* In a recent study, one third of 773 individuals involved in a road accident as a driver, bicycle rider or pedestrian experienced some level of anxiety, depression, fear of travel or post traumatic stress disorder (PTSD) 3 to 12 months later and, in most cases, persisted. After one year, about half the group had phobic travel anxiety, nearly 60 per cent had general anxiety, and half were diagnosed with PTSD (Am J Psychiatry, 2001; 158: 1231-8).

* New research in nearly 1300 men suggests that, during a severe asthma attack, men are less likely than women to notice the symptoms of the attack. The reason for this is unclear, but it may be that men perceive less discomfort because of greater lung size and muscle strength, or because they generally develop asthma at an earlier age than women. Men also tend to only seek medical attention when symptoms are too severe to ignore, the researchers noted (Ann Emerg Med, 2001; 38: 123-8).

* What’s lurking in that paddling pool? Physicians in Canada have found the first outbreak of a new type of Pseudomonas infection called ‘hot foot syndrome’. This discovery was made when 40 children, aged 2 to 15, developed intense pain in the soles of their feet within 40 hours of using the same wading pool. A hot, red swelling began after a few hours, along with pain so severe that the children were unable to stand up. Three children were given oral cephalexin (an antibiotic) while the others were treated with cold compresses, analgesics and foot elevation. In all cases, the condition resolved within 14 days, although it recurred in three children after they revisited the same pool (N Engl J Med, 2001; 345: 335-8).

London’s Royal National Throat Nose and Ear Hospital reports that it has monitored more than 200 children aged between 3 and 8 suffering from chronic or recurrent glue ear in the last two years (The Lancet, 2 January 1993). More than 80 per cent were found to be suffering from rhinitis (inflammation of the mucous membranes of the nose); 35 per cent from asthma; and 20 per cent from eczema. When these children’s allergies were treated, their hearing improved. Only 11 per cent needed grommets.

A Derbyshire hospital identified a link 10 years ago between glue ear and hypersensitivity in 36 out of 89 children attending for treatment, reports The Lancet.

Both these findings follow an announcement by Effective Health Care (WDDTY, vol. 3, no. 12) that most cases of glue ear will recover without the need for surgery. Nevertheless, in one third of cases, surgeons make an immediate decision to operate at the first consultation with no further assessment and glue ear continues to be the most common reason for children to have operations.

The insertion of grommets poses serious risks. These include tympansclerosis (hardening of the ear drum), chronic perforation, and cholesteatoma (a middle ear cyst).

“A very restrictive policy regarding the insertion of grommets is necessary,” says the BMJ in an editorial (2 January 1993).

“Ideas about the [cause] of glue ear are changing,” the BMJ added. “In some perhaps most cases [glue ear] may be a normal reaction to an upper respiratory tract infection. Surgical intervention would therefore be unjustified.”

To prevent one child from experiencing pain by two to seven days after leaving the doctor’s surgery, 17 children would need to be treated with antibiotics.

In the study, which supports the conclusions of other research, the authors recommend that antibiotics should be regarded as an “optional treatment” rather than a first line of attack.

For information on ear ache see WDDTY vol 6 nos 2 and 3 and vol 5 no 12; for antibiotics see WDDTY vol 8 no 1.

Glue ear is the commonest reason for children to have elective surgery, on the grounds that it causes hearing impairment which can lead to speech delay and learning difficulties. Nevertheless, there is no real evidence that glue ear actually causes any significant problems, says Effective Health Care (November 1992). Most children will recover spontaneously after a short time. While nearly half of allthree year olds may suffer from glue ear, only 5 per cent will have hearing difficulties in both ears lasting for at least three months.

Effective Health Care recommends a period of “watchful waiting” accompanied by high quality hearing tests.

Breastfeed. The cheapest and most effective health insurance around. Babies who are breastfed for more than a year don’t seem to suffer from ear infections. Early bottle feeding is linked to recurrent otitis media, whereas longer breastfeeding (for at least six months) has demonstrated a protective effect (Acta Paed Scand, 1982; 71: 567-71). Another study found that children with middle ear infection had been breastfed for 8.6 months, while those in the study group without the condition had been breastfed for 13.7 months (East African Med J, 1993; 70: 623-3).Breastfeeding won’t guarantee that your child will never have an ear ache, but recovery may be more complete and more swift if you do. Breast milk contains copious amounts of gamma linolenic acid, which converts to prostaglandins, offering powerful anti inflammatory properties (Med Hypoth, 1984; 13: 161).

Nutrition. Cut down or cut out fats and sugars which can alter your vascular system and have a knock on effect on your hearing. Food additives such as sulphites and monosodium glutamate (MSG) can provoke ear ache. Try taking molybdenum to counter sulphite allergy and B6 for MSG allergy (J Orthomolec Psychiat, 1984; 105-10; Biochem Biophys Res Commun, 1981; 100: 972-77).

