International Journal of Pediatric Otorhinolaryngology 77 (2013) 926931

Content li t a!aila"le at #ci$er e #cience%irect

International Journal of Pediatric Otorhinolaryngology

& o u r n a l h o ' e ( a g e ) * * *+ e l e ! i e r+c o ' , l o c a t e,i & ( o r l

Co'(le'entary and alternati!e 'edicine for (ediatric otiti 'edia

Je ica -+ .e!i a/1/ -o"ert 0+ 1rody "/2/ 2atie 0c2ee3Cole "/2/ 4d'und Pri"it5in
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1o ton 8ni!er ity/ %e(art'ent of Otolaryngology/ 930 :arri on ;!e/ <th =oor/ >?: "uilding/ 1o ton/ 0; 02119/ 8nited #tate @ho'a Jeffer on 8ni!er ity :o (ital/ %e(art'ent of Otolaryngology 3 :ead and Aec5 #urgery 92B Che tnut #t/ 6th >loor Philadel(hia/ P; 19107/ 8nited #tate Ae'our ,;lfred I+ duPont :o (ital for Children/ P+O+ 1oC 269/ Dil'ington/ %4 19999/ 8nited #tate

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;rticle hi tory) -ecei!ed 17 %ece'"er 2012 -ecei!ed in re!i ed for' < 0arch 2013 ;cce(ted 7 0arch 2013 ;!aila"le online < ;(ril 2013 2ey*ord ) Otiti 'edia $accination Pro"iotic Chiro(ractic O teo(athic 'edicine @raditional Chine e 'edicine

O"&ecti!e) @o re!ie* the literature in!ol!ing co'(le'entary and alternati!e 'edicine (C;0) for (ediatric otiti 'edia+ 0ulti(le 'odalitie are di cu ed/ including (re!ention in!ol!ing "rea tfeeding/ nutrition/ and !accinationE y'(to'atic treat'ent in!ol!ing ho'eo(athy/ natural health (roduct / and (ro"iotic E 'anual 'ani(ulation in!ol!ing o teo(athy and chiro(ractic E and traditional Chine e and Ja(ane e 'edicine+ @he infor'ation (re ented *ill a i t (hy ician in ad!i ing (atient on their deci ion3'a5ing during the early tage of otiti 'edia *hen anti"iotic and urgery are not yet indicated+ 0ethod ) ; y te'atic literature earch *a conducted through January 2012 in Pu"0ed u ing 04#: ter' FFotiti 'edia66 in con&unction *ith FFco'(le'entary thera(ie /66 FFho'eo(athy/66 FF'ani(ulation/ o teo(athic/66 FF'ani(ulation/ chiro(ractic/66 FFacu(uncture thera(y/66 FF(ro"iotic /66 FFnaturo(athy/66 and FFCylitol+66 @he e earche yielded 163 uniGue re ult + ;" tract and title *ere e!aluated for rele!ance+ Ca e re(ort / ca e erie / rando'iHed controlled trial / and "a ic cience re earch *ere included+ Pu"lication not rele!ant to the di cu ion of alternati!e 'edicine in otiti 'edia *ere eCcluded+ 1i"liogra(hie *ere chec5ed for further (u"lication + @hirty3 iC uniGue (u"lication *ere re!ie*ed+ -e ult ) Of all thera(ie in co'(le'entary and alternati!e 'edicine/ only Cylitol ha "een tudied in *ell3de igned/ rando'iHed/ "linded trial E it i li5ely effecti!e/ "ut co'(liance li'it it a((lica"ility+ Conclu ion ) 0anage'ent of acute otiti 'edia "egin *ith *atchful *aiting+ :er"al eardro( 'ay hel( relie!e y'(to' + :o'eo(athic treat'ent 'ay hel( decrea e (ain and lead to fa ter re olution+ Pre!ention hould "e e'(ha iHed *ith eli'ination of ri 5 factor / uch a econd hand 'o5e and "ottle3feeding/ a *ell a 'aintaining nutrition and !accination + $ita'in u((le'entation 'ay "e hel(ful+ Pro"iotic and Cylitol 'ay "e "eneIcial a *ell+ @raditional Chine e,Ja(ane e thera(ie ho* (ro'i ing re ult "ut re'ain (eculati!e until further re earch i conducted+ #e!ere ca e of otiti 'edia *ith co'(lication or tho e that fail to i'(ro!e *ith o" er!ation or C;0 (after <972 h) hould "e treated *ith anti"iotic and/ in o'e ca e / urgical inter!ention+ It i "e t to con ult a (hy ician *hen 'a5ing treat'ent deci ion for full guidance on the ri 5 and "eneIt of any treat'ent o(tion+ 2013 4l e!ier Ireland .td+ ;ll right re er!ed+

1+ Introduction Otiti 'edia i one of the 'o t co''on di ea e of childhood+ It ha a (ea5 incidence "et*een age 6 and 1B 'onth + ;l'o t half of all (ediatric anti"iotic (re cri(tion are *ritten for otiti 'edia/ *hich al o (ro'(t 'ore (hy ician !i it than any other childhood illne + 0ore than J100 i (ent (er e(i ode/ and the co t of treat'ent in the 8# i a((roCi'ately J23+B "illion

(er year K1L+

7 Corre (onding author+ @el+) M1 302 6B1 B929E faC) M1 302 6B1 6<10+ 43'ail addre ) roreillyNne'our +org (-+ O6-eilly)+ 1 @el+) M1 617 639 912<+ 2 @el+) M1 21B 9BB 6760E faC) M1 21B 923 <B32+

@he ;'erican ;cade'y of Pediatric (;;P) and the ;'erican ;cade'y of Otolaryngology and :ead and Aec5 #urgery (;;O:A#) deIne acute otiti 'edia (;O0) a (1) hi tory of acute on et of ign and y'(to' / (2) (re ence of 'iddle3ear effu ion/ and (3) ign and y'(to' of 'iddle3ear in=a''ation+ In 200</ due to concern o!er anti"iotic re i tance and the high (ontaneou re olution rate (90O *ithin three day )/ the ;'erican ;cade'y of >a'ily Phy ician
016B3B976,J ee front 'atter 2013 4l e!ier Ireland .td+ ;ll right re er!ed+ htt(),,dC+doi+org,10+1016,&+i&(orl+2013+03+009

(;;>P) and ;;P reco''ended initial *atchful *aiting in children *ith acute otiti 'edia+ %uring thi ti'e/ fa'ilie often ee5 alternati!e treat'ent + 8nfortunately the e inter!ention are difIcult to e!aluate econdary to the ra(id re olution and natural hi tory of ;O0+ In thi 'anu cri(t *e di cu current conce(t and (re ent a literature re!ie* of co'(le'entary and alternati!e 'edicine (C;0) for otiti 'edia+ @hi literature re!ie* *a in titutional re!ie* "oard eCe'(t+

J+-+ .e!i et al+,International Journal of Pediatric Otorhinolaryngology 77 (2013) 926931

3
2+ Pre!ention One of the Ir t tenet of 'any co'(le'entary and alternati!e 'odalitie i (re!ention+ Increa ed rate of otiti 'edia *ith "ottle3feeding co'(ared to "rea tfeeding ha!e "een ho*n+ In 2009/ #a"iro! et al+ e!aluated children *ith ;O0/ noting the (re!alence of nonty(ea"le :ae'o(hilu in=uenHae *a higher and the (re ence of (eciIc i''unoglo"ulin ? anti"odie *a lo*er in "ottle3fed infant co'(ared *ith "rea t3fed infant K2L+ ;ddition3 ally/ 'o5ing around children/ large daycare etting / and (aciIer u e can al o (lay a cau ati!e role in ;O0 K3L (@a"le 1E ;((endiC ;)+ -ecently/ nutrition and food allergie ha!e "een i'(licated in the (athogene i of otiti 'edia+ In a recent tudy e!aluating nutritional deIciencie / (atient *ith acute u((urati!e otiti 'edia and chronic otiti 'edia (CO0) a *ell a recurrent ;O0 *ere found to ha!e retinol,!ita'in ; le!el lo*er than in age3 'atched control K<L+ Pinc deIciencie al o ha!e "een i'(licated in ;O0+ In a 'eta3analy i in 2009/ 4le'raid et al+ re!ie*ed rate of ;O0,CO0 and !ita'in u((le'entation/ Inding e!idence that deIciencie of Hinc or !ita'in ;/ or "oth/ 'ay lead to increa ed rate of otiti 'edia KBLE ho*e!er/ in 2010/ ;""a et al+ re!ie*ed 12 rando'iHed controlled trial in *hich (lace"o *a co'(ared to Hinc (gi!en at lea t once a *ee5 for at lea t one 'onth) and found con=icting re(ort regarding the efIcacy of u((le'entation K6L+ %eIciencie in 4P; (an o'ega 3 fatty acid)/ !ita'in ;/ and eleniu' al o ha!e "een a ociated *ith recurrent ;O0 K7L/ *ith u((le'entation re ulting in fe*er anti"iotic (re cri(tion + $accine al o (lay an i'(ortant role in ;O0 (re!ention+ In 2001/ the Center for %i ea e Control and Pre!ention reco'3 'ended all young children hould recei!e the (neu'ococcal 73 !alent con&ugate !accine (PC$7)+ @hi led to a decrea e in rate of otiti 'edia cau ed "y (neu'ococcu and decrea ed ty'(ano t3 o'y tu"e (lace'ent for recurrent di ea e K9L+ I''uniHation of all healthy infant could (re!ent o!er one 'illion e(i ode of ;O0 each year+ @he ne*er (neu'ococcal 133!alent con&ugate !accine (PC$13) !accine *a introduced to addre the re idual "urden of (neu'ococcal di ea e that ha (er i ted ince the introduction of PC$7+ Pre!ention of (receding !iral illne e / uch a in=uenHa/ 'ay al o decrea e the incidence of ;O0 K9L+ 3+ #y'(to'atic relief Dith *atchful *aiting reco''endation / y'(to'atic relief of ;O0 i (ara'ount+ Dar' co'(re e / tea'/ gargling alt *ater/ and deconge tant na al (ray 'ay "eneIt o'e (atient + Other Ind her"al eardro( hel(ful/ "ut their efIcacy i unclear econdary to !aria"le co'(o ition (u ually a co'"ination of 'arigold KCalendula =ore L/ garlic K;lliu' ati!u'L/ 'ullein K$er"a cu' tha( u L/ #t+ John6 *ort K:y(ericu' (erforatu'L/ la!ender/ and !ita'in 4)+ Co'(ara"le rate of analge ia in (atient *ith ;O0 can "e achie!ed *ith naturo(athic her"al eCtract co'(ared to ane thetic ear dro( + In 2001/ #arrell et al+ co'(ared Oti5on Otic
@a"le 1 -i 5 factor

