Earache can be related to pain in the throat, gums, teeth or parotid glands (in mumps), which radiates to the ear. It can also be due to inflammation of the outer ear canal, and associated with swelling and an irritating discharge. Most commonly, however, especially in children under six, earache is caused by middle ear infection (otitis media). This may be either acute or chronic. Acute infections can occur as a sequel to other infections including colds, tonsillitis, measles or allergies.
Infection of the outer ear can be caused by an object stuck in the ear, a boil in the ear canal, scratching or fiddling with the ear (which often happens with a skin irritation such as eczema in or around the ears); or from chlorine in swimming pools, which can irritate the skin of children who swim frequently and who do not dry their ears properly.
Any discharge in the outer ear can be washed away gently with a warm infusion of antiseptic herbs, such as chamomile, elderflowers, golden seal (Hydrastis canadensis) or marigold, or a few drops of tincture can be used in warm water. One or two drops of warm olive oil with a few drops of essential oil of either chamomile or lavender (two drops to a teaspoon of oil) can be inserted into the ear canal before bed and plugged gently with a little cotton wool. Garlic oil can also be used but this may be rejected for social reasons. Tea tree oil may be preferable.
Otitis media: middle ear infection
Infection from the nose or throat can easily be carried, via the eustachian tube, into the middle ear and cause middle ear infection. Catarrh and swollen tonsils or lymph glands can block off the opening of the eustachian tube, creating stasis and a build-up of catarrh in the middle ear, and lead to infection. This may not be the whole story, as chiropractic adjustments can often help with drainage problems which lead to frequent acute or chronic ear infections. Some of the pathogenic microorganisms that commonly cause otitis media include: Haemophilus influenzae; Aspergillus spp.; Streptococcus pneumoniae and Moxaxella catarrhalis.
This chronic condition of the middle ear is related to frequent upper respiratory infections – sinus, throat and middle ear infections – and is generally found where there are chronically enlarged tonsils, adenoids and lymph glands in the throat and neck area, which can block the eustachian tube and prevent normal drainage.
Treatment of acute middle ear infection
A recent trial of herbal eardrops in otitis media concludes that “herbal extracts have the potential to meet all of the requirements of appropriate medication that could be routinely used in the paediatric patient, namely in vitro bacteriostatic and bacteriocidal activity against common pathogens, immunostimulation ability, antioxidant activity, and anti-inflammatory effects. They are also well-absorbed with good penetration into the tissue surrounding the tympanic membrane. They have been found to enhance local immunologic activity. Finally, herbal extracts are well-tolerated (owing to their long elimination time), easy to administer, and less expensive than the new antibiotics.” Furthermore, this trial concluded that concomitant treatment with systemic antibiotics did not increase healing time over eardrops alone.
• As long as there is no pus in the ear and the drum has not perforated, a few drops of warmed oil can be dropped into each ear, and plugged with cotton wool. Oils can be chosen from the following.
• Mullein oil: This is made from yellow mullein flowers, picked in the summer when fresh, placed in a jar and covered in olive oil. This is left to macerate in sunlight for 2 weeks and then pressed. It has demulcent and anti-inflammatory properties, and helps to soothe pain and inflammation.
• Garlic oil: In laboratory tests, aqueous extracts of garlic and concentrated garlic oil have been shown to be more or as effective as several pharmaceutical preparations against Aspergillus, while demonstrating lower toxicity.
• St John’s Wort oil: This is made in the same way as mullein oil, using freshly picked yellow Hypericum flowers. It is useful for allaying pain and inflammation. A trial of 103 children with acute otitis media found drops of a herbal product containing garlic, mullein, marigold and St John’s wort to be as effective as anaesthetic eardrops in the management of ear pain. One or two drops of tincture of myrrh (Commiphora molmol) or golden seal (Hydrastis canadensis) can be added to oils to drop in the ears (Box Recipe for eardrops).
Box Recipe for eardrops
This recipe can be made up and kept in the medicine cupboard, for use when necessary.
- 15 drops golden seal (Hydrastis canadensis) tincture
- 5 drops myrrh (Commiphora molmol) tincture
- 15 drops eucalyptus oil
- 5 drops pasque flower (Anemone pulsatilla) tincture
- 15 drops lavender oil
Mix in 30 ml of olive oil or almond oil
Use 2 drops of the warmed mixture in each ear 3-6 times daily.
• Essential oils: Any of the following can be used, diluted (2 drops of essential oil to a teaspoon of olive oil): chamomile, eucalyptus, lemon, lavender or rosewood. These can also be massaged into the area around the ears, neck and throat. Hot compresses can be applied directly to the ears and neck area to ease the pain. Use a few drops of essential oil to a bowl of hot water. Repeat frequently as required. Foot baths can be used with the same mixture.
• A hot-water bottle, held against the painful ear, can also be soothing.
• Teas or tinctures can be given every 2 hours to help relax the child and soothe the pain, combined with remedies to resolve the infection and reduce the congestion: Antiseptic herbs include chamomile, echinacea, hyssop (Hyssopus off.), rosemary, thyme and peppermint; relaxant herbs include chamomile, passionflower and skullcap (Scutellana laterifolia). Herbs to reduce catarrhal congestion include ginger, elderflowers, plantain and ground ivy (Nepeta hederacea).
• If there is accompanying fever, limeflowers (Tilia europea) can be added to the prescription.
• Chamomile is particularly indicated in the treatment of earache as it has anti-inflammatory, antimicrobial and analgesic properties. It is recommended for children with heat and inflammation who tend to get irritable and “difficult” when unwell.
• Garlic capsules, one every 2 hours during the acute stage, can help resolve infection and catarrhal congestion. As the pain diminishes, until the child recovers completely, they can be given three times.
