Natural treatments for ear infections

• PRINCIPAL PROPOSED NATURAL TREATMENTS: Avoiding passive smoke inhalation, breastfeeding, herbal ear drop combinations containing mullein and garlic, xylitol

• OTHER PROPOSED NATURAL TREATMENTS: Andrographis, cranial sacral osteopathy, echinacea, food allergen elimination, garlic, ginseng, probiotics, vitamin C, zinc

DEFINITION: Treatment of infection of the middle ear, a painful condition most common in infants and young children

Introduction

Acute otitis media (AOM) is a painful infection of the middle ear, the portion of the ear behind the eardrumAnother form of ear infection, otitis externa or swimmer’s ear, is entirely different and is not covered in this article. AOM often follows a cold, sore throat, or other respiratory illness. Although it can affect adults, AOM occurs primarily in infants and young children. By age three, 60 percent of all children in the United States will have experienced at least one AOM infection, and 80 percent of children will experience AOM at some point before reaching adulthood. It is the most common reason parents take a child to the doctor.

When the Eustachian tube, also called the pharyngotympanic tube, connecting the upper part of the throat to the middle ear is blocked by a cold’s mucus and swelling, fluids pool behind the eardrum, providing an ideal place for bacteria to grow, an infection may set in, generating even more fluid. The pressure this exerts on the eardrum can be intensely painful. The eardrum turns red and bulges. Children too young to explain their discomfort will cry, fuss, and pull at their ears. They might also appear unresponsive because they cannot hear well due to fluid buildup in the middle ear that prevents the eardrum and small bones from moving and causes temporary hearing loss.

In addition, a complication called secretory otitis mediafluid buildup in the middle earmay develop and cause continuous hearing loss for months. Other possible, though rare, complications of AOM include mastoiditisan infection of the bone behind the earand spinal meningitis.

Without treatment, most middle ear infections resolve on their own, often through a harmless rupture of the eardrum. Some pediatricians—for example, those in the Netherlands—take a conservative approach, generally waiting twenty-four to seventy-two hours until they are certain an ear infection warrants antibiotics. American doctors tend to initiate early treatment. This practice has been criticized on several grounds. First, aggressive antibiotic treatment has been ineffective in preventing complications, such as serous otitis, pneumococcal meningitis, or hearing loss. In addition, antibiotic treatment does not appear to help AOM. A double-blind, placebo-controlled trial of 240 children aged six months to two years found so little benefit with antibiotic treatment that the authors recommended physician-supervised watchful waiting rather than immediate treatment.

In other published reviews, the benefits of antibiotics for AOM have also been found to be less than impressive. A review of thirty-three randomized trials involving 5,400 children concluded that antibiotics modestly improved the rate of recovery. An evaluation of six randomized, controlled studies concluded that early antibiotic use had only slight benefit, reducing pain and fever in a small percentage of children and helping to prevent the development of infection in the other ear, but not significantly speeding up the recovery of hearing. Modest benefits were also seen in a later trial of 315 children. Another study found that children with recurrent ear infections do not appear to benefit from preventive antibiotic treatment. A meta-analysis concluded that antibiotic treatment may be helpful in children younger than two years of age who have infections in both ears and in children with drainage from the ear, but for other children, it may be preferable to delay the use of antibiotics.

However, the claim often made by proponents of alternative medicine that early antibiotic treatment causes an increased rate of ear infection recurrence does not appear to be correct. Despite these issues, simply withholding antibiotic treatment can be dangerous. Any child who appears to have an ear infection should be seen by a physician.

When ear infections do reoccur frequently, a physician may insert a tube into the infected ear to drain fluids and relieve pressure, a procedure called tympanostomy. Nearly one million American children undergo this procedure each year, however, its usefulness is somewhat controversial.

Principal Proposed Natural Treatments

Although there is no known natural treatment for AOM, there are several promising approaches parents can take that may help prevent children from developing ear infections or reduce symptoms.

Xylitol. A natural sugar found in plums, strawberries, and raspberries, xylitol is used as a sweetener in some “sugarless” gums and candies. One of its advantages is that it inhibits the growth of Streptococcus mutans, a type of bacterium that causes dental cavities. Xylitol also inhibits the growth of a related bacteria species, S. pneumoniae, which is implicated in ear infections. Additionally, xylitol acts against Haemophilus influenzae, another bacterium that frequently causes ear infections.

Based on this evidence, xylitol has been tried as a preventive treatment for middle ear infections with some success. Two well-designed studies enrolling 1,163 children found that when taken five times daily throughout a large portion of the cold season, chewing gum and syrup sweetened with xylitol helped prevent middle ear infections. However, xylitol has not proved effective when taken three times daily rather than five times daily, nor when it is used only after the onset of a respiratory infection.

In one of the positive studies, 857 children were given either a placebo or xylitol five times daily in the form of chewing gum, syrup, or lozenges. In the two-month study period, the gum proved distinctly effective, reducing the risk of developing AOM by 40 percent. Xylitol syrup was also effective, but less so. The lozenges did not prove effective; researchers speculated that children got tired of sucking on the large candies and did not get the proper dose of xylitol. (In addition, the children were able to distinguish between the xylitol and placebo lozenges by taste, making that portion of the study single-blind.)

Similarly positive results had been seen in an earlier three-month double-blind study by the same researchers, evaluating about three hundred children and again using a dosing schedule requiring the use of xylitol five times daily. However, taking xylitol five times daily requires a great deal of effort. Other researchers looked at whether xylitol would still work if taken only three times daily. In their three-month, double-blind, placebo-controlled study of 663 children, no benefits were seen.

