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