Middle ear infections also known as otitis media is one of the most common childhood diseases and it is being diagnosed more and more each year. So why does this condition predominantly occur in infants and young children? Can it be managed without orthodox antibiotic therapy? And is osteopathic treatment beneficial and effective? What is the connection between osteopathy, children, and ear infections? Let me explain.
What is Otitis Media?
Otitis media is an acute inflammation of the middle ear, causing severe pain and conductive hearing loss. There have been many studies discussing the causes of otitis media. It is known to be multi-factorial including Eustachian tube (ET) dysfunction, viral or bacterial infection, and inflammation due to allergic rhinitis or other upper respiratory tract infections.
The middle ear is composed of three parts: the nasopharynx, the Eustachian tube, and the mastoid air cells. The Eustachian tube has three main physiological functions: it protects the middle ear from the pathogens of the nasopharynx, clears fluids from the middle ear and ventilates the middle ear to equalise surrounding pressures. The tube is usually closed but opens when yawning or swallowing, thus allowing fluid to drain and air to enter.
In children, this tube is smaller in both length and width and is directed more horizontallythan in adults, where it is orientated more downward. This aids in fluid drainage from the middle ear, hence fluid stagnation is more common in children.
How does Osteopathic Manual Therapy help?
Looking at this condition from an osteopathic point of view, there are many other factors, which could influence the development of otitis media in children. One of these is the normal physiological motion of the temporal bones, which move rhythmically into internal and external rotation. Restricted temporal motion in internal rotation blocks the Eustachian tube, which results in fluid accumulation in the middle ear predisposing to inflammation and infection. Such a cranial somatic dysfunction may be due to birth trauma or hypertonicity of the sterno-cleido-mastoid (SCM) muscle resulting from trauma, impaired mobility secondary to reduced diaphragmatic respiration or hyperirritability of the spinal accessory nerve.
The osteopathic approach to any dysfunction is to examine the patient as a whole, thus not only concentrating on the ear, but the complete body systems, especially the lymphatic and musculoskeletal systems. Specific structural findings commonly found in children with otitis media are internally rotated temporal bones as mentioned above, cranial strain patterns, ligamentous strain patterns, somatic dysfunction in the upper thoracic spine or ribs, and sacral dysfunction. The treatment plan should include releasing all of these restrictions with either cranial and myofascial release techniques or other osteopathic manipulative techniques.
The lymphatic system plays an important role in tissue health as it transports waste products away from the tissues allowing more nutrients into the tissues. Therefore, an increased lymphatic and venous drainage from the head and neck will decrease the inflammation and oedema in and around the middle ear, and will improve blood flow to the area promoting healing and repair. Lymphatic drainage can be achieved through specific techniques to the area, but also by decreasing cervical muscle hypertonicity with soft-tissue techniques, lymphatic pump and rib raising techniques. General mobilisation of the entire lymphatic system will reduce congestion and inflammation in the ears.
As the thoracic and cervical spines play such an important role in the management of otitis media, all factors need to be considered. Especially birth trauma involving the use of a forceps or ventouse may result in restrictions of the cervical spine and surrounding soft-tissue. Another important aspect is the viscero-somatic and the somato-visceral reflex. The cervical spine is connected to the organs via the Vagus nerve, the parasympathetic portion of the autonomic nervous system. The sympathetic portion is the nerves that link the organs to the thoracic spine. It is known that visceral irritation is able to cause spinal restrictions.
The overall result of treating all of these areas is an improved function of all body systems. A healthy environment (structure) ensures optimal function. Research has shown that osteopathic management is successful for most children with otitis media, and is of great benefit, especially as it decreases or prevents any surgical management and anti-biotic therapy, thus avoiding putting the child’s body under the stress of having to deal with scar tissue or drugs. Osteopathic treatment especially when combined with naturopathic treatment can affect many different systems of the body including the immune system, which enhances the body’s own healing powers. As children generally have a greater vitality than adults, they respond quicker and more effectively to treatment.
Natalie Patemean is a UK trained, and qualified osteopathic manual therapist and cranio-sacral therapist. She has completed a 4 year full-time course in osteopathy at the British College of Osteopathic Medicine in London (U.K.) followed by additional courses in cranial osteopathy, pediatric osteopathy and animal osteopathy.
- Kumar, P. & Clark, M. (2005). Clinical Medicine. 6th Ed. London: Elsevier Limited.
- Kuchera, W. & Kuchera, M. (1994). Osteopathic Princples in Practice. 2nd Ed. Ohio: Greyden Press.
- American Osteopathic Association (2003). Foundations for Osteopathic Medicine. 2nd Ed. USA: Lippincott Williams & Wilkins.
- Parson, J. & Marcer, N. (2005). Osteopathy – models for diagnosis, treatment and practice. London: Elsevier Churchill Livingstone.