Chiropractic Manipulation of the Ear
March 11, 2013 10:33 AM   Subscribe

My wife wants to take our 9 month old to the chiropractor to have his ear manipulated to address ear infections. From what I understand, this would involve tugging/manipulating the ear itself, and not the C-spine. Hope me with science?

I've been able to find no scientific literature regarding manipulating the ear, but plenty of stuff addressing c-spine manipulation that is, quite frankly, scary. The lack of literature is a bit of a red flag for me.

My wife would like to pursue this prior to looking at tubes for addressing my son's ear infections.

Lest this go in the direction of a review on communication, we have discussed this. She's of the opinion that "if it can help, why not try?" I'm of the opinion that we could make the same argument for faith healing or psychics, but she wouldn't legitimately consider either of those options. She's polled a couple of our friends who are medical professionals on the topic, so I feel I'm in the clear to (anonymously) ask the hive.

I should also note that it was her chiropractor that brought up this course of treatment after she mentioned that our son had been dealing with chronic ear infections.
posted by anonymous to Health & Fitness (33 answers total) 3 users marked this as a favorite
Presumably the chiropractor thinks he can manipulate the Eustachian tubes in the ear to more easily drain.

I don't really understand how that is possible, but then I'm not a chiropractor.
posted by dfriedman at 10:36 AM on March 11, 2013

Actually, if you do a Google search for "eustachian tube chiropractic manipulation" you get a lot of hits. Whether any of this is valid/good medicine is another question.
posted by dfriedman at 10:38 AM on March 11, 2013

The Mayo Clinic sez:
In most cases, however, researchers haven't studied alternative ear infection treatments adequately using widely accepted scientific methods. For this reason, alternative ear infection treatments aren't generally recommended for use in children.
Chiropractic treatment is another alternative therapy that has been tested as an ear infection treatment. Proponents of chiropractic manipulation claim that by using specific techniques, this treatment helps drain fluid from the middle ear and promotes better ventilation of the narrow passageway (eustachian tube) that connects the middle ear to the nose. Though some people believe this approach to be helpful, long-term studies haven't verified its effectiveness.
So basically their approach isn't "if it can help, why not try" but "don't try because we're not entirely sure it won't hurt, never mind help."
posted by griphus at 10:38 AM on March 11, 2013 [7 favorites]

I would not bring an infant to a chiropractor under any circumstances.

Please take your infant to his regular pediatrician. If he does not have a regular pediatrician, get him one.
posted by Tanizaki at 10:39 AM on March 11, 2013 [45 favorites]

You won't find scientific backing for this. Chiropractic treatment is not based on science or medicine.

posted by ellF at 10:40 AM on March 11, 2013 [32 favorites]

I am a fan of chiropractors for back, muscle related issues (big fan!) but I'm also a fan of tubes. Both of my children had a terrible time till we relented and had them put in. I was faster with second child only because I had seen how completely they helped first child. No comment on how a chiro can help ear infections but tubes were life changing for us.
posted by pearlybob at 10:40 AM on March 11, 2013 [3 favorites]

Anecdata: I know many, many parents who tried the manipulation thing and claimed it was working but ended up having to get tubes in after all, with several realising their little one(s) had been in discomfort/real pain during this whole protracted attempt to avoid a relatively simple, ultimately successful procedure.

As a parent, I would much rather picture my kid having their ear tugged by a chiropractor than in an OR, so I get the visceral urge. Scientifically, though, there's no support for it and I'd really hate to think of her suffering longer or risking her hearing because I was insistent upon a particular path, so I would end up choosing the tubes (with a rock in my belly).

I say this knowing that if she gets even one more ear infection, we're going down this same path, so I feel y'all's pain.
posted by batmonkey at 10:41 AM on March 11, 2013 [5 favorites]

Our son's Pede when he was an infant was a DO (vs. an MD) and did do some manipulation of the bones of my son's ear to drain persistant fluid. It worked after some other treatments had not, and took about 3 minutes in the DO's office. She never touched my son anywhere near his spine; just maniulated the ear (from the lobe end) and gently massaged the area around the ear. This was totally not a "woo" practice, and her belief was that this was a simple thing to try before going the surgical route. (I am aware that the drainage might have been unrelated, but we had tried a few more "medical" things before she did this.)

