Breastmilk and Ear Infections

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Adapted from a discussion thread at bf.com

Research strongly supports the fact that breastfed babies get fewer ear infections than do bottle-fed babies. Even so, breastfed babies may occasionally get ear infections. Parents often ask for alternatives to antiobiotics for treating this illness.

PSA: DO NOT PUT BREASTMILK IN THE EAR.

This is an old wives tale and it is potentially dangerous way to self-treat ear infections and could make his illness worse.

I speak from experience, having followed this folk "wisdom" when it was recommended to me here at this board.

As stated, the eardrum is not permeable. That means that fluids can't get past it, causing the bm to pool in the ear canal where it can breed more bacteria and lead to another infection called "otitis externa" - an infection in the canal.

Which is exactly what happened to Joshua when I tried to self-treat him with BM in the ear. I have a significant hearing loss in my right ear from an infection that went undetected and untreated for a long period of time when I was in junior high school. I take ear infections very seriously. Research now shows that ear infections are as likely to be caused by viruses as bacteria. My chosen course of treatment now is to have the kid checked by the doctor and then make an informed decision as to whether or not to wait a week before starting antibiotic treatment. If the infection is viral, it will clear up on it's own in that time.

Some lay practioners do advise putting breastmilk in the ear. There have been articles at mothering.com on the topic. However, all the health care professionals I"ve ever spoken with advise straongly against the practice, explaining that the ear drum is impermeable and the BM can grow bacteria in the ear canal.

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Member mommychille (aka pedsrnp, leo), a pediatric nurse practioner, write:

I agree with Creme. The TM is impermeable. Any macrophages etc would not be able to get past it to help with a middle ear infection.

The most common cause of otitis externa is pseudomonas. This is a bug that bm is not particularly helpful at fighting in terms of direct application. In fact there have been many outbreaks of psuedomonas infection in neonates in the NICU due to contamination of pumped milk.

BM does not kill psuedomonas on contact. It does not penetrate the TM. At best it will feel soothing due to some mild anti-inflammatory properties.

Here's one article on TM permability. It discusses some studies on topical antibiotics which have been shown experimentally to be absorbed through one specific area of the TM called the Round Window Membrane. It also discusses that most antibiotics and topical applications will not be in contact with the RWM long enough or in high enough concentration to be able to be absorbed, even if it is theoretically possible. The qoute below further highlights the uncertainty about TM permeability during AOM.

Basically they are pointing out that the TM is significantly thickened during infection and that tiny area where absorption may theoretically occur is further compromised.

Just food for thought. Maybe some day we will learn otherwise. It is an area of intense research as people are desperate to find a topical treatment for OM.


ETA: Most of the research on medications absorbed through the TM involve placing the medication directly on the Round Window under an occlusive dressing. Even with this technique absorption is very poor or nondetectable for most substances. Obviously it would be impossible for a typical mom with a wiggly baby to place BM directly on the round window and place an occlusive dressing on it. [roflol]

http://www.findarticles.com/p/articles/mi_m0BUM/is_9_83/ai_n6251600]Article on tympanic membrane permeaibility [/url]
It should be noted that during middle ear infections, there is often an abundance of mucosal edema, microorganisms, and fluid that might occlude the round window niche and further inhibit the absorption of ciprofloxacin and other topical medications.

Here's a nice article on OE from AAFP. I can't seem to find any user-friendly discussions about TM permeability, but I'll keep looking around if I have time. [Smile]

http://www.aafp.org/afp/20010301/927.html]Article on Otitis Externa[/url]

It is the only skin-lined cul-de-sac in the human body. The external auditory canal is warm, dark and prone to becoming moist, making it an excellent environment for bacterial and fungal growth. The skin is very thin and the lateral third overlies cartilage, while the rest has a base of bone. The canal is easily traumatized. The exit of debris, secretions and foreign bodies is impeded by a curve at the junction of the cartilage and bone.

There are many precipitants of this infection (Table 1), but the most common is excessive moisture that elevates the pH and removes the cerumen. Once the protective cerumen is removed, keratin debris absorbs the water, which creates a nourishing medium for bacterial growth.

When disruption occurs, a new pathogenic flora develops that is dominated by Pseudomonas aeruginosa and Staphylococcus aureus.5,6,15,16

Originally posted by Mommy to C:
Leo,

I'm an audiologist, and for the record, the Round Window seperates the middle ear from the inner ear. Your article discusses intratympanic ciprofloxacin drops that are used when there's a perf in the TM, and whether the drops enter the inner ear.

And also, I agree the TM is impermeable and that BM is not a good solution for a middle ear infection. [Smile]

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Listening with A Different Ear:
Holistic Approaches to Ear Infections



by Lawrence P. Palvesky, M.D., F.A.A.P., A.B.H.M.
Jan-Feb 2003


It is 3am and your child wakes up complaining of ear pain. What can you do?

