Chronic Ear infection

Unlike acute infections that are self-limiting and resolve within a short period of time, chronic ear infections are an acute infection that lasts longer than a month or a recurring ear infection that does not respond to treatment. Chronic ear infections, left unchecked can cause hearing damage and significant discomfort. While chronic infections are rare, they are insidious as they often continue for a long time unchecked and over time can cause infection in the mastoid bone, degenerate the bones in the middle ear or harden the tissue surrounding them. In children, hearing loss, temporary or permanent, can affect speech and learning so it is essential that diagnosis is early and treatment is prompt.

How do I know if my child has a chronic ear infection?

Sometimes it can be hard to pick up on a chronic ear infection they can manifest quite subtly. Things to watch out for are:

  • Low grade fever
  • Swelling behind the ear
  • Balance and coordination issues
  • Constant blocked ear feeling
  • Constant runny nose
  • Crankiness or irritability
  • Localised inflammation
  • Tugging on the ear
  • Poor hearing
  • Loss of appetite
  • Poor sleep
  • Pain when lying down or head tilted to side
  • Liquid escaping ear such as pus or fluid

A lot of these symptoms are the same as for acute Otitis media, but in a chronic infection they may be less noticeable and run for a longer period of time, making them harder to detect.

The conventional treatment for chronic ear infection is antibiotics with repeat courses until the infection has cleared as well as steroids to reduce inflammation. This is effective in the short term but it can mean a long term reliance on antibiotics and eventually the side effects of antibiotic overuse or steroid use can impact health. If this course of treatment fails the common allopathic approach is surgery and/or grommets.

This approach doesn’t address any underlying issues that could be causing the infection in the first place. It can also result in long term gut health issues related to antibiotic use. The naturopathic perspective is that chronic ear infections need to be addressed on a holistic level that may mean addressing diet, immunity and physiological issues.

So what do you do if you or your child has persistent or recurring ear infections?

The first thing to do is to bolster immunity; a struggling immune system will not be able to combat chronic infection and may be more susceptible to viruses that can be the precursor to on-going infection. A good way to support immune function is to take a proven antiviral such as elder or Echinacea at therapeutic dosing levels for a period of 8-12 weeks. Kiwiherb Echinacea, (Kiwiherb Children's Echinature for the under 6’s) or Artemis Elder Lemon Tonic are good for this. This will support the body to fight the infection naturally and hopefully eliminate the need for antibiotics. It’s also worth considering a Vitamin D Supplement in the winter months as low levels can suppress immunity and leave you vulnerable.

Another way to address a chronic ear infection is to reduce mucous build up, as this is a strong causal factor usually instigated by an upper respiratory infection. This mucous build up blocks the eustachian tube and invites infection. The eustachian tubes in children are narrow and lie more horizontally which means they are particularly at risk. Phyto medicines that are known to address this are Mullein, Ginger, Turmeric and Cinnamon.

It’s also important to keep well hydrated to help mucous pass. Mullein helps to break down mucous as well as reduce inflammation, it can be found in Kiwiherb Chest Syrup or topically with Weleda Mullein Ear Drops. A home-made turmeric drink can be made with hot water, Manuka Honey and a teaspoon of fresh grated or dried turmeric. These remedies need to be taken on a regular basis to see results, especially through the cold and flu season.

Alongside this, allowing the fluid to drain manually by sleeping with your head in an elevated position can help address physical predisposition to ear infections.  Before bed time, a warm steam inhalation with Thyme Essential Oil or Eucalyptus Essential Oil can help free mucous to stop it from pooling.

Ear infections also respond well to manual treatments such as sinus/ear massage and poultices. It’s important that before engaging in any topical treatments that you ensure the eardrum is intact. This can be established by your practitioner, or you may also be able to see fluid escaping from the ear. Garlic oil or mullein drops in the ear are a well-known traditional remedy, but if the eardrum has burst then a warm poultice applied directly behind the ear for 20-30 minutes can help relieve symptoms and reduce inflammation. Garlic oil is pungent, but makes an excellent massage oil for a sinus or ear massage to help clear mucous. A massage every morning and evening is ideal as part of an overall healing approach.

Another thing to bear in mind with chronic ear infections is that consumption of dairy or dairy allergy has been associated with higher risk of ear infections.(1) It would be worthwhile to do an elimination diet to establish if this is the case for you. Most studies show that chronic ear infections are associated with some form of allergy, dairy being the most likely but wheat, soy and eggs are also a possibility, so eliminating all 4 initially and slowly adding them back in one at a time is the best way to know for sure. If elimination is in the too hard basket for you initially then a food diary is the next best thing.

While dairy is a known trigger, breastfeeding for extended periods of time is a known preventative.(2) It’s not known for certain whether breastfeeding supports immunity or reduces allergy, or a combination of both, but it is certain that maintaining breastfeeding can help with recurrent ear infections.(3) If breastfeeding is not possible for you then you may want to consider donor milk rather than jumping straight to a cow’s milk replacement as this can exacerbate the issue.

Treating chronic otitis media is also about managing the risks. Run down or tired people are at higher risk of recurring infections so ensure you are well rested where possible. Avoiding cigarette smoke and day care situations for children will also reduce risk. Pacifiers have been positively linked to an increase in ear infection incidence so if you are struggling with infection it may be worth weaning from pacifier dependence.

Despite best efforts, antibiotic treatment may be unavoidable; the decision to use antibiotics should always be well informed so it is worthwhile having a discussion with your healthcare provider on the risks and benefits of such treatment and the possible success rate. The most commonly prescribed antibiotic for ear infections is amoxicillin.

The deleterious effects of antibiotics can be minimised by undertaking a probiotic protocol. Bifidobacteria and Lactobacilli have both been shown to return gut microbiota to a normal state more quickly when taken during a course of antibiotics.(4) The key is to take the probiotics during the course but diametrically opposite timings. So if you take your antibiotic 3 times daily 4 hourly then take probiotics 3 times daily 2 hours after an antibiotic dose so there is the longest period of time between doses possible. The most important probiotic dosing is at night time before bed so make sure you allow plenty of time between your evening doses. You may want to discuss this protocol with a practitioner for guidance relative to your treatment plan.

Chronic ear infections are a definite risk for hearing issues as well as long term discomfort, but they can be proactively managed and prevented with the right knowledge and tools.

By Sian Hannagan

Natural Mum on the Cheap

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Have you or your children suffered from a chronic ear infection?

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(1)  Dairy Allergies;jsessionid=KWSnGX5Jg8fQHy7tGEdJ.26

(2)    Breastfeeding and Otitis media


(4)    Probiotic protocol