unaffected. Oils like Melaleuca alternifolia and M. quinquinervia (Tea Tree and Niaouli), Eucalyptus radiata (Narrow leaf peppermint eucalyptus), Cymbopogon martinii (Palmarosa), Cinnamomum camphora (Ravansara), Thymus satureioides (Moroccan Thyme), Citrus limonum (Lemon), Eugenia caryophylla (Clove), and Cinnamomum zeylanicum (Cinnamon leaf and bark) are all useful, attractive smelling, broad spectrum anti-infectious agents that can be used to create a healthy environment and reduce the transfer of infections between people. The Melaleucas and palmarosa make good additions to dish and clothes washing solutions, lemon, cinnamon leaf and thyme can be used around the house for cleaning surfaces and any combination of these oils can be used in a diffuser to effect aerial disinfection. Pay attention to the ratio of stimulating oils to relaxing oils in the blend when there are children in the house, sleep is an important element in the healing process and oils like cinnamon and clove may be so stimulating to children that they make sleep difficult.

CASES
These cases represent just a few of the incidences of OM that I have treated in adults, children and animals.

Case 1- a six-month old infant girl who had her third case of OM. Her mother is a practitioner of cranial-sacral (Upledger), reiki and massage therapies with a good understanding of wholistic health. The parents had removed all carpeting from the home after the second ear infection to reduce the chance of allergy involvement and bacteria harboured in the carpet matrix. The child was being breast-fed but at six months was also receiving supplemental nutrition in the form of a goats-milk baby formula. Cow’s milk products had been avoided completely in case of sensitivity. The OM was doctor diagnosed in all three cases and anti-biotic treatment had been used for the first two infections. The case was referred to me after the third diagnosis but before treatment was undertaken.

The essential oil of M. fistulosa was used in applications to the plantar surface of the child’s feet and in hot water aerial diffusion in the child’s bedroom.

One drop of M. fistulosa was applied undiluted to the index finger of the mother’s hand; the oil was then applied to the solar plexus and lung reflex points of the foot. Care was taken to apply the oil when the child was asleep or being put down for a nap so as to remove the chance that the child would then play with her feet, touching the oil and then getting that oil near her eyes or face. If the oil was used when the child was awake or playing then sock and/or shoes were put on her, again to avoid getting the oils in her eyes. I do not dilute the essential oil in carrier oil for two reasons, first there is sufficient data to show that many carrier oils act as antagonists, slowing or preventing the cutaneous absorption of the oils and interfering with their anti-infectious activity and second, essential oils are volatile and so will both evaporate and be absorbed leaving no residue on the skin, thus it is far less likely that a child will come into contact in an inappropriate manner with undiluted oils whereas, diluted oils and the carrier oil can easily spread to many surfaces where they can be contacted at a later time.

One drop of oil was used t.i.d. for the first 3 days and then b.i.d. for 4 more days. Virtually all signs of the infection resolved within the first 3-4 days of treatment.

Additionally the protocol included the use of hot water diffusion. I prefer hot water to an electric diffuser in an infant or young child’s room as the odour intensity of the diffuser is too intense. A bowl of hand hot water is taken into the child’s room and placed in a location where the child cannot reach it. One to three drops of M. fistulosa is placed on the surface of the water and the bowl is left in the room for 5-10 minutes. My usual rule of thumb is to add the oils, leave the room and return in 3-5 minutes and if you can smell the oil then you can remove the bowl of water, as there is sufficient oil in the air to have an effect.

This little girl is now just over two years of age and has not had an ear infection since using this protocol. Her mother has used M. fistulosa prophylactically during cold and flu season at day-care by applying it to her daughters feet each morning and has also used the oil at the first signs of any respiratory infections, coughs, colds etc and her daughter has been virtually illness free for more than 18 months.

Case 2 – A sixteen-month old girl with chronic otitis media for more then 6 months. Her parents had been advised that the girl’s condition required surgery to implant a drain into the ear to prevent the risk of deafness as the infection was so chronic. Several rounds of antibiotics had been used including back-to-back anti-biotic treatments but to no lasting effect as the infection always returned within 3-5 days after the cessation of anti-biotic treatment.

There was heat and redness in the tissue behind the ear, swelling of the lymph nodes in the neck and jaw and the child cried and complained of the pain much of the time. As the child was somewhat verbal she was able to communicate the symptoms of heat and pain.

The child was eating a fairly standard North American diet that included a lot of wheat products like pasta and bread as well as cow’s milk and a soy-based beverage. I suggested that all wheat, soy and cow’s milk dairy products except yogurt be removed from the child’s diet at least until the infection cleared up and that they be added back to the diet, one at a time, in order to determine if the child had any allergies or sensitivities to these products that could have exacerbated her condition. Unfortunately as the parents did not return with the child I don’t know if they followed the dietary advice.