#olution (:ealthy3OA/ Petach3@i5!a/ I real)/ a naturo(athic her"al eCtract/ *ith ane thetic ear dro( containing a'etocaine and (henaHone in glycerin and found co'(ara"le rate of analge ia for ;O0 K10L+ #i'ilarly/ igniIcantly fa ter re olution of y'(to' *ith ad'ini tration of ho'eo(athic eardro( co'(ared to FF tan3 dard thera(y66 ha "een ho*n K11L+ One Cochrane y te'atic re!ie* la"eled naturo(athic ear dro( FF'ode tly thera(eutic66 K12LE ho*e!er/ a u" eGuent Cochrane re!ie* found in ufIcient e!idence to deter'ine their effecti!ene K13L+ <+ Co'(le'entary and alternati!e 'edicine in general 4!aluating the efIcacy of C;0 for otiti 'edia i difIcult due to lac5 of rando'iHation/ unclear ti'e to effect/ and di agree'ent on the deInition of C;0 it elf+ 1ecau e C;0 'edication are not regulated "y the >%; and (atent are not a!aila"le/ there i little econo'ic incenti!e for re earch+ %e (ite thi / <6O of children aged 17 year *ith three or 'ore e(i ode of ;O0 in iC 'onth had u ed o'e co'(onent of C;0/ and 'any fe*er of the e children (1B3<O) *ere PC$7 or in=uenHa !accinated K1<L+ 0o t C;0 tudie ha!e igniIcant 'ethodological =a* and no co t analy e / 'a5ing deIniti!e conclu ion difIcult+ B+ :o'eo(athy :o'eo(athy i "a ed on the li5e cure li5e (rinci(le) a u" tance that (roduce y'(to' in a healthy (atient can relie!e tho e y'(to' in an ill (atient+ It include "elladonna/ cha'o'illa/ and :e(ar ul(huricu' (;((endiC 1)+ @hey are generally regarded a FF afe/66 "ut there are re(ort of an initial *or ening of y'(to' in a((roCi'ately 1020O *ith ;O0 K1BL+ @hree e!ere ad!er e e!ent *ere re(orted in the (ractice of one ho'eo(athic (ro!ider ((erforation of a ty'(anic 'e'"rane/ chole teato'a/ and 'a toiditi )/ though it i unclear if the e are directly attri"uta"le to the ho'eo(athic inter!ention K16L+ In a 'all/ non3"linded/ rando'iHed controlled trial "y :arri on et al+ in 1999/ 33 children (aged 19 'onth to 9 year ) *ith otiti 'edia *ith effu ion/ a"nor'al ty'(anogra' / and hearing lo (greater than 20 d") *ere rando'iHed to either ho'eo(athic thera(y or *atchful *aiting+ 0ore (atient in the ho'eo(athic grou( had nor'al ty'(anogra' co'(ared to the *atchful *aiting grou( (7BO ! + 31O/ P Q 0+01B)+ @here *a al o a trend to*ard i'(ro!e'ent in hearing/ lo*er anti"iotic u e/ and lo*er referral rate to (eciali t in the ho'eo(athic grou(/ "ut thi *a not igniIcant K17L+ Co'(ared to con!entional treat'ent/ ho'eo(athy 'ay yield fa ter y'(to' i'(ro!e'ent *ith le analge ic and anti"iotic u e K19/19L and 'ay "e 1<O le eC(en i!e K16L+ .arger rando'iHed/ controlled tudie are reGuired to a e the efIcacy and afety of the e treat'ent + 6+ Other natural health (roduct Aatural health (roduct uch a echinacea/ cod li!er oil/ and Cylitol are generally regarded a afe/ though efIcacy i unclear and o'e (atient eC(erience igniIcant ga trointe tinal y'(3

for recurrent acute otiti

'edia (;O0)+

<
J+-+ .e!i et al+,International Journal of Pediatric Otorhinolaryngology 77 (2013) 926931 -i 5 factor >a'ily hi tory of ;O0 %aycare out ide ho'e Aot "rea tfeeding at all ;t lea t one i"ling Child care out ide ho'e >a'ily daycare PaciIer u e -i 5 for ;O0 ;O0 -ecurrent ;O0 -ecurrent ;O0 -ecurrent ;O0 ;O0 ;O0 -elati!e rate 2+6 2+B 2+1 1+9 1+9 1+7 1+6 1+2 P !alue R 0+0 03 R0+0 01 0+0 01 0+ 00 < 0+0 02 0+0 09 0+003

to' + Dhile there are 'any natural health (roduct a!aila"le ( ee ;((endiC C for a 'ore co'(lete li t)/ one of the 'o t co''on her" ta5en in the 8nited #tate i echinacea/ *hich i generally ta5en for or to (re!ent the co''on cold+ 8nfortunately/ 'o t echinacea (roduct in the 8nited #tate are deri!ed fro' augu tofolia/ an her" that ha ne!er "een ho*n to 4chinacea i'(ro!e y'(to' related to u((er re (iratory infection + Only 4chinacea root and 4chinacea (ur(urea leaf ha!e (allidu' de'on trated
;da(ted fro' 8hari et al+ K3L+

1rea t feeding R3 'onth

;O0

1+2

efIcacy in thi regard+ .oo5ing at a 'iCture containing echinacea (a *ell a (ro(oli and !ita'in C)/ Cohen et al+ K20L found the

'iCture reduced the nu'"er of ;O0 e(i ode (er child "y 69O (P R 0+001) co'(ared to (lace"o a'ong <30 children+ 8nfortu3 nately/ ide effect in!ol!ing ga trointe tinal3ty(e y'(to' *ere re(orted in 9 children/ including 7 fro' the 'iCture grou( and 2 fro' the (lace"o grou( (P Q 0+B<)+ Sylitol/ a natural ugar found in 'any fruit and u ed a a *eetener in che*ing gu'/ i al o thought to ha!e (re!entati!e (ro(ertie in otiti 'edia+ 8hari et al+/ 2000 found Cylitol inhi"ited the gro*th of #tre(tococcu (neu'oniae and inhi"ited the attach'ent of "oth #+ (neu'oniae and :+ in=uenHae to na o(ha3 ryngeal cell K21L+ 2urola et al+ in 2009 offered a (o i"le eC(lanation for thi ) eC(o ure to Cylitol lo*ered c( 1 ((neu'o3 coccal ca( ular locu ) gene eC(re ion/ *hich change the ultra tructure of the (neu'ococcal ca( ule K22L+ Perha( 'ore clinically rele!ant/ 8hari et al+ in 1996 found in a rando'iHed controlled trial that Cylitol (9+< g,d in di!ided do e B ti'e daily) reduced the occurrence of ;O0 "y <1O (9BO CI) <+6O to BB+<O) K23L+ In addition/ fe*er of the children recei!ing Cylitol reGuired anti"iotic during the tudy (eriod (19+BO ! + 29+9O/ P Q 0+032) K23L+ In 1999/ the a'e grou( de'on trated a <0O reduction of otiti 'edia in (atient recei!ing Cylitol gu'/ 30O reduction in tho e recei!ing yru(/ and 20O reduction in tho e recei!ing Cylitol loHenge/ co'(ared *ith control K2<L+ In 2000/ they further corro"orated the e Inding in a tudy loo5ing at che*ing gu' ! + yru( ! + control and found the efIcacy at 2 to 3 'onth *a <0O *ith che*ing gu' and 30O *ith yru(+ Intere tingly/ Cylitol *a ineffecti!e in children *ith ind*elling ty'(ano to'y tu"e K21L+ 0o t tudie ho* o'e efIcacy of Cylitol in (re!enting ;O0/ "ut @a(iainen et al+ co'(ared Cylitol 'iCture/ control 'iCture/ control che*ing gu'/ Cylitol che*ing gu'/ and Cylitol loHenge gi!en during an acti!e u((er re (iratory infection and found no (re!enti!e effect for Cylitol in any for' K2BL+ 0o t tudie re(ort a B3ti'e 3a3day do ing chedule/ *hich li5ely li'it full co'(li3 ance+ @o addre thi / :autalahti et al+ loo5ed at 3 ti'e daily Cylitol for 3 'onth (9+6 g,d di!ided into 3 do e ) and found no (re!enti!e effect o!er control olution ,gu' in (re!enting otiti 'edia K26L+ >urther'ore/ Cylitol ha co''on ide effect including a"do'inal (ain and diarrhea/ *hich often lead to nonco'(liance *ith uch freGuent do ing+ 7+ Pro"iotic Pro"iotic are 'icroorgani ' thought to confer health "eneIt "y re toring 'icro"ial "alance+ @here i con=icting e!idence on the effecti!ene of (ro"iotic in (re!enting ;O0+ In a rando'iHed controlled tudy "y :ata55a et al+ in 2001/ B71 children *ere rando'iHed to recei!e 'il5 *ith or *ithout .acto"acillu rha'no u 3 ti'e daily/ B day a *ee5/ for 7 'onth + @here *a a igniIcant decrea e in the nu'"er of day a" ent fro' daycare in the (ro"iotic grou( "ut only a light trend to*ard fe*er e(i ode of ;O0 K27L+ In a later tudy "y :ata55a et al+ in 2007/ children *ere rando'iHed to recei!e a (ro"iotic ca( ule or (lace"o daily for 2< *ee5 + Dhile there *a a large dro(out rate/ they found (ro"iotic did not reduce the occurrence or recurrence of otiti 'edia+ @hey al o o"tained na o(haryngeal a'(le at 3 (oint in ti'e and ho*ed no reduction in the (re ence of #+ (neu'oniae or :+ in=uenHae "ut an increa ed (re!alence of 0+ catarrhali K29L+ Con!er ely/ -oo et al+ in 2001 re(orted on the u e of a (ro"iotic na al (ray in children and found (re!enti!e effect on ;O0 and CO0 (<2O *ithout recurrence in the (ro"iotic grou( ! + 22O in the (lace"o grou(/ P Q 0+02) K29L+ 0ore recently/ in 2009/ #tec5 eT n3 1lic5 et al+ ho*ed 'il5 u((le'ented *ith (ro"iotic and =uoride con u'ed once daily/ B day a *ee5/ for 21 'onth / had (re!enti!e effect on otiti 'edia (0+< day of otiti 'edia ! + 1+3 day of otiti 'edia/ P R 0+0B) K30L+ -auta!a et al+ in 2009 loo5ed at

