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Childhood Ear Infections

by Richard Moskowitz, M.D.

Adapted from a lecture presented at the 150th Anniversary of the foundation of the American Institute of Homeopathy, St. Moritz Hotel, New York, April 9, 1994, and published in the Journal of the American Institute of Homeopathy 87:137, Autumn 1994.

       Otitis media has become the commonest pediatric diagnosis made by physicians who care for children in the United States, [note 1] with an annual budget topping $2 billion in 1982, [note 2] and no relief in sight. After decades of punishing warfare against the nasopharyngeal bacteria, several medical journal articles have recently begun to question the safety and effectiveness of antibiotics and tympanostomy and the wisdom of continuing the purely military strategy based on them. [notes 3, 4, 5]

       The present impasse creates the opportunity and the obligation for anyone with a better idea to share it with the medical community and the general public. Nobody need take my word for it that homeopathic remedies are inexpensive, nontoxic, and effective even in advanced cases, or that parents, children, and their caregivers deeply appreciate the non-invasive philosophy governing their use. I will feel generously rewarded if more laypeople and professionals will only try them and see for them-selves.

       The following cases of childhood ear infections are intended to show how the homeopathic viewpoint can assist both clinically, in the diagnosis and treatment of these all-too-common ailments, and in the design of experimental research into the causal factors that promote and influence them.

       The cases that I have chosen are noteworthy not for any particular skill in choosing the correct medicine, but in precisely the opposite sense, that excellent results are regularly attainable with common remedies and case-taking methods already well known to the serious student. Indeed, the exemplary success of homeopathic remedies in treating such children is itself an important clue to the mystery of pediatric otitis media in our time.

       Case 1. C. Z., a girl of 3, had had recurrent ear infections since the age of 5 or 6 months, typically associated with colds and the production of thick, green mucus, and requiring antibiotics more or less continuously for several months at a time. With no fever and at most a slight earache, she often became irritable and cranky as the cold ended, when the pediatrician often made the diagnosis by otoscope. Apart from mild eczema, the child was seldom ill other-wise, and rarely had the fevers or acute illnesses to be expected at her age. A strapping 8 lb. at birth, she fell short of 16 lb. at 1 year and had remained small for her age. Teething was late, painful, and difficult. She had had all the usual vaccines with no acute reaction.

       I chose Calcarea Sulph.. 200, and two months later her mother reported the best winter ever, with no ear infections and two light colds that were quickly aborted with Calc. Sulph. 12C. I next saw her a year later, several weeks after an acute episode of wheezing in the middle of a cold, for which Pulsatilla 30X prescribed over the phone had worked splendidly. But though she had been free of ear infections in all that time, she had had a fever or two and was still plagued by quantities of thick greenish-yellow phlegm in her nose and throat. After one dose of Sulphur 200, she never came back. When I called recently, over five years later, in preparation for this talk, her mother told me that she had had no more ear infections, and there was no need to bring her back, since her general health had remained good, and the usual first-aid remedies had been very effective for the usual colds, fevers, and URI's that had developed along the way.

       I want to add a few comments about this rather typical case. First, as I reread it now, I doubt that either Calc. Sulph. or Sulphur was the best remedy for this patient, since she was on the chilly side, and even after treatment she continued to produce thick green phlegm and be subject to rather frequent colds. I can't really defend or explain either prescription at this point. Yet her mother was more than satisfied. The ear infections disappeared and never came back, the long-term or constitutional issues stayed in the background, and the remedies she herself came up with continued to help without further assistance.

       Notwithstanding the small remedies and "cured" cases that we like to parade at our conferences, I must admit that the bulk of my reputation is built on stories as generic and unspectacular as this one. I feel deeply grateful to a method that adds feathers to my cap even when I bumble or fall short.

       Second, my experience confirms numerous reports in the European literature that most kids eventually outgrow their ear infections anyway, if simply allowed to do so without further allopathic interference. [note 6]

       Case 2. K. G.-S., a boy of 16 months, had already had five ear infections and five rounds of antibiotics when I first saw him. Only the first episode at six months was associated with fever (102.8 F.) and acute earache, which subsided promptly once the eardrum had perforated and discharged the pus that had accumulated behind it. Although weighing 7 lb. and appearing normal and healthy at birth, he was slow to nurse, fell behind in his gross motor development, had considerable discomfort with teething, and weighed only 20 lb. by the time I first saw him. His only other complaint was a chronic diarrhea that began on antibiotic treatment and had never gone away. Despite intense, prolonged crying after the first and second DPT's, the third was uneventful, as was the MMR.