Ear pain is one of the most common complaints in the pediatric population. Parents exchange frequent stories about the number of times their child has taken a banana or cherry flavored antibiotic for one or more ear infections. It is the rare parent who sits by, not wanting to add to the anxiety of other parents, with the knowledge that their child has never taken an antibiotic for an ear ache. What's more, the child has never had a serious problem resulting from not using antibiotics.

When I went through my medical school and residency training, we were warned about the serious complications of allowing an ear infection to progress without antibiotic treatment-mastoiditis, an inflammation and infection of the bony area behind the ear at the base of the skull, and meningitis, an inflammation and infection of the lining of the brain and spinal cord which could lead to permanent brain damage, not to mention, the possibility of permanent hearing loss.

Over the last 13 years, evidence from the European medical literature and observation of the medical practice of some of our own pioneering primary care providers and ENT (Ear, Nose & Throat) physicians, has taught us that the majority of cases of ear pain can and will resolve on their own. Without antibiotics. Without serious outcomes. With good clinical follow-up. Yet, many children receive antibiotics, and sometimes multiple antibiotics, for ear aches. And their ear aches continue to recur.


Are Ear Aches Really Ear Infections?

Inflammation occurs in the body as characterized by the following five observations--redness, swelling, heat, pain and loss of function. When a young child has an ear ache, the ear drum is usually found to be red (redness) with clear fluid or mucus buildup in the middle ear (swelling) causing pain, often accompanied by fever (heat) and occasionally accompanied by an acute loss of hearing; clearly a description of inflammation. Even if there were an infection, most studies confirm that viruses are the main organisms responsible for causing the development of these symptoms, not bacteria. Neither a viral infection, nor an inflammation in the ears responds to treatment with antibiotics. Only bacteria respond to antibiotic treatment. Therefore, in the majority of cases, antibiotics do not help. And, in many cases, antibiotics may cause more harm than good when they are used inappropriately.


A child is found on exam to have a red ear and no complaint of ear pain even though a fever is present. A pre-verbal infant or toddler with a red ear drum or fluid behind the ear appears well and is smiling. Another child presents with ear fluid and is no longer in pain. Most often these children are not suffering from ear infections and do not warrant antibiotic treatment. By definition, these children simply have inflamed ears which often respond better to other types of treatment.

Children who have infections, on the other hand, also present with these five signs of inflammation but, for the most part, do not look clinically well and often have an illness that is more serious than a simple ear infection. A child in pain who appears not to look well should be re-evaluated after the pain is relieved.

Early in my pediatric practice, I often gave a child a ten day course of an antibiotic for what I believed was a classic ear infection using the criteria I described for inflammation. More often than not, 2-3 days after completing the antibiotic, the child returned with the same symptoms. I would subsequently write another antibiotic prescription. Frequently, the same pattern would recur. Conventional training taught me that the child had an infection caused by a bacterium that was resistant to the antibiotic. Therefore, a different and stronger antibiotic was needed. Eventually it occurred to me that perhaps the child never needed the antibiotic in the first place. Perhaps there was a different process going on that required a different set of treatments and understanding.

Why do infants & children get ear aches? How do the ears become inflamed?

Conventional pediatric practice focuses on prescribing treatment interventions once a child's symptoms have already appeared. Non-conventional approaches concentrate on preventing the development of inflammation and infection and attempt to evaluate the causes that contribute to their presentation. In addition, non-conventional approaches use remedies and interventions that facilitate the body's natural healing abilities in a nourishing way in an attempt to avoid suppressing the inherent healing mechanisms that are present in the body. Often, elimination of the factors that are known to contribute to the development of the underlying symptoms is sufficient to treat the problem(s) without introducing additional remedies. This is especially true when it comes to ear pain and ear inflammation.

Infants and children have a natural tendency to generate a lot of mucus. The production and the amount of mucus lessen as the child grows older and the developing immune system strengthens. When a child has a build up of excess mucus (one of the primary indicators of inflammation), his/her body attempts to "burn off" this mucus in order to return to a balanced state, also known as homeostasis. This is accomplished by the onset of an illness accompanied by a fever.

Children, even without the presence of a fever, tend to run on the hot side. Most of their heat rises towards the head. Heat generated by a fever (another of the primary indicators of inflammation), further raises the energy towards the head. With an abundance of mucus already present in the nose and throat during an upper respiratory infection it is no coincidence that the ears repeatedly become inflamed.

Many clinicians and parents report that after a child has recovered from an illness with a fever without the use of suppressive pharmaceuticals, he/she experiences a growth spurt in neurological, developmental and behavioral milestones. Clearly, the immune system is now stronger. Children, who develop excess mucus and need to burn it off through an array of normal childhood febrile illnesses, and are blocked from accomplishing this through the use of inappropriate, suppressive pharmaceutical treatments, often remain in a state of chronic mucus production, i.e., chronic inflammation. This can be seen today in many of our children who live with excess mucus, are often sick and never quite fully recover and have a life of chronic illnesses and delays in reaching their milestones.