So, while I would not take my son to a chiropractor, our DO experience was very good and she did this exact thing.
posted by anastasiav at 11:19 AM on March 11, 2013

I can't explain the science but I took my doctor to a chiropractor when she was 3 months old because she was having trouble nursing. He was very gentle (there was no "popping" of anything) and just pressed on some spots on her head and then one spot right above her eye. I swear she nursed better from that day forward. But maybe it's because she was just getting bigger, who knows? Either way, it didn't hurt and it made me feel better. Btw, I didn't believe it when he "tested" me for allergies in a really weird way (I held my arm up while he touched vials labeled with different substances and when my arm dropped, that was something I was supposedly allergic to.) So I wasn't all taken in by his voodoo magic.

With your kid, you could try it and then if he gets another ear infection in X number of months, agree to go for the tubes if that's what your ped is recommended.

Another thing I'd like to add is that my daughter had to undergo anesthesia when she was 18 months old and is was scary for me but she came out of it so soon after the procedure and was running around that afternoon like nothing ever happened. So if that's what's freaking out your wife, I totally understand. She can memail me anytime with questions.
posted by dawkins_7 at 11:26 AM on March 11, 2013 [1 favorite]

I am another that is really concerned when I hear chiropractic care for infants. In this case, even if your kiddo doesn't have an active infection, he/she may have fluid that is compromising his/her hearing. This is especially important at this age, because it can interfere with speech development. I guess the question is how long would you or your wife be willing to wait knowing that your child isn't hearing speech accurately during a critical period for speech development.
posted by goggie at 11:31 AM on March 11, 2013 [2 favorites]

Stresses like being in pain -- like many experiences -- can affect the structure of the brain and personality, especially in a young person, especially early in life. This hasn't been studied very long, but it has been studied (no, I don't have citations -- it's from a couple of university psychology classes I took a while ago).

I'd act to treat the pain as soon as possible. Of course you have to weigh against risks, but ear tubes have been around a while, so the risk is probably small. If you can be sure that ear tubes will prevent your child being in pain, I'd skip the low-probability-of-success intermediate steps.

My answer might be different after antibiotic-resistant bacteria become more common, though. I hope someone studies your chiropractor's approach soon.
posted by amtho at 11:39 AM on March 11, 2013

I do anesthesia for ear tubes all the time (4 sets before lunch today, in fact; I gave a descrition of what to expect in this answer) There are a lot of good answers here regarding the fact the chiropractic in general is unproven and especially so for something like ear infections. The fact that delaying accepted treatment to undergo chiropractic puts the hearing at risk is also worth noting. If it were my daughter I wouldn't let her anywhere near a chiropractor, especially one who goes beyond the normal scope of chiropractic to treat these sort of problems. On the other hand, I would have no problem letting a qualified surgeon put ear tubes in my daughter.
posted by TedW at 11:41 AM on March 11, 2013 [20 favorites]

You refer to your son's ear in the singular, which suggests that the problem is with infections in one ear, and not in both. If that is indeed the case, you may wish to reflect upon the following:

Andrew Goldberg, who is the director of rhinology and sinus surgery at the U.C.S.F. Medical Center, likes to tell a story about earwax. One day in 1986, when he had just begun a residency at the University of Pittsburgh School of Medicine, a man walked into the clinic. The patient had been there many times before, always for the same reason—a chronic infection in his left ear. Stubborn ailments like that are common, though they usually occur in both ears.
“It was one of those refractory cases,” Goldberg told me recently. “The doctors had tried everything: several types of antibiotics, antifungal drops, the works. That was standard practice, and we were proud of ourselves for doing it.” Goldberg and I sat one chilly August afternoon in a coffee shop across from his office, in the Clinical Sciences Building. He spoke almost wistfully, as if recalling an antiquated practice, like bloodletting. Despite repeated treatments, the man’s ear had not improved. But on this day he walked into the clinic with a smile, and Goldberg soon saw why: the ear looked great. “I have not felt this well in years,’’ the patient said. “Do you want to know what I did?” The doctor assumed that one of the drugs had finally found its mark. “I took some wax out of my good ear and put it into my bad ear, and in a few days I was fine,” the patient said.
“I thought he was nuts,’’ Goldberg told me. He never gave the encounter another thought—until a couple of years ago, when he began to investigate the causes of those common ear infections. Goldberg explained that earwax contains many bacterial species and that antibiotics might have destroyed one or more in his bad ear. “It was actually something like a eureka moment,’’ he said, chuckling. “I realized that this patient was the perfect experiment: a good ear and a bad ear separated by a head. That guy wasn’t crazy; he was right. Clearly, he had something protecting one ear that he then transferred to the other ear. Drugs didn’t cure him. He cured himself.”

