CHILDREN'S EAR INFECTIONS

Recurrent infections help make Acute Otitis Media (AOM)

the #1 reason for a visit to a family doctor or pediatrician in this

antibiotics are administered to patients under 10 years old than

evidence that antibiotics are beneficial for routine treatment of

Chinese Medicine (TCM) uses pattern identification as the basis

for diagnosis. Because a pattern is

determined by a semi-mutable set

of signs and symptoms occurring

in concert, formulas are designed

to address a complex of issues.

Otitis media can have multiple

causes, including bacterial infection,

viral infection, anatomical

factors, impaired immunologic

status, airborne allergy, food

allergy, feeding method, and gastroesophageal

study involving 456 children with

AOM found that viruses caused

can include bulging eardrums and ear pain, moderate

to high fever, blocked sinuses, cough, ear edema, headache, irritability,

insomnia and restlessness, sore throat, sweating,

appetite changes, and even rash. Chinese medicine believes that

its dynamic approach provides a safer, more inclusive and superior

treatment strategy.

Though utilized for a broad range of clinical complaints, the

action of an antibiotic is focused and narrow. Antibiotics are

designed to do one (and only one) thing: kill bacteria. And

though antibiotics can occasionally improve some symptoms,

especially those caused by inflammation, they possess no direct

action to do anything other than kill the bacteria. They cannot

relieve distress or pain, promote drainage, repair damage, prevent

recurrence or any of the other issues commonly encountered

in a case of AOM.

Some studies suggest that when used for treating AOM,

evidence suggesting a connection between frequent use

of antibiotics in the treatment of common ear infections and children

Another example involves the interference of antibiotics

Before nutrients or microorganisms can enter the bloodstream

from the intestinal tract, they must first pass through

three layers of defense. In the outer most layer, that is, the layer

furthest from the bloodstream, lies about 400 species of bacteria,

some beneficial, others dangerous. These bacteria are in a

constant battle for dominance. In this battle, chemicals produced

by the bacteria can make the environment antagonistic for competing

species or enable another to proliferate. The next layer

closer to the bloodstream is made up of epithelial cells with

TOLLreceptors on their surface. These receptors pick up chemical

signals from the battle zone to keep the immune system prepared

to respond to potential transgressors. Behind the epithelial

layer directly protecting the blood stream is a compact layer of

immune cells (lymphocytes, microphages, monocytes, and dendritic

cells), some of which bear TOLL receptors themselves.

For any potential pathogen entering the body through the intestinal

tract, this signaling through the TOLL receptors is the primary

mechanism for immune

activation. The proximity of the

compact immune cell layer to the

blood stream implies a potentially

global response. Oral antibiotics

profoundly influence the enteric

population dynamics and therefore

have a comparably profound

influence on the signaling system.

Some of the effects antibiotics

have on the immune system are

well understood. Many more

remain insufficiently investigated.

One effect that is fairly well

understood is a form of malnutrition

resulting from an over-stimulated signaling system. Overstimulation

of signaling can cause a hypersensitivity of the intestinal

tract's immune response. This hypersensitivity can result

in an allergic-type response to certain foods and the nutrients

they contain. Generally speaking, the more hyperactive this

immune cell layer, the fewer nutrients will be properly

absorbed. Suppression of this immune response is critical to

avoid malnutrition.

In TCM terms, antibiotics have a very cold property, which

makes them effective to clear heat and reduce inflammation. But

the same cold property also damages the spleen qi and the digestive

function in general. When applied to the intestines, the function

of the spleen qi to "separate clear from turbid" directly

translates into modern nutritional terms as the separation of

nutrients from waste material. When the spleen qi is damaged,

its ability to separate clear from turbid is impaired and "turbid"

substances are allowed into circulation, while nutritive substances

(clear) manage to pass through the stool. The spleen also

which it produces through a transformation process involving

"clear" substances obtained from diet. Without sufficient "clarity"

in this raw material, the strength of the wei qi is compromised,

defense against external pathogens is diminished, and

chances for recurrent infection increase.

There are a number of other mechanisms by which antibiotics

are still being researched. The important facts for the present

AOM is a disease primarily affecting the eustachian tubes

but originating usually in the nasopharyn . The eustachian tube

is lined with mucus membrane. It begins just behind the tympanic

membrane (the "eardrum") and, in adults, courses downward,

forward, and medially to communicate with the nasopharynx,

where it also terminates. The total length of the tube in an

adult is 3-4cm. In children, the downward aspect of the angle is

less pronounced and the total length of the tube is less than 3cm.

