Please Make Sure You Check Out The Latest and Greatest Chiro-Kids Research Here.

Are You Raising A Healthy, Drug-Free Family?

(The picture says it all)

Dear Friend,

Our families have a problem!  Our children are growing up with nowhere else to turn.  The statistics are staggering.  Every year more than 5000 teenagers commit suicide and another 500,000 attempt to do so.  Thousands of kids are killed and injured each year in automobile accidents and horrible acts of violence that are linked to drugs.  Millions of kids are turning to drugs and alcohol to try to find their place in the world.  What can we do, as parents, to make sure that our children grow up saying “NO” to drugs and alcohol?

Have you set up a value system based on love and understanding, a value system free from drugs?  Are you raising a healthy, drug-free family?   

Many times, while your intention is to raise a drug- free family, you are creating a drug dependent one without even realizing it.  You may be actually programming drug dependency into your family’s behavior!

What do I mean by this?  How could this be?   

Think about what happens when your baby is born and he/she gets sick for the first time.  You probably have not been taught about your child’s natural immunity and how it develops, you might immediately run to your doctor in a panic to alleviate your child’s apparent suffering, at any price, and give your child a drug. 

As they grow up to become toddlers they may get another cold or infection and so they won’t “suffer”, you give them a drug. Think about it…How many bottles of cough medicine, sleep medicine, flu medicine, ear medicine, nose medicine, pain medicine and fever medicine do you have in your home?  They are all drugs!  

Drug companies market their products (drugs) to physicians and parents with little emphasis placed on these side effects.  Ritalin, for example, includes side effects such as insomnia, appetite loss, stunted growth and suicide.  Antibiotics cause digestive disturbances and create highly resistant bacteria that cause super infections, which strain your immune system and are untreatable.  Aspirin causes abdominal bleeding while Tylenol and Ibuprofen increase the risk of kidney disease. 

Even worse than the side effects of these drugs is the message it sends.  From the time they are born, your children get the message that when they feel bad they should take drugs to help them feel better.  As subtle as it may seem, this behavior is conditioned.  They see it every time you say, “I have a headache” and choose to take a pill.  It is any wonder that when a child doesn’t make the cheerleading squad or gets dumped by their boyfriend or girlfriend, they turn to DRUGS to relieve their pain?

You can stop the insanity that this quick fix, relief orientation causes.  Millions of people already have.    

People today want wellness.  They know that the human body has an incredible inborn healing power that heals them from infections and diseases the same way it heals them from a cut.  At the same time they have little faith in drugs.  They are demanding information on how to build their body’s immune system for long term health rather than performing constant crisis care. 

Chiropractic has led the way for these people by providing incredible results, information, scientific validation and research material on how to restore the body to optimum health and keep it that way. 

Thousands of families receive Chiropractic Wellness Care and have practically eliminated medical expenses because they are healthier now than ever before.  These are not just people who had back pain.  These are also people who were suffering from migraines, headaches, chronic pain, neck pain, shoulder pain, whiplash, ear infections, asthma, allergies, sports injuries, numbness, frequent colds and even bed wetting.  While chiropractic doesn’t treat these conditions, it allows the body to return to normal function so that it has the best opportunity to heal itself.   

Here’s what some of my “Practice Members” had to say:
“I was experiencing upper back pain and wanted relief.  I noticed immediate improvement in my health and attitude.  Chiropractic care has increased my stamina, recovery and overall bodybuilding program.”  Kimberly Silva, Westminster, age 34, Executive Assistant
Many of these people are perfectly healthy and are just looking to get to the next level of health and vitality. People are seeking out chiropractic care for superior performance also.  Olympic and professional athletes receive Chiropractic Wellness Care to help them get the most out of their training and enhance their performance. 
“I was at a point where I considered stopping triathlons.  With the assistance of Dr. Rob I have renewed my desire to race!” Pete Alfino, Highlands Ranch,  Iron Man

Children who used to get sick all the time and be on constant medication are now getting Chiropractic Wellness Care with their families and they are truly healthy and drug free.  Think about the difference in the message you kids are receiving with these two different approaches.  The old system says, “I’m sorry you feel bad.  Your body is weak and you need these drugs to be well.”  Wellness, on the other hand says, “Your body is strong and has the ability to heal itself.  Let’s remove the interference so you can get well on your own.  You can trust your body.” 

Children that grow up in wellness grow up believing in themselves and their independence from drugs.  Families that receive Chiropractic Wellness Care are sharing healthy times and perpetuating healthy values.  Kids run into Chiropractic offices and can’t wait to get on the table for their adjustments.  They are much healthier for it. 

Are you ready to make the commitment?  Let me help you raise a healthy, drug-free family with Chiropractic Wellness Care.  Let’s face it, your family’s health is priceless but everyone wants the best service at the lowest fee.  My office was voted Best Chiropractor in Highlands Ranch.  I am the only Chiropractor who is honored to have the Newcomer’s Seal of Approval.  I am the Chiropractor for the local high schools and provide donated care at Valor Christian High.  I served as chair of the Health Advisory Committee of Douglas County Schools.  My qualifications…I graduated Cum Laude from Western States Chiropractic College following my undergraduate education at the University of Colorado.  I have been entrusted to take care of everyone from tiny babies to professional athletes.  We perform the most state of the art computerized examinations in Highlands Ranch, which virtually guarantees our success with you.  So, I assure you the best service at my office.  As for the lowest fee, with this letter you will receive a complete examination at a cash rate of $57.  The computer portion of the exam is $93-$165 at other offices. Each additional family member accompanying the first may receive this amazing offer for $17.  You will be happy to know that I have family wellness plans for valuable yet affordable wellness adjustments.

