from ‘kids life’ issue 9 - May 2005
Osteopaths are often correctly thought of in relation to ailments such as stiff spines, sciatica, shoulder and knee strains or a ‘cricked’ neck, but much more can also be amenable to Osteopathic treatment.
Plenty of non-muscular-skeletal conditions can be treated using a wide variety of osteopathic techniques. For example, headaches and migraines, sinus congestion and infections, asthma, gastro-intestinal problems like colic, bloating and infrequent bowel motions and ear infections can all be treated using techniques such as cranial osteopathy.
But first let me explain Osteopathy. It is a well-established system of health care developed by Dr. Andrew Still from Missouri, U.S.A. The founding principals Dr Still developed enable the osteopath to provide a holistic, manual therapy that is tailored to the individual needs of the patient. The osteopath works from the belief that the body has its own innate ability to heal itself, with each part of the body designed to carry out its function efficiently. It is of paramount importance to the osteopath that every cell in the structure of the body in adequately perfused with oxygenated blood and there is good drainage of deoxygenated blood.
Additionally, osteopaths view the body as a complete unit, whose ability to function is dependant upon the harmonious interrelations of each body system: organs, nerves, blood vessels, and of course muscles and skeleton. Osteopathy has become one of the most comprehensive, effective and valid forms of treatment available.
Cranial osteopaths work subtly with the skull. Like the spine, the skull is designed to move and may be thought of as a ‘clockwork mechanism’. Each of the 26 cranial bones ‘drives’ the motion of the bone it is attached to. This motion remains throughout life – the skull in adulthood doesn’t fuse and become rigid.
Clinically, we may cope better with a spinal ‘segment’ that does not move for whatever reason (trauma or disease) then we do when our cranial bones become restricted in their mobility. This may lead to localised symptoms such as headaches, migraines, sinus infections, poor concentration or depression to name but a few. In babies and children, poor sleeping habits, poor feeders with reflux, colic, difficulties in latching on, difficult behaviour and recurrent ear infections may result when there is cranial restriction.
Cranial osteopathy uses a simple, gentle, non-evasive approach to accurately identify what physiological structures may be dysfunctional, and then provides an extremely effective method for helping the body resolve these ‘strains’. The touch, or ‘palpitation’ as the practitioner calls it, is very gentle and effective treatment method, we are seeing ever increasing numbers of babies and children presenting to osteopathic clinics.
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Osteopaths treat a wide range of conditions in an equally diverse range of patients from the newborn right through to the elderly. One such prevalent condition in New Zealand is childhood ear infections. When a child suffers from recurrent ear infection, life can be pretty miserable for both them and their families. Around 75 percent of children under age three will suffer from at least one episode of middle ear infection (half are likely to have three or more infections during the first three years of life), making it one of the most common conditions affecting babies and young children today. In fact, the treatment of childhood ear infections is one of the most common reasons parents take their children to an osteopath.
What is ‘glue ear’? Its clinical name is ‘ottis media with effusion’ (OME). It is the presence of fluid in the middle ear while the eardrum is not inflamed, fever is absent and often discomfort is minimal (a situation that can be transient or last many months). ‘Ottis media’ is a general term referring to inflammation of the middle ear. ‘Acute ottis media’ (AOM) refers to active infection in the middle ear with inflamed eardrum, often associated with pain and fever.
For normal hearing to occur, both the middle ear and ear canal must be full of air. When sound waves enter the ear canal, they cause the eardrum to vibrate. These vibrations are transmitted to the inner ear by three small bones within the middle ear. The vibrations are changed into nerve impulses, which carry sound information to the brain. When fluid is present in the middle ear, as is occurs in ‘glue ear’, the eardrum is unable to vibrate freely, resulting in hearing loss.
The Eustachian tube connects to the nasal passageway, playing a vital role in the healthy functioning of the ear. Its main function is to equalise middle ear pressure to atmospheric pressure. For example, when we go up in a lift or travel in an airplane, our Eustachian tube will open for equalisation to occur (as happens everytime we swallow or yawn). In children the Eustachian tube is shorter, softer and more horizontal than in adults, reducing its efficiency. Children with OME might not be able to equalise at all. The Eustachian tube also drains the middle ear, protecting it from secretions and infections from the nose. However, children with OME will often have a significantly reduced capacity for ear drainage, which will dramatically increase the risk for future ear infections.
So what does this mean for the child? The potential ramifications of moderate hearing loss in a child aged between one and three should be taken seriously, as studies show there is a direct correlation between children who have reduced ability to hear and sub-standard learning abilities and intelligence. Parents are well aware of the need to stimulate their child to learn using all five senses to promote good developmental progress. A critical period for early development is between one and three years of age, coinciding with the age that most children are likely to develop ear infections and ‘glue ear’.