Before the 1990's the most accepted explanation for the

underlying cause of AOM was under-aeration of the eustachian

tube due to obstruction or blockage of

the tube. More recent studies suggest that

the opposite is true. Rather than an

obstruction, an over-compliant eustachian

For protection, a normally functioning

tube remains closed except for

brief moments of aeration during yawning

or swallowing. Otitis media can

begin when the pressure around the

nasopharynx rises substantially above

the pressure of the middle ear, allowing

pre-infected nasopharyngeal secretions

to infiltrate the mucosal lining of the

Several factors can contribute to the

change in the pressure relationship

between the nasopharynx and the

eustachian tube. Most significantly, the

nearly horizontal orientation of the

eustachian tube in younger children

makes them more vulnerable to pressure

changes. But other factors come into play.

Adenoids consist of lymphatic tissue

and are located in the nasopharynx.

As part of the immune system, they are the first destination for

many viruses entering the body. They may also serve as a

adenoid can become swollen. Swallowing causes the adenoid

to elevate while simultaneously opening the eustachian

tube, thus allowing transfer of infection from the adenoid to

the eustachian tube.

TCM discusses pathogenic factors in environmental terms

such as "wind," "heat," "cold," "dampness," and "dryness." Each

of these has a set of pathological signs and symptoms associated

with it. An acute case of otitis media (AOM) is generally

associated with wind and heat. Two of the main properties of

heat are that it rises and expands. This rising and expansion can

explain, in TCM terms, another mechanism by which the pressure

differential between the nasopharynx and eustachian tube

shifts. As the adenoid becomes inflamed, it gives off heat. This

heat rises and creates pressure at the termination point of the

eustachian tube. When enough pressure has accumulated, the

eustachian tube can no longer protect itself. A simple act of

swallowing is all it takes to open the eustachian tube, thus allowing

the pressure to push the wind-heat pathogen into contact

with the mucosal lining of the tube.

an excellent formula for the routine treatment of pediatric AOM.

has strong action to dispel wind-heat and resolve toxin. The second,

help direct the rest of the formula to the middle ear, which the

opens and drains the sinuses and other orifices in the head,

which can help restore the balance of pressure between the

nasopharynx and the eustachian tube. Dr. Fratkin reduced this

combination to its therapeutic essentials

and augmented the formula to focus its

actions specifically on ear infections.

destroys pathogens and reduces inflammation,

but also resolves phlegm in the

head, supports the digestive function,

prevent re-occurrence. It contains ingredients

shown to possess not only essential

but also which are beneficial for treating

other signs and symptoms of the pattern.

Several ingredients have strong antiinflammatory

ear can cause distress and pain for children;

analgesic property with an affinity for

an infection from developing into otitis media. If the child has a

recently developed mild fever, a red tympanic membrane that is

not yet bulging, or sinus congestion where the heat factor is

into AOM.

Though wind-heat is the most common TCM pattern of

true AOM, it is important to distinguish between this and other

conditions and patterns.

TOXIC HEAT

Profuse suppuration and high fever indicate the presence of

toxic heat. Severe headache may be part of the pattern. To treat

is a serious condition and in rare cases can lead to deafness.

two formulas, you should decide upon one as the lead formula

and the other as its assistant. The lead formula can be given at

full strength, the assistant at ½ to ¾ strength. To determine the

lead formula, determine whether there is an underlying condition

of toxicity that lead to the AOM, or whether the AOM

developed into a toxic condition. In the case of underlying toxicity,

CRT Formula should be your lead, while CE Formula

guides it to the auditory canal and sinuses. If the AOM was contracted

entirely from the exterior and developed into a toxic condition,

then the CE Formula will be your lead and the CRT Formula

will be used at ½ or ¾ strength to augment the lead formula.]

WIND-COLD ATTACKING THE EAR

If there is ear pain causing a headache with only slight or no

fever, a runny nose with clear discharge, no redness in the tympanic

membrane, and slight blue or purple color changes in the

cartilage of the ear, then clearing wind-heat will be of limited

value. A cold pathogen has invaded from the exterior through

the ear. There will probably not be any bulging to the eardrum.

relieve ear pain and headache.

