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.