So as you can see Chiropractic Wellness Care is the only option we have to raise a Healthy, Drug-Free Family and my office provides the best service at a very affordable fee.  Why would you want to entrust your family’s health to anyone else?

Make the commitment to your family and come experience chiropractic. 

 

Please check out the research corner to the left of the site with specific kids related health issues. 

 

 

Antibiotics Not Always Necessary In Ear Infections
Waiting a few days to see whether symptoms of an ear infection improve before beginning a course of antibiotics appears to be a practical way to reduce the use of antibiotics. This may help prevent the overuse of the drugs, and thus prevent bacteria from becoming resistant.
And even though physicians often complain that parents pressure them to prescribe antibiotics, most parents in the study were satisfied with a "wait-and-see" approach for treating the common ear infection otitis media.
A wait-and-see approach in the management of acute otitis media is feasible and was acceptable to most parents, and resulted in a 76% reduction in the use of antibiotic prescriptions.
Each year millions of children are prescribed antibiotics to treat the middle ear infection, but the evidence that the drugs speed a child's recovery is mixed. Plus, antibiotics can cause side effects such as diarrhea, and widespread prescription of the drugs is thought to be increasing the risk that bacteria will become resistant to antibiotics.
The study showed there was no significant difference in the reduction of pain or distress in children given antibiotics versus those who were not.
Parents of children who were treated immediately were more likely to believe in the effectiveness of antibiotics for otitis media, even though the infection can clear up on its own. This may encourage repeat visits for future ear infections, leading to even more antibiotic prescriptions, according to the authors.
While it is difficult to fault parents who want to seek treatment for a child in pain, parents can help a child without resorting to antibiotics, the authors note.
British Medical Journal February 10, 2001; 322: 336-342

Most Ear Infections Clear Up Without Antibiotics
A newly released report from the Agency for Healthcare Research and Quality (AHRQ) suggests that children may not always need antibiotics to treat a middle ear infection (otitis media).
Researchers from the Southern California/RAND Evidence-based Practice Center (EPC) found some interesting findings, including:
• Nearly two-thirds of children with uncomplicated ear infections recover from pain and fever within 24 hours of diagnosis without antibiotic treatment
• Over 80% recover within 1 to 7 days.
• Approximately 93% of children treated with antibiotics recover within 1 to 7 days.
• Researchers also found that the newer and more costly antibiotics, such as cefaclor, cefixime, azithromycin, or clarithromycin, provided no additional benefit to children than amoxicillin.
• Amoxicillin caused fewer side effects than the other antibiotics as well.
• The EPC also found no evidence that short-duration (5 days or less) versus long-duration therapy (7-10 days) made a difference in the clinical outcome for children over 2 years of age.
• More than 5 million cases of acute ear infections occur annually, costing about $3 billion.
The report points out that in other countries otitis media is not always treated with drugs at the first sign of infection. Rather, in children over the age of 2 years, the norm is to watch and see how the infection progresses over the course of a few days.
The report notes that in the Netherlands the rate of bacterial resistance is about 1%, compared with the US average of around 25%.
The Summary of the findings of this study, entitled Management of Acute Otitis Media Summary, Evidence Report/Technology Assessment 15, is available by calling the AHRQ Publications Clearinghouse at 1-800-358-9295.
Agency for Healthcare Research and Quality, Rockville, MD, August 9, 2000