(ro"iotic in infant "y u((le'enting for'ula for infant younger than 2 'onth co'(ared to (lace"o u((le'entation daily until the age of 12 'onth + @here *a a igniIcant reduction in the nu'"er of e(i ode of otiti 'edia in the Ir t 7 'onth of life (22O ! + B0OE ri 5 ratio K--L/ 0+<< K9BO CI/ 0+21/ 0+90LE P Q 0+01<) and a decrea e in the a'ount of anti"iotic (re cri"ed (31O ! + 60OE --/ 0+B2 K9BOCI/ 0+29/ 0+92LE P Q 0+01B) K31L+ @he e con=icting re(ort highlight the need for further re earch in thi area+ 9+ O teo(athy O teo(athy i a thera(y "a ed on the conce(t that the "ody can heal it elf *hen it i in a nor'al tructural relation hi(/ nor'al en!iron'ent/ and ha good nutrition+ Cranio acral thera(y/ often u ed for ;O0/ i 'ani(ulation of the "one and ti ue of the head and nec5 to affect FFo teo(athic re triction +66 O teo(athic 'ani(ulati!e treat'ent (O0@) for ;O0 include 'yofa cial relea e/ articulation/ "alanced 'e'"ranou ten ion/ "alanced liga'entou ten ion/ facilitated (o itional relea e/ and counter train on FFarea of re triction+66 In co'"ination *ith anti"iotic / the e (rocedure can decrea e the freGuency of ;O0 a *ell a the need for ty'(ano to'y tu"e co'(ared to anti"iotic *ithout O0@ K32L+ ; rando'iHed controlled trial "y 0ill et al+ in 2003 e!aluated O0@ for treat'ent of otiti 'edia+ Children aged 6 'onth to < year *ith recurrent ;O0 *ere rando'iHed to tandard care ( uch a anti"iotic ) either *ith or *ithout O0@ o!er 6 'onth + Patient in the O0@ grou( had fe*er e(i ode of ;O0 (er 'onth (P Q 0+0<) and le need for ty'(ano to'y tu"e (P Q 0+03)+ @here *a no difference in anti"iotic u e/ (arental ati faction/ or hearing re ult + 8nfortunately/ there *a a large dro(out rate (2BO)/ 'a5ing conclu ion difIcult K32L+ 0any O0@ tudie ha!e a lac5 of control / 'all grou( iHe / and high dro(out rate K33L+ Other O0@ for otiti 'edia include the FF?al"reath 'aneu!er66 ('o!e'ent of the 'andi"le to indirectly generate a (u'(ing action on the 4u tachian tu"e that (ur(ortedly drain the 'iddle ear) K3<L+ @he FF0uncie66 and FF'odiIed 0uncie66 techniGue in!ol!e (lace'ent of a Ingerti( on -o en'uller6 fo a or the (o terior ton illar (illar/ re (ecti!ely/ to o(en the 4u tachian tu"e K3B37L+ 4ffecti!ene of the e techniGue i 'ainly anecdotal "ut *arrant future re earch+ 9+ Chiro(ractic Chiro(ractic i "a ed on the (rinci(le the "ody can heal it elf *hen the 5eleton i in correct align'ent+ Chiro(ractor feel 'ani(ulation i'(ro!e inner!ation and function of the ten or !eli (alatini/ *hich hel( treat or (re!ent otiti 'edia+ >roehle eCa'ined the effecti!ene of chiro(ractic in <6 children *ith ;O0 aged B year and younger+ Patient *ere gi!en 3 treat'ent (er *ee5 for 1 *ee5/ then 2 treat'ent (er *ee5 for 1 *ee5/ and then 1 treat'ent (er *ee5 *ith ter'ination at any (oint *hen (arent / (hy ician / or the chiro(ractic (ractitioner dee'ed the child i'(ro!ed+ O!erall/ 93O of ;O0 i'(ro!ed/ 7BO of *hich i'(ro!ed *ithin 10 day and <3O *ith only 1 or 2 treat'ent K39L+ In 200</ Phang et al+ loo5ed at otiti 'edia re olution in 21 children (aged 9 'onth to 9 year ) diagno ed *ith ;O0 (deIned "y ty'(anic 'e'"rane a((earance and fe!er)+ @he e children *ere treated *ith FFtoftne 66 (lo* force) chiro(ractic ad&u t'ent o!er 1< day / and o!erall/ 9BO had return of nor'al3a((earing ty'(anic 'e'"rane and a decrea e in their fe!er + 8nfortunately/ there *a no control grou( and thu conclu ion are difIcult K39L+ >allon K<0L eCa'ined 332 children (aged 27 day to B year ) *ith a diagno i of otiti 'edia (acute or chronic) for effecti!ene of chiro(ractic 'ani(ulation+ Children *ho had ;O0 (n Q 127) recei!ed an a!erage of < 1+03 ad&u t'ent and attained

nor'al oto co(ic eCa' and

ty'(anogra' after 6+67 ( 1+9) and 9+3B ( 2+99) day / re (ecti!ely+ @he e children al o had an o!erall ;O0 recurrence rate of only 11O in 6 'onth + Patient *ith chronic O0 reGuired B+0 1+B3 ad&u t'ent / attained nor'al oto co(ic eCa' in 9+B7 1+96 day / and had nor'al ty'(anogra' in 10+19 3+39 day K<0L+ @here i o'e concern o!er the afety of chiro(ractic in a (ediatric (o(ulation+ Children 'ay "e at increa ed ri 5 for in&ury follo*ing ra(id rotational 'o!e'ent or force econdary to anato'ic i''aturity+ #eriou ad!er e e!ent ha!e "een re(orted *ith chiro(ractic / uch a (ara(legia and death K<1L+ O!erall/ the effecti!ene of chiro(ractic 'edicine in treat'ent of otiti 'edia i unclear "ecau e the fe* eCi tent tudie all ha!e igniIcant 'ethodological hortco'ing + 10+ @raditional chine e and &a(ane e 'edicine @raditional Chine e 'edicine (@C0) (ractice enco'(a 'any healing 'odalitie / including acu(uncture/ 'oCi"u tion (heat thera(y)/ ;n'a or @uina (ancient 'a age techniGue )/ diet/ and her" to create har'ony and "alance *ithin the "ody+ @raditional Ja(ane e 'edicine (2a'(o) ha it root in @C0+ 1oth acu(uncture and Chine e,Ja(ane e her"al 'edicine are a((ro!ed "y the Dorld :ealth OrganiHation a thera(ie to treat CO0 and ;O0+ ;cu(uncture i "a ed on the notion that the "ody6 energy force/ chi/ tra!el channel that can "eco'e "loc5edE 'all needle are in erted to correct thi =o* of the energy+ ; rando'iHed/ controlled trial in dog ha ho*n efIcacy of acu(uncture co'(ared to ha' thera(y in (re!enting otiti 'edia (93O (re!ention ! + B0O)+ @hirty3one dog *ith recurrent otiti 'edia *ere rando'iHed to con!entional 'edicine *ith either ha' acu(uncture or actual acu(uncture in four e ion + O!er the u" eGuent year/ 1< (93O) dog in the acu(uncture grou( *ere free of otiti / co'(ared *ith 7 (B0O) in the ha' grou( (P R 0+01) K<2L+ It ha "een ugge ted that acu(uncture ha i''uno'odulatory effect that 'ay (lay a role in the clearance of 'iddle ear =uid+ 0any co'"ination of her" eCi t in traditional Chine e 'edicine and include 5ullca( (#cutellaria "aicalen i )/ ali 'a (;li 'a (lantago3aGuatica)/ (lantain (Plantago 'a&or)/ "u(leuru' (1u(leuru' Chine e)/ and licorice (?lycyrrhiHa uralen i )+ -e earch i li'ited "y a'(le iHe/ rando'iHation/ and outco'e 'ea ure / and fe* tudie are in 4ngli h+ ;ni'al tudie are 'ore nu'erou ) in the guinea (ig/ airei3to enhance 'ucociliary clearance K<3L and (re!ent endotoCin3induced otiti K<<L+ 4ryanling liGuid reduce in=a''atory eCudate and 'uco al *elling in guinea (ig and 'ay enhance the i''une y te' of 'ice K<BL+ Patient ha!e noted i'(ro!ed hearing "ut no change in otalgia after ta5ing UingGiao ca( ule K<6L+ ;llergina (a co'"ination of 'any her" ) 'ay decrea e the ign of otiti 'edia co'(ared to anti"iotic a a re ult of a change in cyto5ine (roIle K<7L+ Other tudie ha!e ho*n the efIcacy of @ongGiao K<9L and "orneol3*alnut oil K<9L+ ;gain/ the e are all li'ited "y a'(le iHe/ rando'iHation/ and outco'e 'ea ure + In 2a'(o/ (ro!ider e!aluate uniGue (attern of di har'ony in (atient through (atient hi tory and eCa'ination of the tongue and (ul e + 2a'(o6 effecti!ene 'ay "e due in (art to electi!e increa e in ion tran (ort acro the ear e(itheliu' KB0L+ @he her" Ju en3taiho3to (@J3<9) *a ho*n to decrea e ho (ital !i it / anti"iotic treat'ent / and fe!er in 2< otiti (rone infant + 8(on di continuation/ 'any had recurrent O0/ "ut rate again decrea ed after re u'(tion KB1L+ 11+ Other thera(ie ;ro'athera(y *ith la!ender e ence/ cha'o'ile/ ca&u(ut/ e!ening (ri'ro e oil/ =aC oil/ and "orage ha "een u ed to treat otiti 'edia "ut ha not "een *ell tudied to date+

