Complementary, Alternative Medicine Use High and Varied in Treating Middle Ear Infection in Israeli Children (press release)

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Israeli researchers have found that slightly more than half of children admitted to a major treatment facility for acute otitis media have received alternative and complementary therapy. The most common therapy received was various immune boosting national preparations containing Echinacea Purpurea, despite the fact that no evidence exists proving that this product is effective against this common pediatric medical disorder.

Background: Otitis media with effusion (OME), or middle infection is a very common childhood affliction, with a cumulative incidence of 80 percent at the age of four years. OME may occur as a sequel to single or recurrent acute otitis media (RAOM). OME may cause a conductive hearing loss at a level of about 25 to 30 dB associated with fluid in the middle ear, which has been associated with language and speech impairment. Medical treatment options may include the use of decongestants, antihistamines and antibiotics. However, recent guidelines have recommended a strategy of watchful waiting with surgical intervention reserved for prolonged and difficult cases.

Research regarding the use of complementary and alternative medicine (CAM) in the treatment of acute otitis media is scarce. Such treatment may include certain types of herbal medicine, osteopathy, chiropractic, and homeopathy.

The prevalence of CAM use for the treatment of AOM and OME may be high. A large Canadian prevalence study stated “Respiratory” and “ENT” conditions as the main reason for children to seek CAM Treatment, comprising of 27 percent and 24 percent of total visits to a CAM practitioner, respectively. No study regarding the use of CAM within the researchers’ specific population of children had been performed. In order to delineate the prevalence, type of CAM therapies used, factors associated with CAM use tendency, cost to parents and satisfaction from treatment, they performed a self-administered questionnaire study among parents of children visiting their hospital- based pediatric otolaryngology outpatient clinic who were referred for COME (Chronic Otitis Media with Effusion) or RAOM.

The authors of “The Use of Complementary and Alternative Medicine among Children with Otitis Media” are Michael Rotstein MD and Ari DeRowe MD, both with the Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Israel. Their findings are being presented at the 21ST Annual Meeting of the American Society of Pediatric Otolaryngology, being held May 19-22, 2006, at the Hyatt-Regency Hotel, Chicago, IL.

Methodology: The study took place at an outpatient pediatric otolaryngology clinic in a tertiary university affiliated city hospital from May 2003 to February 2004. Children were referred to this clinic documented middle ear effusion for more than three months or a history of at least three episodes of AOM in the preceding six months or four episodes in the preceding year. All parents of children arriving at the clinic for treatment of RAOM or OME were identified by the clinic nurse and given a self-administered questionnaire to be filled out while in the waiting area and were returned to the nurse.

The self-administered questionnaire was comprised of 27 items with an estimated completion time of 10 to 15 minutes. The questionnaire was divided into parts dealing with demographics, CAM use, CAM practitioner assistance, objective and perceived disease severity and satisfaction with medical and CAM treatment.

CAM therapies listed were 1. immune defense boosting natural preparations (i.e. Echinacea Purpurea preparations), 2. dietary modification (including non-physician prescribed elimination diets), 3. naturopathy and nonspecific herbal or vitamin preparations, 4. homeopathy, 5. “Hopi candles” (a method for removing earwax by a burning paper stick inserted into the external auditory canal) 6. nonspecific folk remedies (i.e. olive oil insertion into the external auditory canal), 7. Acupuncture 8. Reflexology, 9.massage, 10. biofeedback 11. Yoga, hypnosis or other methods of relaxation, 12. energy healing methods: Reiki, magnet or crystal therapy, 13. osteopathic, cranio-sacral or chiropractic manipulation 14. religious activities including prayers, blessing, spiritual healing or religious artifact use and 15. a blank used for “other”.

Disease severity was assessed using objective parameters including age of onset, frequency of middle ear infections, need for hospitalization, need for ventilation tube insertion or Adenoid removal and middle ear puncture. Parental subjective (perceived) disease severity was assessed using the OM-6 questionnaire, assessing child quality of life in 6 sub domains including physical suffering, hearing impairment, language and speech impairment, behavior, activity restrictions and overall parental concern (19). Additionally, parents were required to estimate the overall child’s quality of life on a scale of 1 to 10.

Results: 127 questionnaires were distributed, handed out, with 94 (74.01 percent) returned completed. After exclusions, 89 questionnaires were submitted for analysis. Key findings were:

-- 46 (51.7 percent) children reported treatment with CAM. -- 17 (19.1 percent of total, 37.0 percent of total CAM treated) being CAM practitioner assisted. -- 29 (32.6 percent of total, 63.0 percent of total CAM treated) reporting self-administered CAM therapy. -- Parents in all groups showed similar results for paternal education level, country of origin and religious beliefs. -- Maternal education level was significantly higher in the CAM treated vs. non-CAM treated group.

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