EAR INFECTION ANTIBIOTICS OVERPRESCRIBED
Experts say the routine use of antibiotics against pediatric ear infections produces little health benefit while contributing to the spread of drug-resistant bacteria. The article evaluated the results of seven different studies conducted over the past 30 years. They found that while antibiotics were linked to short-term decreases in the duration of pain or fever in patients in a few (but not all) of the studies, no
long-term (more than six weeks) benefits are reported. All seven studies concluded that children recovered from ear infections at roughly similar rates, regardless of type of treatment.
The authors believe the frequent use of antibiotics for common ear infections raises risks that children will harbor drug-resistant bacteria during subsequent illness. They point out that children whose previous ear infections were treated with antibiotics have a rate of Ampicillin (amoxicillin)-resistant bacteria that is three times higher during subsequent otitis media episodes In extreme cases, deaths from drug-resistant meningitis have been linked to built-up antibiotic resistance traced to previous treatment for ear infection.
The experts advocate that except in severe, recurrent cases, infants and toddlers with ear infections should be initially treated with 'symptom-relieving' drugs such as Acetaminophen and nasal decongestants. If symptoms persist past three days, antibiotics can be considered at that time.
JAMA November 26,1997;278(20):1643-1645
OTITIS MEDIA
* Articles * Studies * Questions *
Studies
Two hundred pediatricians and two hundred chiropractors that were selected were surveyed to determine what, if any, differences were to be found in the health status of their respective children as raised under the different health care models. The 'chiropractic' children showed a 69% otitis media free response, while the 'medical' children only had a 20% otitis media free response.
 van Breda WM; van Breda JM. A comparative study of the health status of children raised under the health care models of chiropractic and allopathic medicine. J Chiro Res 1989; 5:101-3 / Mantis ID: 10048
93% of all episodes of otitis media treated with chiropractic care improved, 75% in 10 days or fewer and 43% with only one or two treatments. This study's data indicates that limitation of medical intervention and the addition of chiropractic care may decrease the symptoms of ear infection in young children.
 Froehle RM; Ear infection: a retrospective study examining improvement from chiropractic care and analyzing for influencing factors. J Manipulative Physiol Ther 1996; 19(3):169-77 / Medline ID: 96294956
The author has presented a case series of five patients with chronic recurrent otitis media who underwent a program of chiropractic case management, including specific spinal adjustments. All patients had excellent outcomes with no residual morbidity or complications.  The associated morbidity of current medical and surgical options for otitis media with effusion (OME), coupled with a lack of rigorous experimental designs in some reports, further necessitates the exploration of alternative approaches to case management.
 Fysh PN Chronic recurrent otitis media: Case series of five patients with recommendations for case management. J Clin  Chiro Ped 1996; 1(2): 6 / Mantis ID: 36438
A misconception is that otitis media is a primary disease entity; more accurately it is a complication of other childhood complaints such as the common cold, sinusitis, and sore throats. 
 Ballantyne J. The ear in paediatric practice. Practitioner 1985; 229(1407):809-12 / Medline ID: 86067665
Based on these findings, the authors conclude that there appears to be no basis to the commonly held belief that swimming may induce or exacerbate otitis media. In fact, the converse may be true.
 Robertson LM; Marino RV; Namjoshi S. Does swimming decrease the incidence of otitis media? J Am Osteopath Assoc 1997; 97(3):150-2 / Medline ID: 97261095
Inflammation in the nasopharynx and the pharyngeal portion of the eustachian tube was considered to be closely related to the tubal constriction, which represents a considerable part of the cause of tubal ventilatory dysfunction in otitis media with effusion.
 Takahashi H; Miura M; Honjo I; Fujita A; Cause of eustachian tube constriction during swallowing in patients with otitis media with effusion.Ann Otol Rhinol Laryngol 1996; 105(9); 724-8 / Medline ID: 96393273
Musculoskeletal eustachian tube dysfunction is an important etiological factor for otitis media. The eustachian tube dysfunction manifests primarily by poor ventilation from the nasopharynx to the middle ear, by allowing sniff induced negative pressure in the middle ear.
 Todd NW, Feldman CM. Allergic airway disease and otitis media in children. Int J Pediatr Otorhinolaryngol 1985: 10(1):27-35 / Medline ID: 86084755
In cases of secretory otitis media it is generally agreed that the usual basic factor is an inflammatory process with functional or mechanical obstruction of the eustachian tube.
 Lehnert T, Acute otitis media in children. Role of antibiotic therapy., Can Fam Physician 1993; 39: 2157-62. / Medline ID: 94034451
Tympanostomy treatment in cases of chronic otitis media does not eliminate the dysfunction of the eustachian tube, but only serves to substitute tubal function.
 Virtanen H. Eustachian tube function in children with secretory otitis media. Int J Pediatr Otorhinolaryngol 1983; 5(1):11-7 / Medline ID: 83184994
Only 4% of the 222 infants with recurrent acute otitis media developed chronic otitis media with effusion and an additional 12% continued having recurrent episodes. Spontaneous recovery from recurrent acute otitis media is common with increasing age. Thus, until reliable causal evidence between recurrent otitis media and developmental disability is presented, chemoprophylaxis or tympanostomy tubes seem superfluous for most infants after the age of 16 months.
 Alho OP; Läärä E; Oja H; : What is the natural history of recurrent acute otitis media in infancy? J Fam Pract 1996; 43(3):258-64 Medline ID: 96390780
Myringotomy and tympanostomy with tube implantation are frequently both ineffective and expensive. 
 Gates GA; Wachtendorf C; Hearne EM; Holt GR. Treatment of chronic otitis media with effusion: results of tympanostomy tubes. Am J Otolaryngol 1985; 6(3):249-53 / Medline ID: 85249128
 Gates GA; Wachtendorf C; Hearne EM; Holt GR; Treatment of chronic otitis media with effusion: results of myringotomy. Auris Nasus Larynx 1985; 12 Suppl 1: S262-4 / Medline ID: 86241798
In a study of  6611 children, making generous clinical assumptions, 41% of the proposals for these reasons had appropriate indications, 32% had equivocal indications, and 27% had inappropriate ones. About one quarter of tympanostomy tube insertions for children in this study were proposed for inappropriate indications and another third for equivocal ones.
 Kleinman LC, Kosecoff J, Dubois RW, Brook RH, The medical appropriateness of tympanostomy tubes proposed for children younger than 16 years in the United States. JAMA 1994; 271(16): 1250-5 / Medline ID: 94202440