;yur!edic 'edicine/ de!elo(ed in ancient India/ i "a ed on the (rinci(le of "alance+ In otiti 'edia/ the ly'(h node out ide the ear are 'a aged to o(en the 4u tachian tu"e + Often a drin5 'ade *ith the her" a'la (*hich contain !ita'in C and 'ay ha!e anti!iral (ro(ertie ) i gi!en+ 12+ #u''ary and reco''endation ;ccording to the ;;>P and ;;P/ 'anage'ent of ;O0 "egin *ith *atchful *aiting+ :er"al eardro( 'ay hel( relie!e y'(to' + :o'eo(athic treat'ent 'ay hel( decrea e (ain and lead to fa ter re olution+ Pre!ention hould "e e'(ha iHed *ith eli'ination of ri 5 factor uch a econd hand 'o5e and "ottle3feeding/ a *ell a 'aintaining nutrition and !accination + O teo(athy and chiro(ractic 'ay lead to i'(ro!e'ent in y'(to' E ho*e!er/ ca e re(ort ca t dou"t on the afety of the e 'ethod + $ita'in u((le'entation 'ay "e hel(ful+ Pro"iotic and Cylitol 'ay "e "eneIcial a *ell+ Of all C;0 thera(ie / only Cylitol ha "een tudied in *ell3de igned/ rando'iHed/ "linded trial E it i li5ely effecti!e "ut co'(liance li'it it a((lica"ility+ @raditional Chine e,Ja(ane e thera(ie ho* (ro'i ing re ult / "ut they generally ha!e not "een e!aluated in dou"le3"lind/ rando'iHed/ controlled tudie and thu re'ain (eculati!e+ #e!ere ca e of otiti 'edia *ith co'(lication or tho e that fail to i'(ro!e *ith o" er!ation or C;0 (after <972 h) hould "e treated *ith anti"iotic and/ in o'e ca e / urgical inter!ention+ It i "e t to con ult a (hy ician *hen 'a5ing treat'ent deci ion for full guidance on the ri 5 and "eneIt of any treat'ent o(tion+ Con=ict of intere t Ao con=ict of intere t eCi t to di clo e for any of the author + ;((endiC ; In 200</ a (art of their guideline / the ;'erican ;cade'y of Pediatric and the ;'erican ;cade'y of >a'ily Phy ician reco'3 'ended initial o" er!ation of ;O0 in elected (atient ) 6 'onth to 2 year ) non e!ere illne at (re entation and uncertain diagno i 2M year ) non e!ere illne at (re entation or uncertain diagno i If y'(to' do not re ol!e in 2<<9 h/ (atient treated *ith anti"iotic + ;((endiC 1 .i t of co''on ho'eo(athic re'edie u ed to treat otiti 'edia and condition they are u ed for+ 70o t co''only u ed re'edie + 7;conitu',;conite,;conitu' na(ellu ) >or thro""ing ear (ain that co'e on uddenly after eC(o ure to cold or *ind and in children *ith high fe!er and *ho e ear are "right red or tender to the touch+ 1etter in the initial tage of an ear infection+ 71elladonna) >or thro""ing and har( (ain acco'(anied "y fe!er/ inten e heat/ and =u hing in the outer ear and along the ide of the face+ #o'e ugge t it i "etter for the right ear+ It co'e fro' an eCtract fro' a (oi onou (lant of the night hade fa'ily and hould "e u ed *ith caution+ Ca( icu') @reat heat/ in=a''ation/ and igniIcant (ain+ 7Cha'o'illa) >or children *ith otiti 'edia *ho are !ery irrita"le/ in great (ain/ and incon ola"le+ hould then "e

>erru' (ho (horicu') In early otiti 'edia/ thi i a co''on re'edy u edE gradual on et of y'(to' E (atient ha =u hed face/ doe n6t li5e noi e/ *ant to lie till+ :e(ar ul(huricu') Pain in ear e (ecially *ith *allo*ingE yello*i h3green di charge/ *ind or draft aggra!ate (ain+ 2ali 'uraticu') Po((ing and crac5ling ound heard in ear *hen *allo*ing and *ith no e "lo*ing/ hearing 'ay "e decrea ed/ feeling of fullne and conge tion in the ear+ ;l o u ed to clear 4u tachian tu"e *hen =uid (er i t after ;O0+ .yco(ediu') >or right3 ided ear (ain that i *or e in the late afternoon and early e!eningE fullne of the ear / ringing or "uHHing of the ear + 0agne ia (ho (horica) 4arache/ e (ecially after eC(o ure to cold *ind and draft + 0ay not "e an infection at all/ "ut rather ner!e irritation/ 'ore right ear than leftE (ain relie!ed "y heat/ feel "etter *ith ru""ing+ 0ercuriu ) ?ood for chronic ear infection E for (ain that i *or e at night and 'ay eCtend do*n into the throatE relief co'e fro' no e "lo*ingE earache 'ay occur *hen da'( or fog or *eather change occur/ 'ay ali!ate or *eat+ 7Pul atilla) >or infection follo*ing eC(o ure to cold or da'( *eatherE the ear i often red and 'ay ha!e a yello*i h,greeni h di charge fro' ear or no eE ear (ain 'ay *or en after lee( and *ith *ar'th/ 'ay "e alle!iated "y cool co'(re e + #ilica) >or chronic or late tage infection *hen the child feel chilly/ *ea5/ and tiredE *eating 'ay al o "e (re ent+ $er"a cu') 4 (ecially left3 ided otiti 'edia/ 'ay ha!e a cough or laryngiti a *ell+ ;((endiC C .i t of co''on natural health (roduct u ed to treat otiti 'edia+ Cha'o'ile (0atricaria cha'o'illa)) It i thought to ha!e anti!iral (ro(ertie and ha "een u ed for infant colic/ dige ti!e u( et/ and diarrhea+ @he oil fraction i "elie!ed to ha!e the anti3infecti!e (ro(ertie / *hile the =a!onoid are thought to "e anti3in=a''atory+ @here i little e!idence for it u e in otiti 'edia+ It co'e a a tincture (13 '. three ti'e dailyE infant ) 13 dro( ,l" "ody *eight three ti'e daily) and a tea (1 cu( of "oiling *ater o!er 1 hea(ing t" ( of =o*er )+ Occa ionally (atient are allergic to it+ Clea!er ) 8 ed to a i t ly'(hatic clearance of de"ri during ;O0 or *ith erou otiti 'edia+ @incture 0+B2 '. three ti'e daily+ @ea i al o u ed) 1 cu( t*o or three ti'e daily+ Cod .i!er Oil) ; ource of o'ega33 fatty acid and !ita'in ; and %+ It ha "een ho*n that (atient *ith recurrent otiti 'edia ha!e lo* "lood le!el of o'e o'ega33 fatty acid / !ita'in ;/ and eleniu'+ #afety of long3ter' con u'(tion of cod li!er oil i not 5no*nE tudie ha!e ho*n ad!er e health effect fro' (olychlori3 nated "i(henyl and dioCin re idue found in I h oil+ 4chinacea (4chinacea (ur(urea)) It acti!ity i "elie!ed to "e non (eciIc acti!ation of the i''une y te' (including acti!ating natural 5iller cell and 'acro(hage and increa ing circulating le!el of al(ha interferon)/ "ut there i o'e e!idence that the caffeic e ter are anti"acterial and anti!iral and the (olyacetylene 'ay "e "acterio tatic+ It i 'o t co''only u ed for treat'ent of u((er re (iratory infection / "ut it i not *ell tudied for otiti 'edia (eciIcally+ %o e of echinacea) tincture / either in alcohol or glycerite / are a!aila"le+ Children) 1B '. three to I!e ti'e daily/ infant ) 1 or 2 dro( ,l" "ody *eight three ti'e daily+ @a"let / ca( ule / and *hole her" ta5en a tea or infu ion are al o u ed orally+

4lder =o*er,"erry (#a'"ucu nigra)/ 4uro(ean alder (#a'"ucu canaden i )/ or ;'erican elder (Ca(rifoliaceae)) 8 ed to dry eCce i!e na al ecretion / al o ha anti!iral acti!ity/ "e t during ;O0/ e (ecially if an u((er re (iratory tract infection i (re ent+ @incture 0+B3 '. 3 ti'e daily+ @ea i al o u ed) 1 cu( t*o or three ti'e daily+ 4leca'(ane root (Inula heleniu')) 1acterio tatic and anti!iral acti!ity and 'ay trengthen re i tance of 'uco al lining+ Can "e u ed in ;O0 or chronic erou otiti 'edia+ @incture 0+B2 '. three ti'e daily+ 4ucaly(tu ) ;d'ini tered u ually a tea' inhalation and i u ed 'o tly late in the cour e of ;O0+ ?olden eal (:ydra ti canaden i )) 8 ed only during ;O0 *hen there i e!idence of (urulence+ @incture 0+B2 '. three ti'e daily+ 0ar h'allo* (;lthea ofIcinali )) 8 ed for oothing in=a'ed 'ucou 'e'"rane and hel( loo en and 'oi ten thic5 'ucu + In otiti 'edia/ it i u ed (articularly to hel( o(en the eu tachian tu"e+ @incture) 1 dro( (er 2 (ound of "ody *eight (u( to 2 '.) three to iC ti'e daily+ %ecoction) 1 t" ( root i''ered in 1 cu( of *ater for 10 'inE 1 to 3 t" ( of the trained liGuid i ta5en t*o to iC ti'e daily+ If ta5ing *ith (re cri(tion 'edication / ta5e the 'edication at lea t 1 h "efore or 2 h after ta5ing 'ar h'allo* root/ "ecau e the her" 'ay decrea e the a" or(tion of drug + 0ullein ($er"a cu' tha( u )) %ecrea e (hleg' and trengthen the re (iratory 'uco a and act to(ically a a local anti3in=a''ato3 ry+ It can "e u ed a to(ical ear oil for otiti eCterna+ >or otiti 'edia/ it i cho en to un"loc5 the eu tachian tu"e and to decrea e in=a''a3 tion+ @incture) 1 dro( (er 2 (ound of "ody *eight e!ery < h+ @ea) 1 to 2 t ( her",cu( of "oiling *ater/ tee(ed co!ered 101B 'in/ and trainedE 1< cu( (er day+ 8 nea (8 nea "ar"ata)) :a anti!iral and anti"acterial (ro(ertie / u ed during acute e(i ode of otiti 'edia+ @incture 0+BB '. three ti'e daily+ Sylitol) 8 ed a an artiIcial *eetener in che*ing gu' and ha "een ho*n to inhi"it the gro*th of #tre(tococcu (neu'oniae "y changing the ultra tructure of the "acterial ca( ule+ 0any tudie ho* effecti!ene of Cylitol (gu' V yru() in (re!enting otiti 'edia *hen gi!en I!e ti'e daily+ It can cau e a"do'inal (ain and loo e tool / *hich lead to large dro(out rate fro' 'any tudie and difIculty dra*ing 'eaningful conclu ion + It al o (re!ent dental carie + -eference
K1L #+4+ #tool/ 0+J+ >ield/ @he i'(act of otiti 'edia/ Pediatr+ Infect+ %i + J+ 9 (1999) #11 #1<+ K2L ;+ #a"iro!/ J+-+ Ca ey/ @+>+ 0ur(hy/ 0+4+ Pichichero/ 1rea t3feeding i a ociated *ith a reduced freGuency of acute otiti 'edia and high eru' anti"ody le!el again t A@:i and outer 'e'"rane (rotein !accine antigen candidate P6/ Pediatr+ -e + 66 (2009) B6BB70+ K3L 0+ 8hari/ 2+ 0aW nty aari/ 0+ Aie'elaW/ ; 'eta3analytic re!ie* of ri 5 factor for acute otiti 'edia/ Clin+ Infect+ %i + 22 (1996) 10791093+ K<L ;+O+ .a i i/ @he role of retinol in the etiology and outco'e of u((urati!e otiti 'edia/ 4ur+ ;rch+ Otorhinolaryngol+ 266 (2009) 6<76B2+ KBL 0+;+ 4le'raid/ I+J+ 0ac5enHie/ D+%+ >ra er/ 1+J+ 1ra"in/ Autritional factor in the (athogene i of ear di ea e in children) a y te'atic re!ie*/ ;nn+ @ro(+ Paediatr+ 29 (2009) 9B99+ K6L 2+ ;""a/ ;+ ?ulani/ :+#+ #achde!/ Pinc u((le'ent for (re!enting otiti 'edia/ Cochrane %ata"a e #y t+ -e!+ (2) (2010) C%006639+ K7L .+;+ .inday/ J+A+ %olit 5y/ -+%+ #hindledec5er/ C+4+ Pi((enger/ .e'on3=a!ored cod li!er oil and a 'ulti!ita'in3'ineral u((le'ent for the econdary (re!ention of otiti 'edia in young children) (ilot re earch/ ;nn+ Otol+ -hinol+ .aryngol+ 111 (2002) 6<26B2+ K9L J+ 4 5ola/ @+ 2il(i/ ;+ Pal'u/ J+ Jo5inen/ J+ :aa(a5o 5i/ 4+ :er!a/ et al+/ 4fIcacy of a (neu'ococcal con&ugate !accine again t acute otiti 'edia/ A+ 4ngl+ J+ 0ed+ 3<< (2001) <03<09+ K9L #+.+ 1loc5/ @+ :ei55inen/ #+.+ @o"ac5/ D+ Pheng/ C+#+ ;'"ro e/ @he efIcacy of li!e attenuated in=uenHa !accine again t in=uenHa3a ociated acute otiti 'edia in children/ Pediatr+ Infect+ %i + J+ 30 (2011) 203207+

