The Somatic Connection  |   October 2013
Systematic Review of CAM Approaches to Otitis Media: The Otolaryngology Perspective
Author Affiliations
  • Hollis H. King, DO, PhD
    University of Wisconsin School of Medicine and Public Health, Madison
Article Information
The Somatic Connection   |   October 2013
Systematic Review of CAM Approaches to Otitis Media: The Otolaryngology Perspective
The Journal of the American Osteopathic Association, October 2013, Vol. 113, 795. doi:
The Journal of the American Osteopathic Association, October 2013, Vol. 113, 795. doi:
Levi JP, Brody RM, McKee-Cole K, Pribitkin E, O'Reilly R. Complementary and alternative medicine for pediatric otitis media [published online April 4, 2013]. Int J Pediatr Otorhinolaryngol. 2013;77(6):926-931. doi:10.1016/j.ijporl.2013.03.009.  
This review on complementary and alternative medicine for pediatric otitis media by Levi et al was chosen for inclusion in “The Somatic Connection” because it looked at osteopathic manipulative treatment (OMT). This review illustrates the context within which osteopathic research is often viewed. Although most osteopathic physicians who use OMT to treat patients with otitis media have had clinical success, research has produced mixed findings. This review suggests that, compared with other complementary and alternative medicine approaches, we are not alone in the struggle to demonstrate efficacy in our approach to health care. 
Included in the review were case reports, case series, randomized controlled trials (RCTs), and basic science research articles on pediatric otitis media that used interventions including homeopathy, natural health products and probiotics, osteopathic and chiropractic manual therapy, and traditional Chinese and Japanese medicine. 
The only complementary and alternative medicine approach found to have strong RCTs demonstrating evidence of benefit for pediatric otitis media was xylitol, a natural sugar found in many fruits and used as a sweetener in chewing gum. All other substances, including the familiar Echinacea, and modalities including OMT were not found to be of reliable benefit. The authors' discussion of OMT was limited to the Mills et al (2003)1 and Degenhardt and Kuchera (2006)2 studies, which were found to be flawed because of high dropout rates and lack of controls. Interestingly, these authors reported specifically on the use of the “Galbreath maneuver”3 and the “Muncie technique.”4 
The authors concluded that herbal eardrops may relieve symptoms and homeopathic remedies may decrease pain and result in faster resolution of this disorder. The authors end with the admonition to consult a physician when making treatment decisions for pediatric patients with otitis media. 
On the basis of these findings, the challenge for the osteopathic medical profession is apparent. We need to develop better-designed RCTs and fully address the concern for the safety of OMT. My opinion is that we have proven the benefit of OMT in musculoskeletal disorders. Next, we need to develop and fund well-designed studies that demonstrate the benefit of OMT in physiologic functions and systematic disorders such as otitis media,1 asthma,5 pneumonia,6 and pregnancy.7 
   Section Editor's Note: The osteopathic medical profession has progressed slowly in generating the evidence base for osteopathic manipulative treatment (OMT). Since the establishment of the Osteopathic Research Center at the University of North Texas Health Science Center in 2001, its current executive director, John C. Licciardone, DO, MS, MBA, authored a systematic review and meta-analysis showing the benefit of OMT in the management of low back pain (BMC Musculoskelet Disord. 2005;6:43). In the following 3 reviews, I look at OMT research from health care professionals outside the osteopathic medical profession. This research reflects the current state OMT research and the issues facing osteopathic researchers.—H.H.K.
Mills MV, Henley CE, Barnes LL, Carriero JE, Degenhardt BF. The use of osteopathic manipulative treatment as adjuvant therapy in children with recurrent acute otitis media. Arch Pediatr Adolesc Med. 2003;157(9):861-866. [CrossRef] [PubMed]
Degenhardt BF, Kuchera ML. Osteopathic evaluation and manipulative treatment in reducing the morbidity of otitis media: a pilot study. J Am Osteopath Assoc. 2006;106(6):327-334. [PubMed]
Pratt-Harrington D. Galbreath technique: a manipulative treatment for otitis media revisited. J Am Osteopath Assoc. 2000;100(10):635-639. [PubMed]
Channell MK. Modified Muncie technique: osteopathic manipulation for eustachian tube dysfunction and illustrative report of case. J Am Osteopath Assoc. 2008;108(5):260-263. [PubMed]
Guiney PA, Chou R, Vianna A, Lovenheim J. Effects of osteopathic treatment on pediatric patients with asthma: a randomized controlled trial. J Am Osteopath Assoc. 2005;105(1):7-12. [PubMed]
Noll DR, Degenhardt BF, Morley TFet al. Efficacy of osteopathic manipulation as an adjuvant treatment for hospitalized patients with pneumonia: a randomized controlled trial. Osteopath Med Prim Care. 2010;4:2. doi:10.1186/1750-4732-4-2. [CrossRef] [PubMed]
King HH, Tettambel MA, Lockwood MD, Johnson KH, Arsenault DA, Quist R. Osteopathic manipulative treatment in prenatal care: a retrospective case control design study. J Am Osteopath Assoc. 2003;103(12):577-582. [PubMed]