Many ear infections are a secondary symptom resulting from a cold that was not properly dealt with in the initial stages and was left to develop mucous, fever, and lowered immunity. Other causes may be due to an incorrect diet that increases mucous production such as excessive dairy, fruit juices, sugars, and cold foods, or inadequate clothing where Cold entered the ear through Wind points and took shelter.
In children, the Eustachian tube that connects the middle ear to the nasopharynx or the upper throat and back of the nasal cavity does not yet angle into the throat to allow drainage but is instead anatomically straight. As a person matures, this tube will drop and angle into the throat. But in childhood, this has not yet taken place. As a result, when the tube is filled with phlegm, as in the case of a cold with a stuffy nose, the mucous has no easy way to be eliminated and will remain in the tube causing pain.
Childhood ear infections are so common that they are the “bread and butter” of a TCM pediatric practice. They are typically easy to overcome, and I wish that Western medicine medical professionals would first refer every child with an ear infection to a nearby complementary practitioner. This practice would prevent the overuse of antibiotic therapy along with the problems that come from antibiotic overuse.
Parents can learn how to deal with most ear infections on their own with simple tools such as herbs, heat, diet, massage, and proper clothing relative to weather. This knowledge can empower them, give them more well-rounded parenting skills, save money and time, and save doctors and pediatricians from having their offices filled with children with a simple problem, thus leaving them to deal with more pressing ones. Many parents are unable to get a same day or next day appointment with their pediatrician, forcing them into urgent care or sometimes emergency rooms for an ailment that is easily remedied with understanding and a plan of action.
Common Causes
Ear infections or ear pain often come after a child has been in a cold and windy environment without adequate covering on the neck, upper back, and especially over the ears. A down jacket with a hood or a warm jacket and a hat that covers ears can prevent the cold and wind from entering and save many crying babies and children from ear pain.
If the parent finds herself in an environment where a cold wind suddenly arrives and the child does not have a hoodie jacket or hat, taking a small piece of Kleenex and putting it in the child’s ears will prevent that cold wind from directly entering the ear canal. Then, when a jacket or warmth is available, make sure the ear is covered and warmed to disperse the cold. When a child is fighting a viral condition, this protection for the ears is essential.
Caution parents that if they see a red ear, to check and make sure it is not a result of the child having just awakened after having slept on the ear when it is warm and slightly redder than the other ear. Other times the parent will notice that the ear itself looks red and when they touch it, it is hot. If they pull slightly on the ear lobe or touch the areas at the root of the ear, the child will cry out from discomfort or pain. This signifies an outer ear or middle ear infection, and the first line of help here is to warm the ear and keep the child warm.
Gathering History of Ear Problems
For all children with a history of ear infections, ask the following questions:
- How many episodes of ear pain has the child had and how have they been treated?
- Did the child have fevers with the episodes or were they discovered by accident during routine visits for immunizations? If there was a fever, get a description of it and find out how high the fever was. Remember that a fever of 101 will usually resolve with thoughtful parental care.
- Did the child have pain with the episode, and if so, how was that treated?
- If the child was prescribed antibiotics, what were they and how quickly and well did they work?
- If the ear was diagnosed as an infection and the child was given antibiotics that worked within hours or half a day, then the likelihood of the problem is that there was a bacterial component, usually in the ear, the lungs or the sinuses. However, if the antibiotics took three to five days or so before the child felt better or the symptoms diminished or disappeared, then you will know that this episode was treated incorrectly because the problem was viral. When antibiotics are appropriate, the changes in fever and pain are rapid.
Practitioner Assessment
Every practitioner should learn to use an otoscope and buy a good one that will last a lifetime. My Welch Allyn otoscope remains perfect after 40 years of use. If a problem occurs with it, the customer service at Welch Allyn is excellent. Plastic otoscopes are inferior for a practitioner but are useful for parents who have a child with a history of ear infections or fevers with ear pain. These parents can be instructed on how to use them for information and confirmation, and it is often useful for them. However, before practitioners rely too closely on a tool, remember that it is always important to be able to make a diagnosis with just the tools of your body. Once a dependency begins with the use of tools, it is easy to forget that in more primitive times doctors, midwives, nurses, and shamans were able to diagnose without the use of external tools. Also, if the practitioner finds herself or himself in a situation without medical tools, she/he will still want to be able to diagnose something as simple as an ear infection.