K10L 4+0+ #arrell/ ;+ 0andel"erg/ :+;+ Cohen/ 4fIcacy of naturo(athic eCtract in the 'anage'ent of ear (ain a ociated *ith acute otiti 'edia/ ;rch+ Pediatr+ ;dole c+ 0ed+ 1BB (2001) 796799+ K11L J+;+ @aylor/ J+ Jaco" / :o'eo(athic ear dro( a an ad&unct to tandard thera(y in children *ith acute otiti 'edia/ :o'eo(athy 100 (2011) 10911B+ K12L P+P+ ?la Hiou/ C+1+ %el 0ar/ #+.+ #ander / 0+ :aye'/ ;nti"iotic for acute otiti 'edia in children/ Cochrane %ata"a e #y t+ -e!+ (1) (200<) C%000219+ K13L -+ >oClee/ ;+ Johan on/ J+ De&fal5/ J+ %a*5in / .+ %ooley/ C+ %el 0ar/ @o(ical analge ia for acute otiti 'edia/ Cochrane %ata"a e #y t+ -e!+ (3) (2006) C%00B6B7+ K1<L P+ 0archi io/ #+ 1ianchini/ C+ ?aleone/ 4+ 1aggi/ 4+ -o i/ ?+ ;l"ertario/ et al+/ 8 e of co'(le'entary and alternati!e 'edicine in children *ith recurrent acute otiti 'edia in Italy/ Int+ J+ I''uno(athol+ Phar'acol+ 2< (2011) <<1<<9+ K1BL >+ %ante / :+ -a'(e / %o ho'eo(athic 'edicine (ro!o5e ad!er e effect X 1r+ :o'eo(ath+ J+ 99 (2000) #3B#39+ K16L :+ >rei/ ;+ @hurney en/ :o'eo(athy in acute otiti 'edia in children) treat'ent effect or (ontaneou re olutionX 1r+ :o'eo(ath+ J+ 90 (2001) 190192+ K17L :+ :arri on/ ;+ >iC en/ ;+ $ic5er / ; rando'iHed co'(ari on of ho'oeo(athic and tandard care for the treat'ent of glue ear in children/ Co'(le'ent+ @her+ 0ed+ 7 (1999) 13213B+ K19L J+ Jaco" / %+;+ #(ringer/ %+ Crother / :o'eo(athic treat'ent of acute otiti 'edia in children) a (reli'inary rando'iHed (lace"o3controlled trial/ Pediatr+ Infect+ %i + J+ 20 (2001) 177193+ K19L 0+A+ #inha/ $+;+ #iddiGui/ C+ Aaya5/ $+ #ingh/ -+ %iCit/ %+ %e*an/ et al+/ -ando'iHed controlled (ilot tudy to co'(are ho'eo(athy and con!entional thera(y in acute otiti 'edia/ :o'eo(athy 101 (2012) B12+ K20L :+;+ Cohen/ I+ $ar ano/ 4+ 2ahan/ 4+0+ #arrell/ Y+ 8Hiel/ 4ffecti!ene of an her"al (re(aration containing echinacea/ (ro(oli / and !ita'in C in (re!enting re (ira3 tory tract infection in children) a rando'iHed/ dou"le3"lind/ (lace"o3controlled/ 'ulticenter tudy/ ;rch+ Pediatr+ ;dole c+ 0ed+ 1B9 (200<) 217221+ K21L 0+ 8hari/ @+ @a(iainen/ @+ 2ontio5ari/ Sylitol in (re!enting acute otiti 'edia/ $accine 19 (2000) #1<<#1<7+ K22L P+ 2urola/ @+ @a(iainen/ @+ 2ai&alainen/ 0+ 8hari/ ;+ #au55orii(i/ Sylitol and ca( ular gene eC(re ion in #tre(tococcu (neu'oniae/ J+ 0ed+ 0icro"iol+ B9 (2009) 1<701<73+ K23L 0+ 8hari/ @+ 2ontio5ari/ 0+ 2o 5ela/ 0+ Aie'elaW/ Sylitol che*ing gu' in (re!ention of acute otiti 'edia) dou"le "lind rando'i ed trial / 10J 313 (1996) 1190119<+ K2<L 0+ 8hari/ @+ 2ontio5ari/ 0+ Aie'elaW/ ; no!el u e of Cylitol ugar in (re!enting acute otiti 'edia/ Pediatric 102 (1999) 97999<+ K2BL @+ @a(iainen/ .+ .uotonen/ @+ 2ontio5ari/ 0+ -en5o/ 0+ 8hari/ Sylitol ad'ini tered only during re (iratory infection failed to (re!ent acute otiti 'edia/ Pediatric 109 (2002) 419+ K26L O+ :autalahti/ 0+ -en5o/ @+ @a(iainen/ @+ 2ontio5ari/ @+ Po55a/ 0+ 8hari/ >ailure of Cylitol gi!en three ti'e a day for (re!enting acute otiti 'edia/ Pediatr+ Infect+ %i + J+ 26 (2007) <23<27+ K27L 2+ :ata55a/ 4+ #a!ilahti/ ;+ PoW n5aW/ J+:+ 0eur'an/ @+ Pou a/ .+ AaW e/ et al+/ 4ffect of long ter' con u'(tion of (ro"iotic 'il5 on infection in children attending day care centre ) dou"le "lind/ rando'i ed trial/ 10J 322 (2001) 13271329+ K29L 2+ :ata55a/ 2+ 1lo'gren/ #+ Poh&a!uori/ @+ 2ai&alainen/ @+ Pou a/ 0+ .einonen/ et al+/ @reat'ent of acute otiti 'edia *ith (ro"iotic in otiti 3(rone children3a dou"le3 "lind/ (lace"o3controlled rando'i ed tudy/ Clin+ Autr+ 26 (2007) 31< 321+ K29L 2+ -oo / 4+?+ :aZ 5an on/ #+ :ol'/ 4ffect of recoloni ation *ith FFinterfering66 al(ha tre(tococci on recurrence of acute and ecretory otiti 'edia in children) rando'i ed (lace"o controlled trial/ 10J 322 (2001) 210212+ K30L C+ #tec5 eT n31lic5 / I+ #&oW troW '/ #+ @*et'an/ 4ffect of long3ter' con u'(tion of 'il5 u((le'ented *ith (ro"iotic lacto"acilli and =uoride on dental carie and general health in (re chool children) a clu ter3rando'iHed tudy/ Carie -e + <3 (2009) 37<391+