• Solid food is best avoided until the acute condition has cleared, but children need plenty to drink – water, diluted fruit juice, herbal teas, vegetable juice, but no milk produce.
• Dairy produce, wheat, red meats, sugar and refined foods are best omitted from the diet during acute infections. A light digestible diet will allow the energy of the body to be directed towards resolving infection.
Ayurvedic approach to ear problems
The ears are the province of ether and are ruled by Vata, and so are sensitive to pain. Soreness, irritation and inflammation in the outer ear can be treated with 10 drops of neem oil in a base of sesame oil. One or two drops of sesame oil rubbed into the external ear daily is considered to be preventative. Inflammation of the ear with pus is known as Putikarna.
Ear infections tend to be complications of colds and other Kapha problems associated with catarrhal congestion. However, other doshas can be involved. Vata symptoms involve intense pain associated with fear and anxiety, Pitta with burning, pain, heat and irritability, Kapha with congestion and mucus and greater tolerance of pain.
General treatments for reducing Kapha and for colds and catarrh can be applied to ear infections.
• A ½ tsp of turmeric powder in hot water can be taken every 2 hours in acute infections and three times daily for chronic problems.
• A Kapha reducing diet is recommended, particularly avoiding dairy produce.
• Nirgundi (Vitex negundo) is the remedy of choice for external use in ear infections. The juice of the leaves is mixed with mustard oil and boiled. This medicated oil is dropped into the ear twice daily.
• Alternatively bilva (bael fruit) root or a garlic clove is boiled with mustard oil and then filtered and used as ear drops.
• Ginger, garlic and onion are recommended in the diet.
• Other herbs recommended for the doshas involved:
– Vata: Dashmula, bringaraj, ginger, asafoetida, lemon juice. For ear drops medicated oil of mullein or garlic
– Pitta: mullein, echinacea, hops (Humulus lupulus), manjishta, bringaraj, fennel (Foeniculum vulgare)
– Kapha: echinacea, hops, thyme, oregano (Oreganum vulgare), manjishta, Dashmula, bringaraj, ginger, asafoetida, lemon juice. Hot foot bath / massage with mustard oil.
Treatment of recurrent middle ear infection and glue ear
It is important to treat the underlying conditions at the root of the problem and not solely the acute infections when they arise. Since chronic ear problems are largely related to throat, tonsil, nose, sinus and catarrhal problems, these need to be resolved, and the digestive and immune system strengthened through the use of herbs and diet.
• Passive smoking has been found to be closely related to the incidence of glue ear. Affected children need to have plenty of fresh air and to be kept away from smoky or polluted atmospheres as far as possible.
• Ginger tea can be given daily to enhance digestion and clear phlegm.
• Mucus-forming foods are best avoided – milk produce, refined carbohydrates and excess wheat and sugar.
Children with recurrent upper respiratory and ear infections frequently suffer from chronic catarrh combined with chronically enlarged tonsils and cervical glands. In many cases this is related to an allergic response to milk produce or sometimes to wheat (see also Allergies). A study of 153 children with earache concluded that 93.3% had allergies to foods or inhalants, and that an elimination diet gave a significant improvement. It is best to omit all milk produce from the diet, initially for 1-2 months, if the child suffers from these problems. During this time herbs can be given to help resolve the condition and, at the end of this period, the situation can be reassessed. Very often, within the first week or two, an infection arises, which represents the body’s attempt to throw off toxins and preferably this should not be suppressed with antibiotics. After this there should be signs of improvement: infections should develop much less frequently and, should they arise, they are likely to be much milder. If positive change is observed after the first 2 months, the milk-free diet is best continued for a couple more months to give the child’s immune system an opportunity to recover. If the child seems well after this (while continuing with the herbal treatment) small amounts of milk produce can gradually be introduced, goat’s yoghurt initially, once a week and slowly returned to the diet. Should an infection develop, milk produce should be avoided again until the symptoms are completely clear, and then re-introduced again, but this time more slowly. Milk produce may need to be kept to a minimum for the best part of a year, and other nutritionally comparable foodstuffs used to replace it to avoid compromising a child’s nutrition.
• Garlic can be given every day, either in foods, as juice or in capsules, to enhance immunity to infection and as a decongestant.
• Supplements of cod liver oil, 200-500 mg natural vitamin C and a children’s multi-mineral and vitamin can be given daily (see Immune System).
Herbal remedies need to be given during this time to enhance digestion and immunity and to clear catarrhal congestion in the nose, sinuses and throat. If the tonsils and lymph glands in the neck are inflamed or swollen, herbs can be added to the prescription for the lymphatic system (see Tonsillitis).
• Herbs for the digestion – ginger, cinnamon (Cinnamomum zeylanica), fennel (Foeniculum vulgare), asafoetida, thyme.
• Herbs for the immune system – chamomile, echinacea, hyssop (Hyssopus off.), liquorice, peppermint and turmeric.
• Herbs for the tonsils and lymph glands – cleavers (Galium aparine) and marigold and burdock.
Choose one or two herbs from each group and combine them together as an infusion. Give a cupful three times daily.
Essential oils diluted in sesame oil (1-2 drops per 5 ml) can be massaged regularly around the nose, throat and ears, and steam inhalations can be given daily using chamomile, eucalyptus, lavender or rosewood. Hot compresses can be applied to the nose, ears and throat, and hand and foot baths can be given regularly using the same oils.
At the first sign of a cold, start to treat the ears with drops, and give the remedies for acute infections to help prevent the infection affecting the middle ear. The neck, throat and ears are best kept warm, and the child dressed up well to go outside in cold winter air.