Investigate allergies. Ear ache is more than twice as common in allergic children than non allergic children (Laryngoscope, 1967; 77: 636). Cow’s milk, cocoa, cane sugar, cola, grains, citrus, eggs and nuts are the most common culprits, according to one study of 1000 patients (F Speer, Food Allergy, PSG Publishing Co, 1983). Allergy to salicylates may also be a cause (Am J Otol, 1989; 10: 256) The problem may be countered by avoiding aspirin and most herbs, spices and nuts, most fruits (except bananas, peeled pears, mangoes, pomegranates and papayas), most vegetables (except cabbage, Brussels sprouts, bean sprouts, celery, leeks, lettuce and peas), potato skins but not potatoes themselves, caffeine, fruit juices, alcohol and yeast rich foods such as Marmite.

Assess your environment. Airborne allergens such as house dust, tobacco smoke, animal hair and fungus spores have all been linked to ear infections (J Allergy Clin Immunol, May 1984). Lead and aluminium toxicity have also been associated with hearing loss.

Supplements. The cochlear needs vitamin A to stay healthy and functioning well (Arch Otorhinol 1978; 124: 379-82). Supplementation can improve hearing loss and tinnitus (Arch Otolaryngol 1951; May: 515-26. Combined with vitamin E it may be more effective (Acta Vitaminnol Enzymol, 1985; 7 Suppl: 85-92). Extra vitamin D may also reverse hearing loss (Otolaryngol Head Neck Surg, 1985; 93(3): 313-21; J Laryngol Otol, 1983; 97: 405-20).

Deficiencies in calcium, iron, magnesium, zinc, potassium and sodium have all been associated with symptoms of hearing loss and tinnitus.

Homeopathy. Pulsatilla can be helpful for middle ear infection (J AM Inst Homeop, 1986; 79: 3-4; Allgemeine Homeopathische Zeitung, 1985; 230: 89). Other remedies include Chenopodium for exposure to loud noise and Causticum for build up of ear wax; Phosphorus, China, Aconite, Arnica or Gelsemium can be used to treat deafness, depending on constitutional type.

Osteopathy or chiropractic. Occasionally recurrent ear ache can be caused by a mechanical problem at the top of the neck (Manuelle Medizin, 1987; 25: 5-10).

Stress management. Apart from lifestyle modifications, stress management and relaxation may be a more positive way to deal with the side effects of tinnitus. There is evidence that hypnotherapy can be helpful (J Laryngol Otol, 1996; 110: 117-20).

In only the latest indictment of day care facilities (nurseries in the UK) an American study of nearly 6000 children under six found that 17 per cent had repeated ear infections. Although certain factors seems to predispose children to ear aches (enlarged adenoids, asthma and repeated tonsillitis), the greatest risk factor was placement outside the home. Children placed in child care had a 50 per cent greater chance of repeated ear infections than did children cared for at home. But the greatest risk of all was placement in day care centres whether for four or forty hours a week.

The other revealing study (Obstetrical and Gynaecology Survey, November 1993) shows that breast feeding protects babies against ear infections. In a study of 1300 babies under a year, researchers found that babies who had been breast fed for the first four months had half the number of infections of the middle ear during their first six months as other babies protection that carries on for at least a year.

Ear aches have become a virtual epidemic in the UK and the US affecting up to half of all children under five and boosting the business in grommets (tympanostomy in the States). The new link with day care centres means that ear aches can now join haemophilis influenzae meningitis, hepatitis A, giardia lamblia, salmonella and E coli as diseases caused by institutionalizing children too early.

Neither study pinpointed the factor in day care centres that caused ear infections, or the factor in breast feeding which prevented them. Other studies have demonstrated that bottlefed babies have a higher incidence of middle ear infections than breastfed babies do, but we don’t know whether the particular ingredients in the milk or the baby’s sucking action more aggressive in breast feeding than in bottle feeding is behind it. Or maybe it has something to do with of being within close proximity to mum.

If you put these two isolated studies together, what you cannot avoid bumping into are the implications, upon the health of the next generation, of women rushing back to full time work immediately after the birth of their children.

Yet a third study offers the kind of modern solution to problems created by separating mother and infant. A set of Canadian researchers tested whether a drug, Imocur, composed of extracts of eight species of bacteria, could, in effect, prevent recurrent respiratory infections among day care children. Not surprisingly, vaccinating children against institutionalization doesn’t really work.

This isn’t a call for a turning back of the clock. Most families need two incomes, many women are heads of household, and probably a majority of women would like some interest outside the home. But the most important feminist issue may be for greater flexibility in the workplace, for the right for women to be both mothers and employees. Otherwise, the price of equality may prove too high.

Early bottle feeding has been linked to recurrent otitis media, whereas longer breastfeeding (for at least six months) has demonstrated a protective effect (Acta Paed Scanda; 1982: 71: 567-71). An allergy to cow’s milk may cause the infection, whereas breast milk contains copious amounts of two types of gamma linolenic acid, which convert to prostaglandins, offering powerful anti-inflammatory properties (Med Hypoth, 1984; 13: 161). Also, feeding babies on their backs via “bottle propping” produces aspiration via the eustachian tube into the middle ear, and ear infections usually follow.