K31L #+ -auta!a/ #+ #al'inen/ 4+ I olauri/ #(eciIc (ro"iotic in reducing the ri 5 of acute infection in infancy a rando'i ed/ dou"le3"lind/ (lace"o3controlled tudy/ 1r+ J+ Autr+ 101 (2009) 17221726+ K32L 0+$+ 0ill / C+4+ :enley/ .+.+ 1arne / J+4+ Carreiro/ 1+>+ %egenhardt/ @he u e of o teo(athic 'ani(ulati!e treat'ent a ad&u!ant thera(y in children *ith recur3 rent acute otiti 'edia/ ;rch+ Pediatr+ ;dole c+ 0ed+ 1B7 (2003) 961966+ K33L 1+>+ %egenhardt/ 0+.+ 2uchera/ O teo(athic e!aluation and 'ani(ulati!e treat3 'ent in reducing the 'or"idity of otiti 'edia) a (ilot tudy/ J+ ;'+ O teo(ath+ ; oc+ 106 (2006) 32733<+ K3<L %+ Pratt3:arrington/ ?al"reath techniGue) a 'ani(ulati!e treat'ent for otiti 'edia re!i ited Kre!ie*L/ J+ ;'+ O teo(ath+ ; oc+ 100 (2000) 63B639+ K3BL @+J+ -uddy/ O teo(athic 'ani(ulation in eye/ ear/ no e/ and throat di ea e/ ;;O Year"oo5 (1962) 1331<0+ K36L J+#+ :eatherington/ 0ani(ulation of the 4u tachian tu"e/ ;;O J+ (199B) 2729/ Dinter+ K37L 0+2+ Channell/ 0odiIed 0uncie techniGue) o teo(athic 'ani(ulation for eu ta3 chian tu"e dy function and illu trati!e re(ort of ca e/ J+ ;'+ O teo(ath+ ; oc+ 109 (2009) 260263+ K39L -+0+ >roehle/ 4ar infection) a retro (ecti!e tudy eCa'ining i'(ro!e'ent fro' chiro(ractic care and analyHing for in=uencing factor / J+ 0ani(ulati!e Phy iol+ @her+ 19 (1996) 169177+ K39L J+U+ Phang/ 1+J+ #ynder/ 4ffect of @oftne chiro(ractic ad&u t'ent for children *ith acute otiti 'edia/ J+ $erte"ral #u"luCation -e + 29 (200<) 1<+ K<0L J+0+ >allon/ @he role of the chiro(ractic ad&u t'ent in the care and treat'ent of 332 children *ith otiti 'edia/ J+ Clin+ Chiro(ract+ Pediatr+ 2 (1997) 167193+ K<1L 2+P+ .ee/ D+?+ Carlini/ ?+>+ 0cCor'ic5/ ?+D+ ;l"er / Aeurologic co'(lication follo*ing chiro(ractic 'ani(ulation) a ur!ey of California neurologi t / Aeurol3 ogy <B (199B) 1213121B+ K<2L 0+ #aT ncheH3;rau&o/ ;+ Puchi/ ;cu(uncture (re!ent rela( e of recurrent otiti in dog ) a 13year follo*3u( of a rando'i ed controlled trial/ ;cu(unct+ 0ed+ 29 (2011) 2126+ K<3L Y+ #ugiura/ Y+ Oha hi/ Y+ Aa5ai/ @he her"al 'edicine/ airei3to/ enhance the 'ucociliary acti!ity of the tu"oty'(anu' in the healthy guinea (ig/ ;cta Otolaryngol+ #u((l+ B31 (1997) 1720+ K<<L Y+ #ugiura/ Y+ Oha hi/ Y+ Aa5ai/ @he her"al 'edicine/ airei3to/ (re!ent endotoCin3 induced otiti 'edia *ith effu ion in the guinea (ig/ ;cta Otolaryngol+ #u((l+ B31 (1997) 2133+ K<BL :+ Phang/ #+ .i/ -+ .iu/ KClinical and eC(eri'ental tudy on treat'ent of acute catarrhal otiti 'edia *ith eryanling oral liGuidL/ Phongguo Phong Si Yi Jie :e Pa Phi 20 (2000) 7<37<6+ K<6L Y+%+ #un/ .+:+ Chen/ D+J+ :u/ Y+.+ Jiang/ S+.+ Chen/ #+1+ Phang/ 4!aluation of the clinical efIcacy of UingGiao ca( ule in treating (atient *ith ecretory otiti 'edia/ Chin+ J+ Integr+ 0ed+ 11 (200B) 2<32<9+ K<7L :+J+ Jeong/ #+:+ :ong/ #+C+ 2i'/ 4+J+ Par5/ C+:+ Jang/ 2+#+ 2i'/ et al+/ 4ffect of ;llergina on the treat'ent of otiti 'edia *ith effu ion / In=a''ation 26 (2002) 999B+ K<9L Y+ .iao/ Y+ :uang/ Y+ Ou/ KClinical and eC(eri'ental tudy of @ongGiao ta"let in treating catarrhal otiti 'ediaL/ Phongguo Phong Si Yi Jie :e Pa Phi 19 (1999) 669670+ K<9L #+.+ .iu/ K@hera(eutic effect of "orneol3*alnut oil in the treat'ent of (urulent otiti 'ediaL/ Phong Si Yi Jie :e Pa Phi 10 (1990) 939B/ 69+ KB0L 2+ I5eda/ 0+ >uru5a*a/ A+ @anno/ 0+ Ya'aya/ @+ @a5a a5a/ Increa e of Cl3 ecretion induced "y 2a'(o 'edicine (Ja(ane e her"al 'edicine)/ #ai3rei3to/ in 0ongolian ger"il 'iddle ear e(itheliu'/ J(n+ J+ Phar'acol+ 73 (1997) 2932+ KB1L Y+ 0aruya'a/ #+ :o hida/ 0+ >uru5a*a/ 0+ Ito/ 4ffect of Ja(ane e her"al 'edi3 cine/ JuHen3taiho3to/ in otiti 3(rone children a (reli'inary tudy/ ;cta Otolar3 yngol+ 129 (2009) 1<19

Pengobatan Komplementer Dan Alternatif Untuk Otitis Media Anak ABSTRAK

@u&uan) 8ntu5 'enin&au literatur 'eli"at5an (engo"atan 5o'(le'enter dan alternatif untu5 otiti 'edia ana5+ 1e"era(a 'odalita yang di"aha / ter'a u5 (encegahan 'eli"at5an (e'"erian ;#I/ nutri i/ dan !a5 ina i/ (engo"atan i'to'ati5 'eli"at5an ho'eo(ati/ (rodu5 5e ehatan ala'i/ dan (ro"ioti5/ 'ani(ula i yang 'eli"at5an (engguna o teo(ati dan chiro(ractic / dan o"at tradi ional Cina dan Je(ang+ Infor'a i yang di a&i5an a5an 'e'"antu do5ter dala' 'ena ehati (a ien (ada (enga'"ilan 5e(utu an 'ere5a ela'a taha( a*al otiti 'edia 5eti5a "elu' 'engindi5a i5an (e'"erian anti"ioti5 dan tinda5an "edah+ 0etode) Pencarian literatur dengan cara i te'ati dila5u5an (ada Januari 2012 di Pu"0ed 'engguna5an 04#: dengan 5ata 5unci [otiti [o teo(ati/\ ['ani(ula i/ chiro(ractic/\ [tera(i 'edia\ dala' [(ro"ioti5/\ hu"ungannya dengan [tera(i 5o'(le'enter/\ [ho'eo(ati/\ ['ani(ula i/\ a5u(un5tur/\ [naturo(ati/\ dan [Cylitol+\ Pada (encarian ini dida(at5an 163 ha il yang uni5+ ;" tra5 dan &udul die!alua i untu5 dia'ati rele!an inya+ Case reports/ case series/ randomized controlled trials/ dan basic science research dii5ut erta5an+ Pu"li5a i yang tida5 rele!an dengan (e'"aha an (engo"atan alternatif (ada otiti 'edia di5eluar5an+ 1i"liografi di(eri5 a untu5 (u"li5a i le"ih lan&ut+ @iga (uluh ena' (u"li5a i yang uni5 ditin&au 5e'"ali+ :a il) %ari e'ua tera(i dala' (engo"atan 5o'(le'enter dan alternatif/ hanya Cylitol telah di(ela&ari erta dirancang dengan "ai5/ dengan aca5/ blinded trials/ 'e'"eri5an 5e'ung5inan efe5tif/ teta(i "ata 5e(atuhan (enera(annya+ 2e i'(ulan) 0ana&e'en otiti 'edia a5ut dia*ali dengan (enga*a an 5etat+ O"at tete telinga her"al da(at 'e'"antu 'eringan5an ge&ala+ Pengo"atan dite5an5an dengan eli'ina i fa5tor ri i5o/ e(erti ho'eo(ati da(at 'e'"antu 'engurangi ra a a5it dan 'enye"a"5an re olu i ce(at+ Pencegahan haru (ero5o5 (a if dan (e'"erian u u "otol/ erta 'en&aga nutri i dan !a5 ina i+ #u(le'en !ita'in da(at 'e'"antu+ Pro"ioti5 dan Cylitol da(at "er'anfaat &uga+ @era(i tradi ional Cina,Je(ang 'enun&u55an ha il yang 'en&an&i5an na'un teta( (e5ulatif a'(ai (enelitian le"ih lan&ut dila5u5an+ 2a u yang (arah otiti 'edia

dengan 5o'(li5a i atau 'ere5a yang gagal dengan o" er!a i ( etelah <9372 &a') haru dio"ati dengan anti"ioti5 dan/ dala' "e"era(a 5a u / diinter!en i dengan tinda5an "edah+ 0ela5u5an 5on ulta i dengan do5ter 'eru(a5an (ilihan yang "ai5 aat 'e'"uat 5e(utu an (engo"atan untu5 "i'"ingan (enuh 'engenai ri i5o dan 'anfaat dari etia( (ilihan (engo"atan+ 1+ Pengantar Otiti 'edia adalah alah atu (enya5it yang (aling u'u' dari 'a a 5ana535ana5+ 0e'ili5i in iden (unca5 antara u ia 6 dan 1B "ulan+ :a'(ir etengah dari e'ua re e( anti"ioti5 (ediatri5 dituli untu5 otiti 'edia/ yang &uga 'endorong le"ih "anya5 5un&ungan do5ter dari(ada (enya5it ana5 lainnya+ .e"ih dari J100 diha"i 5an (er e(i ode/ dan "iaya (engo"atan di ;# adalah e5itar J 23 3+B00+000+000 (er tahun K1L+ American Academy of Pediatrics (AAP) dan American Academy of Otolaryngology dan 1edah 2e(ala dan .eher (;;O:A#) 'endefini i5an otiti 'edia a5ut (O0;) e"agai (1) e&arah ti'"ulnya tanda a5ut dan ge&alanya/ (2) adanya efu i telinga tengah/ dan (3) tanda dan ge&ala (eradangan telinga tengah+ Pada tahun 200</ 5arena 5e5ha*atiran re i ten i anti"ioti5 dan tingginya ting5at re olu i (ontan (90O dala' *a5tu tiga hari)/ American Academy of Family Physicians (;;>P) dan ;;P 'ere5o'enda i5an (enga*a an (enuh dini (ada ana5 dengan otiti 'edia a5ut+ #ela'a ini/ 5eluarga ering 'encari (engo"atan alternatif+ #ayangnya Inter!en i ini ulit untu5 die!alua i (ada ce(atnya re olu i dan ri*ayata ala'i dari O0;+ %ala' na 5ah ini 5ita 'e'"aha 5on e( aat ini dan 'enya&i5an tin&auan (u ta5a (engo"atan 5o'(le'enter dan alternatif untu5 otiti 'edia+ 2+ Pencegahan #alah atu (rin i( (erta'a dari "anya5 'odalita 5o'(le'enter dan alternatif adalah (encegahan+ Pening5atan ting5at otiti 'edia dengan u u "otol di"anding5an dengan ;#I telah ter"u5ti+ Pada tahun 2009/ #a"iro! et al+ 'ela5u5an e!alua i terhada( ana5 dengan O0;/ 5e'udian 'encatat (re!alen i ti(e non3:ae'o(hilu influenHae le"ih tinggi dan adanya anti"odi i'unoglo"ulin

