Otitis Media treatment - antibiotics or natural therapy
January 20 2016 by
Ray Sahelian, M.D.

Otitis media means inflammation of the middle ear (the space behind the ear drum). Many different conditions are lumped together under the term otitis media - including infections due to a number of different viruses or bacteria, or the presence of different types of uninfected fluid. The presence of middle ear fluid and redness or inflammation of the ear drum is usually referred to as acute otitis media, is typically due to bacterial infection, and is usually treated with antibiotics. Chronic otitis media means long-standing middle ear fluid (with or without infection). Fluid in the ear, without signs of infection or inflammation, is usually called otitis media with effusion or serous OM.

Natural treatment

Bee propolis
Recurrent acute otitis media (rAOM) is frequently encountered in infants and children and the lack of any definitive treatment has led parents and physicians to try complementary and alternative therapies. We evaluated the efficacy of a propolis and zinc suspension in preventing AOM in 122 children aged 1-5 years with a documented history of rAOM, who were prospectively, blindly, randomized 1:1 to receive the suspension plus elimination of environmental risk factors or elimination of environmental risk factors only. AOM- and respiratory-related morbidity were assessed at study entry and every four weeks. In the 3-month treatment period AOM was diagnosed in 31 (50%) children given the propolis and zinc suspension and in 43 (70%) controls. The mean number of episodes of AOM per child/month was 0.23 in the propolis and zinc group and 0.34 in controls (reduction 32%). The administration of a propolis and zinc suspension to children with a history of rAOM can significantly reduce the risk of new AOM episodes and AOM-related antibiotic courses, with no problem of safety or tolerability, and with a very good degree of parental satisfaction. No effect can be expected on respiratory infections other than AOM. Int J Immunopathol Pharmacol. 2010 Apr-June. Effectiveness of a propolis and zinc solution in preventing acute otitis media in children with a history of recurrent acute otitis media. Department of Maternal and Pediatric Sciences, University of Milan, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy.

Role of antioxidants
J Membr Biol. 2013. Serum Myeloperoxidase Activity, Total Antioxidant Capacity and Nitric Oxide Levels in Patients with Chronic Otitis Media. Department of Otorhinolaryngology, Yuzuncu Yıl University, Van, Turkey. It has been suggested that oxidative stress may play an important role in the pathogenesis of chronic otitis media (COM), but the role of oxidative stress in the pathogenesis of COM has not yet been fully explored. Therefore, the aim of this study was to investigate serum myeloperoxidase (MPO) activity, 4-hydroxynonenal (4-HNE), malondialdehyde (MDA), total antioxidant capacity (TAC) and nitric oxide (NO) in patients with COM. Sixty-one patients with COM and 30 controls were enrolled in the present study. Patients were divided into two groups according to the presence (n = 21) or absence (n = 40) of cholesteatoma. Serum MPO activity and 4-HNE, MDA and NO levels were significantly higher in patients with COM than controls, while TAC levels were significantly lower. Increased oxidative stress seems to be associated with decreased antioxidant levels in patients with COM. Thus, increased oxidative stress may play a role in the pathogenesis of COM. It is believed that the administration of antioxidant vitamins such as A, C and E may be useful in preventing and treating COM.

Otitis Media Treatment - Antibiotic or no Antibiotic?
Giving children antibiotics for ear infections does little to speed their recovery while raising the risk of some side effects. The study found that 80 out of 100 otherwise healthy children would recover from an acute ear infection within a few days if given medication only to relieve pain or fevers. If all 100 were given antibiotics instead, 92 would be better in the same period butt three to 10 kids will develop rash and five to 10 will develop diarrhea. Journal of the American Medical Association, November 2010.

A wait-and-see approach that allows parents to decide if their child needs antibiotics for acute otitis media can reduce antibiotic use without adversely affecting outcomes. Previous studies investigating the value of a wait-and-see approach have excluded children with severe acute otitis media and have not been conducted in an emergency department setting, say lead author Dr. David M. Spiro, from the Oregon Health and Science University in Portland. The present study involved 283 children who were seen in an ER for suspected acute otitis media. The children were randomized to a wait-and-see prescription (WASP) group or to a standard prescription group. All of the children received ibuprofen and otic analgesic drops for pain control. With WASP, the parents were given an antibiotic prescription, but told not to fill it unless the child's condition had not improved in 48 hours. Parents in the standard prescription group, by contrast, were told to fill the prescription and have their child start taking the drug after leaving the office. Sixty-two percent of subjects in the WASP group did not have an antibiotic prescription filled compared with just 13% of those in the standard prescription group. Despite the difference in antibiotic use between the groups, clinical outcomes were similar. The occurrence of subsequent fever, otalgia, and unscheduled medical visits were not significantly different between the groups. Further analysis showed that fever and otalgia were predictors of filling the antibiotic prescription in the WASP group. In a related editorial, Dr. Paul Little, from the University of Southampton in the UK, comments: "If parents are given clear information about the timing of antibiotic use and specific guidelines for signs and symptoms that should trigger reassessment, delayed prescribing probably has its place, should be acceptable to parents, appears reasonably safe, and provides a significant step in the battle against antibiotic resistance." JAMA 2006.

Am Fam Physician. 2013 Oct 1. Otitis media: diagnosis and treatment. Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis are the most common organisms isolated from middle ear fluid. Management of acute otitis media should begin with adequate analgesia. Antibiotic therapy can be deferred in children two years or older with mild symptoms. High-dose amoxicillin (80 to 90 mg per kg per day) is the antibiotic of choice for treating acute otitis media in patients who are not allergic to penicillin. Children with persistent symptoms despite 48 to 72 hours of antibiotic therapy should be reexamined, and a second-line agent, such as amoxicillin/clavulanate, should be used if appropriate. Otitis media with effusion is defined as middle ear effusion in the absence of acute symptoms. Antibiotics, decongestants, or nasal steroids do not hasten the clearance of middle ear fluid and are not recommended. Children with evidence of anatomic damage, hearing loss, or language delay should be referred to an otolaryngologist.

Mastoiditis following acute otitis media
Antibiotic therapy does not affect the subsequent development of acute mastoiditis.

Serous otitis treatment
Do you have any natural remedies for releasing fluid from the inner ear? It makes me feel dizzy and sometimes panicky and I've had it for over a month. I did have a sinus infection but that got cleared up with antibiotics.
   I haven't yet found an effective natural treatment for serous otitis after an infection. Most of the time the condition will get better with time. Keeping some candy in the mouth and swallowing frequently can perhaps help open the Eustachian tubes. Steroids such as prednisone, for a few days, are quite potent and may work. Sometimes decongestants are prescribed afterwards.

Chronic OM
Chronic otitis media is a common problem facing general practitioners, pediatricians and otolaryngologists with various sub-categories according to the disease state. It most commonly presents with painless otorrhoea and hearing loss. Treatment options vary according to the activity and type of disease encountered. COM carries significant patient morbidity.

Iím 54 years old and have a perforated eardrum which causes recurrent ear infections with discharge. When I go to some dusty places or swim the infection recurs. I read somewhere that ear infections causes inflammation which may cause Dementia or Alzheimerís. Can serrapeptase help me?
   We have not seen such studies with serrapeptase for ear infection treatment, we doubt it would help.