       One month after Sulphur 10M, his mother reported that the diarrhea had worsened, becoming acute the first week after the remedy, but that, ever since a fever of 103 F. on the third day, his highest so far, he had had no symptoms of a cold or ear infection at all. Because of the diarrhea, I gave him Calc. Carb. 10M, and by the next visit, two months later, he was well, and had made good progress developmentally, with no ear infections, one brief cold for which Calc. Sulph. 12C worked well, and no more diarrhea.

       I did not see him again for more than a year, four months after an episode of acute otitis with no earache but a fever of 103F. that had lasted a full week on antibiotics. Apart from a few colds and a reappearance of diarrhea at these times, he had had no more ear infections and was continuing to grow and develop normally. Repeating Sulphur 10M, I had no further news of him until I asked my receptionist to call recently, more than five years later, and learned that he had been healthy, had had no ear infections, and needed no antibiotics throughout that time. After buying a remedy kit and studying on her own, the mother had found Belladonna to be highly effective for his various colds and acute illnesses, and no longer needed my help.

       Once again, not for any elegant prescribing on my part, much less from any notion that the child was "cured," I treasure cases like this one, because our work together helped the mother to take charge of her son's health, and to perform competently in that role. When my own learned prescriptions fail, as they not seldom do, I have good reason to feel proud when the parents themselves find the remedies that work best for their child. Perhaps the most precious gift that homeopaths can offer is our relationships with our patients, which can continue to grow and flourish even when the search for the ideal remedy proves elusive.

       Case 3. J. L., a girl of 6, had had frequent ear infections since the age of five months, especially when exposed to other kids in crowded day care or classroom settings. With little fever and no earache, the acute episodes were typically mild, with red cheeks, loss of appetite, and grumpy or irritable behavior. Also vulnerable to staying up late and to sudden changes of weather, she seldom ran fevers of any degree, the highest being around 102F. with a "Strep throat," but she had already taken antibiotics over two dozen times. Although vaccinated at the usual times without any obvious reaction, she developed an ear infection soon after her last DPT shot that had lasted for four months despite continuous antibiotics, and had subsided only after chiropractic treatment.

       Soon after Sulphur10M, she developed a generalized rash that lasted several days, followed by a buoyant mood and more lively energy than she had shown in a long time. At her first follow-up, she had a cold, with the usual red cheeks, runny eye, temporary hearing loss, and the dreaded positive Strep culture. It required a considerable leap of faith for her mother to let this tiny cold run its course without antibiotics, using only Pulsatilla 30X as needed, and later buying a kit of remedies and a book to show her how to use them. Two months later, her pediatrician was happy to report and even take credit for the fact that her ears were uninfected for the first time that anyone could remember.

       The following winter she returned with mild symptoms, a low fever, and a weakly positive Strep culture. As the illness subsided, I repeated Sulphur 10M, and by her next visit two months later the picture had changed to recurrent sore throats, foul breath, enlarged tonsils, dark circles under the eyes, and a loose, productive cough. This time I gave her Mercurius 1M, followed by the 10M a month later, with excellent results until her next cold many months later, when she developed the same swollen tonsils and loose cough as before. After the third dose of Sulphur 10M, I lost track of her for a few years, but the mother eventually called to report that she had been well the whole time, with no major colds and no ear infections, and a perfect attendance record at school for the year just finished. A few months ago, I called to check up and learned that she was doing splendidly in high school, with no more ear infections in the nine years since she had begun using remedies.

"Equating fluid behind the drum with infection requiring treatment ignores what all pediatricians know, that URI's with swelling of the tonsils and adenoids produce congestion of the middle ear and temporary hearing loss as a result. Decades of warfare against the nasopharyngeal bacteria have culminated in a Vietnam-like strategy of killing everything in the vicinity."