? (e ifi5 le"ih rendah (ada "otol "ayi yang di"eri u u di"anding5an dengan "ayi yang di"eri ;#I K2L+ %ita'"ah5an &uga fa5tor 'ero5o5 di e5itar ana53ana5/ (engaturan te'(at (eniti(an ana5 yang "e ar/ dan (enggunaan e'(eng &uga da(at 'e'ain5an (eran (enye"a" dala' O0; K3L (@a"el 1E .a'(iran ;)+ 1aru3"aru ini/ nutri i dan 'a5anan yang 'enye"a"5an alergi telah terli"at dala' (atogene i otiti 'edia+ %ala' (enelitian ter"aru 'enge!alua i 5e5urangan giHi/ (a ien dengan otiti 'edia a5ut u(uratif dan otiti 'edia 5roni5 (O02) erta O0; "erulang dite'u5an 'e'ili5i retinol,!ita'in ; le!el le"ih rendah dari(ada di u ia35ontrol K<L+ 2e5urangan Pinc &uga telah terli"at dala' O0;+ %ala' 'eta3anali i (ada 2009/ 4le'raid et al+ tarif 8la an O0;,O02 dan u(le'en !ita'in/ 'ene'u5an "u5ti "ah*a 5e5urangan Pinc atau !ita'in ;/ atau 5eduanya/ da(at 'enye"a"5an (ening5atan otiti 'edia KBL/ na'un/ (ada tahun 2010/ ;""a et al+ 12 (erco"aan ter5ontrol aca5 di 'ana (la e"o di"anding5an dengan Pinc (di"eri5an etida5nya e5ali e'inggu ela'a etida5nya atu "ulan) dan 'ene'u5an la(oran yang "ertentangan tentang 5e'an&uran u(le'en K6L+ 2e5urangan dala' 4P; ( e"uah 3 a a' le'a5 o'ega)/ !ita'in ;/ dan eleniu' &uga telah di5ait5an dengan O0; "erulang K7L/ dengan u(le'enta i 'engha il5an re e( anti"ioti5 le"ih edi5it+ $a5 in &uga 'e'ain5an (eran (enting dala' (encegahan O0;+ Pada tahun 2001/ Pu at Pengendalian dan Pencegahan Penya5it 'ere5o'enda i5an e'ua ana5 'uda haru 'enda(at (ne'uococal 73!alent !a5 in 5on&uga i (PC$7)+ :al ini 'enye"a"5an (enurunan ting5at otiti 'edia yang di e"a"5an oleh (neu'o5o5u dan (enurunan ty'(ano to'i untu5 (enya5it "erulang K9L+ I'uni a i e'ua "ayi yang ehat da(at 'encegah le"ih dari atu &uta e(i ode O0; etia( tahun+ Yang le"ih "aru (neu'o5o5u 133!alent !a5 in 5on&uga i (PC$13) !a5 in di(er5enal5an untu5 'engata i "e"an ia (enya5it (neu'o5o5u yang telah "erlang ung e&a5 di(er5enal5annya PC$7+ Pencegahan e"elu'nya (enya5it !iru / e(erti influenHa/ &uga da(at 'enurun5an 5e&adian O0; K9L+

3+ 0engurangi ge&ala

%engan (enga*a an/ 'engurangi ge&ala3ge&ala O0; 'eru(a5an hal yang ter(enting+ 2o'(re dengan air hangat/ ua(/ "er5u'ur dengan air gara'/ dan e'(rot hidung de5onge tan diduga "er'anfaat "agi "e"era(a (a ien+ Pada (ene'uan lain dite'u5an o"at tete telinga her"al 'e'"antu/ teta(i 5e"erha ilan 'ere5a tida5 &ela untu5 5o'(o i i !aria"el ("ia anya 5o'"ina i dari 'arigold Kcalendula flore L/ "a*ang (utih K;lliu' ati!u'L/ 'ullein K$er"a cu' @ha( u L/ #t John Dort K:y(ericu' (erforatu'L/ la!ender/ dan !ita'in 4)+ Pada (a ien dengan O0; nilai analge i5nya da(at dica(ai dengan e5 tra5 her"al naturo(ati e"anding dengan ane te i tete telinga+ Pada tahun 2001/ #arrell et al+ di"anding5an Oti5on #olut Otic (#ehat3OA/ Petach3@i5!a/ I real)/ e5 tra5 her"al naturo(ati/ dengan ane te i o"at tete telinga yang 'engandung a'etocaine dan (henaHone dala' gli erin dan dida(at5an ting5at e"anding analge ia untu5 O0; K10L+ %e'i5ian (ula/ ecara ignifi5an le"ih ce(at re olu i dari ge&ala dengan (e'"erian o"at tete telinga ho'eo(ati di"anding5an dengan tera(i [ tandar\ K11L+ #atu re!ie* i te'ati Cochrane "erla"el tete telinga naturo(ati tera(i [ ederhana\ K12L/ na'un/ re!ie* Cochrane elan&utnya 'ene'u5an "u5ti yang cu5u( untu5 'enentu5an efe5ti!ita 'ere5a K13L+ <+ Pengo"atan 5o'(le'enter dan alternatif ecara u'u' 0ela5u5an e!alua i efe5ti!ita C;0 untu5 otiti 'edia ulit 5arena 5urangnya (engaca5an/ 5etida5&ela an *a5tu untu5 'enge!alua i efe5/ dan 5etida5 e(a5atan 'engenai defini i C;0 endiri+ 2arena o"at C;0 tida5 diatur oleh >%; dan tida5 ter edia dala' "entu5 (aten/ adanya (ena'"ahan "iaya untu5 (enelitian+ 0e 5i(un de'i5ian/ <6 O ana5 u ia 137 tahun dengan tiga atau le"ih e(i ode O0; dala' ena' "ulan telah 'engguna5an "e"era(a 5o'(onen C;0/ dan 5e"anya5an edi5it dari ana53ana5 (1B33< O) adalah PC$7 atau telah di!a5 ina i influenHa K1<L+ 2e"anya5an (enelitian C;0 'e'ili5i 5ele'ahan 'etodologi yang ignifi5an dan tida5 ada anali i "iaya/ 'e'"uat 5e i'(ulan yang (a ti ulit+

B+ :o'eo(ati

:o'eo(ati (a ien

dida ar5an

(ada

'enye'"uh5an

e(erti

(rin i()

Hat

yang

'engha il5an ge&ala (ada (a ien ehat da(at 'eringan5an ge&ala3ge&ala (ada a5it+ Ini ter'a u5 "elladonna/ 5a'o'il/ dan :e(ar ul(huricu' (.a'(iran 1)+ 0ere5a u'u'nya diangga( a'an/ teta(i ada la(oran dari a*al 'e'"uru5nya ge&ala (ada e5itar 10320 O dengan O0; K1BL+ @iga efe5 a'(ing "erat dila(or5an dala' (ra5te5 dari alah atu o(erator ho'eo(ati ((erfora i 'e'"ran ti'(ani/ 5ole teato'a/ dan 'a toiditi )/ 'e 5i(un tida5 &ela a(a5ah ini ecara lang ung di5ait5an dengan inter!en i ho'eo(ati K16L+ %ala' 5ala 5ecil/ non-blinded/ u&i co"a ter5ontrol ecara aca5 oleh :arri on et al+ (ada tahun 1999/ 33 ana5 ("eru ia 19 "ulan a'(ai 9 tahun) dengan otiti 'edia dengan efu i/ ty'(anogra' a"nor'al/ dan gangguan (endengaran (le"ih dari 20 d") ecara aca5 "ai5 tera(i ho'eo(ati atau (enga*a an 5etat+ .e"ih "anya5 (a ien dala' 5elo'(o5 ho'eo(ati yang telah dila5u5an ty'(anogra' dengan ha il nor'al di"anding5an dengan 5elo'(o5 (nga*a an 5etat (7B O ! 31 O/ P Q 0/01B)+ ;da &uga 5ecenderungan 'enu&u (er"ai5an dala' (endengaran/ (enggunaan anti"ioti5 yang le"ih rendah/ dan ting5at ru&u5an yang le"ih rendah untu5 (e iali dala' 5elo'(o5 ho'eo(ati/ ta(i ini tida5 ignifi5an K17L+ %i"anding5an dengan (engo"atan 5on!en ional/ ho'eo(ati da(at 'engha il5an (er"ai5an ge&ala le"ih ce(at dengan "er5urangnya (enggunaan analge i5 dan anti"ioti5 K19/19L dan 'ung5in 1< O dinyata5an le"ih 'urah K16L+ #tudi aca5/ tudi ter5ontrol yang le"ih "e ar di(erlu5an untu5 'enilai efi5a i dan 5ea'anan dari (era*atan ini+ 6+ Produ5 5e ehatan ala'i lainnya Produ5 5e ehatan ala'i e(erti echinacea/ 'inya5 i5an cod/ dan Cylitol u'u'nya diangga( a'an/ 'e 5i(un 5e"erha ilan tida5 &ela dan (ada "e"era(a (a ien 'engala'i ge&ala ga trointe tinal yang ignifi5an+ 0e 5i(un ada "anya5 (rodu5 5e ehatan ala'i yang ter edia (lihat .a'(iran C untu5 daftar yang le"ih leng5a()/ alah atu yang (aling u'u' her"al yang dia'"il di ;'eri5a #eri5at adalah echinacea/ yang u'u'nya dia'"il untu5 'encegah flu "ia a+ #ayangnya/ e"agian "e ar (rodu5 echinacea di ;'eri5a #eri5at "era al dari Echinacea augustofolia/ e"uah ra'uan yang tida5 (ernah ter"u5ti untu5 'enurun5an ge&ala

