Treatment of Otitis Media: How Long Is Long Enough?

Many autistic children complain of earaches and it is not uncommon for them to have multiple ear infections. Case reports in the literature suggest that treating the ear infection may help reduce some autistic behaviors (Tajima-Pozo et al., 2010). In many cases symptoms may be masked by the communication disorder and what may have been an easy to treat disorder snowballs into a worsening condition. According to a recent study (Adams DJ et al., 2016):

“Acute otitis media (AOM) symptoms can be masked by communication deficits, common to children with autism spectrum disorders (ASD). We sought to evaluate the association between ASD and otitis media. Using ICD-9-CM diagnostic codes, we performed a retrospective case-cohort study comparing AOM, and otitis-related diagnoses among children with and without ASD. Children with ASD had a significantly increased rate of AOM, otitis media with effusion, otorrhea, and PE tube placement. Children with ASD were more than twice as likely to develop mastoiditis, and to undergo mastoidectomy and tympanoplasty. Children with ASD are more likely to have middle ear infections and otitis-related complications, highlighting the importance of routine middle ear examinations and close attention to hearing impairment in this population.”

It may be that children with autism may be predisposed by their condition to recurrent ear infections. However, it may also be possible that the treatment they received was inadequate. Basic question as to treatment of acute otitis media are still being argued in the medical literature. It is for this reason that I found a recent article in the New England Journal of Medicine of great interest. The article was entitled, “Treatment of Otitis Media: How Long Is Long Enough?” (Lehman D, 2016).

The authors of this study reported that young children with otitis media treated with antibiotics for 10 days did better than those treated for 5 days.

Researchers randomized 520 children aged 6–23 months with acute otitis media to receive amoxicillin-clavulanate (90.0 mg/kg amoxicillin, 6.4 mg/kg clavulanate) for 10 days or amoxicillin-clavulanate for 5 days followed by 5 days of placebo.

Children receiving 5-day antibiotic therapy had a higher rate of clinical failure (34%) than those in the 10-day treatment group (16%). No differences in adverse events or nasal colonization with resistant bacteria were noted between treatment groups.

References

Adams, D.J., Susi, A., Erdie-Lalena, C.R. et al. J Autism Dev Disord (2016) 46: 1636. doi:10.1007/s10803-015-2689-x

Lehman D. Treatment of Otitis Media: How Long Is Long Enough? NEJM December 22, 2016.

Tajima-Pozo K. Otitis and autism spectrum disorders. BMJ Case Reports 2010 pii: bcr1020092351. doi: 10.1136/bcr.10.2009.2351.

3 responses to “Treatment of Otitis Media: How Long Is Long Enough?

  1. I had chronic ear infections for most of my life,well into adulthood.As with severe GI disease,which I also have,ear infections are a big red flag for primary immune deficiencies in a subpopulation of those with autism.An autoimmune reaction,related to PIDs,would explain why some children would get sick and regress after vaccines.This might also explain the phenomena of PANDAS and PANS.

    I have been diagnosed with a very rare primary immune deficiency,through genetic testing,and I have met a number of other parents online,whose children have both autism and primary immune deficiencies.The advocacy organizations for primary immune deficiencies really need to promote the connection between autism,and PIDs,the way the mitochondrial disease organizations have.

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  2. I wonder how this relates to a neurological condition. Two likely candidates, the mutations that happen causing autism in the womb have side effects on the rest of the body (people with adhd have a greater tendency towards immune disorders). Or the fact the the brain itself controls so much of the workings of our body, that it mishandles other parts. (Like with unidentifiable gut problems, no signs of damage or abnormal growths or tumors in intestines of autistic children, but what it overseeing the function of said organ? Or with hypotonia(floppy muscles), no signs of wasting away or damage in cells in the muscles themselves, normal response to reaction tests, it’s the brain piloting them here.)

    To add, I had an epiphany you might like. I read another spectrum news article on mitochondrial mutations being higher in autistic children than siblings. Again they sequenced genes etc etc blah blah thousands of dollars (groan). But if they spent time finding the factors surrounding autistic births, they could follow an environmental factor or see what other changes happened in the mother’s lifetime then follow it and find all the mutation/changes from deduction, they could then deduce where and what it would effect and find the downstream effects saving a whole lot of time and cash. Instead they are trying to find each single darn mutation then painfully backtracking and then asking “oh where did it come from? Not there? okay lets go back to beginning and try another route.

    Imagine trying to repair someone’s computer, you open it up and spend hours looking to find an abnormality among thousands of different locations. After several more hour you are only halfway through inspecting the entire computer and have made a small list of changes you are unsure of, you still have no clue why any of this happened or what you can possibly do.

    Finally you ask in great frustation you ask the customer “what happened when you built it?” he say “I think I put the blue wire in the red socket and used it like that for a year” and then you find out where and what the abnormalities are in less then five minutes.

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  3. Hans, like always, you provide a thoughtful analysis of the problem. I may only want to add that many genes involved in brain development have profound effects in the whole body. This is unlike other body organs. Also in expanding your analogy about broken parts in a computer, most research today is reductionistic. They try to investigate a system by examining its component parts (trying to piece together Humpty Dumpty). This approach does not take into account the possible synergism and the emergence of properties within hierachical systems. Overall an archaic way of thinking. Thanks you again for your comment and wishing you a Blessed New Year.

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