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recurrent otitis media
Integrative Treatment Guide for Recurrent Otitis Media
Integrative Therapies


Definition

Naturopathic HealthCare

Integrative Treatment Guide for Recurrent Otitis Media

Naturopathic Treatment Goals

Treat acute otitis media with non-antibiotic treatment options

Reduce frequency of otitis media

Prevent need for tympanostomy surgery

Prevent chronic otitis media complications

Reduce and eliminate risk factors associated with chronic otitis media

Reduce frequency of other Upper Respiratory Infections

Patient (parent/guardian) education and training

Create permanent healthy lifestyle and diet changes for patient and family

Decrease number of office visits to PCP as overall health improves

Enhance management of chronic otitis media

Naturopathic Assessment

History and Physical

Comprehensive Health Questionnaire, Food Journal

Lifestyle and Diet

Assess risk factors

Diet: high simple carbohydrate, high sugar

Environmental hypersensitivities

Food hypersensitivities-12

Recurrent URI, flu, colds

History of allergy and allergy associated symptoms

Chronic antibiotics3-7, 13

Increased intestinal permeability

Stress

Exposure to second-hand smoke1

Not breast-fed1, 15-16

Early bottle feeding

Family history of allergy

Assess risk of developing other allergy related symptoms and illness

Eczema, hay fever, asthma, etc.

Criteria for naturopathic treatment exclusion and inclusion, contraindication and precaution

Naturopathic Treatment

Therapeutic Nutrition

Botanicals

Homeopathy

Hydrotherapy

Individual diet

Develop permanent healthy diet and lifestyle changes for patient and family

Reduce and eliminate risk factors

Identify health goals

Patient (parent/guardian) Education and Training

Chronic Otitis Media Management and Prevention Information

Recurrent ear Infection information

Treatment explanations

Compliance and agreement

Treatment options and choices

Strategies to reach health goals

Food. allergies and chronic otitis media

Naturopathic Prevention Plan

Naturopathic Health Maintenance Plan

Chronic Ear Infection Information Packet:

Chronic Ear Infection, What Is Naturopathic Medicine?, Healthy Lifestyle Choices, Healthy Food Choices, Hypoallergenic Diet, Elimination Diet, Rotation Diet, General Diet Guidelines, Dairy Substitutions

Forms:

Comprehensive Health Questionnaire, Food Journal with list of food reaction/symptom response

Support Network Resources

Lectures (Southwest Naturopathic Medical Center), Southwest College of Naturopathic Medicine & Health Sciences (books, journals, information about naturopathic medicine, integrative and complementary medicine, references)

Long-Term Naturopathic Treatment Plan

Return to PCP for annual follow-up, physical exam and screening

One year follow-up with adjunctive treatment provider

Report of Findings to PCP

Physical Exam

Vitals

Weight, height

HEENT, Neck, CV, lung, abdominal

Naturopathic treatment plan individualized by selecting from the following therapeutic nutrition, botanicals and homeopathy:

Therapeutic Nutrition

Vitamin A (up to 50,000 IU per day for two days in children under six years of age)

Beta-carotene (age in years times 10,000 IU per day, up to 100,000 IU per day)

Vitamin C (age in years times 50 mg every two hours)

Bioflavonoids (age in years times 50 mg every two hours)

Zinc (age in years times 2.5 mg per day, up to 30 mg per day)

Thymus extract17-19 (500 mg crude polypeptide fraction/qd)

Human Micro Flora (HMF)25-26 (1/4-1/2 tsp/qd)

Colostrum 20-24 (1/8-1/4 tsp/qd)

Botanical Medicine

per individual patient

Homeopathy

per individual patient14

Hydrotherapy

per individual patient

footnotes

1. Daly KA. Epidemiology of otitis media. Otolaryngol Clin North Am 1991;24:775-86.

2. Kleinman LC et al. The medical appropriateness of tympanostomy tubes proposed for children younger than 16 years in the united states. JAMA 1994;271:1250-5.

3. Froom F et al. Antimicrobials for acute otitis media? A review from the international primary care network. B Med J 1997;315:98-102.

4. Bluestone CD. Otitis media in children: to treat or not to treat. New Eng J Med 1982;306:1399-404.

5. Van Buchen FL et al. Therapy of acute otitis media: myringotomy, antibiotics or neither? Lancet 1981;2:883-7.

6. Williams RL et al. Use of antibiotics in preventing recurrent acute otitis media and in treating otitis media with effusion. JAMA 1993;270:1344-51.

7. Rosenfeld RM et al. Clinical efficacy of antimicrobial drugs for acute otitis media: meta-analysis of 5400 children from thirty-three randomized trials. J Pediatr 1994;124:355-67.

8. McMahan JT et al. Chronic otitis media with effusion and allergy: modified RAST analysis of 119 cases. Otol Head Neck Surg 1981;89:427-31.

9. Viscomi GJ. Allergic secretory otitis media: an approach to management. Laryngoscope 1975;85;751-8.

10. Bellionin P et al. Allergy: a leading role in otitis media with effusion. Allerg Immunol 1987;15:205-6.

11. Hurst DS. Association of otitis media with effusion and allergy as demonstrated by intradermal skin testing and eostinophil cationin protein levels in both middle ear effusions and mucosal biopsies. Laryngoscope 1996;106:1128-37.

12. Nsouli TM et al. Role of food allergy in serous otitis media. Annals Allergy 1994;73:215-219.

13. Diament M, Diament B. Abuse and timing of use of antibiotics in acute otits media. Arch Otol 1974;100:226-32.

14. Friese KH et al. The homeopathic treatment of otitis media in children-comparisons with conventional therapy. Int J Clin Pharmacol Ther 1997;35(7):296--301.

15. Duffy LC et al. Exclusive breast feeding protects against bacterial colonization and day care exposure to otitis media. Pediatr 1997;100(4):E7.

16. Saarinen UM. Prolonged breast feeding as prophylaxis for recurrent otitis media. Acta Ped Scand 1982;71;567-71.

17. Fiocchi A et al. A double-blind clinical trial for the evaluation of the therapeutic effectiveness of a calf thymus derivative in children with recurrent respiratory infections. Thymus 1986;8:831-9.

18. Genova R, Guerra A. Thymo-modulin in management of food allergy in children. Int J Tissue Reac 1986;8:239-42.

19. Cazzola P et al. In vivo modulating effect of a calf thymus acid lysate on human T lymphocyte subsets and CD4+/CD8+ ratio in the course of different diseases. Curr Ther Res 1987;42:1011-7.

20. Tzipori S et al. Remission of diarrhoea due to cryptosporidiosis in an immunodeficient child treated with hyperimmune bovine colostrum. B Med J 1986;293:1276-1277.

21. Butler JE. Immunoglobulins of the mammary secretions. Lactation: A Comprehensive Treatise, Eds. Vol 3. Academic Press, NY. 1974;217-252.

22. Palmer EL et al. Antiviral activity of colostrum and serum immunoblobulins A and G. Medical Virology 1980:123-9.

23. Rump JA et al. Treatmemt of diarrhea in human immunodeficiency virus-infected patients with immunoglobulins from bovine colostrum. Clinical Invest 1992:588-94.

24. Pakkanen R, Aalto J. Growth factors and antimicrobial factors of bovine colostrum. Int Dairy J 1997;7:285-297.

25. Friend BA et al. Nutritional and therapeutic aspects of lactobacilli. App Nutr 1984;36(2):125-35.

26. Anand SK et al. Antibacterial activity associated with Bifidobacterium bifidum. Cult Dairy Pro 1984;6-80.