Ear Pain | Healthy Living Blog

Ear infection is one of the most common reasons for pediatric visits to the doctor. For the purpose of this article, I’m talking about otitis media which is infection of the middle ear. Ear infections can be extremely uncomfortable producing symptoms such as ear pain and muffled hearing. School aged children with otitis media often have a difficult time concentrating in class.

Causes & Risk Factors:

Otitis media is caused by either bacterial, viral or fungal infection. Interestingly, it appears that for the majority of ear infections, both bacteria and viruses are present (1). Why do some children get ear infections and others do not? The main reason is that your child’s immune system is out of balance. If the immune system were functioning optimally, the body would fight off the infection with little difficulty before it truly becomes a problem. Below are a few risk factors or triggers for ear infection.

Recent cold: An upper respiratory tract infection often precedes an ear infection. (Cold and flu infections are both viral.)
Anatomical considerations: The eustachian tube of a child is oriented more horizontally than in an adult which anatomically can result in poorer drainage of fluid from the inner ear to the back of the throat.
Exposure to second-hand smoke & other environmental toxins: Toxins in the environment and foods (like certain preservatives) can hamper immune system function making one more susceptible to ear infection (and other infections).
Food allergies and sensitivities: Food allergies and sensitivities can thicken mucus and contribute to inflammation. One of the most common culprits is milk and milk products.
Eustachian tube dysfunction: The eustachian tube connects the inner ear to the back of the throat and is responsible for allowing the inner ear’s pressure to equalize with atmospheric pressure and to serve as a passageway for fluid to drain. Eustachian tube dysfunction is commonly implicated in inner ear infection.
Imbalance in overall immune system function: There are other physical, chemical and psychological factors that affect immune system function. Overall health and lifestyle choices will affect immunity.

Medical Management of Ear Infection:

The current literature supports that family doctors and pediatricians follow a “watch and wait” approach for acute ear infections. Certainly, if you suspect your child has an ear infection, he/she should be evaluated and appropriately diagnosed. That being said, most ear infections will heal on their own within a couple weeks (hence, the reason for initial watch and wait recommendation). In rare circumstances, symptoms can persist, become chronic or worsen.

The initial medical management for ear infections is antibiotic use. Keep in mind though, that antibiotics kill bacteria but not viruses and that most ear infections harbour both bacteria and viruses. So if there is a viral component, antibiotics are unlikely to work and may actually make things worse. In addition, antibiotics will destroy the healthy bacteria inhabiting the gut thus lowering one’s overall immunity (as the gut plays an important role in immune system function). Overall, the evidence suggests that antibiotics are poorly effective in treating otitis media (2).

Another option is tympanostomy tube or “ear tube” insertion. This is reserved for chronic cases whereby the infection is gone but fluid persists in the ear. The child is put under general anesthesia and small tubes are surgically attached to the ear drum allowing aeration of the middle ear. Similarly, the necessity and effectiveness of ear tubes is questionable.

Chiropractic Management of Patients with Ear Infection:

For the record, chiropractors do not diagnose or claim to cure ear infection. That being said, there are many benefits to chiropractic care for patients with ear infection. Chiropractic offers an alternative approach or an additional type of care for those who opt for co-management.

Chiropractic care, through natural means, seeks to optimize nervous system function and to correct any mechanical causes or contributors to the problem. It’s about putting your body in balance so that it may heal itself to its greatest potential. Healing comes from the inside.

How does chiropractic work? We know that the central nervous system controls and co-ordinates all systems and functions in the body. A nervous system free of interference will allow optimal communication and hence optimal healing. This is achieved by providing specific spinal adjustments to optimize spinal alignment and mobility. Chiropractic care has been shown to balance immune system function by reducing inflammation and stimulating antibody production (3, 4). A healthy spine = a healthy body.

Chiropractic care can often correct eustachian tube dysfunction as well. As mentioned earlier, it is often implicated in ear infection. Sometimes eustachian tube dysfunction persists after the infection is gone leading to persistence of muffled hearing and stuffiness. Correcting this dysfunction will allow the pressure to balance and the fluid to drain. Read my article about eustachian tube dysfunction.

Chiropractic care is very safe and for pediatric patients, gentle techniques are used. Kids enjoy their visits to the chiropractor!

