Should Watchful Waiting Be Used
More Often for Acute Otitis Media?
Are antibiotics really needed for ear infections? An article from
the October 2001 issue of the Archives of Internal Medicine suggests
otherwise. According to the article the medical profession is facing
a situation where the antibiotics they have relied on in the past are
becoming less effective, prompting physicians around the world to consider
alternatives. One of
the alternatives is ear surgery called myringotomy, an operation where the
child is strapped to a papoose board and held down. Myringotomy is
an operation in which a small cut is made in the ear drum to relieve
pressure caused by pus or fluid in the middle ear. A small tube may then
be placed in the cut to allow fluid to drain from the ear and air to pass
inside. The tube usually falls out on its own in about a year and the cut
heals. While myringotomy is done on both adults and children, it is done
most often on children. In fact, it is the most common operation done on
children. Myringotomy is not without potential serious complications.
The disturbing part of the report raises the question of effectiveness,
"Perhaps the most important question is whether myringotomy is an
effective treatment for acute otitis media. The available evidence (1
randomized controlled trial and 1 case series) suggests probably
not." The researchers go on to question, "How safe is
myringotomy? What other costs are there? The operation's psychological
effects of being held down and strapped to a papoose board are not
described."
The researcher noted that otitis media is a spontaneously remitting
disease. This means that in most cases it clears up by itself. They
also noted that other populations have already adopted a watchful-waiting
strategy. The result was that nothing catastrophic happened. The
Netherlands already has a policy of supportive treatment only and
using antibiotics and/or myringotomy for less than 5% of diagnosed cases
of acute otitis media. In that country a study showed that more than
90% of nearly 5000 children recovered within a few days.
The option that these
researchers are suggesting is "watchful-waiting". They
suggest, "Perhaps we need to offer the alternative of watchful
waiting more often for acute otitis media, rather than marginally
effective antibiotics (which cause bacterial antibiotic resistance) or the
fearsome procedure of myringotomy."
Chiropractors have long talked about the benefits of chiropractic care
for children with otitis media. One study in 1998 of 401 children
showed marked improvement for the children with otitis media who received
chiropractic care.
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