CONTINUED BELOW

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Prevention & Treatment

Ultimately, the goal is to reduce the production of excess mucus, support the process of acute illnesses with good clinical follow-up and safe and effective, non-suppressive, supportive interventions and offer information for families that will both prevent and treat serious acute and chronic illnesses. In the case of ear inflammation, the two approaches that I have seen work most effectively to reduce ear fluid, ear pain and chronic ear problems is a change in the child's and family's diet and the incorporation of manipulative modalities into the treatment plan, i.e., chiropractic, osteopathic and/or cranial sacral therapy.

Children have undeveloped digestive systems. Spitting up, vomiting, frequent burping, excess gas and loose stools are frequent pediatric complaints indicative of poor digestive function. Often, children are given a food or a combination of foods that serve to further weaken and stress their digestive systems. Invariably, food is incompletely digested and, as a result, children are confronted with having to deal with nourishment that does not serve them. Consequently, the body's response is to produce additional mucus

As described in immunology, Chinese Medicine, Ayurveda and nutritional medicine, mucus in the nose, throat, sinuses, airways, ears and other parts of the body can arise merely from the failure of the digestive system to accomplish its task successfully. Adults may suffer from the same process as well. Those foods most likely to increase mucus production and further stress a child's already weak digestive system are: dairy, soy (especially overly processed soy products), commercial formulas, a heavy diet of raw fruits and vegetables, iced or cold foods and beverages, wheat and most flour products, baby cereals and commercial cereals, thick, creamy and heavy foods, processed grains, juice, soda, soft drinks, refined sugars, processed and refined foods, fried foods and oils, multiple food choices at a time and overfeeding.

Reducing and/or eliminating these foods from a child's diet will often quiet the inflammation and prevent the development of further problems in acute flare-ups and, more specifically, in chronic inflammation of the ears. On the other hand, offering a child warm, cooked, simple, smooth, easy to digest, whole, non-processed foods, accompanied by small amounts of food herbs and spices, will strengthen and support a weak digestive system and keep mucus production and inflammation at a minimum.

Immediate Management

So, it is still 3am and your child's body is doing its best to purge the excess mucus. Yet, the fluid is not draining and the pain is the main focus. Ultimately, the goal is to rid the body of the mucus. The following is a list of suggestions for parents to help them get through this difficult situation:

1) Hold and comfort your child.
2) Try to raise the head of the bed. For smaller children, place blankets or pillows under the mattress.
3) Keep your child hydrated with room temperature water, clear soup and/or tea. Herbs that help to break up the mucus and comfort your child include thyme, ginger, licorice, eyebright, elder flowers and chamomile. Keep the diet simple. Keep solid foods to a minimum. Offer small doses of vitamin C throughout the day with fluids. Start children's Echinacea within the first 24 hours of illness.
4) Diffuse lavender essential oil in the room to help calm any anxiety you may have.
5) Place several drops of mullein oil in a container and warm inside a pot of water on the stove. Take several drops of the mullein oil and place them in the affected ear canal. Gently pull and massage the ear lobe away from your child's head and in a slightly downward direction. Use extra virgin olive oil in the same manner if no mullein oil is available or,
6) Take 1-2 drops of organic tea tree essential oil and mix in a base of 20 drops of olive oil and place several warmed drops of this mixture into the affected ear canal. Use any one of the ear drop remedies several times a day to relieve the discomforts of the inflammation. Please be sure to use essential oils that are organic and top grade quality whenever possible.
7) Use the tea tree oil combination and massage it into the front of your child's chest below the collarbones in a horizontal fashion. Then rub the oil behind the affected ear(s) and massage down the side of the neck towards the collarbones. This will help open the drainage of lymph fluid into the chest cavity and allow the congestion to drain from the head. This can be done 2-3 times per day until the congestion has resolved.
8) See your chiropractor, osteopath or cranial sacral worker the next day. Repeat visits as discussed with your provider.
9) Contact your medical health care provider if your child does not improve within 48 hours, develops drainage from the ear or appears to be getting worse.

Dr. Lawrence B. Palevsky, MD is a board certified pediatrician who received his medical degree from the NYU School of Medicine. He completed a pediatric residency at the Mount Sinai Hospital in NYC and a one year fellowship at Bellevue Hospital-NYU School of Medicine in the outpatient department and emergency room. Dr. Palevsky's clinical experience includes pediatric emergency room and pediatric acute care medicine, in-patient and out-patient pediatric medicine, neonatal intensive care, newborn and delivery room medicine and private practice. Most recently he was in practice as the holistic and integrative pediatrician at the Center for Health & Healing, a complementary medical facility affiliated with the Beth Israel Medical Center in NYC. Dr. Palevsky is a Fellow of the American Academy of Pediatrics and a Diplomate of the American Board of Holistic Medicine.

References provided on-line at:
www.icpa4kids.com/chiropractic_newsletter_references.htm