It is concluded that the use of ventilation tubes in children with primary secretory otitis media is not justified. Observation has shown that only a small proportion will require surgical treatment of the middle ear. A ventilation tube may be indicated in order to combat hearing loss, but it should be borne in mind that its use involves a high risk of complications and sequelae which may result in chronic middle ear disease. 
 Lildholdt T, Ventilation tubes in secretory otitis media. A randomized, controlled study of the course, the complications, and the sequelae of ventilation tubes., Acta Otolaryngol Suppl (Stockh) 1983 (398): 1-28 / Medline ID: 84076229
Medical treatment failures probably already surpass eustachian tube dysfunction as the most common reason for tympanostomy tube insertion.
 Poole MD; Otitis media complications and treatment failures: implications of pneumococcal resistance. Pediatr Infect Dis J 1995; 4(14):S23-6 / Medline ID: 95312350
Antibiotic treatment of otitis media is no more effective than placebo, and increases the risks of reoccurrence.
 Cantekin EI. Antibiotics to prevent acute otitis media and to treat otitis media with effusion. JAMA 1994; 272(3):203-4 / Medline ID: 94293436
To determine the effect of antibiotic treatment for acute otitis media in children six studies of children aged 7 months to 15 years were reviewed.  60% of placebo treated children were pain free within 24 hours of presentation, and antibiotics did not influence this.  Antibiotics seemed to have no influence on subsequent attacks of otitis media or deafness at one month.  Antibiotics were associated with a near doubling of the risk of vomiting, diarrhoea, and/or rashes.  Early use of antibiotics provides only modest benefit for acute otitis media: to prevent one child from experiencing pain by 2-7 days after presentation, 17 children must be treated with antibiotics early.
 Del Mar C, Glasziou P, Hayem M, Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis., BMJ 1997; 314(7093) :1526-9 / Medline ID: 97326380
Otitis media with effusion usually resolves spontaneously. The available literature indicates that antibiotic treatment has at most a short-term effect. Therefore it is not indicated for the treatment of otitis media with effusion.
 Grote JJ; Antibiotics in otitis media with effusion. Ned Tijdschr Geneeskd 1997;141(2):76-7 / Medline ID: 97166702
Antibiotics are not the best treatment for middle ear infections (otitis media) and doctors should stop routinely prescribing drugs for them.
 Froom J; Culpepper L; Jacobs M; DeMelker RA; Green LA; van Buchem L; Grob P; Heeren T. Antimicrobials for acute otitis media? A review from the International Primary Care Network. BMJ 1997; 315(7100): 98-102 / Medline ID: 97384382
Records from 2,089 otitis media patients were examined to determine incidence and treatment success. There was no difference in success rates between antibiotic and no antibiotic therapies.
 Tilyard MW; Dovey SM; Walker SA. Otitis media treatment in New Zealand general practice. N Z Med J 1997; 110(1042):143-5 / Medline ID: 97296886
Most clinical trials comparing the efficacy of different antibiotics have failed to show differences in clinical efficacy. To date, no definitive trials of bacteriologic efficacy in children have been published.  Cohen R. The antibiotic treatment of acute otitis media and sinusitis in children. Diagn Microbiol Infect Dis 1997; 27(1-2):35-9 / Medline ID: 97272394
In a review and critical appraisal of the literature on antibiotic therapy for acute otitis media in children between 1939 and 1991, poor evidence supported the routine use of antibiotic therapy.  This approach cannot be recommended for children 2 years and younger because this age group has been excluded from most studies.
 Fysh PN Chronic recurrent otitis media: Case series of five patients with recommendations for case management. J Clin  Chiro Ped 1996; 1(2): 6 / Mantis ID: 36438
Few issues in clinical medicine are as controversial as the efficacy and risks associated with antibiotic treatment of otitis media. Recent studies document the emergence and rapid spread of drug-resistant streptococcus pneumoniae in acute and unresponsive otitis as well as persistent effusions and chronic suppurative otitis. It is best to avoid the antibiotic treatment dilemma as much as possible by not over diagnosing otitis media.
 Berman S; Management of acute and chronic otitis media in pediatric practice. Curr Opin Pediatr 1995; 7(5):513-22 / Medline ID: 96120875
Oral decongestants are ineffective in treatment, or prevention, of otitis media in children.
 Olson AL, Klein SW, Charney E, et al. Prevention and therapy of serous otitis media by oral decongestant, a double-blind study in pediatric practice. Pediatrics 1978; 61:679-84 / Medline ID: 78201214
While once-a-day dosing was equivalent to twice-a-day dosing for amoxicillin prophylaxis, there was no benefit of amoxicillin prophylaxis compared with a placebo control in preventing new AOM episodes. Because of the potential of excessive antibiotic use to promote the acquisition of resistant pneumococci and the lack of effectiveness in this trial, routine use of amoxicillin prophylaxis should be discouraged.
 Roark R; Berman S. Continuous twice daily or once daily amoxicillin prophylaxis compared with placebo for children with recurrent acute otitis media. Pediatr Infect Dis J 1997; 16(4):376-81 / Medline ID: 97262931
Amoxicillin with and without decongestant-antihistamine combination is not effective for the treatment of persistent asymptomatic middle ear effusions in infants and children.
 Cantekin EI; McGuire TW; Griffith TL Antimicrobial therapy for otitis media with effusion ('secretory' otitis media) JAMA 1991; 266(23): 3309-17 / Medline ID: 92072085
Patient recovery from otitis media seemed not to be influenced by either the type of antibiotic given, or the period of time for which it was given, except that the rates of recovery were better in patient's of all age groups who did not receive any antibiotic therapy at all.
 Froom J, Culpepper L, Grob P,  et al, Diagnosis and antibiotic treatment of acute otitis media: report from international primary care network, BMJ 1990; 300(6724):582-6 / Medline ID: 90212921
Within a prospective group study of five practicing otorhinolaryngologists, conventional therapy of acute otitis media in children was compared with homeopathic treatments. Group A (103 children) was primarily treated with homeopathic single remedies. Group B (28 children) was treated by decongestant nose-drops, antibiotics, secretolytics and/or antipyretics. Comparisons were done by symptoms, physical findings, and duration of therapy and number of relapses. The children of the study were between 1 and 11 years of age. The median duration of pain in group A was 2 days and in group B 3 days. Median therapy in group A lasted 4 days and in group B 10 days. Antibiotics were given over a period of 8-10 days, while homeopathic treatments were stopped after healing. In group A 70.7% of the patients were free of relapses within 1 years and 29.3% had a maximum of three relapses. Group B had 56.5% without relapses and 43.5% a maximum of six relapses. Of 103 subjects 98 (95.1%) responded solely to homeopathic treatments. No side effects of treatment were found.
 Friese KH; Kruse S; Moeller H; Acute otitis media in children. Comparison between conventional and homeopathic therapy. HNO 1996; 44(8):462-6 / Medline ID: 96398163