       Again leaving aside my rather crude prescribing in this case, I want to point out a few of the methodological issues it poses, issues so obvious and fundamental as to be easily overlooked. First, equating fluid behind the eardrum with an ear infection requiring antibiotic treatment ignores what every pediatrician knows, that most colds or URI's with swelling of the tonsils or adenoids produce secondary congestion of the middle ear and temporary hearing loss as a result. The girl in this case was prone mainly to tonsillitis, and could be said to have ear infections only to the extent that pneumatic otoscopes can detect even minute amounts of fluid, and that years of deadly warfare against the nasopharyngeal bacteria have culminated in a Vietnam-like strategy of killing every living thing in the vicinity.

       Second, her longest period of ear involvement followed a DPT shot, a connection that I have often verified in practice, but is rarely suspected by pediatricians, because vaccines are regarded as sacrosanct and almost risk-free, except for negligibly rare acute reactions developing within the first hours or days. [note 7]

       Third, like most of my chronic otitis patients, this child seldom ran fevers during the time she received conventional treatment, and began to do so only as her general condition improved. Useful both for reassuring the family and for making a simple prognosis, this humble fact carries a profound implication for the natural history of the disease and its recent evolution.

       Case 4. L. P., a girl of ten months, had already had four acute ear infections and received antibiotics for each one. The first began at two months, when her mother weaned her to go back to work, and the child developed a rash and unusually cranky behavior on a milk-based formula. These symptoms were also intensified for the week following her first DPT shot. A few weeks after that, the ear infection developed suddenly, with high fever and violent earache, like all the others. With the help of Calcarea Carb. 1M initially and Chamomilla 30X as needed acutely, she did quite well, with fewer colds and no acute episodes, but mild symptoms persisted and were aggravated by teething, when the remedies had to be repeated. She relapsed the following spring, six months later, with three acute ear infections and three rounds of antibiotics in the three months since her father had insisted on her long-overdue MMR shot.

       At this point I gave Lycopodium 10M, Sulphur 10M a month later, and almost a third remedy after that, but I heard that the parents had separated and were vying angrily over the child. From then on, she did very well on infrequent doses of Sulphur, despite a violent gastroenteritis following a DT-polio booster, and a tendency to relapse when she stayed with her father, who let her eat her fill of dairy products and took her to the doctor for her regular quota of vaccines and antibiotics. I have continued to see this child at long intervals for more than nine years, and although she has long since outgrown her ear infections, her underlying health issues have not changed very much. Since the acute, vigorous responses of her infancy, her basically strong constitution and maturing immune system have enabled her to bounce back more quickly when she does fall ill. While very fond of milk and cheese and somewhat allergic to them as well, she continues to grow and develop normally in the face of her conflicted heritage that she can as yet neither understand nor change.

       In short, this is a child of strong vitality, representing the opposite side of the same issues already discussed: 1) an innate ability to respond acutely and vigorously, and rebound quickly from illness; 2) a tendency to relapse following vaccination (and milk allergy, often associated with it); and 3) the classic signs and symptoms of acute otitis media that were the rule in the pre-vaccine era.

       With these representative cases in mind, I will try to summarize my experience with otitis media in children, giving special emphasis to the practical issues of diagnosis, treatment, prognosis, and long-term case management. As with my allopathic colleagues, middle-ear infection is one of the commonest presenting complaints of children in my practice. In an average week I will triage several acute episodes over the phone, and see at least one new and probably two or three established patients with chronic or recurrent otitis that has been diagnosed and treated on a long-term basis or repeatedly with antibiotics or tympanostomy or both.

"In the 1960's, otitis media was an acute disease, with high fever and pain, which subsided dramatically once the eardrum burst and discharged its contents. It didn't last long, had often taken care of itself before we could do anything about it, and was unlikely to come back for a long time. It was just what I have come to recognize as a favorable sign when I see it today."

       What most of these patients have in common is the absence or paucity of strong symptoms like high fever or violent earache that would indicate an acute, vigorous response to their illness. With a few notable exceptions, like the last case I presented, their symptoms even during acute flareups are typically vague or nondescript in character, e. g., fussy or cranky behavior, whining or picking at the ear, congestive hearing loss, poor appetite, and the like. In quite a few cases, there are no symptoms whatsoever, and the child behaves and functions normally, but at the well-baby visit the pediatrician detects fluid in the ear, signs it off as an "ear infection," and begins or continues the cycle of antibiotics that often proves so difficult to break.

