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FOR IMMEDIATE RELEASE
Middle Ear Infection in Infants and Children
by Ralph Campbell, MD
(OMNS Jan 23, 2018) We call those big flaps on each side of our heads "ears"; so where is the middle ear? "Middle ear" refers to the medical terminology in which there are three parts: The external ear, the middle ear - a space bordered on the outer side by the tympanic membrane (ear drum) and the inside by the inner ear. Eustachian tubes lead from this space into the naso-pharynx. Hearing is accomplished when sound waves travel through the external canal and move the eardrum. The drum cannot move freely without letting air escape through these tubes. The slightest movement is magnified through three little bones connecting the ear drum to the inner ear. The inner ear looks like a snail. It is a marvelous design, consisting of a coiled fluid-filled tube, with a membrane of its own attached to the little bones, and hair-like nerve cells of varying length projecting into the fluid. When a pulse of fluid causes movement of the hair cells, mechanical energy is converted into electrical signals. These nerve cells send their electrical signals through the auditory nerve. The different lengths of their hairs vibrate in response to different sound wave lengths. The semicircular canals that control balance share this space but only rarely suffer the same sort of problems.
In years past, otitis media (O.M., or inflammation of the middle ear) in an infant or child was the foremost cause for a doctor visit. Why? Because the resulting earache can be severe. Anything that causes post-nasal drip (a head cold, nasal allergy, irritants in the air or food particles) can cause swelling and occlusion of the ends of the Eustachian tubes. Those bad germs that love damp, dark areas for breeding, love the middle ear. As the process continues, pus (for lack of a nicer word) builds up, creating pressure. The more pressure, the greater the pain. An older child, adults included, can locate the pain; an infant merely cries, letting Mom or Dad know something is drastically wrong. An infant has shorter and more horizontally positioned Eustachian tubes than older children, and has more of a lump of tonsil-like lymphoid tissue, the adenoid, sitting between the Eustachian tubes, that further inhibits normal drainage and relief of the building middle ear pressure.
What to do
To relieve the pain, prop up the patient. If an infant, a child's car-seat can prove useful. Swallowing and chewing motions can both aggravate and relieve stopped- up ears, so infant feeding should be done in the upright position. For the infant, use a rubber bulb syringe to draw mucus out of the nose, particularly before feeding. After doing this, test the airway by holding a wisp of cotton in the air stream as you look for movement of it. If still, there is a poor airway, infant nose drops such as pediatric strength Afrin or Neosynephrine can provide good relief. Nose drops, often used for too long, thus becoming ineffective and leading to a chronically stuffy nose, got bad press. So they should be used sparingly, perhaps mainly at bedtime to allow the child to sleep. Applying heat to the ear works for some; not for others. Ask the child, and have him tell you whether or not it helps. If a heating pad is not available, heat up a bag of beans in the microwave and wrap with a thin rag.
When to go to the doctor
If symptoms are mild, one can afford to wait before rushing to the doctor. I think most parents know when fussiness is severe enough that their child needs attention. If so, go. Diagnosis is done with an otoscope - an instrument with a light that shines through a replaceable tip that is inserted into the ear canal and allows the doctor to see the ear drum. It may look blood shot, which is just a manifestation of inflammation (maybe just a virus infection) or it may look dull or even be bulging, which likely means there is pus formation - the building pressure being a good reason for the discomfort. Sometimes, another instrument is used to check the mobility of the ear drum, by pumping air onto it. Before the days of "super bugs" (resistance to antibiotic treatment), there was little hesitation in prescribing an antibiotic. There often was dramatic improvement within 24 hours. But now, proper treatment, when uncertain of there being a bacterial infection, would be to wait a few days while being in telephone contact should there be signs of worsening. Middle ear infection can expand to the adjacent mastoid area or even on to the covering of the brain (meningitis); so any new signs or symptoms should be promptly reported. If pain accompanied by bulging is severe, immediate relief can be had by a myringotomy. This procedure is done with a small knife that goes through the otoscope speculum in order to puncture the drum and relieve the pressure. Sounds horrible? It scared me until I found the recommendation to first put in a few drops of topical anesthetic to be remarkably effective.
A follow-up visit is necessary. The infection might have responded well to the antibiotic, or it may have worked just well enough to get over the acute phase as shown by disappearance of irritability, but still leaving material behind the drum that could reduce mobility and cause hearing loss. This material could result from a subacute persistence of infection or from non-descript "gunk" (normal mucus secretions not able to escape through still partially blocked tubes). Efforts to keep drainage adequate should continue. If unsuccessful, a "glue ear" might develop due to a drying out (what doctors call, inspissation) of this material and necessitating an operative procedure. These complications are not common, but must be avoided due to their severity.