Otitis Media in Young Children
By: Chris L. Hendricks, D.C. and Susan M. Larkin - Thier, D.C
Originally Published: The Journal of Chiropractic Research, Study and Clinical Investigation 1989; 2(1):9-13
ABSTRACT
This article explores the current medical literature on otitis media. Utilizing the information gathered from this literature search, a research study is being developed to test the hypothesis that chiropractic adjustments of the cervical region may effect a resolution of acute and chronic otitis media. The authors review anatomy of the middle ear and current medical treatment of otitis media and propose a hypothesis for future chiropractic clinical research.
KEY WORDS: Antibiotic therapy, chiropractic, myringotomy,otitis media.
INTRODUCTION
Otitis media , an inflammation of the middle ear, is a problem that has plagued young children and the health care community for years. [1] [2] A misconception is that otitis media is a primary disease entity; more accurately it is a complication of other childhood complaints such as the common cold, sinusitis and sore throats.[3] [4] By the age of two, 33 percent of all children have had three or more episodes of otitis media, and approximately 66 percent have had at least one attack.[5] [6] Children between four and seven years of age experience more frequent attacks of otitis media than younger children.[1] [7] Otitis media is a common cause for significant loss of school time among elementary school children.[8] Some learning disabilities can be traced to the asymptomatic hearing loss associated with chronic otitis media.[3] [9] [10]
Currently, antibiotic therapy is the first step in the standard medical approach.[11] [12] Myringotomy and tympanostomy tube placement are more radical procedures employed for non-responsive cases.[13] [14] Unfortunately, these surgical procedures frequently are both ineffective and expensive.[15] [16] The annual cost of diagnosis and treatment of children with otitis media reaches nearly $2 billion per year.[16]
Chiropractic has been ignored in the literature as a viable treatment for otitis media. There is a direct relationship between the middle ear, the tensor veli palatini muscle and the superior cervical ganglion. Employing the basic tenets of the science of chiropractic, it is logical to hypothesize that doctors of chiropractic may be able to effectively treat otitis media.
ANATOMY OF THE EAR
The ear is divided into three parts; the external ear , the middle ear and the inner ear. Since the inner ear is not germane to otitis media, it will be excluded from this writing.[17]
THE EXTERNAL EAR
The external ear consists of the auricle and the external auditory meatus. The external auditory meatus is continuous with the tympanic membrane, which transmits pressure to the three auditory ossicles of the middle ear: the stapes, incus and malleus.[17] [18]
The tympanic membrane is divided into two parts: the pars flaccida (located in the superior aspect) and the remainder of the membrane, the pars tensa.[19] The manubrium, or handle of the malleus attaches to the center of the tympanic membrane, drawing it inward, which forms a concavity on the tympanic membrane's outer surface.[17] [18] The center of this concavity is referred to as the Umbo. The cone of light, a landmark of the normal tympanic membrane, is visualized in the anterior inferior quadrant, while the lateral or short process of the malleus is located in the posterior superior portion of the pars flaccida. [8] [17] [18] [20] Posterior and parallel to the posterior to the upper portion of the handle of the malleus is the long process of the incus. The head of the stapes is inferior to the incus.
THE MIDDLE EAR
The middle ear consists of the tympanic membrane and three additional openings or windows. The round window and the oval window communicate with the inner ear and the final opening permits the eustachian tube to provide a drainage mechanism into the paranasal sinuses.[17] [18] [21] (Figure 2).