(from GERMS ARE US - Bacteria make us sick. Do they also keep us alive?
by Michael Specter in The New Yorker, October 22, 2012)

posted by tenderly at 12:03 PM on March 11, 2013 [5 favorites]

As an adult, I went to a chiropractor for hearing issues, since this person was known for that.

Two different times, he had me sit lie with my hands under me "otherwise, you might hit me," and then gloved up and put his pinkie finger up my eustachian tubes, via the throat.

It was one of the most unpleasant procedures that I have ever undergone, and did not help at all.
posted by Danf at 12:03 PM on March 11, 2013 [4 favorites]

Chiropractic is pure quackery and may be risky for babies. The risk is the answer to "why not try?"
posted by callmejay at 1:04 PM on March 11, 2013 [9 favorites]

I had an osteopath that said osteopathy had some techniques for helping with ear issues in young children (specifically re: ear infections in cases where the normal treatment would be tubes). Osteopathy typically uses gentle manipulations though. If you are in the US the schooling is similar to MDs and they are afforded similar licences. Outside the US it seems to be more of a crapshoot as to what the term implies.

You could try asking some questions of osteopaths and see what is out there that might actually have some scientific backing or studies you could look at.
posted by Feantari at 1:13 PM on March 11, 2013

If the doctor is recommending tubes, then I presume the infection is behind the eardrum. So, drainage like that described above would not happen unless the hope is to have drainage occur via the eustacean tube (unless I'm misreading it, it sounds like the fluid drained out of the ear canal. That would indicate an infection of the outer ear, not the middle ear.) If the middle ear is packed with fluid, I'd be concerned that the manipulation would rupture the ear drum, dislocate the bones in the middle ear that allow you to hear, or cause some other sort of damage. (Here's a good list of diagrams to help get you oriented, and a nice article on how hearing works, and a nice summary of ear infections in children.)

If your son has an infection in his ear, tugging and pulling on it is going to be quite painful for him, I'd imagine. I did a cursory literature search, and found 3 results, two of them press releases from chiropractors with no citations, and one an article in a peer reviewed journal (here's the abstract. It's worth nothing that this paper is a retrospective study of children ages "5 years and under" [incredibly vague], not infants). Of the methods cited in the press releases or abstracts, each citation claimed a different method for relieving the infection: one chiropractor said it was poor drainage of the lymph node systen that causes infections, another said it was spinal manipulation that was needed, and a third said that it was the eustacean tubes that needed to be opened. The two press releases had no citations to back up the claims.

I guess if I had any advice to give (I am not your SLP, I am not your medical professional, this is not medical advice), it's that you educate yourself on how the ear works, ask the chiropractor exactly what systems he's hoping to manipulate to bring about improvement, ask your primary care physician about what he/she thinks of this method, ask the chiropractor for references or some literature, and ask the chiropractor about success rate for this type of procedure (and ask to see the literature on that, too.) In this case, I don't think "it can't hurt" is useful... there are things that could go wrong and cause damage if the manipulation goes awry.

And, as a backup, find a good otolaryngologist and an audiologist if tubes are needed.

Best of luck.
posted by absquatulate at 1:17 PM on March 11, 2013 [3 favorites]

Just a little anecdata-

My son had chronic ear infections and delayed speech at two years old. Finally, after much hemming and hawing, we had the tubes put in. (He was playing like nothing happened the same afternoon.) Within a week he started talking! The repeated ear infections had kept him from hearing properly and once he could hear the world of communication just opened wide. It was fantastic! Thankfully, my delay in treatment didn't cause any lasting damage to his hearing, but we were lucky.

Tubes are done so quickly and easily with such a huge payoff. I know it's general anesthesia, but it's not like they're intubating the kid. Like I said, my kid was playing like nothing happened by that afternoon. Based on my experience, I don't see the payoff in delaying proper treatment to persue an unproven quackery technique.
posted by PorcineWithMe at 2:02 PM on March 11, 2013 [6 favorites]

As a parent I know how worrisome it is to think about having your child put under general anesthesia. I just had my two year old put under last week, for a different procedure. Talking to the anesthesiologist helped me enormously, and I encourage you to talk to one yourself. General anesthesia isn't a one-size-fits-all kind of thing; it is tailored to the procedure, and reading TedW's answer in the other thread indicates ear tubes don't need a big hit. It's not abdominal surgery.