LIVER & GALL BLADDER FIRE

Onset of pain will be rapid, as in a wind-heat condition, but

pain may be mild and chronic with a sudden trigger for acute

severe pain. Yellow discharge is likely. Child will probably have

a ringing in the ear that accompanies the pain and have a bitter

taste in his or her mouth. The recent history will not necessarily

include a viral exposure. Though bacteria will show up in the

exudates, the underlying cause is not viral or bacterial, but

induced by stress and diet. In the days leading up to the acute

attack, the child will likely appear irritable or nervous. He or she

will have a thick, yellow, greasy tongue coat and/or a diet that is

not unlike antibiotics. If given to younger children (under age 7),

or to children with already weakened digestion (even with this

"fire" condition) the formula can damage the spleen qi. The

damage is usually not as severe as antibiotics. Yeast are killed by

this formula too, so the chance of a yeast infection developing

When there is a question about the child's digestive strength and

this formula is otherwise appropriate for the condition, combine

CHILDREN'S EAR FORMULA

A dose is administered orally (NOT through the ear) at 0.4

to 0.5 grams every 2-3 hours for infants and children up to 25

pounds during the painful stage of the infection. (This period is

usually only the first 1-3 doses.) The dose may be increased to

0.5 to 0.75 grams for children 26 to 50 pounds. Most parents

report significant improvement within the first 2-3 hours after

the initial dose. After the pain has significantly subsided and

fever has dropped, you may reduce frequency to every 4 hours. If

fever becomes very mild and no pain is present, you may continue

with the same size dose, but administered only 3-4 times a day.

A normal course of treatment during a moderate infection

looks something like this:

2nd dose (4-6 hours after first dose)

shortly after that. Change the administration to every 4

hours at this point. Continue every 4 hours for about 1

day or until fever is eliminated.

about every 6-8 hours (3 times a day) for 1-2 days after

fever has maintained below 100.5F.

3rd day.

granules only, there are a few tricks to getting the child to

swallow the formula. The taste is quite bitter and most smaller

children will try and spit it out. Some older children can be

"bargained" with.

grams of the formula with a little boiling water. The

amount of water is insignificant for the sake of the formula,

but can be an important factor when it comes to swallowing.

Some children will accept a diluted decoction

more easily, others need it thick, like a sludge. Shake or

mix thoroughly while decoction is still hot. After cooling

to a safe temperature, give the child about 1/10th of the

total formula every 2-3 hours, shaking or mixing vigorously

prior to each administration. Remember to keep the

herbs refrigerated in between administrations, but warming

it slightly just before administration is a good idea.

with boiling water in the same way as infants

(though the dose might be bigger depending on weight),

but they have more alternatives. One way that has

worked with many parents is to first give the child the

herbs mixed with water so they know what it tastes like.

If the child refuses later, you can offer to omit the water

and mix the granules directly into honey or some other

thick, sweet carrier such as caramel or chocolate sauce.

Have a glass of warm water handy to chase it down. The

warm water will help the herbs absorb into the system as

well as clear away most of the bitter taste quickly.

EXTRA-CONCENTRATED TABLETS FOR NON

dose every 2-3 hours during the acute stage of the attack

(while ear pain and fever are present) and every 4-8 hours

in the sub-acute stage (immediately after the ear pain has

been eliminated.)

When combining formulas as suggested above you are

usually safe giving an entire dose of each formula, except

above.) In smaller children, the tablets will need to be

crushed into a powder to avoid choking. Once in a powder,

you may use any of the methods described above for

the Children's Ear Formula. Older children may be able

to swallow a tablet either whole or split.

Dec;68(12):1489-92.

28;340(4):260-4.

viii 1) by destroying mitochondria in WBC;

2) by blocking protein synthesis in WBC; for these, see

Kimball JW, “Endosymbiosis and the Origin of Eukaryotes”,

(http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/E;

3) by destroying the beneficial flora of the GI tract triggering

2004;13(Suppl):S24-5; and

4) over-use of antibiotics has lead to the development of

1992;166:1346-53.

a thorough discussion of the immune signaling system of the

intestinal tract. The author is indebted to Dr. Chin's article

for the discussion on intestinal immune response.

xi For some further examples of the adverse effects antibiotics

have in the context of pediatric ear infections, see Jake Paul

1995, 97(5):73-82.

Nov;10(7):581-4

Nov;12(7)484-7

dampness through the urine (see any Chinese Materia

Medica such as that of Bensky, Clavey, and Stöger).

Fritillaria (Bei Mu) is shown to enhance renal function,

increase the output of urine and the clearance and excretion

2005 HERBAL MEDICINE PRESS