If you think of how much a TCM practitioner uses tongue, pulse, and the Four Methods of Diagnosis, (asking, looking, listening and touching) to make a diagnosis, you will realize that most of the information you seek is available from the patient and from these ancient diagnostic methods. When I began to treat children, I didn’t own an otoscope, and by the time I got one, I knew from the methods described above whether a child had a mild, moderate, or severe ear condition. So, train your skills in these ancient methods and use the otoscope for confirmation.
Before saying that the child has an ear infection and frightening a parent, notice the behavior of the child. If he is sick with a cold or cough and is pulling on one or two ears but is playing, sleeping well or through the night, eating, and is not irritable or crying, he might indeed have an external wind chill or wind heat which is also affecting the ear. This is not a problem that needs antibiotic care, and both you and the parent do not need to doubt that. Calling it a wind chill is easier for parents to deal with than calling it an infection
After observing the behavior of the child and hearing about the symptoms that brought him or her into your clinic, palpate these following points:
- TW 17 Yi Feng/Shielding Wind
- GB 2 Ting Hui/Reunion of Hearing
- SI 19 Ting Gong/Palace of Hearing
- TW 3 Zhong Zhu/Middle Islet
- GB 41 Zu Ling Qi
If any or all of these points are sore, you will know there is a problem in the ears along with the symptoms of a cold or cough. If the ears are not sore with palpation, you know that the ears will most likely look relatively normal upon inspection with an otoscope.
Next, take a heart rate and add that information to the full picture. If the child is not yet fevering, but the heart rate is very rapid and with palpation or auscultation is feeling as if it is about to come out of the chest, then you know that a fever is on its way and that the child is about to get much sicker. If the heart is running just a bit faster than normal, this will tell you that there is not going to be eardrum pain, nor will there be a rupture. If there is no change in the rate and no resistance with palpation, there is likely nothing going on in the ears.
A normal eardrum and ear canal is the light pink color of the child’s flesh, and with ear pain, depending on severity, the color changes to a deep pink, then to salmon pink, and eventually to red. You can use a score of ten beginning with zero as the feel or color of a healthy ear, and as the numbers increase, so does the severity of the condition.
When you look in an ear, a rating system of one to two would look like just a hint of pinkness in the ear canal or on the eardrum. A three or four is a bit pinker. A five to seven is a deeper salmon color and is indeed a problem that could easily get much worse if exposed to wind, cold, overplay, exhaustion, or the wrong foods. Somewhere between five and seven you will see that the tympanic membrane/eardrum, which is usually relatively flat, is now rounded as if there is a tiny ball under it. This is not a good sign and usually is accompanied by symptoms of pain, deep resistance to palpation, a deeper color of salmon to red, and a rapid heart rate. A number eight to ten will be red, inflamed, and the tympanic membrane will be swollen, round, and looking like it could rupture. The child will be sick with a fever and resist palpation of the ear.
You will also be using this scale based upon the child’s behavior and symptoms, heart rate, palpation, and fever. If a one to ten scale seems too big a scale for the parents, then reduce it to a scale of three. On a scale of three a one is a mild condition, a two is a moderate one, and a three is severe. If parents have an otoscope, they can confirm or correct their findings through visual inspection. Parents whose children have a history of ear infections are quick to learn these skills. When they know what to give the child in terms of herbs, how to warm the ear and use drops, and know how to rub certain acupuncture points, they can become proactive enough so that by the time the child comes in for an evaluation and a treatment, healing has already begun.