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For many parents of children complaining of sore ears or suspected hearing difficulties, their GP is the first port of call. However, there are alternatives to the orthodox medical route. Why would parents seek alternative advice in the first place? Well, the answer may lie in the orthodox treatment rationale, which at present consists of either antibiotic medication or surgery should the infections continue. But for some parents and practitioners, this path is less than satisfactory. Antibiotics only work if there is an active infection present. In ‘glue ear’ infection is not present, so the only result of the antibiotic course is that children are more likely to carry antibiotic-resistant bacteria in their nose and throats. The diminishing effectiveness of antibiotics is a worldwide concern and it is generally acknowledged that inappropriate prescriptions of antibiotics are a main cause of drug-resistant bacteria. For example, overuse of antibiotics in the U.S accounts for 25-45 percent of the prevalence of streptococcus pneumonia bacteria. In the Netherlands, where they’ve adopted an ‘observation without antibiotics programme’, the incidence of drug resistant streptococcus pneumonia is only one percent. Interestingly, in the Netherlands only 31 percent of children aged two or under with AOM are treated with antibiotics compared to 95 percent in the U.S. Also, of note is the damage antibiotics can cause to ‘good’ bacteria in the gastrointestinal tract, where 80 percent of our immune system is housed. With helpful bacteria and other protective factors missing, unhealthy bacteria, yeast, parasites and toxins may accumulate, damaging the intestinal wall and producing poor intestinal health, thereby harming our immune system!
When OME has been present for 2 months or more, it is labelled ‘chronic’ and surgery is often considered. Ventilation tubes or ‘grommets’ are surgically implanted (under general aesthetic) allowing air to pass to pass from the ear canal to the middle ear, effectively acting as an artificial Eustachian tube. They usually stay in place for 6-12 months, depending on their size. However, the possible ramifications of ‘grommets’ are that they may cause scarring in the ear drum (though this may not interfere with hearing), or fall into the middle ear requiring surgical removal. They may also cause secondary infections. Studies show 50 percent of children will require just one set of grommets; the rest will need a second set, which still may or may not remedy thy infection. Children with recurring OME, despite several sets of tubes, are considered very difficult to treat.
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So how do osteopaths treat glue ear? Here are a couple of typical case studies of children with ear infections that we saw in the clinic recently:
The parents of a two-year-old boy came to see me, concerned about their son’s left ear infection of five months duration. In three weeks time they were due to fly overseas on holiday. However, with the state of health of the young boys ear, flying may have been out of the question. An earlier visit to an otolarygologist confirmed that there was 60 percent fluid within the middle ear, where there should have been only air. The case history also revealed the boy had a caesarean birth, an important factor as clinically we find that caesarean babies and children tend not to have very good mucus drainage because they have not passed through the birth canal, which creates a ‘rinsing’ effect. Caesarean children are more likely to suffer from upper repertory infections, sinus infections and ear infections. Recent history revealed he’d had three different colds, the last of which required a 10-day course of antibiotics. His parents mentioned that he sneezed a lot too, which might indicate an allergic tendency. Family history also revealed that his mother suffered from some hearing loss in her left ear.
Otoscopy (the examination of the outer and inner ear using a handheld torch) revealed good health in the ear. Transparency of the eardrum allowed us to see the air bubbles within the middle ear. Osteopathic examination also revealed there was an overall restriction pattern to the top of the head. This meant that the temporal bones (the bones behind his ears) were in a position that caused the Eustachian tube to be held more horizontally, hindering good drainage of the middle ear. There was also a ‘hard’ or ‘tight’ quality to the cranial bones and membranes, which again is not uncommon amongst caesarean babies.
Following two sessions of cranial osteopathy, the child was returned to the specialist for the required pre-flight re-examination. The specialist remarked that the ears had improved significantly, with reduced fluid and pressure in the middle ear. Subsequently the boy was deemed healthy enough to fly!
A second child, aged two and a half, was brought into the clinic by a concerned parent. Her son had suffered three ear infections in the previous eight and a half months and she was concerned that he didn’t respond when his name was called and that his speech could be delayed (he was not yet able to walk alone either). A consultation with an audiometrist revealed he had mild, low frequency conductive hearing loss plus Eustachian tube dysfunction. The specialist did not recommend treatment, advising hearing was sufficient for normal speech and language development. He recommended ear checks again in three years.
Osteopathic examination of this chills revealed the left ear canal to be inflamed, with fluid present in the meddle ear. The right ear was not inflamed, however fluid was again present in the middle ear. It was also discovered the top of the head was not moving as it should; the ‘cranial base’ section (which is very important as it drives the motion of the rest of the skull) was found to have a left-sided restriction. The right temporal bone, which determines whether the ear canal is relatively open or closed, was held in a position that was narrowing the right ear canal. Following three sessions of cranial osteopathy, the parents reported the boy’s speech had improved and he was saying the name of his siblings for the first time. The change in his disposition from how he had been three months earlier was dramatic to his parents and to myself!
Every child that presents to the clinic is unique, with their own individual histories, and responds differently to treatment. As such prognosis for children with ear infections is specific for each child.
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