As for homeopathy, two controlled studies demonstrated good results with Pulsatilla (J Am Inst Homeop, 1986; 79: 3-4; Allgemeine Homoeopathische Zeitung, 1985; 230: 89).

If homeopathy doesn’t work, investigating allergies well might. Secretory ear ache is more than twice as frequent in allergic children than in non-allergic children, according to a study of 540 patients (Laryngoscope, 1967; 77: 636). One study showed that significant pressure changes occur in the middle ear of children when their nasal passages are exposed to allergens (Ann Allergy, December 1984; 53 (6): 468-71); another study shows that in three quarters of cases, repeated antibiotic therapy may eliminate bacteria, but not middle ear fluid (TTK Jung et al, in Recent Advances in Otitis Media with Effusion, D J Lim et al (eds), B C Decker, Philadelphia, 1984).

Cow’s milk, cocoa, cane sugar, cola, grains, citrus, eggs and nuts are the most common culprits, according to one study of 1000 patients (F Speer, Food Allergy, PSG Publishing Co, Littleton, Mass, 1983). If children are allergic to milk they have a one in four chance of being allergic to soy. Besides food, sulphites and monosodium glutamate (MSG), both common food additives, can provoke ear ache. Supplementation molybdenum for sulphites, vitamin B6 for MSG can improve symptoms (J Orthomol Psychiat, 1984: 105-10; Biochem Biophys Res Commun, 1981; 100: 972-77). Airborne allergens, such as house dust components, tobacco smoke, animal dander and fungus spores, have also been linked to ear infections

( J Allergy Clin Immunol, May 1984).

Because a baby’s digestive tract is highly permeable, particularly during the first 15 weeks, it is advisable to exclude wheat, barley, rye, egg, cow’s milk products and poultry from its diet during the first nine months and to have no frequent repetitions of any other food. This will reduce the risk or even prevent the development of food allergies. Supplementing a child’s diet with bioflavonoids, vitamin C, beta carotene, zinc, omega-3 and omega-6 essential fatty acids, and thymus extract also prevents or minimizes allergies (J R Pizzorno and M Murray, Textbook of Natural Medicine, Bastyr University Publications, Seattle, 1992).

Occasionally, recurrent ear ache can be caused by a mechanical problem at the top of the neck (Manuelle Medizin, 1987; 25: 5-10). In this case, the child should be taken to a experienced, registered osteopath or chiropractor.

Harald Gaier is a registered naturopath, homeopath and osteopath.

A double blind study conducted at the University of Utrecht in the Netherlands of 121 children aged 6 months to 2 years with chronic middle ear infections were given either co amoxiclav or a placebo over seven days. Although the antibiotic seemed to have a slight effect on babies, the study concluded that “Co-amoxiclav has no significant benefit over placebo in treating children older than two with acute otitis media.” In other words, antibiotics are no better than a sugar pill in treating acute ear ache.

“The most striking result of this study is that even in a population of children aged 6 months to 12 years prone to otitis media the natural course of the clinical improvement is not different from the course when co-amoxiclav is prescribed,” the authors wrote. Translated that means that antibiotics don’t do anything that nature doesn’t do itself.

The second study from the University of Pittsburgh examined the effects of antibiotics used with or without an oral decongestant antihistamine combination on “secretory” , or weeping, otitis media in children aged 7 months to 12 years. Once again, amoxicillin with and without decongestant antihistamine combination was “not effective” for the treatment of persistent middle ear infection in both infants and children.

“Furthermore,” said the study, “recurrence rates were significantly higher in the antibiotic treated group than in the placebo group. Six weeks after antibiotic treatment, the number of children without effusions was about the same in each group.”

This means that repeated antibiotic treatment could be the source of the chronic problem!

After reviewing the earlier studies, American researchers conclude that antibiotics are of ‘limited’ use in treating acute otitis media (AOM), ‘requiring treatment of nine children to show an improved outcome in one.’

The effect of antibiotics is also limited in the treatment of otitis media with effusion (discharge). ‘Six patients need to be treated to improve the outcome in one . . . And [im-provement] is of relative short duration. ‘One month or more after treatment is completed, there is no statistically significant improvement with controls.’ They conclude that the lack of any long-term improvement undermines one of the principle rationales for administering the drugs.

‘As a major goal of treatment of [otitis media with effusion] is the prevention of language or developmental delays due to hearing deficits, the lack of long-term effectiveness leads one to question the value of antibiotic treatment.’ – JAMA, 15 September 1993.

Meanwhile, the PRP conjugate vaccine against the Haemophilus influenzae type b (Hib), the most common cause of bacterial meningitis in the US and Europe, has only been found to be 74 per cent effective. (The Lancet, 17 August 1991)

Another study showed that the higher the dose of Hib vaccine, the lower the immunity to the disease.