Shonishin for Ear Pain and/or Infections
When there is ear pain or a diagnosed infection, you can add Shonishin treatment to the parents' instructions. With a Shonishin tool or a very thin gauge needle, the important points are:
- TW 17 and GB 2. Use the Shonishin retracting needle or pine brush needle or use a thin gauge needle and do a quick in and out insertion.
- St 40 can be tapped with the Shonishin pine brush, retracting needle, or quickly needled with a thin gauge needle.
- TW 3 and GB 41 can be tapped with the retracting needle, speared with the arrow, or quickly needled with a thin gauge needle.
- The UB meridian is rubbed with the rake from the neck to the bum. Once the line that corresponds to the UB meridian is pink, a spinal roll can be done.
Points that are found to be sore with the spinal roll can be tapped with the pine brush or the retracting needle, quickly needled with a thin gauge needle or massaged with your finger. Normally these sore points are:
- UB 12 Feng Men/Wind Gate
- UB 13 Fei Shu/Lung Shu
- UB 17 Ge Shu/Diaphragm Shu
- UB 18 Gan Shu/Liver Shu
- UB 19 Dan Shu/Gall Bladder Shu
- UB 20 Pi Shu/Spleen Shu or UB 23 Shen Shu/Shen Shu might also be sore
If you are not yet skilled in working quickly enough to needle all those points in just a few minutes or if the child is not ready for this, then use the retracting needle or the tapping needle from the Shonishin kit. Children who have been treated by you for some time will likely be fine if you quickly needle those points. Children are rarely resistant if you work fast enough and distract them while you are working. Do not engage with the mother or answer her questions while treating the child, as your full attention is needed to get this job done in a timely manner.
Many times, I have taken my pen and drawn a moon or a sun on the child’s TW 3 or GB 41 as a map for the parent to use when they continue working on those points. Once they go home with these images and work with them, it is easy to find them again after the drawing has washed or worn off. This is an especially good idea if the child resists the parent working close to the ears and the parent is reluctant to do that because of the resistance. Children love moons and suns on their hands and feet. Using stickers on these points is less effective, because children often tear them off before they leave the office and certainly before they arrive home.
Herbal Remedies
Chinese Medicine Herbs & Formulas
- Xiao Chai Hu Tang/Minor Bupleurum is the number one formula used for ear infection, and it works like a charm for most children. If the child has already had symptoms of a runny nose or cough, the formula would already be in use and as a result, the ear problem should not be too well established. Xiao Chai Hu Tang is a classic formula available in pill form or extract powder/granule. This formula is wonderful for fevers and is used in pediatrics as an all-around formula for problems that accompany fevers such as common colds, bronchitis, tonsillitis, otitis media, mumps, alternating chills and fevers, nephritis, cystitis, and lymphadenitis. The herbs are Chai Hu/Bupleurum, Huang Xin/Scute, Dang Shen/Codonopsis, Ban Xia/Pinellia, Sheng Jiang/Ginger, Da Zao/Jujube, and Zhi Gan Cao/Licorice. The formula is practically a panacea and in the literature is referred to as a folk medicine. It is a typical Shao Yang formula, which is what most children have when ill, and was recorded in the Shang Han Lun (Treatise of Febrile Diseases) and Chin Kuei Yao Lueh/Jin Gui Yao Lue (Summaries on Household Drugs) by Chang Chung Ching/Zhang Zhong Jing of the Han dynasty in 250 A.D. If there is one pediatric formula that your clinic should never be without, it is Xiao Chai Hu Tang. When you see a child who is ten months old who has had six or more courses of antibiotics for problems such as ear infections or bronchitis, this formula can be used for an entire season, raising and lowering the dose as needed. For children who are five years old and have been on antibiotics several times each winter or spring for each of those years, this formula can be used for an entire year and the problems will end within a few days and not return.
