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
BarShalom R, Soileau J. (eds.) Natural Health Hotline. Beaverton, OR: Integrative Medical Arts, 1991-1999.
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.