The middle ear or tympanic cavity is an epithelial lined cavity, hollowed out of the temporal bone. The eustachian tube, lined with ciliated columnar epithelium containing goblet cells, connects the middle ear cavity to the paranasal sinuses.[21] [22]
The paranasal sinuses connect with the nasal cavity via the normally patent ostium of the eustachian tube.[23] The middle ear cavity and the sinuses constantly accumulate transmucosal exudates and require a mechanism to clear this fluid.[21] [24] The entire epithelial lining is ciliated so that, under normal circumstances, ventilation and drainage readily occur through the ostium. If the ostium is even partially blocked, as occurs in pathologic conditions, such as sinusitis, the common cold and sore throats, accumulations of fluid with mucosal inflammation and/or infection will result. [3] [21] [24] [25] [26]
When the eustachian tube functions normally, there is a clearance of fluid, exchange of gases and equalization of pressure. [24] [27] This occurs by contraction of the tensor veli palatini muscle. [16] [18] [21] This muscle is innervated by the mandibular branch of the trigeminal nerve with motor fibers. These fibers exit the middle cranial fossa through the foramen ovale and unite outside the skull, forming portions of the superior cervical ganglion located between the C-1 and C-4 nerve roots. [5] [17] [26] [28] [29]
The eustachian tube in infants is nearly horizontal, and slowly acquires an angle of 45° by the time the child reaches the age of seven.[8] The ostium very closely approximates the lymphatic tissue of Waldeyer's Ring. As the child grows and the eustachian tube assumes a greater angle, more space develops between the ostium and this lymphatic tissue.[8] [20] However, during frequent upper respiratory infections in early childhood, the lymphatic tissue hypertrophies and may block the eustachian tube opening. [30] [31] This makes ventilation of the middle ear impossible and provides a simple explanation for the occurrence of otitis media.
PATHOPHYSIOLOGY
Otitis media is classified by duration and type of exudate.
Acute Otitis Media
Acute otitis media is a disorder generally seen in young children ages 0 through 7 years of age following an upper respiratory infection.[3] [8] [20] The acute type of otitis media is an infection that lasts less than three weeks and produces a purulent exudate that is either bacterial or sterile. The organisms responsible for the development of the disease are pneumococci (30%). H. Influenzae (20%). Beta-hemolytic streptococcus (10%), and sterile injection (40%). [8] [32] [33] [34] In the case of bacterial infection the eustachian tube is partially open allowing contamination from the nasopharynx by reflux (seen in tympanic membrane rupture or tube placement), aspiration (as seen in an increase in middle ear pressure) and insufflation (as seen in crying, nose blowing, sneezing, and swallowing when the nose is obstructed). The tensor veli palatini muscle is the only active opener of the eustachian tube. When there is total obstruction of the eustachian tube, drainage of effusion is prohibited by impaired mucociliary transport and by sustained negative pressure in the middle ear. The process results in the accumulation of sterile transudate in the middle ear.[20]
Diagnosis of acute otitis media depends on the appearance of the tympanic membrane, patient presentation and /or a recent history of upper respiratory infection. [8] [25] [35] [36] The tympanic membrane may appear either red or yellow, depending upon the amount of fluid present in the middle ear. In the early stages, bulging may be limited to the pars flaccida, but later the entire tympanic membrane bulges outward giving it a doughnut like appearance.[8] [20] [35]
The major clinical presentations of acute otitis media are earache, fever and bulging of the tympanic membrane. Otitis media caused by H. Influenzae more often presents with a low grade fever, minimal pain and only a slightly bulging tympanic membrane. If the tympanic membrane is inflamed but flat, the exudate is most probably sterile. If only the pans flaccida is bulging, a 20 percent probability of bacterial infection exists. Beta- hemolytic streptococcus is frequently the organism present in cases where there is a spontaneous rupture of the tympanic membrane. [8] [20] [35] [36]
The drugs of choice are broad ranged antibiotics (e.g. Ampicillin, Amoxicillin, Erythromycin, Cefaclor and Sulfonamide) for a period of ten days. Sterile effusion will not respond to antibiotics. If there is not improvement within 36 hours antibiotics should be discontinued. [37] [38]
Chronic Otitis Media
Chronic otitis media is an infection seen most often in school-aged children, which lasts longer than three months and produces a thick and tenacious secretion found in the middle ear. [39] [40] It is characterized by a dull, immobile tympanic membrane due to persistent fullness of the middle ear with sterile exudate. There is no superimposed infection. [2] [16] [41] The main cause often complete occlusion of the eustachian tube. which, creates a vacuum in the middle ear. [42]
Chronic otitis media. unlike the acute variety is usually clinically asymptomatic.[39] Permanent hearing loss is commonly encountered although its gradual onset frequently goes unnoticed. The patient may complain of fullness in the ear or the sensation of "speaking in a barrel". This type of otitis media is closely associated with learning disabilities. The child frequently presents as agitated. irritable or unable to concentrate in school. [43] [44] [45] [46] [47] [48]
Upon examination. the tympanic membrane may appear mildly infected and dull, or it may appear normal in the resolution stage there may be fluid levels or air bubbles seen on the tympanic membrane indicating a return of eustachian tube function.[3] [8]
CONVENTIONAL MEDICAL TREATMENT
Many methods and approaches have been utilized by the medical community for the treatment of otitis media. In the 1940’s and 1950’s patients underwent adenoidectomies, on the assumption that the adenoids were occluding the eustachian tube opening. The uselessness of the surgery became apparent, hence the practice was gradually abandoned. [8]
In the 195O’s and early 1960’s, the practice of lancing the tympanic membrane (myringotomy) was the procedure of choice. [49] [50] While somewhat successful, this surgery addressed only half the problem of otitis media. Following the myringotomy, fluid is released for a short period of time, but the opening created by the procedure closes quickly, allowing fluid build up. Even the short period of ventilation did not seem to have any effect on the negative pressure vacuum created by the eustachian tube dysfunction. [51]