- Ge Gen Tang/Pueraria Combination is for a child who has a strong constitution and has sensitivity in the back of the neck. It is used for middle and external ear infections. This is a good formula if the lungs are also involved or if the child has not yet produced any sweating. Ge gen/Kudzu regulates intestinal function and evacuation. Ma huang/Ephedra is no longer used, but Xiang Ru/Elsholtzia splendens can be used in its place. Xiang Ru, like Ma Huang induces sweating, releases the exterior, and resolves dampness. Xiang Ru and Gan cao/Licorice relieve cough and contraction in the skin. Xiang ru and cinnamon promote sweating. Cinnamon and Ginger circulate blood. Gan cao is a detox for the liver, and Da zao/Jujube is nourishing.
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Huang Qin/Scutellaria Baicalensis can also be given as a tea or a tincture.
American herbal tinctures and vitamins
Common herbal tinctures that clear microbes and enhance the body’s ability to handle them (i.e. Echinacea or Skullcap/Scutellaria lateriflora) can be diluted and used several times daily.
- Echinacea tincture is as good for ear infections as it is for colds. Literature recommends that for dosing tinctures to children under three, use 1 drop per two pounds of body weight every 4 hours while awake. For older children, follow the recommended dose depending on age or weight.
- Skullcap/Scutellaria lateriflora tincture can be taken with symptoms of headache, irritability, or difficulty in sleeping. The dose is up to 3-15 drops depending on body weight and should be taken every four hours. Skullcap is anti-inflammatory, antimicrobial, dries the moisture, and calms the spirit.
- Vitamins A and D3 are antimicrobial and strengthen the child’s ability to overcome the infection and resolve discomfort. Vitamin C Is an antioxidant and anti-inflammatory that helps the body fight off microbes and aids the body’s recovery. Vitamins A and C are easy to provide via the diet, as each is present in foods that children are happy to eat. A roasted sweet potato with butter is a good source of vitamin A, as are greens, and fruits in general are high in vitamin C. Red, orange, or sweet yellow peppers are high in both vitamins A & C. If using vitamins from a bottle, follow the recommended dose for the child’s age.
Essential Oils
Essential oils are a wonderful addition to use for ear pain. Adding a drop of essential oil to a carrier oil and gently massaging it around the ear and down the neck increases healing. When using an essential oil, it is important to test the child’s reaction to it before introducing it as medicine. To do this, add 1 drop of the essential oil into 1 teaspoon of carrier oil (extra virgin olive or coconut oil work well) and apply one or two drops to the child’s inner wrist to assess if there is a skin reaction. If any redness exists, then that particular oil is not to be used.
Dosing for an essential oil depends upon the age of the child. If a baby is under two years old, the dose is 1 drop of essential oil to 1 teaspoon of carrier oil. If the child is between 2-5 years old, the dose is 1 drop of essential oil to 10 drops carrier oil. You can use this infused oil to rub all the nooks and crannies of the external ear. Then rub the back of the ear beginning at the apex and continue all the way to the root of the ear and down the neck. This can be repeated several times throughout the day.
If the child is resistant to touch, then a cotton ball with one drop of essential oil by itself can be used and placed in the external ear. This oil will evaporate or diffuse into the ear, but it will not have direct contact with the eardrum.
Because of conflicting information and parental concerns, the use of essential oils (even when mixed with a carrier oil) should not be recommended for direct placement inside the ear. Essential oils are very dense molecularly, and a mere drop can address every cell of the body quite immediately.
Essential oils can be massaged around the ear and the mastoid process, and if you are gentle, down the neck. Common essential oils for ear infections are:
- Tea Tree is antimicrobial and reduces pain. It can be found readily in most natural food stores.
- Thyme oil is antimicrobial and anti-inflammatory. It boosts the immune system, is an expectorant, and calms the spirit.
- Oregano oil is a powerful antimicrobial that helps fight infections. It is used to fight off colds and sinus infections.
At-Home Remedies
The following suggestions are considered folk remedies by today’s medical system, but they have been proven to be reliable and effective.
Heat
The first tool that addresses healing the ear is heat, which is wise to use with early ear symptoms or tenderness.
