Osteopathic Manipulative Treatment is Beneficial for Otitis Media
By Simon French

A recent study in the prestigious Archives of Pediatrics and Adolescent Medicine has demonstrated that children with recurrent acute otitis media (AOM) benefit from osteopathic manipulative treatment as adjuvant therapy to routine medical care.

This clinical trial randomised children (6 months to 6 years) with recurrent AOM to one of two treatment groups. One group (25 children) was treated with routine paediatric care plus osteopathic manipulative treatment (OMT), the other group (32 children) was treated with routine paediatric care only. AOM diagnosis included documentation of 1 of 3 systemic symptoms (irritability, fever or otalgia), plus inflammatory changes of the middle ear.

The OMT consisted of articulation, myofascial release, balanced membranous tension, balanced ligamentous tension, facilitated positional release and/or counterstrain treatments. No high velocity techniques to produce cavitation were used. The treating osteopathic physicians examined and treated the entire body, with attention to the head and neck. Treatment took place over 6 months, with both groups receiving the same frequency of treatment over this time.

The OMT group had fewer episodes of AOM and fewer surgical procedures (1 OMT compared to 8 routine care patients). There was no difference in the number of antibiotics prescribed by the treating paediatricians between the two groups.

The lack of a placebo group with a sham treatment is the most significant weakness of the study, plus the parents of the OMT patients were not blinded to what treatment they were receiving. It is thus not possible to determine from this study what aspect of the osteopathic treatment actually contributed to the improvement in the OMT group. This study design does not rule out that placebo generated from the physical contact of the treatment contributed a beneficial effect in the OMT group. However, a placebo group would have necessitated a third study group and would have substantially increased the costs and length of the study.

Other weaknesses included, the two groups had different baseline variables with the routine care group having more exposure to cigarette smoke at home (1 intervention group, 7 control group). This may have interfered with the effectiveness of the routine care. Also, there were a high number of patient drop-outs from the study – 6 OMT and 13 routine care patients.

Overall, this small study shows that patients with AOM given routine paediatric care would benefit from the addition of OMT. A larger study with a placebo group would strengthen the findings of this trial.

Source: Mills MV, Henley CE, Barnes LLB, Carreiro JE, Degenhardt BF. The use of osteopathic manipulative treatment as adjuvant therapy in children with recurrent acute otitis media. Arch Pediatr Adolesc Med 2003;157:861-866.