Ears, and hearing, are not something to be trifled with. Anecdotally I know a bunch of people who had ear tubes put in with great results. I've never heard someone regret it, only regret not doing it sooner.
posted by ambrosia at 2:17 PM on March 11, 2013 [1 favorite]

I think you are going to have a hard time convincing your wife to not do this if she is the chiropractor going type already. She does not view him as a quack, but rather, as a healer. I would focus my research on making sure that the chiropractor will do no harm and ask your wife how long after the chiropractor does whatever it is he is going to do to determine if it worked. I would have her make an appointment with the surgeon to do the tubes on the day after whatever date you agree on for the chiropractor working. If it works, cancel the appointment. If not, only a little time is wasted if indeed he does no harm.
posted by JohnnyGunn at 3:05 PM on March 11, 2013 [1 favorite]

I would be hesitant to allow internal manipulation for an infant; even adults can't really be trusted to be clear about what they're experiencing in terms of levels and types of pain, etc.

I'd check out the website for the regulating body for chiropractors in your area to get a better idea of how legitimate a chiro is likely to be; don't dismiss it all as quackery right off the bat. If the chiro suggested it they must have a fairly broad scope of practice and so it's more likely that this person knows what they're doing. But I would not feel safe allowing this, personally.
posted by windykites at 3:19 PM on March 11, 2013

My son had chronic ear infections and delayed speech at two years old. Finally, after much hemming and hawing, we had the tubes put in. (He was playing like nothing happened the same afternoon.) Within a week he started talking! The repeated ear infections had kept him from hearing properly and once he could hear the world of communication just opened wide. It was fantastic! Thankfully, my delay in treatment didn't cause any lasting damage to his hearing, but we were lucky.

I had EXACTLY the same experience with a 2yr old I nannied for. Exactly. It didn't even take a week for her - the next day she was talking (well, verbalizing really - she still mostly only had syllables rather than full words) whereas before she had mainly been using sign language with very few spoken words.

She was also happier - IMMEDIATELY - to a significant degree, which would seem to indicate she felt more comfortable without fluid in her ears.

Speech delay isn't the end of the world, but it's a very real possibility with repeated ear infections in the first two years. I personally wouldn't put off surgery as waiting to see if the chiro worked could also mean waiting longer for language development.
posted by sonika at 5:00 PM on March 11, 2013

I'm a big fan of chiropractic and it has helped me with a serious health problem even though I was a huge skeptic at the time, I married into a family with a chiropractor in it and had an adjustment just to shut everyone up. He has also helped me with improving ear drainage when I had an ear infection as well. Having said that, I would still recommend talking to a pedestrian first and looking at getting tubes in the ears (or what ever treatment they recommend). Work fast to get this problem fixed as soon as you can. My nephew had chronic tonsillitis that ended up effecting his hearing very badly he was 2 at the time the problems started and it took a couple of years for them to finally get the tonsils removed, and he ended up with delayed speech development that took a speech therapist too help rectify. Don't muck around where a childs hearing is concerned as these are important times in your child's development
posted by wwax at 6:33 PM on March 11, 2013

hi, i can explain what the chiropractor (or osteopath) would do.

i could talk about this stuff for hours but i'm going to try to be (mercifully) brief.

the eustachian tubes of a child are more horizontal than an adult, so they get filled up with gunk and don't drain as easily. the working part of the ear is lodged in the bones called the temporal bones, from which the eustachian tubes drain, into the back of the throat, generally.

so, in childbirth, the baby's head goes through an enormous squeeze, and change in pressure, and the bones of the head "fold in on themselves" (hence the fontanella, or soft spots - these allow the head to go through the birth canal). after birth, the bones in the head should release back into their proper places, but sometimes they get stuck. all our head bones (even as adults) should be slightly mobile - they fuse together, sort of, but they remain independent bones and move kind of like tectonic plates, in a way.

if the temporal bone (one or both) is blocked, the ear will suffer more congestion, and won't drain as well.

the chiro (or osteo) will be able to feel if the bones are moving, and then gently help to guide them into place. and then the ear will be able to move better and drain more easily. this will take about 10 minutes.

this is anatomy.

tubes may also help, but that involves general anaesthetic, needles, and scary hospitals), and if it was my kid, i would try the thing that doesn't involve any of those things first.

the reason there's not a lot of research for it is that it's not funded by billions of dollars from drug companies. there's no money in the research.

you could read this
or this
or this

it's not the double-blind billions of subjects tested kind of study that you want, but at least you could get a sense of why you might consider going for it.