In the mid 1960’s tympanostomy tubes were introduced.[49] [52] In the same surgical procedure practiced today, the tympanic membrane is incised and a drainage tube inserted and secured. The tubes are generally held in place for a period of six months then removed if they have not been spontaneously aborted. During the time the tympanostomy tubes are in place, the patient experiences a decrease in symptomatology. [2] [8] [13] [14]
INEFFECTIVENESS OF MEDICAL TREATMENT
Since the 1940’s antibiotics have been the medical community's first approach to most aliments. As previously stated, 40 percent of otitis media cases are the result of sterile effusion , and therefore unresponsive to the antibiotics. [43] [53]
The side effects of antibiotic usage include allergic reaction (e.g. hives, shortness of breath, anaphylactic shock). gastrointestinal upsets (e.g. nausea, vomiting, diarrhea), superimposed yeast infections (caused by candida albicans resulting in thrush and vaginitis), and finally, an increase in tolerance of the child to antibiotics, rendering the drugs ineffective at some point. Some sources believe that the increased frequency of otitis media noted in this decade is due to antibiotic resistance. [8] [20] [54]
Children through the age of two who have had two or more episodes of acute otitis media in the same ear are considered to be appropriate candidates for myringotomy. [13] [14] Children over two who have had three episodes of otitis media in the same ear are considered to be candidates for myringotomy with the placement of ventilating tubes.[55] [56] However, 98 percent of children who have had myringotomies will experience a recurrence of effusion buildup after 53 days, and 75 percent of children with ventilation tubes will experience a recurrence after 223 days. [15] [57] [58]
Evidence suggests short term adverse effects of myringotomy and tympanostomy tubes include the occlusion of the incision before pressure equalizes and the displacement of tubes, requiring a second surgical placement.[58] There is mounting evidence that these surgical procedures produce adverse effects which will show up years later.[55] [56] [57] [58]. Forty percent of the cases of the insertion of tympanostomy tubes have resulted in permanent structural damage to the tympanic membrane, such as the atrophy of the tympanum presenting five or more years later, Twenty-five percent of the persons subjected to this procedure for the prevention of deafness experienced total hearing loss seven to ten years later.[5]
CONCLUSION
The key to the pathogenesis of otitis media appears to be the eustachian tube. Inappropriate function of the tensor veli palatini muscle, the small muscle responsible for opening and closing the eustachian tube, may be due to delayed nerve supply. When normal function is present, fluid is free to drain away from the middle ear. In abnormal function, fluid is trapped and the middle ear initiates an inflammatory response. [17] [28]
Motor nerve fibers can be traced from the tensor veli palatini, to the superior cervical sympathetic ganglion. The cervical plexus receives these fibers between the spinal levels of C-l through C-4. Subluxation’s affecting these levels may be responsible for deranged function of the tensor veli palatini muscle resulting in the pathological response of otitis media. Restoring the spine to its proper alignment through chiropractic care should result in the return of normal nerve supply to the tensor veli palatini muscle and ultimately normal function of the eustachian tube. A controlled clinical trial of the efficacy of chiropractic care on otitis media is indicated to verify this conclusion. Such a study is planned by the authors and should begin later this year.
ACKNOWLEDGMENTS
The authors wish to acknowledge the editorial support of Alana C. Ferguson and Carol J Goetzke, Palmer College of Chiropractic. Illustrations are by Larry Sigulinsky, DC
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Otitis Media
Otitis media (OM) is a generic name for several conditions that can affect the middle ear, including inflammation of the middle ear, ranging from acute to chronic and with or without symptoms. Acute otitis media (AOM) is characterized by symptoms of pain and fever. Otitis media with effusion (OME) is typified by the presence of fluid in the middle ear without signs or symptoms of infection.
Otitis media is the leading reason for visitation to the pediatrician's office. This is probably true for first time visits by frustrated parents to chiropractic offices. From 1975 to 1990, office visits for otitis media have increased by 150 percent to 24.5 million visits, or 81 percent of the pediatric profile for children under the age of 15. The leading age group for OM is children under the age of two.
In 1991, the management costs for each episode were $406 per patient; direct and indirect surgical treatment costs were $2,174. These costs included physician office visits, prescription medications, and parents' time lost from work.
The usual treatment for OM is a 10 day regiment of the antibiotic amoxicillin. In this author's clinical experience, it is not unusual to take a history on a child under the age of two and discover that they have been on antibiotics for half of their short lives. A recent trend which is even more frightening is the increase of children who have been recommended that they maintain a low daily dose of antibiotics for months after no signs of OM are present. With this direction, why should it surprise us that we face an epidemic of bacteria resistance, leaving an alarming number of drugs on the market ineffectual.
In 1994, George Washington University and the University of Minnesota reviewed 33 studies evaluating the efficacy of various antibiotics for the treatment of AOM. Using the statistical technique of meta-analysis, they discovered that drugs have only about a 14 percent advantage over the body's own immune system.
This extrapolates to treating six children (who will not benefit from chemical treatment) to help a seventh child. Not knowing who needs the treatment and who doesn't is a problem for the medical community.