A hot water bottle filled with warm water or a sock filled with uncooked grain heated in the microwave are good ways to warm the ear. Once the bag or sock is heated, wrap it in a cloth (a child’s t-shirt works well) for safety and comfort before applying it to the ear. Sitting with the child during this application of heat and telling him the pain will soon go away is emotionally soothing. It is also a good time to read a story or let the child put their head into the parent’s lap with the heating poultice on the sore ear. Remind parents not to underestimate the importance of touch as well as spending time with their child. Try to keep the heat on the ear for 15-20 minutes. By then the pain will subside and the child will typically return to play or sleep. Heat softens the phlegm behind the eardrum, often enough for some of it to drain out of the eustachian tube and into the throat where it will be swallowed and excreted in tomorrow’s bowel movement.
At the end of the heat treatment, if the child is old enough to blow a balloon, it is advised to have her blow one up, equalizing the pressure in the ears. Since the pressure of blowing into a balloon is a closed circuit, it forces the softened/heated phlegm down and out of the eustachian tube. As a result of both the softening and movement of phlegm, the pressure in the tube is reduced and the pain will subside. If the balloon is left untied, it can be reused after further heat treatments. I learned not to let children blow up balloons in the clinic, because when they released them, droplets contaminated the environment.
Garlic and Mullein Oil
Garlic and mullein oil is easy to find in most health food stores, and if kept in a dark and cool place, it lasts up to two years. This is not an essential oil; it is an oil infused with garlic and mullein flowers and is advised as a soothing oil applied directly into the ear. To apply, fill a dropper with three to four drops, then run the dropper under warm water to warm the oil to body temperature. Test the heat by applying one drop to the inner wrist. If it is too cold or too hot, the child will resist the oil. Apply approximately 4 drops of the oil when the child is either sitting up or lying on his side with the sore ear facing up and the head tilted toward you to aid the oil’s descent. Gently tugging on the base of the ear helps the oil descend. Once the oil is in the ear, the parent may choose to place a cotton ball over the opening of the ear. The cotton ball is not critical for the drops to work, but if parents use one, caution them that it be kept in the external ear opening only and not pushed into the ear. The oil should remain in the ear for at least 10-15 minutes.
If parents do not have an eyedropper, or if it is easier on the child, an alternative application is done by placing a cotton ball that has been soaked in the garlic oil into the external ear, then lay the child down with the painful ear up. The oil will gradually seep into the ear and produce the same outcome. Caution the parent not to push the cotton ball deeply into the ear. Again, sitting with the child until the pain is reduced is extraordinarily helpful.
Garlic oil can be made by finely chopping a few garlic cloves or pressing them through a press, then letting them sit in one ounce of olive oil for 5-10 minutes. This garlic oil treatment increases the allicin content, enhancing its natural antibiotic quality. The oil and garlic are then simmered on low until warm, and the garlic is then strained out. With an eyedropper, apply one drop on your wrist to make sure the oil is not too hot. Once it is body temperature, put two to three drops of it into the ear. Garlic is analgesic as well as antimicrobial, soothing pain while inhibiting microbial growth.
Onion Treatment
Another remedy used with great success is the use of an onion. Begin by cutting an onion in half, then wrap it in a Ziploc bag and microwave it until it is soft. Check the onion every 30 seconds or so, and when it feels soft, take the onion out of the bag and place it in a sock or similar fabric bag to prevent it from coming apart during the treatment. Then wrap the sock in a hand towel to reduce the heat from the microwave and prevent a burn. Place the onion poultice over the ear using the same steps as previously described in the garlic treatment. Stay with the child and soothe them while the onion treatment takes effect. Just like the above suggestions, onion is also antimicrobial, antiseptic, and reduces inflammation. After approximately 10 minutes, the child should have relief and will often stop crying. When the child is sick with a fever and crying in pain, the child may go to sleep after the treatment. Repeating this several times during the day is suggested. The onion can be heated and used twice more. Then begin the following day with a fresh onion.