Again the essential oil of M. fistulosa was used in undiluted topical applications to the planter surface of the feet across the solar plexus, chest and ear/nose/throat reflex points. One drop applied t.i.d. for one week and then b.i.d. until all symptoms had cleared up and remained clear for 3 days. To help ameliorate the symptoms of heat and pain in the ear and lymph nodes a cool compress of water and hydrosols of Achillea millefolium (Yarrow) and M. fistulosa was used. The hydrosols were combined 40/60 and then added to cool water at the rate of 2 tablespoon per soup-bowl of water. A small dish-cloth was used for the compress and the child could apply the compress and control its use on her own.

Interestingly the child began telling her mother when she wanted the compress or the oil after the second day of treatment. I received one phone call from the mother after the initial visit when she called to tell me of her daughter’s improvement, self-medication and that the child had asked for the oils in her bath and was this okay? I recommended the use of 1-2 drops of M. fistulosa added to 4 tablespoons of full-fat milk in an adult-size tub half-full of water.

Case 3 – A two year old girl with an acute case of OM. The mother is trained in the use of essential oils and is also a close friend of mine and the child has been exposed to essential oils and drinking hydrosols since birth. I received a phone call at 10 o’clock at night, the child had just fallen asleep after her mother resorted to the use of one baby aspirin after hours of crying and pain. The mother had tried candling her daughter’s ear but it caused pain for the child and she had stopped after just a few minutes, she had also tried squeezing garlic juice into the ear but again it caused her daughter great distress as the tissue in the ear canal was red and inflamed. I suggested Bee Balm but as she did not have any to hand we made a blend of tea tree, Thymus vulgaris linalool (Thyme linalool), and Lavendula x hybrida (Lavendin grosso), we also discussed using Picea mariana (Black Spruce) and Eucalyptus radiata as these were all oils she had at home. Two days later we spoke and she related using all the mentioned oils on the bottom of her daughters feet, using a maximum of one drop on each foot t.i.d. or q.i.d.. She also used oils in the diffuser and used E. radiata and Thyme linalool along the neck and jaw line to cool and drain the lymph. However at the end of the first day of treatment when the infection flared and was causing much pain she took matters into her own hands and made a formula of 10ml of organic olive oil with 3 drops of lavendin grosso, she then gently warmed the mix in hot water and put three drops of the blend in her daughters ear at bed time. The following morning when her daughter rolled over in bed, yellow pus and discharge poured out of the ear. The pain and inflammation cleared rapidly after that and she ceased all use of oils by the next afternoon.

I almost never recommend putting essential oils, hydrosols or anything into the ear canal as people are so prone to over-use thinking more is better, but ear drops are a traditional remedy and certainly have their place as this case illustrates.

Case 4 – a 9 year old boy with recurring OM since three years of age due to a blocked Eustachian tube. Medical diagnosis was treatment with antibiotics and the doctors also recommended surgery for the implantation of a drainage tube. The OM would appear every three to four months and would last from 7-10 days on average. His mother had come for a consultation regarding her congested lymph nodes, which was a recurring problem and I had recommended a protocol with Laurus nobilis (Bay laurel) hydrosol and oil. Having this oil at home she decided to use the bay on her son during his next bout of OM as he had a fever, pain and his lymph nodes were swollen due to the infection. She applied two drops undiluted to a warm compress, which was applied to the skin behind the ear and down the side of the neck, the pain and fever subsided within hours. The treatment was repeated next day and the infection cleared after the two applications. In the 18 months since this first treatment with bay he has had two slight flare-ups both of which have been prevented form developing into full-blown otitis by the immediate application of bay laurel oil.

In conclusion, the treatment of OM in infants and children with the careful use of essential oils offers treatment options as, if not more effective then standard anti-biotic treatment. M. fistulosa is a safe and contra-indication free oil for use on children and infants and has an attractive odour profile that children can feel comfortable around. The widely broadcast warnings against the use of essential oils on infants and children is certainly dramatically overstated and the advice should be rewritten to describe the judicious use of small amounts of selected essential oils for the treatment of specific health issues for short periods of time.

What is perhaps most important in the use of essential oils is the non-recurrence of the infections. In virtually every case the use of essential oils has not just cleared up the infection but has prevented any reoccurrence, even in those cases where the infection was chronic or had recurred on several occasions despite anti-biotic treatment. For this reason alone I would always use some form of essential oil treatment for otitis media even if standard medical / pharmaceutical treatment is also undertaken.

References:
WHO/CIBA Foundation Workshop. Prevention of hearing impairment from chronic otitis media. WHO/PDH/98.4. 1996. London, CIBA Foundation. 19-11-1996

Reichler MR, Allphin AA, Breiman RF, et al. The spread of multiply-resistant Streptococcus pneumoniae at a day care center in Ohio. J Infect Dis 1992;166:1346-53