pressure applied to the external ear, etc., ameliorate or aggravate symptoms of ear pain. The medication that will treat the child’s AOM will be selected based on these individual variations in mood, behavior, thirst, appetite, responses to changes in temperature, pressure, etc.
There are certain homeopathic medications that often are indicated for AOM. Pulsatilla (windflower) is indicated if the child is very weepy, clingy and wants to be held constantly, or more than usual. Often the child has very little thirst, despite copious secretions from the nose and lots of crying and tears. The parents may report that the child feels better outdoors, craves open air or wants the windows to be opened. Often the symptoms of the AOM may have begun following a change in the child’s caregiver routine. The child may have just started day care, or there was an abrupt change in babysitters, or one parent recently went out of town and is not able to care for the child for some period of time. The parents or caregivers may report that the child is very sad; the crying has a pitiful quality to it, as if the child feels lost or abandoned.
The child needing Chamomilla
(German chamomile) acts very dif-
ferently. The child is very cranky
and extremely irritable, and the
caregivers often will describe the
child’s cry as very intense and an-
gry. It is very difficult to comfort
this child; he or she may first want
something then throw it away. The
child’s face may show a characteris-
tic feature with one cheek being red,
while the other is pale. The child
may be comforted only by being
carried and rocked back and forth,
often continually and for hours.
Many times, a child with AOM may not have a clear clinical picture indicating a particular homeopathic medication. In daily clinical practice, pharmacists also may feel that they do not have enough knowledge or training to use single homeopathic drugs effectively. In these situations, combination homeopathic products are available, which contain the most commonly indicated homeopathic medications for many different conditions. These products are safe to use in infants. Table 3 contains combination homeopathic products available for the management of AOM.
The pharmacist should instruct the caregivers to administer the products as per the package instructions, and stop medications when there is clear and marked improvement in the child. Both the ear drops and ear tablets are safe even in infants. The tablet formulation consists of quick-dissolving tablets that also do not pose any
TAblE 3
Murine® Homeopathic Earache Relief Ear Drops Similisan Earache Relief™ Ear Drops
Patient Scenario 1
The mother of 13-month-old Jamie wants to know if there is something she can give her child for her runny nose and cold.
Jamie recently started daycare a few weeks ago, and she has had a clear runny nose for the past week. Last night Jamie was pulling on her ear and also started to run a fever. She also has been weepy and crying more, not sleeping well at night and more clingy. Mom states that typically Jamie is a very happy, active and independent toddler, but now she seems sad and wants to be held constantly. Jamie was taken to the pediatrician’s office and was diagnosed with an acute otitis media and given a prescription for amoxicillin. Mom also has been advised to use normal saline nasal drops and Tylenol as needed, and give plenty of fluids.
Mom wants to know if she can use a decongestant or some other OTC product to help with the runny nose. She also is concerned that Jamie is drinking less than normal. What would you advise her?
Discussion
Jamie’s age (< 2 years old), plus certain diagnosis of AOM, along with her clinical symptoms of fever, ear pulling and behavioral and sleep disturbances, indicate that she would benefit from a course of antibiotics. Explain to Mom that it is important that she makes sure that Jamie completes the entire course of the antibiotics. However, given Jamie’s age, inform Mom that OTC decongestants or medicines containing phenylephrine, diphenhydramine, pseudoephedrine, cloropheniramine, brompheniramine, dextromethorphan, guaifensisin and doxylamine should not be used in children younger than 4 years of age because of serious and potentially life-threatening side effects, as well as lack of evidence of efficacy. Encourage Mom to use normal saline drops as needed for the nasal discharge. Mom also can be encouraged to give Jamie sips of age-appropriate fluids throughout the day so that she does not become dehydrated.
You also can recommend homeopathic Pulsatilla pellets. Jamie recently began daycare and also is exhibiting symptoms that may respond to Pulsatilla, such as decreased thirst, runny nose, weepy, sad mood and wanting to be held constantly. Pulsatilla can be used alongside the antibiotics without any risk of drug-drug interaction. Concentrations of 6X/6C or 12X/12C can be used, and instruct Mom to place one to two pellets on Jamie’s tongue between meals two to three times a day for the next two to three days. Explain to mom that while she should complete the entire course of antibiotics, she can stop the homeopathic Pulsatilla once Jamie starts to feel better. Also instruct Mom that while she is using the Pulsatilla, she should avoid any products containing menthol or camphor, as these can interfere with the action of the Pulsatilla. Mom also should be instructed to follow-up with Jamie’s pediatrician if Jamie is not doing better in 48 to 72 hours.
Patient Scenario 2
Christopher is a 5-year-old boy who recently began kindergarten and was diagnosed with AOM at the family doctor’s office. Christopher has had no fever, mild ear pain and has been acting normally with normal appetite and normal sleep pattern. The mom was given a prescription for amoxicillin but was instructed to wait for two to three days and fill it only if Christopher developed any symptoms of fever, increased ear discomfort or any behavioral or sleep disturbances. Mom wants to know if there is anything else she could give to her son. She also states that she was surprised that Christopher got an ear infection since he has not had one since he was a toddler. What would you advise her?
Discussion
Christopher’s age (> 2 years of age) and nonsevere illness (i.e., no fever, minimal ear pain and no change in behavior or sleep pattern) support a wait-and-see period, or wait-and-see prescription. You can inform Mom that many children can experience an ear infection upon school entry. You also can let her know that given that Christopher has no fever, is acting well otherwise with very little ear pain, it is good for her to wait and see for 48 to 72 hours, since many cases of AOM can get better on their own.
Given that Chris has no characteristic symptoms of any particular homeopathic medication, you can suggest to Mom to use any of the OTC combination homeopathic products for ear pain. Inform Mom that these products are safe to use for children Christopher’s age and will support his body’s innate healing. She can use the drops as instructed or use one of the oral preparations. Inform her that she should not use products containing menthol or camphor, as these can sometimes interfere with the action of homeopathic medications. She can use OTC analgesics if needed alongside the homeopathic medications without any concern for drug-drug interactions. If the ear pain persists or he develops a fever, she should go ahead and start the amoxicillin.
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