Natural prevention and treatment
As with other infections, many natural preventative and treatment measures are effective. One of the most important is to greatly increase vitamin C intake at the very first sign of a cold or any sign of a stuffy nose or "gunk" forming in the throat. The daily dose should be proportional to body weight; 50-150 mg/pound/day, or for infants and children, 1000 mg for every year of their age, in divided doses: 1 year, 1000 mg/day, 350 mg/meal. You can break or cut tasty chewable tablets in half or quarters to divide the doses. Crushing a chewable between two teaspoons gives you a fine powder to feed on a moistened fingertip, or in food or liquid.
Vitamin C supports the immune system, and can help to limit or prevent bacterial and viral infections. Besides being an antioxidant that removes free radicals and toxins from the body, vitamin C is also essential for many important biochemical pathways, including the synthesis of collagen, an important protein in skin, blood vessels, muscles and tendons, joints, and mucus membranes. An adequate level of vitamin C helps the tissues lining the mucus membranes recover from an infection. 
How much vitamin C?
In recent years, we have learned more and more about the value of vitamin D. Since there are vitamin D receptors in every tissue in the body that enable the vitamin to provide a useful health function, give double doses during the added stress of an infection. However, since vitamin D is fat-soluble, it takes several weeks for the level in the body to fully register an increase in dose. To make sure that by winter the infant's vitamin D levels are high and fully protective, it may be best to start supplements of vitamin D in the fall months (start with 100 IU/pound/day for 2 weeks, then continue with 35-50 IU/pound/day).
It is important for an infant or toddler to have adequate doses of all the vitamins (A, B1-B6, folate, biotin, B12, C, D, E), along with provide adequate doses of minerals. A children's multivitamin is easy to administer because it comes with a dropper that measures the right dose. When an infection starts, give two droppers of multivitamin to the infant rather than just one, and for an older child, also double up the vitamin intake. It has recently been shown that autism in children responds to nutritional treatment and multivitamin use by mothers before or during pregnancy lowers the risk of autism in the child.  Probiotics are often very effective in alleviating symptoms of an infection. The cheapest, best tolerated probiotic of all is plain, unsweetened yogurt. Talk to your doctor about contra-indications for vitamin and mineral supplements.
During any type of infection it's important to give adequate fluids to help the kidneys eliminate virus particles and bacterial toxins. A good fluid to supply is broth made from a mix of vegetables. Chop/slice up potatoes, carrots, celery, onion, beet tops, add herbs such as garlic, rosemary, thyme, sage, mix with 1-2 quarts of water, cook slowly, then strain, add bouillon or miso to taste, 
Infants and toddlers are often deficient in magnesium, which tends to promote anxiety and depression, and makes sleeping difficult. To relieve magnesium deficiency give magnesium chloride in liquid form (3-5 mg/pound/day or as directed on bottle). In contrast to commonly sold forms of magnesium (e.g. magnesium oxide) which tend to cause a laxative effect, magnesium chloride is fully absorbed in the gut.  You can add some magnesium chloride to broth for a bit more salty flavor. Adequate magnesium can mean the difference between crying all night and quiet sleep.
An earache in infants and small children can be severe but along with visits to the doctor can be treated with supplements of vitamins and minerals. Children who are deficient in essential nutrients are more prone to viral and bacterial infections, and tend to recover more slowly. By providing your child with an excellent diet containing lots of vegetables along with moderate amounts of protein from dairy, meat and fish, and optimal doses of vitamins and minerals, you can lower the risk of infections.
(Pediatrician Ralph Campbell, MD, now retired, is digging out from yet another Montana winter. He is 90.)
1. Case HS. Vitamins & Pregnancy: The Real Story: Your Orthomolecular Guide for Healthy Babies & Happy Moms. Basic Health Pub. (2016) ISBN-13: 978-1591203131
2. Grant WB. Top Twelve Vitamin D Papers for 2017. http://orthomolecular.org/resources/omns/v14n03.shtml
3. Vanderheyden T. Multivitamin and folic acid use lowers autism rates. http://orthomolecular.org/resources/omns/v14n04.shtml
4. Dean C. The Magnesium Miracle. Ballantine Books. 2017. ISBN 9780399594441.
To learn more:
Cathcart RF. Vitamin C, titrating to bowel tolerance, anascorbemia, and acute induced scurvy. Medical Hypotheses, 7:1359-1376, 1981. http://www.doctoryourself.com/titration.html
About "Objections" to Vitamin C Therapy. http://orthomolecular.org/resources/omns/v06n24.shtml
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