Hydrogen Peroxide
Hydrogen Peroxide is a remedy that many people have in their homes and is one that may be used for ear pain. When the child is lying on his side, a full dropper of hydrogen peroxide is dropped into the ear and the bottom of the ear is tugged so the fluid will descend. The child must lie still and while he does, he might hear some bubbling sounds. This is normal. After 10 minutes, the child can sit up and tilt his head to empty the hydrogen peroxide out of the ear. It is normal if the hydrogen peroxide is frothy. This can be repeated every 3 hours throughout the day.
Colloidal Silver
Colloidal Silver is an antimicrobial that is made of minute silver particles suspended in water. It works by cutting off the oxygen supply to viral and bacterial infections, making their reproduction difficult. Like hydrogen peroxide, apply when the child is lying down, but only use 2-3 drops in the affected ear. Have the child lay still for approximately 10 minutes to retain the colloidal silver before letting the child sit up.
Ruptured Eardrum: Special Caution
Special caution should be used if you believe the eardrum has been ruptured. This is often identified by fluid or pus exiting the ear. If a child has been screaming out in pain and they suddenly feel better, parents should check to see if an exudate is coming out of the ear. It is common to have a feeling of relief when the eardrum ruptures. If this is the case, nothing should be put into the ear canal. Instead, apply heat on the ear and give the child an oral formula such as the Xiao Chai Hu Tang/Minor Bupleurum (as discussed earlier).
Additional Tools & Tips for Parents to Use
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Otoscope: If parents have an otoscope which they have learned to use, it will confirm or give valuable information.
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Tiger Warmer: This is a wonderful tool for parents to use for ear pain. Teach the parents to apply the warmer behind and in front of the root of the ear, pointing out that this is a major Wind point that not only warms the cold, but also soothes and opens the stasis in the ear (TW 17 Yi Feng). Parents can move the tiger warmer back and forth in a small area so that the heat will not build up too quickly and cause the child to resist. The tiger warmer is used until the area is warm and then moves in a downward direction until halfway down the neck, or all the way to the clavicle. It is also applied to the root of the ear in the front (GB 2 Ting Hui) and above it in the soft indentation (SI 19 Ting Gong). Just as the tiger warmer moved down the neck in the back of the ear, after these two points are warmed, move it down the front of the ear and toward the jaw.
If the child is impatient, parents can choose the sorest point and begin with that one. If the child does not want the parents to continue with the tiger warmer, then they can forego warming the other less sensitive points. For children with repeated ear infections, they will likely have swollen lymph under the ears, in the neck, and sometimes directly under the occipital bone. - Balloons: As previously mentioned, blowing up a balloon can help the child equalize the pressure in the ears after a heat treatment. Practitioners can keep balloons for children and patients to select from, along with buttons and shells for Shonishin, plus herbs and instructions.
- Shells & Buttons for Shonishin: A basket of shells, rocks, and large buttons can be kept in the clinic for parents to choose for Shonishin. Children can also help with the selection.
- Sleeping: If there is fluid in the eustachian tube, have the child sleep at a slight incline.
- Treatment order: If both ears are sore, choose treatment on the sorest ear first.
In Summary
Treating ear pain or ear infections in babies and children is a topic that is easily addressed with Chinese medicine. Sharing the age-old knowledge of generations past gives parents an understanding relative to common colds, fevers, and ear pain. Touch medicine, the correct diet and clothing, along with Chinese herbs is primarily all that is required. In today’s modern practice, the pediatrician does not have time to coach and educate the parent when they are only allotted 10 minutes per patient. The knowledge we impart to parents not only prevents the use of unnecessary pharmaceuticals for viral conditions, but it also saves time, money, and worry. A new family may call with follow up questions after the first meeting to make sure they understood everything you’ve explained. Beyond this, the normal problems that arise with the common cold, phlegm, fever, or ear pain come to an end; parenting skills are strengthened; and so are the immune systems of the children. And for beginning practitioners, treating a child for ear pain is often the start of a whole new family joining your practice.