"The most striking and disturbing feature of these cases is precisely their chronicity, their tendency to develop smoldering or persistent responses to illness and to relapse more and more easily, resulting in a failure to heal or resolve them in a clearcut or timely fashion."

       Similarly, although the symptoms often recede during treatment, relapse is common, and even when the child appears clinically well, the presence of fluid is regularly interpreted as continuing infection and cited as a mandate for further treatment. In this way, a child who may never have been that sick never gets entirely well, and continues to relapse until the doctor recommends antibiotics for months at a time and later surgical drainage as well, if the condition persists despite these lesser measures, as indeed it often does. In short, the most striking and disturbing feature of these cases is precisely their chronicity, their tendency to develop smoldering or persistent responses to illness and to relapse more and more easily, resulting in a failure to heal or resolve them in a clearcut or timely fashion.

       Breaking this cycle of chronicity proves quite easy if parents and caregivers can suspend the conventional wisdom that reduces the art of diagnosis to the specialized detection of abnormalities and the goal of treatment to the killing of our resident bacteria. As much as finding the correct remedy, the critical requirement for success in treating these kids is to re-educate the parents and develop an alternative model that works and makes sense to everyone.

       First, it is necessary to redefine the illness and how best to detect it, beginning with basic anatomy and the clinical and pathological features of a URI with ear involvement (congestion, earache, etc.), in contrast with classic acute otitis media. In my own practice I emphasize the signs and symptoms that parents themselves are aware of, i. e., how each child feels and functions in his or her own special world, or what homeopaths like to call the "totality of symptoms." If they are willing to trust me thus far, I'll take the next step and propose that we not look in the ear unless the illness is acute and intense, or hasn't resolved after giving remedies, or either of us is so panicked that we just have to know. Since any URI can produce detectable fluid or congestion behind the eardrum, and the homeopath does not need or even want to treat illness all the way to the end, the totality of symptoms is what best defines the illness, and the otoscope is useful primarily to confirm or qualify what the alert observer already knows.

       With significant ear involvement, it is helpful to assure the parents that antibiotic treatment is no more effective than placebo, [notes 8, 9, 10] and that it produces more frequent relapses than giving symptomatic treatment or simply allowing the children to recover on their own. [note 11] At that point it makes sense to offer homeopathic remedies, both as needed for the acute episodes, and preventively, to minimize their number and severity.

       Finally, it is imperative to take a careful vaccine history, and to look for familial influences or other factors that may aggravate a pre-existing chronic state, such as traumatic birth, food allergy, emotional upset, and the like. Quite often, the first episode can be traced to the time of a DPT, MMR, or other vaccine, even though no acute or obvious reaction was noted at the time, [note 12] or an old pattern of chronic or recurrent otitis is activated by a booster after a long period of remission. [note 13] Such apparent-ly speculative connections have also been verified by the successful use of homeopathic "nosodes" prepared from the vaccines themselves in re-solving difficult cases. [note 14] Drawing on these experiences, I routinely ask parents not to vaccinate their children until they are cured, and refer them to my various publications on the subject for further study. While I have also seen chronic otitis in unvaccinated kids, the crucial importance of vaccines lies in the fact that they are compulsory for all and regarded as so uniformly safe and beneficial that the possibility of chronic, long-term problems from them is seldom investigated or taken seriously. [note 15]

       With this educational work in progress, it is appropriate to proceed with homeopathic remedies. Both the procedure that I follow and the remedies I use are much the same as would be found in any homeopathic practice involving children, and I see no need to elaborate on them here. If the child is not acutely ill at the time of the first visit, I may begin with one dose of the indicated constitutional remedy, or perhaps three weekly doses. In addition, it is reassuring to give parents a strategy and a list of remedies to have on hand for acute flare-ups, and to see the child or at least coach the parents through these episodes with words of encourage-ment, changing the remedy as needed. Often these acute remedies will include the constitutional plus a few others that are complementary to it.