Another study, this one enrolling 1,277 children, took a different approach to simplify the use of xylitol: they used the original dosage schedule but began treatment only after a respiratory infection had begun rather than over many months. Again, no benefits were seen.

Breastfeeding. Breastfeeding may help prevent AOM. Numerous studies tracking ear infection frequency in large groups of infants found that the infants who were exclusively breastfed had significantly fewer middle ear infections than infants who were fed formula. Such observational studies are not as reliable as placebo-controlled or double-blind designs, but the results suggest breastfeeding is a good preventive measure. Studies examining whether breast milk inhibits bacteria associated with AOM have yielded mixed results. In general, breast milk is reported to have antibodies that help fight ear infections. Other studies note that the position of the baby’s head when breastfeeding may help drain the ear canal better than bottle feeding.

The amount of time a child is breastfed impacts the ear infection prevention they receive from breast milk. One study found that one month of breastfeeding resulted in a four percent reduction in ear infections, while six months reduced rates by seventeen percent.

Avoidance of cigarette smoke. Environmental conditions may predispose a child to middle ear infections. A study of 132 children in daycare found that the forty-five children exposed to cigarette smoke at home had a 38 percent higher risk of middle ear infections than the eighty-seven children whose parents did not smoke. Smoke irritates the eustachian tube, and even passive smoke exposure has been linked to an increased rate of ear infections in children.

Herbal ear drops. The herbs mullein and garlic are traditionally combined with other herbs in oily ear drops designed to reduce the pain of ear infections. One study supports this use. Two double-blind trials enrolling more than 250 children with eardrum pain caused by middle ear infection compared the effectiveness of an herbal preparation containing mullein, garlic, St. John’s wort, and calendula with a standard anesthetic ear drop productametocaine and phenazone. The results indicated that the two treatments were equally effective. In addition, one of the studies found that the use of the antibiotic amoxicillin did not add additional benefits. However, because of the strong placebo response in pain conditions, this study needed a placebo group to provide dependable evidence that the herbs were effective.

While herbal naturopathic eardrop products may relieve pain, the infection is on the other side of the eardrum. Some older studies provided evidence that essential oils of herbs may penetrate the eardrum and reach the other side. However, modern studies note that herbal ear drops do not impact infection but may help alleviate some symptoms temporarily. Additionally, some essential oils can be toxic and irritating to tissues. Garlic and its oil are too harsh to introduce into the ear. Herbal drops that contain garlic use much milder extracts of the herb. Tea tree oil is harsh on the ear.

Other Proposed Natural Treatments

Allergies. Allergies may contribute to ear infections, possibly by increasing the amount of fluid in the middle ear. There is some evidence that children allergic to pollens, dust, molds, and certain foods may be more likely to develop AOM. Weak evidence suggests that a food-allergen-elimination diet might help prevent middle ear infections.

Other herbs and supplements. Numerous natural products have been proposed to prevent or treat ear infections. These include all herbs and supplements used for colds, including echinacea, probiotics (such as Lactobacillus acidophilus), zinc, vitamin C, Andrographis paniculate, garlic, and ginseng. However, there is no direct evidence that any of these treatments are effective for AOM. In the case of echinacea, a few studies specifically found no benefit. There is mixed evidence for the effectiveness of probiotics. Cranial-sacral osteopathy has also failed to prove helpful in preventing ear infections.

Several other natural treatment options exist for AOM, including many homeopathic treatments, such as the herb belladonna, ginger for its anti-inflammatory properties, and olive oil for its antibacterial properties. Lifestyle changes are also recommended, including changing sleeping positions and applying hot and cold compresses to the ears. If pain and infection in the ear are accompanied by a buildup of dead skin and ear wax, hydrogen peroxide may help clean debris out of the ear. However, if there is a perforation in the eardrum, using hydrogen peroxide or any drop in the ear without the advice of a medical practitioner is ill-advised.

Bibliography

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Butler, C. C., et al. “Should Children Be Screened to Undergo Early Treatment for Otitis Media with Effusion?” Child: Care, Health, and Development, vol. 29, 2003, pp. 425-32.

Choi, Sung-Won, et al. “Effects of Cigarette Smoke on Haemophilus Influenzae-Induced Otitis Media in a Rat Model.” Scientific Reports, vol. 11, no. 1, 2021, doi:10.1038/s41598-021-99367-w.

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Kristinsson, K. G., et al. “Effective Treatment of Experimental Acute Otitis Media by Application of Volatile Fluids into the Ear Canal.” Journal of Infectious Diseases, vol. 191, 2005, pp. 1876-80.

Rautava, S., et al. “Specific Probiotics in Reducing the Risk of Acute Infections in Infancy.” British Journal of Nutrition, vol. 101, 2009, pp. 1722-26.

Rovers, M. M., et al. “Antibiotics for Acute Otitis Media.” The Lancet, vol. 368, 2006, pp. 1429-35.

Wahl, R. A., et al. “Echinacea purpurea and Osteopathic Manipulative Treatment in Children with Recurrent Otitis Media.” BMC Complementary and Alternative Medicine, vol. 8, 2008, p. 56.

Wilson, Debra Rose, and Rena Goldman. “Earache: 11 Effective Remedies.” Healthline, 5 May 2023, www.healthline.com/health/11-effective-earache-remedies. Accessed 31 Aug. 2023.