A recent issue of the Journal of the American Medical Association carried an interesting article on the use of antibiotics for acute otitis media (AOM) or middle-ear infection. The reference is:
Tumaini R. Coker et al “Diagnosis, Microbial Epidemiology, and Antibiotic Treatment of Acute Otitis Media in Children” - A Systematic Review, in Journal of the American Medical Association, Vol. 304, No. 19, November 17, 2010, pp. 2161-2169.

The objective of the study was to perform a systematic review on AOM diagnosis and treatment with antibiotics. The study selected studies with a criterion standard, observational studies, randomized controlled trials on AOM microbiology and randomized controlled trials assessing antibiotic treatment.

The conclusion of the study was that antibiotics are modestly more effective than no treatment but cause adverse effects in 4% to 10% of children. Therefore, giving children antibiotics for ear infections does little to speed their recovery while raising the risk of some side effects.
The study found that 80 out of 100 otherwise healthy children would recover from an acute ear infection within a few days if given medication only to relieve pain or fever.

The study found that it does not matter which antibiotic is used to treat an ear infection when antibiotics are warranted. It found older types such as amoxicillin work as well as newer and more expensive antibiotics: indeed, newer antibiotics seem to cause more side-effects.

The study was designed to review existing research on the topic for the American Academy of Pediatrics, which is in the process of revising its guidelines for treating uncomplicated acute otitis media. The pediatricians’ group and the American Academy of Family Physicians have suggested that “observation” (i.e. avoiding antibiotics) is an option for treating ear infections in otherwise healthy children between the ages of 2 and 12. See http://aappolicy.aappublications.org/cgi/content/full/pediatrics;113/5/1451.

Of the three basic types of ear infections, acute otitis media may benefit from antibiotics because it is often caused by a bacteria. However, it can also be caused by a virus, which will not respond to antibiotics. Another type of ear infection, otitis media with effusion, causes a buildup of fluid in the middle ear. That is also caused by a viral infection, against which antibiotics are ineffective.

This is interesting from the perspective of Chinese medicine. I have observed over and over again in practice that antibiotic treatment seems to have little effect on ear infections (whilst, by contrast, they have some effect on chest infections). One obvious reason for this is that, as mentioned above, some ear infections may be viral. There may be another interesting reason. The ears are on the Shao Yang area of the body; indeed the Triple Burner and Gall-Bladder channels (Shao Yang channels) course around the ears. In the context of exterior diseases, i.e. diseases caused by external Wind, the Shao Yang stage behaves quite differently than the Tai Yang or Yang Ming stages. The Tai Yang stage is a purely exterior stage when Wind is located on the Exterior of the body, i.e. in the Wei portion. The Yang Ming stage, on the other hand, is an interior stage that occurs when the pathogenic factor has penetrated into the Interior and it has transformed into Heat.

The Shao Yang stage is quite different: it is the stage that is the “hinge” between the Exterior and the Interior. Because of this nature, pathogenic factors can get “stuck” in the Shao Yang stage, bouncing between the Exterior (Tai Yang) and the Interior (Yang Ming). When it is on the Exterior, the patient feels cold; when in the Interior, the patient feels hot: hence the famous “alternation of chills and fever” of the Shao Yang stage.

Another characteristic of the Shao Yang stage, and one that is related to its being the “hinge”, is that pathogenic factors can get “stuck” there and remain in the body for a long time. This cannot happen at the Tai Yang stage because, at this stage, either the Wind is expelled or it changes into Heat and penetrates in the Interior. At the Yang Ming stage too, the pathogenic factor is either cleared or it will injure Yin and it will penetrate into the Yin.

Because of the tendency of pathogenic factors to linger in the Shao Yang, this may be a cause for antibiotics not working and for middle-ear infections becoming chronic which, in children, they very frequently do. Moreover, the use of antibiotics may tend to injure the Stomach and lead to the formation of a residual pathogenic factor in the ears that is usually Damp-Heat. A residual pathogenic factor in the ear from the improper use of antibiotics is the most common cause of chronic ear pathology in children.

The remedy "Ear Release" in The Little Treasures was designed to treat chronic retention of Damp-Heat in the ears in children.

By Giovanni Maciocia