Otitis media is an infection of the middle ear, the area just behind the eardrum. It happens when the eustachian tubes, which drain fluid and bacteria from the middle ear out to the throat, become blocked. Otitis media is common in infants and children, because their immune systems are immature and their eustachian tubes are easily clogged. It is important that children with otitis media be seen by a health care provider, because there can be serious complications if the infection is left untreated.

Acute otitis media causes pain, fever, difficulty in hearing, and general signs of illness such as vomiting and diarrhea. In infants, the clearest sign of otitis media is often incessant crying.

Blockage of the eustachian tubes may be caused by the following.

• Respiratory infection
• Allergies
• Tobacco smoke or other environmental irritants
• Infected or overgrown adenoids
• Sudden increase in pressure (such as during an airplane landing)
• Drinking while lying on the back, such as with a propped bottle
• Excess mucus and saliva produced during teething

Otitis media appears most frequently in the winter. It is not contagious in itself, but a cold may spread among a group of children and cause some of them to get ear infections.

Your health care provider will use an otoscope to examine your child's eardrums, and look for signs of infection.

Antibiotics are generally prescribed to be taken for a week to 10 days, and it is essential that the instructions be followed carefully and that the entire course be completed in order to avoid a relapse. For acute otitits media, first-line treatment is amoxicillin (500 mg orally four times daily for 7 to 10 days), or azithromycin if penicillin allergy is present. Second-line treatment is amoxicillin-clavulanate (500 mg orally four times daily for 7 to 10 days) or cefuroxime axetil (500 mg orally twice daily for 7 to 10 days). Children can also be given acetaminophen or ibuprofen to relieve the pain.

If there is fluid in the middle ear and the condition persists, even with antibiotic treatment, a healthcare provider may recommend the insertion of typanostomy tubes. In this procedure, a tiny tube is inserted into the eardrum, keeping open a small hole through which fluids can drain to the outside. Tympanostomy tube insertion is a 10 to 15-minute procedure done under general anesthesia. Usually the tubes fall out by themselves or are removed in your provider's office.

Eliminate food allergens from the diet. Common allergenic foods are dairy products, soy, citrus, peanuts, wheat, fish, eggs, corn, tomatoes.

Essential fatty acids reduce swelling and help the immune system function. Children should be supplemented with cod liver oil or other fish oils (¹/2 to 1 tsp. per day). Vitamin C (250 to 500 mg two times per day) enhances immunity and decreases inflammation. Vitamin C from rose hips or palmitate is citrus-free and hypoallergenic.

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

Herbal eardrops may be effective at reducing infection, pain, and fluid accumulation. Do not use eardrops if your provider suspects perforation of the eardrum. An ear oil from mullein (Verbascum densiflorum) and garlic (Allium sativum) can reduce pain and treat the infection. For otitis with pain, include one of the following oils: St. John's wort (Hypericum perforatum), Indian tobacco (Lobelia inflata), or monkshood (Aconitum napellus). Place 3 to 5 drops in the ear two to four times per day. Monkshood is toxic if taken internally.

Coneflower (Echinacea angustifolia, purpurea, and pallida) may be taken internally as tincture or glycerite, 20 drops three to four times a day. The following herbs also may be taken internally: eyebright (Euphrasia officinalis), cleavers (Galium aparine), marigold (Calendula officinalis), and elderberry (Sambucus nigra) combined in a tea (2 to 4 oz. three times a day), tincture (10 to 20 drops three times a day), or glycerite (20 drops three times a day).

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of ear infections based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Aconitum -- for throbbing ear pain that comes on suddenly after exposure to cold or wind; and in children with high fever and whose ears have a bright red coloring�
• Belladonna -- for sudden onset of infection with piercing pain that often spreads to the neck, flushed face including reddened ears, agitation (even impaired consciousness and nightmares), wide-eyed stare, high fever, and swollen glands; this remedy is most appropriate for children who feel relief when sitting upright and from warm compresses to the ear; this remedy should not be used in children whose symptoms have persisted for more than 3 days
• Chamomilla -- for intense ear pain and extreme irritability and anger (including screaming); this remedy is most appropriate for children who are difficult to comfort unless being rocked or carried by a person who is walking back and forth
• Pulsatilla -- for infection following exposure to cold or damp weather; the ear is often red and may have a yellowish/greenish discharge; ear pain worsens in warm bed and is relieved somewhat by cool compresses; this remedy is most appropriate for children who tend to be gentle, weepy, and mildly whiny and are easily soothed by affection
• Hepar Sulphuricum -- for sharp pains and a smelly, yellowish-green discharge that occur in the middle and late stages of an ear infection, particularly when the child is extremely moody and clearly angry; this remedy is most appropriate for individuals whose symptoms are worsened by cold air and improved by warmth

A hot pack applied to the ear and side of the neck may relieve pain. Blanch half an onion, wrap in cheesecloth, and apply to your child's ear while it is still hot (be sure it has cooled enough to not burn the skin). The sulfur bonds in the onion will be soothing. May also use a hot water bottle or a sock filled with raw rice and heated.

Chiropractors report and preliminary evidence suggests that spinal manipulation may benefit some children with otitis media. In one study involving 315 children with otitis media, a total of five spinal manipulations significantly improved symptoms after 11 days.

Gentle massaging of the neck may assist lymph flow, which may speed healing.

Let your health care provider know if your child's ear infection does not improve within 24 to 48 hours.

You can reduce your child's risk of ear infection by reducing his or her exposure to respiratory infections and tobacco smoke. For children who are old enough to chew gum, xylitol-sweetened gum has been shown to lessen the frequency of ear infections as well as dental cavities.

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