To me, chiropractic care along with other approaches to boost natural immunity is a logical choice. Read my article about tips to boost immunity.

Has your child been diagnosed with acute or chronic otitis media? Are you searching for alternative care that is safe and effective? See a children’s chiropractor! Or, if you’re near North York, come see me.

Infectious Diseases Society of America (2006, November 6). Most Ear Infections Host Both Bacteria And Viruses, Study Shows.
Dowell, S, Marcy, M, Phillips, W, Gerber, M & Schwartz, B. (1998) Otitis media – participles of judicious use of antimicrobial agents. Pediatrics; 101(supplement)165-171.
Tedorzyk-Injeyan JA, et al. Spinal Manipulative Therapy Reduces Inflammatory Cytokines but Not Substance P Production in Normal Subjects. J Manipulative Physiol Ther 2006 (Jan); 29 (1): 14–21.
Teodorczyk-Injeyan JA, et al. Interleukin-2 regulated in vitro antibody production following a single spinal manipulative treatment in normal subjects. Chiropr Osteopat, 2010;18:26.

Dr. Elisabeth Miron

Check out Dr. Mirons Chiropractic Website!

Eustachian tube dysfunction refers to when the pressure of the middle ear is unable to equalize with atmospheric pressure. It can cause a muffling of one’s hearing and can also cause ear pain (otalgia), facial pain and headache.

The eustachian tube connects the middle ear to the nasopharynx (see diagram). It is composed partly of bone (near the middle ear) and partly of cartilage. There are 4 muscles that insert into the eustachian tube controlling its ability to open and close. These are the salpingopharyngeus, tensor tympani, levator veli palatini and tensor veli palatini. These muscles are related to the pharynx so each time you swallow or yawn, the ears (in normal cases) will make a mild clicking sound which represents the temporary opening of the eustachian tube to equalize the pressure. It is thought that eustachian tube dysfunction is a result of disruption of the normal tone of these muscles affecting their ability to contract optimally (1). Malfunction of these muscles may also affect the ear’s ability to drain fluid. As soon as the tone returns to normal, the opening and closure mechanism of the eustachian tube is restored and pressure equalization and drainage of any fluids can resume. Eustachian tube dysfunction can occur with or without middle ear infection (1).

Middle ear infections can also occur in adults. The eustachian tube is responsible for draining fluid of the middle ear, so sometimes when you have an upper respiratory infection (or a cold), mucus and bacteria get trapped in the eustachian tube and the blockage results in an inner ear infection.How can chiropractic help with ear pain?

Ear pain can occur for a variety of reasons. It can result from eustachian tube dysfunction (as discussed above), from dysfunction of the joints in the neck, dysfunction of the temporomandibular joint (or TMJ) and ear infection, for example. A chiropractic examination can identify mechanical causes/contributors of your ear pain and adjustments to the affected areas will help to restore normal function. For example, the ear itself can be adjusted, the neck can be adjusted and the TMJ can be adjusted if dysfunction is found there. A few treatments may be required before you notice any difference. Long standing mechanical issues take a longer time to normalize than newer mechanical issues. Often times, people have more than one mechanical issue that needs to be addressed. Depending on the cause of the ear pain, there are also different exercises that may help.

There is preliminary evidence that chiropractic adjustments to the upper four vertebrae of the neck improve symptoms of middle ear infection (3). The tensor veli palatini muscle is innervated by a branch of the trigeminal nerve which has branches to the C1-C4 nerve roots. The mechanism of benefit is thought to be from freeing neurological compromise to the tensor veli palatini such that its normal tone is restored (3).

Interesting study:

In children with recurrent ear infections, chewing xylitol gum daily appears to reduce the occurrence of middle ear infection by 40% compared to chewing sucrose gum (2). Xylitol also inhibits the growth of Streptococcus pneumoniae.

Dietary Suggestions:

stay well hydrated
eliminate dairy foods (dairy may thicken and increase mucus making it more difficult for an infected ear to drain)

1) Murphy D & Gay, C (2011). Manual therapy and ear pain: a report of four cases. J Can Chirop Assoc; 55(1):40-46.
2) Uhari, M, Kontiokari, T, Koskela, M & Niemela, M (1996). Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BGJ; 313:1180-4.
3) Fallon (1997). Preliminary evidence SMT may benefit some children with otitis media. J Clin Chiro Ped; 2(2).