OR you could also ask your chiropractor to demonstrate what he/she wants to do to your child on you before actually doing it.

good luck!
posted by andreapandrea at 7:08 PM on March 11, 2013

andreapandrea, the bones in your head do not "move kind of like tectonic plates."

The fontanelles in a newborn's skull do allow the cranial bones to compress while the baby moves through the birth canal, but the cranial bones fuse after about a year. Temporal bones do not get blocked because the bones in your skull are moving around. The bones in your skull are not moving around under normal circumstances.

More on fontanelles here.
posted by topoisomerase at 12:30 AM on March 12, 2013 [4 favorites]

Double-blind studies with tons of subjects are what you really need to test the efficacy of a lot of stuff. They help separate what's really happening from things like chance and what the researchers or even the people being studied think should be happening. You're right to think that a lack of literature is a red flag. If there's no literature or very little literature, there's no way to really tell whether a treatment is helpful, harmful, or does nothing.

People are really comforted by anecdata (like hearing a treatment helped a friend), but that isn't really a good way to make decisions that can impact important things like hearing.

You should bring your child to an actual licensed MD. If your child's pediatrician says a tube is a good idea, you should try to get your child's tube inserted by someone who is very experienced at doing tube insertions on kids. I hope your kid feels better soon!
posted by topoisomerase at 12:43 AM on March 12, 2013 [1 favorite]

Since it has come up: an osteopath, in the United States, must be licensed and trained as a physician. That requirement implies that they went to medical school, studied science, and went through a residency. They are functionally equivalent to an MD. Many (not all) osteopaths (all of whom use the initials "DO" instead of "MD") are more inclined towards viewing medicine in terms of the whole person; osteopathic training does include various forms of manipulative therapy, which may or may not be medically effective. Some DOs emphasize it, and others do not.

This is not true of a chiropractor. They call themselves "doctors", but they are not physicians, and have little to no medical training.

Perhaps seeing a DO might allow your wife to pursue the manipulative treatment that she is interested in, without subjecting your child to the risk of not seeing a doctor.
posted by ellF at 3:43 AM on March 12, 2013 [4 favorites]

This is why I say it's neccessary to check out the regulatory body in your area. Here, chiropractors are medical doctors (Doctor of Chiropractic) with the same level of training and level of privileges as an MD. They're not "quacks" everywhere. However, here an osteopath is NOT a doctor and does NOT have medical training.
posted by windykites at 4:28 AM on March 12, 2013

Never take a child to a chiropractor.
posted by Thorzdad at 6:04 AM on March 12, 2013 [6 favorites]

Not wading in on the chiropractor issue, but I want to point out that in the US doctors of osteopathy (DO) have the same licenses to practice as doctors of medicine (MD). They DO have medical training. Perhaps where windykites is located this is not the case.
posted by citygirl at 8:11 AM on March 12, 2013 [1 favorite]

In the United States, chiropractors call themselves "Doctors of Chiropractic". They are not medical doctors, and are not afforded the same training or level of privileges as MD/DOs.

I don't believe that any other nation uses "Doctor of Chiropractic", but could be mistaken. It's certainly very relevant to get this right, especially if you're taking a child to one.
posted by ellF at 1:12 PM on March 13, 2013

Coming back in..... I did have a chiro absolutely solve a very severe back issue I had.... it was instant and amazing....I went from not being able to move (no lie) to perfectly normal. But....I wouldn't take an infant for an ear issue. Go with the tubes.... proven, trusted..have a great dr put them in....
posted by pearlybob at 12:27 PM on March 14, 2013

[This is a followup from the asker.]
Update: Another ear infection shortly after this question was posted forced us back to the pediatrician, who recommended a visit to the ENT. Some of my wife's coworkers had children that had tubes implanted by this same, well reviewed doctor. This did wonders for her fears. Our son got his tubes and has had no ear issues since.
posted by cortex (staff) at 7:15 AM on August 26, 2013 [4 favorites]

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