The Somatic Connection  |   January 2016
As the Twig Is Bent, so Grows the Tree—Part 7: Severe Temporal Bone Restriction in Children Is Risk Factor for Acute Otitis Media
Author Affiliations
  • Hollis H. King, DO, PhD
    University of California, San Diego School of Medicine
Article Information
The Somatic Connection   |   January 2016
As the Twig Is Bent, so Grows the Tree—Part 7: Severe Temporal Bone Restriction in Children Is Risk Factor for Acute Otitis Media
The Journal of the American Osteopathic Association, January 2016, Vol. 116, 61. doi:
The Journal of the American Osteopathic Association, January 2016, Vol. 116, 61. doi:
Three reviews in this edition of “The Somatic Connection” (see items titled “As the Twig is Bent, so Grows the Tree”) describe the notable progress in research related to osteopathic manipulative therapy (OMTh; manipulative care provided by foreign-trained osteopaths) in pediatrics. These studies were highlighted in the First Global Congress on Pediatric Osteopathy in September 2015 in Montreal, Canada. In his presentation at the Congress, Francesco Cerritelli, MsC, DO, announced that because of the recent randomized controlled studies, a systematic review and meta-analysis had been conducted and submitted for publication. According to Cerritelli, the analysis showed benefit of OMTh in the neonatal population. 
The studies reviewed herein add to the growing literature on osteopathic manipulative treatment (OMT) and OMTh in neonatal conditions. Lund et al1 showed OMT benefit in premature infants with nipple feeding dysfunction. Improvement in plagiocephaly has been shown,2 as well as in postural asymmetry3 and otitis media.4,5 Preceding the Pizzolorusso et al and Cerritelli et al studies reviewed in this edition of “The Somatic Connection” were 3 studies6-8 that set the stage for the Cerritelli systematic review. 
I am gratified to see the evidence base for pediatric osteopathy come to the fore in such strong fashion, and I am pleased to bring this research to the attention of US-trained osteopathic physicians. 
Morin C, Dorion D, Moutquin J, Levasseur M. Suture restriction of the temporal bone as a risk factor for acute otitis media in children: cohort study. BMC Pediatr. 2012;12:181. doi:10.1186/1471-2431-12-181. 
Canadian osteopathic researchers carried out a prospective cohort study of 64 infants (128 ears) aged 6 to 18 months assessing whether temporal bone suture restriction was a risk factor for the development of acute otitis media (AOM). The children were recruited from community-based recreational organizations. Inclusion criteria were no previous episodes of AOM and exclusion criteria were congenital anomalies like cleft palate or Down syndrome and any hearing problems. 
Temporal bone status was assessed by Canadian osteopaths using visual observation to identify obvious displacement between temporal squamous and petrous parts and suture overlapping and manual examination of each temporal bone. Each temporal bone was assessed for mobility of cranial concept for external and internal rotation, and severe restrictions were noted. Interrater reliability was 0.58 for right and 0.71 for left temporal bones. No osteopathic intervention was applied. 
The outcome measure was the diagnosis of AOM by a physician. All children who received an AOM diagnosis received standard care. Documentation of AOM was completed by a research assistant using telephone interviews with parents every 2 months. Physicians, parents, and the research assistant were blinded to temporal bone status. 
Severe temporal bone restriction was identified in 23 children (35.9%). Of these 23 children, 14 (43.3%) had at least 1 episode of AOM. Twenty-eight (28.3%) of those without severe temporal bone restriction had an episode of AOM. Higher risk of AOM was associated with restricted temporal sutures (P<.01), pacifier use (P<.01), and younger age (P=.001). 
Strengths of this study included the population-based longitudinal prospective design, rigor of the documentation of the health status of the children, and occurrence of only 1 subject dropout. The authors acknowledge that because the families recruited for the study knew the nature of the concern for AOM, parents may have sought AOM consultation, which they may not have otherwise done. 
Lund GC, Edwards G, Medlin B, Keller D, Beck B, Carreiro JE. Osteopathic manipulative treatment of hospitalized premature infants with nipple feeding dysfunction. J Am Osteopath Assoc. 2011: 111(1): 44-48. [PubMed]
Lessard S, Gagnon I, Trottier N. Exploring the impact of osteopathic treatment on cranial asymmetries associated with nonsynostotic plagiocephaly in infants. Complement Ther Clin Pract. 2011; 17(4): 193-198. doi:10.1016/j.ctcp.2011.02.001. [CrossRef] [PubMed]
Philippi H, Faldum A, Schleupen A, et al. Infantile postural asymmetry and osteopathic treatment: a randomized therapeutic trial. Dev Med Child Neurol. 2006; 48(1): 5-9. doi:10.1017/S001216220600003X. [CrossRef] [PubMed]
Mills MV, Henley CE, Barnes LLB, 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]
Steele KM, Carreiro JE, Viola JH, Conte JA, Ridpath LC. Effect of osteopathic manipulative treatment on middle ear effusion following acute otitis media in young children: a pilot study. J Am Osteopath Assoc. 2014; 114(6): 436-447. doi:10.7556/jaoa.2014.094. [CrossRef] [PubMed]
Pizzolorusso G, Turi P, Barlafante G, et al. Effect of osteopathic manipulative treatment on gastrointestinal function and length of stay of preterm infants: an exploratory study. Chiropr Man Therap. 2011; 19(1): 15. doi:10.1186/2045-709X-19-15. [CrossRef] [PubMed]
Cerritelli F, Pizzolorusso G, Ciardelli F, et al. Effect of osteopathic manipulative treatment on length of stay in a population of preterm infants: a randomized controlled trial. BMC Pediatr. 2013; 13: 65. doi:10.1186/1471-2431-13-65. [CrossRef] [PubMed]
Pizzolorusso G, Cerritelli F, Accorsi A, et al. The effect of optimally timed osteopathic manipulative treatment on length of hospital stay in moderate and late preterm infants: results from a RCT. Evid Based Complement Alternat Med. 2014; 2014: 243539. doi:10.1155/2014/243539. [CrossRef] [PubMed]