Otitis media and spinal manipulative therapy: a literature review

Abstract

Objective

Otitis media (OM) is one of the common conditions for doctor visits in the pediatric population. Spinal manipulation therapy (SMT) may be a potential conservative treatment of OM. The purpose of this study is to review the literature for OM in children, outlining the diagnosis of OM, SMT description, and adverse event notation.

Methods

Databases (PubMed, Cochrane Library, Cumulative Index to Nursing and Allied Health, Index to Chiropractic Literature, The Allied and Complementary Medicine, and Alt Health Watch) were queried and hand searches were performed to identify relevant articles. All potential studies were independently screened for inclusion by both authors. The inclusion criteria were as follows: written in the English language, addressed OM, involved human participants 6 years or younger, and addressed SMT. Studies were evaluated for overall quality using standardized checklists performed independently by both authors.

Results

Forty-nine articles were reviewed: 17 commentaries, 15 case reports, 5 case series, 8 reviews, and 4 clinical trials. Magnitude of effect was lower in higher-quality articles. No serious adverse events were found; minor transient adverse effects were noted in 1 case series article and 2 of the clinical trials.

Conclusions

From the studies found in this report, there was limited quality evidence for the use of SMT for children with OM. There are currently no evidence to support or refute using SMT for OM and no evidence to suggest that SMT produces serious adverse effects for children with OM. It is possible that some children with OM may benefit from SMT or SMT combined with other therapies. More rigorous studies are needed to provide evidence and a clearer picture for both practitioner and patients.

Introduction

Otitis media (OM) is one of the primary conditions for which antibiotics are prescribed in the United States.¹ Failure to distinguish acute otitis media (AOM) from otitis media with effusion (OME) is a possible reason for the use of antibiotics when they are not indicated, and this may contribute to the development of antibiotic-resistant organisms. Acute OM and OME both are upper respiratory tract infections, but children with AOM also have pain and fever.² The current recommendation for the treatment of AOM is to use an antibacterial agent (usually amoxicillin).³ Antimicrobial therapy is not recommended for patients with OME because it typically resolves spontaneously.² Because of the concerns of increasing antibiotic-resistant infections and overuse of antibiotics, other methods for conservative care for the common condition of OME are needed. Methods traditionally associated with complementary and alternative medicine (CAM) are usually conservative and do not include pharmaceutical drugs or surgery. Currently, CAM is not considered a potential treatment of either AOM or OME because of limited evidence in the literature.3, 4

In addition to musculoskeletal disorders, both the chiropractic and osteopathic professions have claimed that spinal manipulation therapy (SMT) may alleviate disorders involving visceral organs, such as OME.5, 6 Hypotheses regarding how SMT accomplishes this generally attribute the effects of SMT to biomechanical changes produced in the spine, which subsequently mediate changes in sympathetic or parasympathetic nerve activity.5, 6

Certain chiropractic and osteopathic manipulative techniques address the function of cranial structures (including intraoral structures) for treatment of OM.⁷ These structures may directly affect the Eustachian tube (ET), which is thought to be the primary structure involved in reoccurrence of OM.⁸ The ET has an increase in goblet cells during and up to at least 6 months after OM regardless of the bacterium causing the condition. Otitis media causes an increased secretory capacity of the ET. This increase may contribute to the excessive mucus and deteriorated ET function. These factors could also predispose the patient to the reoccurrence of OM or to a more aggressive middle ear complication.

Another hypothesis, which also indirectly involves the ET, is the impact of cervical manipulation on the lymphatic and muscular systems. Lymphatic flow requires muscular contractions, arterial pulsations, and external compression of body tissues. It is hypothesized that restricted joint movement within the cervical spine may result in muscle hypertonicity restricting lymphatic drainage away from the cranial region. This hypothesis suggests that cervical SMT reduces tension within hypertonic muscles, thus increasing lymphatic drainage.⁹

At present, there has not been a review of the literature summarizing the effects of spinal manipulation therapy (SMT) on OM or the safety of SMT for treating OM. The purpose of this study was to review the literature on the treatment effects of SMT and/or mobilization (including both chiropractic and osteopathic approaches) for all types of OM. This study also evaluates the literature for information relating to the diagnosis of OM, SMT description, and reported adverse events.