       Once remedies help them through this critical phase of the illness without antibiotics, the rest of the treatment is likely to proceed very smoothly. But if the child has never responded so acutely or intensely before, it is useful to prepare the family for such an eventuality as the underlying condition improves. By no means cause for discouragement, relapses many months or even years later are much easier to treat, since precipitating factors are usually much more obvious after a long period of good health, and remedies that worked well before will most likely do so again, as the children often know and will ask for it themselves. Indeed, this uncanny clarification and ordering of cases over time is a major and predictable benefit of successful treatment, and the awe and wonder it inspires in doctor and patient alike are among our highest rewards.

"In the 1960's, otitis media was an acute disease, with high fever and pain, which subsided dramatically once the eardrum burst and discharged its contents. It didn't last long, had often taken care of itself before we could do anything about it, and was unlikely to come back for a long time. It was just what I have come to recognize as a favorable sign when I see it today."

        What is mysterious and problematic about ear infections in children thus lies not so much in their treatment, which is not particularly difficult and involves many of the same remedies as for other chronic ailments, as in the disturbing fact of that chronicity itself. As a medical student in the early 1960's, I encountered otitis media promarily as an acute disease, usually presenting in the Emergency Room with high fever and piercing screams of pain, both of which subsided dramatically once the eardrum burst and discharged its infected contents. While certainly not a pleasant experience for doctor or patient, it didn't last very long, indeed had often taken care of itself before we had a chance to do anything about it, and was unlikely to come back for a long time to come. In every way it close-ly resembles the kind of flare-up which, when I see it in a patient today, I have learned to recognize as a favorable sign.

"The epidemic of chronic ear disease must be attributed to two colossal public health blunders: the war on the nasopharyngeal bacteria, fought with antibiotics, tubes, and the cultivation of fear; and the vaccination of entire populations against a growing list of diseases with no end in sight, and no strategy or inclination to consider the long-term consequences."

       After 1982, when I moved to Boston, stopped attending births, and limited my practice to homeopathy, I began to see large numbers of the sort of chronic otitis patient that I have just described. Why the sporadic acute infections I knew in medical school had mushroomed into a chronic disease of colossal proportions was also precisely the question with which I began this article. Both my clinical experience and the research I have conducted to try to make sense of it have strongly corroborated my "gut" feeling that the modern epidemic of chronic ear disease must largely be attributed to two colossal public health blunders that carry on the same outmoded militaristic philosophy:

1) the war on the nasopharyngeal bacteria, fought with antibiotics, tympanostomy tubes, and the systematic cultivation of fear; and

2) the vaccination of entire populations against a growing list of diseases, with no end in sight, and no inclination or strategy to consider the possible long-term consequences.

       Based on Koch's postulates and their immense predictive power, the war on bacteria is nevertheless unwinnable even in thought. As the most basic life form on the planet, bacteria reproduce themselves in about six hours, and through natural selection rapidly become resistant to even the most lethal antibiotics. In clinical medicine, some major examples include hospital-borne epidemics of resistant Staphylococci and E. coli, and the emergence of infections with L-forms, Mycoplasma, and PPLO organisms, all lacking cell walls, neat adaptations to penicillin-rich environments. In a recent Newsweek cover story, the spread of resistant strains made U. S. hospitals look like centers of germ warfare from which many types of virulent organisms are disseminated into a general population more or less helpless to stop them. [note 16]

       In the case of childhood ear infections, resistant strains have been similarly implicated in the weak primary immune responses and high relapse rates associated with antibiotic treatment. [note 17] Other frequent complications include superinfection with yeast and other common fungi, as well as the food and environmental allergies that often accompany them.

       Furthermore, numerous studies have shown that the supposedly causative organisms isolated from children with chronic ear infetions are simply the common pathogens of the tonsils and nasopharynx, such as the "pneumococcus," or Streptococcus pneumoniae, Group A -hemolytic Streptococcus, Hemophilus influenzae type B, and Staphylococcus aureus, all of which are regularly found in healthy throats as well. [note 18] In 25% of children with acute otitis, and in 80% of those with the most prevalent chronic serous variety, the middle-ear discharges and cultures are sterile and contain no organisms whatsoever. [notes 19, 20] Once these resident bacteria are destroyed, the result could have been foreseen by ordinary common sense: chronic serous otitis, or "glue ear," an important cause of chronic and even permanent deafness. Thus even more destructive than these antibacterial weapons themselves is the fanatical strategy of attacking and killing that makes such imagery seem attractive.