If the medical community is failing to appropriately rule out which children would not benefit from chemical treatment, we have an even larger pandemic usage of drugs for the treatment of OME. Recommendation for the management of OME was published by the U.S. Department of Health and Human Services in the July 1994 Clinical Practice Guideline (CPG), number 12.
The guideline strongly suggests the observation of OME. In approximately 60 percent of children, middle ear fluid goes away without treatment within three months; in 85 percent, it goes away within six months. The use of antibiotics may only speed up 14 percent of the fluid that will dissipate and may decrease the chance of middle ear infection. The disadvantages are that the fluid may not go away; there may be unwanted drug side-effects; and drug-resistant strains of bacteria may develop. Surgical use of tubes is not considered an initial treatment.
Specific requirements were necessary to even consider the child as a candidate. Those requirements were 4-6 months of bilateral effusion and bilateral hearing deficit. The disadvantages of insertion of tympanotomy tubes were: the risk involved with anesthesia; the repeated surgery needed to replace tubes that fell out; and changes in the eardrum (tympanosclerosis in 51 percent and postoperative otorrhea in 13 percent of the children).
Other factors that the CPG concluded to predispose the child to a higher risk for OME were infants who were bottle-fed, those subjected to passive smoking, and those attending group child care facilities.
Chiropractic Considerations
The chiropractic evaluation must include a thorough evaluation of the entire cervical spine for vertebral subluxation. A close examination of the C1-C4 region should be undertaken. The cervical plexus receives motor fibers that can be traced from the eustachian tubes (tensa veli palatine) to the superior cervical sympathetic ganglion. Often doctors assume that C1 or C2 is the involved segment and they neglect to examine the entire cervical spine.
Prior to the adjustment, motion and static palpate the vertebral segment directly under the suspected segment. Confirm with motion palpation that a larger vertebra (e.g., C2) has not been chosen because it is easier to contact. Secondly, static palpation often reveals taut and tender fibers over the atlas. Do not misconstrue this finding as the involved segment without confirming the analysis with motion palpation. In rare occasions, a sacral segment (e.g., S2, S3) may be the involved subluxation site (or is involved in conjunction with a cervical subluxation). This is due to parasympathetic association.
Frequency and length of care will vary from patient to patient. A weak immune system will have a longer response period (sometimes several months, if not loner, to chiropractic care). The doctor should communicate to the parents that environmental and lifestyle changes (e.g., passive smoking, poor diet, etc.) may lengthen the child's response time. Inform parents that along with chiropractic care, you will be advising them regarding lifestyle changes.
The child with a previous history of antibiotic usage is often a difficult case. All these children have a depressed immune system and their bodies need time to rebuild their own natural defenses.
The bottle-fed infant definitely has a greater risk to OM. Many theories have arisen why this may contribute to OM. Most authorities believe that there is some influence to the function of the eustachian tubes. Some discussion has been given to the following factors: a decreased angle (slant) of the infant being fed; different suckling response on the nipple of the bottle; and being fed on the same side depending on the left/right-handedness of the caretaker. One suspect is the fluid residue which may lead to a breeding ground for bacteria.
Day care facilities appear to be a breeding ground for illness, further contributing to a child struggling to regain a strong immune system. Although many parents don't have options, you may want to suggest ideas to reduce the child's risk. Find a smaller center, or better yet a home where this child will only be with the caretaker's children. In a more serious situation, attempt to have the child cared for by a family member (e.g., grandparent) or a caretaker who will watch only their child.
Also beware of the Monday sick child. This may be the result of a weekend of late nights, no naps, poor diets, or a stay in the church nursery.
Teething may often give the appearance of AOM. The child will exhibit irritability, pulling the ear on the side of the tooth breaking through, crying, ever, and mild cold symptoms. Inform parents what to expect during these periods and closely monitor the child in your office.
Review the eating habits of the family. Often, you will discover that the child has a poor diet, with the balance weighing heavily towards dairy, fruit juices, fast foods and sweets.
Spinal hygiene is another factor. Inquire to the habits of the child. Children sleeping on their stomach will place constant rotational stress on the cervical spine. Repetitive trauma to the forehead as the child is learning to master the skills of walking, rough laying, and falls all warrant closer evaluation of the child's spine.
The chiropractic community has much to offer to families when it comes to health care for children. Although we may not be able to help all children with OM/OME, if chiropractic care could help the six out of seven who are exposed needlessly to drugs, we have an ethical responsibility to pursue this problem.

 

 

Highlands Ranch Chiropractor, Dr. Rob Anderson, Doctor of Chiropractic, specializes in family health, sports performance, spine degeneration, disc injuries, disc herniation, children's health, ear infections, correction, traction, decompression, headaches, back, neck, and shoulder pain.  He has served as the Chair for the Douglas County Health Advisory Committee, as Director of Sport Sensory Performance for HitStreak Baseball Academy, as Team Doctor for Highlands Ranch High School and Valor Christian High School and been honored to be a guest speaker for many local groups and businesses.  He also owns and operates the Vitality Performance ZONE in Centennial which teaches elite athletes to dominate their sport with enhanced vision techniques, reaction time, hand-eye coordination, breathing enhancements, balance and coordination.   He serves practice members from Castle Rock, Englewood, Littleton, Centennial, Denver, Lakewood, Highlands Ranch, Lone Tree.  He is seen by his colleagues and practice members as the Best of the Best in Chiropractic in Colorado.