       A further application of the same approach has been the develop-ment of the pneumatic otoscope, its tight seal permitting the detection of even minute amounts of fluid and thus facilitating both early diagnosis and more minute surveillance. Yet diagnosing more infection has only unleashed more of the same firepower, and thus more of the same results already described. Indeed, with tympanostomy the war against chronic otitis media has reached its final dead end, since it looks like an obvious mechanical solution to the problem, yet has itself recently been found to be a major cause of otosclerosis and permanent hearing loss, the same spectre used to browbeat reluctant parents into accepting it in the first place. [note 21] Still more ironic is the fact that it simply makes permanent and structural the natural perforation and drainage that the acutely infected ear heals so well by itself and with so few complications.

       In any case, it makes little sense to search out and destroy the friendly bacteria that already live with us and police our bodies so effectively most of the time, or to imagine that making war on them could ever produce anything but more devastation, more war, and ultimately more resistant and less friendly bacteria.

       Although I have previously written about vaccinations in some detail, relatively little of my experience with vaccine-related illness is of the kind that Harris Coulter and Barbara Fisher write about in A Shot in the Dark, [note 22] or what might be termed the specific effects of a particular vaccine. While these reactions are apt to be the most severe and also the most useful in learning how to prescribe the nosodes that correspond to them, most of the complications I have seen in my practice have been limited to subtler reactions that I would describe as non-specific in type. By that I mean that they resemble exacerbations of the pre-existing chronic state, looking more or less the same in a given individual, regard-less of which vaccine is given, and are benefited by the same group of remedies are used to treat chronic illness in the general population, vaccinated or not. Although such reactions are more difficult to recognize and verify, they are also much more common, and I suspect much more important as well.

"Two of four cases suffered relapses of their chronic state after a vaccine, one suffered identical relapses after two different vaccines, and all four first developed their complaint during their initial series. In none were their responses acute enough to be identified as symptoms of the vaccine. What was repeatable was simply the chronicity of the responses."

       Thus two of the four cases I presented suffered prolonged, severe relapses of their chronic state after a vaccination, one patient suffered almost identical relapses after two different vaccines, and all four first developed their chief complaint during their initial three-dose vaccine series. In no case were their responses acute or obvious enough to be identified as a repeatable symptom of the vaccine. Indeed, all that was repeatable in all cases and with all the vaccines was simply the chronicity of the responses, the fact that they occurred more frequently, persisted for longer periods of time, and were less likely to resolve spontaneously.

       It is just this congruence between the vaccine-related responses and the original illness that suggests how vaccines act nonspecifically on the immune system as a whole, and so implicates vaccination in the basic riddle of chronicity itself. As new biotechnology companies produce new genetically-engineered vaccines as fast as possible, the unrestricted war against identifiable acute diseases has already added to the pre-existing chronic disease burden a considerable array of DNA and RNA fragments looking for chromosomes to recombine with and certain to engender new diseases of which as yet we know nothing. In short, I am afraid that doctors, like politicians, are here to stay.

Notes

1. Koch, H., Office Visits to Pediatricians, National Center for Health Statistics, Washington, 1974.

2. Bluestone, C., "Otitis Media in Children," New England Journal of Medicine 306:1399, June 10, 1982.

3. Cantekin, E., et al., "Antimicrobial Therapy for Otitis Media with Effusion," Journal of the AMA 266:3309, December 18, 1991.

4. Frenkel, M., "Acute Otitis Media: Does Therapy Alter Its Course?" Postgraduate Medicine 82:83, October 1987.

5. Family Practice News, December 15, 1990, p. 1.

6. Van Buchem, F., et al., "Therapy of Acute Otitis Media," Lancet 2:883, 1981.

7. Moskowitz, R., "The Case Against Immunizations," Journal of the American Institute of Homeopathy 76:7, March 1983.

16. "The End of Antibiotics," Newsweek, March 28, 1994, p. 47.

17. Cantekin, op. cit.

18. Bluestone, op. cit.

19. Ibid.

20. Cantekin, op. cit.

21. Family Practice News, op. cit.

22. Coulter and Fisher, DPT: A Shot in the Dark, Avery, New York, 1991.

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