infe5 i aluran (erna(a an ata + :anya a&a a5ar Echinacea pallidum dan daun Echinacea purpurea telah 'enun&u55an 5e"erha ilan dala' hal ini+ 0elihat ca'(uran yang 'engandung 4chinacea ( erta (ro(oli dan !ita'in C)/ Cohen et al+ K20L 'ene'u5an ca'(uran 'engurangi &u'lah e(i ode O0; (er ana5 e"e ar 69O (P R0/001) di"anding5an dengan (la e"o antara <30 ana53ana5+ #ayangnya/ efe5 a'(ing yang 'eli"at5an ge&ala ga trointe tinal yang dila(or5an di 9 ana5/ ter'a u5 7 dari 5elo'(o5 ca'(uran dan 2 dari 5elo'(o5 (la e"o (P Q 0+B<)+ Sylitol/ gula ala'i yang dite'u5an dala' "anya5 "uah3"uahan dan diguna5an e"agai (e'ani dala' (er'en 5aret/ &uga diangga( 'e'ili5i ifat (encegahan (ada otiti 'edia+ 8hari et al+/ 2000 'ene'u5an Cylitol 'engha'"at (ertu'"uhan #tre(tococcu (neu'oniae dan 'engha'"at (erle5atan #+ (neu'oniae dan :+ influenHae el na o(haryngeal K21L+ 2urola et al+ (ada tahun 2009 'ena*ar5an (en&ela an yang 'ung5in untu5 hal ini) (a(aran Cylitol 'enurun5an c( 1 ((neu'o3coccal 5a( uler lo5u ) e5 (re i gen/ yang 'engu"ah ultra tru5tur dari 5a( ul (neu'o5o5u K22L+ 0ung5in le"ih rele!an ecara 5lini / 8hari d55+ (ada tahun 1996 dite'u5an dala' (erco"aan aca5 ter5ontrol Cylitol (9+< g,d dala' do i ter"agi B 5ali ehari) 'engurangi ter&adinya O0; e"e ar <1O (9BO CI) </6O 'en&adi BB/<O) K23L+ #elain itu/ le"ih edi5it ana53ana5 yang 'eneri'a anti"ioti5 Cylitol di(erlu5an ela'a 'a a (enga'atan (19/BO ! 29/9O/ P Q 0/032) K23L+ Pada tahun 1999/ 5elo'(o5 yang a'a 'enun&u55an (enurunan <0O dari otiti 'edia (ada (a ien yang 'eneri'a (er'en Cylitol/ (engurangan 30O (ada 'ere5a yang 'eneri'a iru(/ dan (engurangan 20O (ada 'ere5a yang 'eneri'a (er'en Cylitol/ di"anding5an dengan 5ontrol K2<L+ Pada tahun 2000/ 'ere5a le"ih di5uat5an te'uan ini dala' tudi 'elihat (er'en 5aret ! iru( ! 5ontrol dan 'ene'u5an 5ha iat (ada 2 a'(ai 3 "ulan adalah <0O dengan (er'en 5aret dan 30O dengan iru(+ 0enari5nya/ Cylitol tida5 efe5tif (ada ana5 dengan yang teta( ada ta"ung ty'(ano to'yK21L+ 2e"anya5an (enelitian 'enun&u55an "e"era(a 5e"erha ilan Cylitol dala' 'encegah O0;/ ta(i @a(iainen et al+ di"anding5an ca'(uran Cylitol/ ca'(uran 5ontrol/ 5ontrol (er'en 5aret/ (er'en 5aret Cylitol/ dan ta"let hi a( Cylitol di"eri5an ela'a infe5 i aluran (erna(a an ata yang a5tif dan tida5 'ene'u5an efe5 (encegahan untu5 Cylitol dala' "entu5 a(a(un K2BL+ 2e"anya5an (enelitian 'ela(or5an

&ad*al do i B35ali ehari/ yang 5e'ung5inan 'e'"ata i (enuh 5e(atuhan+ 8ntu5 'engata i ini/ :autalahti et al+ 'elihat 3 5ali ehari Cylitol ela'a 3 "ulan (9/6 g,dl di"agi dala' 3 do i ) dan tida5 'ene'u5an efe5 (encegahan dala' 'encegah otiti 'edia K26L+ #elain itu/ Cylitol 'e'ili5i efe5 a'(ing yang u'u' ter'a u5 a5it (erut dan diare/ yang ering 'enye"a"5an 5etida5(atuhan dengan do i ering e(erti itu+

7+ Pro"ioti5 Pro"ioti5 adalah 'i5roorgani 'e yang dici(ta5an untu5 'e'"eri5an 'anfaat 5e ehatan dengan 'enge'"ali5an 5e ei'"angan 'i5ro"a+ ;da "u5ti yang "ertentangan tentang efe5ti!ita (ro"ioti5 dala' 'encegah O0;+ %ala' tudi ter5ontrol ecara aca5 oleh :ata55a et al+ (ada tahun 2001/ B71 ana5 diaca5 untu5 'eneri'a u u dengan atau tan(a Lactobacillus rhamnosus 3 5ali ehari/ B hari e'inggu/ ela'a 7 "ulan+ ;da (enurunan yang ignifi5an dala' &u'lah hari a" en dari (eniti(an ana5 (ada 5elo'(o5 (ro"ioti5 teta(i hanya edi5it 5ecenderungan edi5it 5e arah e(i ode O0; K27L+ %ala' tudi "eri5utnya oleh :ata55a et al+ (ada tahun 2007/ ana53ana5 ecara aca5 'eneri'a 5a( ul (ro"ioti5 atau (la e"o etia( hari ela'a 2< 'inggu+ #e'entara ada &u'lah drop out yang "e ar/ 'ere5a 'ene'u5an (ro"ioti5 tida5 'engurangi ter&adinya 5e5a'"uhan atau otiti 'edia+ 0ere5a &uga 'e'(eroleh a'(el na ofaring (ada 3 titi5 *a5tu dan tida5 'enun&u55an (engurangan adanya #+ (neu'oniae atau :+ influenHae teta(i (ening5atan (re!alen i 0+ catarrhali K29L+ #e"ali5nya/ -oo et al+ (ada tahun 2001 'ela(or5an (enggunaan na al (ray (ro"ioti5 (ada ana53ana5 dan 'ene'u5an efe5 (encegahan (ada O0; dan CO0 (<2O tan(a 5e5a'"uhan (ada 5elo'(o5 (ro"ioti5 ! 22O (ada 5elo'(o5 (la e"o/ P Q 0/02) K29L+ 1aru3"aru ini/ (ada tahun 2009/ #tec5 e ]n31lic5 et al+ 'enun&u55an u u dileng5a(i dengan (ro"ioti5 dan fluoride yang di5on u' i e5ali ehari/ B hari e'inggu/ ela'a 21 "ulan/ 'e'ili5i efe5 (encegahan (ada otiti 'edia (0/< hari otiti 'edia ! 1/3 hari otiti 'edia/ P R0/0B) K30L+ -auta!a et al+ (ada tahun 2009 'e'andang (ro"ioti5 (ada "ayi dengan 'ena'"ah for'ula untu5 "ayi "eru ia 5urang dari 2 "ulan di"anding5an dengan u(le'en (la e"o etia( hari a'(ai u ia 12 "ulan+ ;da (enurunan yang ignifi5an dala'

&u'lah e(i ode otiti 'edia (ada 7 "ulan (erta'a 5ehidu(an (22O ! B0OE ra io ri i5o K--L/ 0/<< K9BO CI/ 0/21/ 0/90L/ P Q 0/01<) dan (enurunan &u'lah anti"ioti5 yang dire e(5an (31O ! 60OE --/ 0/B2 K9BO CI/ 0/29/ 0/92L/ P Q 0/01B) K31L+ .a(oran3la(oran yang aling "ertentangan 'enyoroti 5e"utuhan untu5 (enelitian le"ih lan&ut di daerah ini+ 9+ O teo(ati O teo(ati adalah tera(i "erda ar5an (ada 5on e( "ah*a tu"uh da(at 'enye'"uh5an dirinya endiri "ila dala' hu"ungan tru5tural nor'al/ ling5ungan yang nor'al/ dan 'e'ili5i giHi yang "ai5+ @era(i cranio acral/ ering diguna5an untu5 O0;/ adalah 'ani(ula i tulang dan &aringan dari 5e(ala dan leher untu5 'e'(engaruhi [re tri5 i o teo(ati+\ Pengo"atan 'ani(ulatif o teo(ati (O0@) untu5 O0; ter'a u5 myofascial release/ arti5ula i/ 5e ei'"angan 5etegangan 'e'"ran/ 5e ei'"angan 5etegangan liga'en/ 'e'(er'udah (o i i relea e/ dan (eregangan (ada [daerah re tri5 i+\ %ala' 5o'"ina i dengan anti"ioti5/ (ro edur ini da(at 'engurangi fre5uen i O0; erta 5e"utuhan untu5 ti'(ano to'i di"anding5an dengan anti"ioti5 tan(a O0@ K32L+ #e"uah u&i co"a ter5ontrol ecara aca5 oleh 0ill et al+ tahun 2003 'enge!alua i O0@ dengan (engo"atan otiti 'edia+ ;na53ana5 "eru ia 6 "ulan a'(ai < tahun dengan O0; "erulang diaca5 untu5 (era*atan tandar ( e(erti anti"ioti5) "ai5 dengan atau tan(a O0@ diata 6 "ulan+ Pa ien dala' 5elo'(o5 O0@ 'e'ili5i e(i ode O0; le"ih edi5it (er "ulan (P Q 0/0<) dan 5urang (erlu untu5 ti'(ano to'i (P Q 0/03)+ @ida5 ada (er"edaan dala' (enggunaan anti"ioti5/ 5e(ua an orangtua/ atau ha il (endengaran+ #ayangnya/ ada ting5at dro( out "e ar (2BO)/ 'enga5i"at5an ulitnya 'e'"uat 5e i'(ulan K32L+ 1anya5 (enelitian O0@ 'e'ili5i 5urangnya 5ontrol/ u5uran 5elo'(o5 5ecil/ dan ang5a dro( out yang tinggi K33L+ O0@ lain untu5 otiti 'edia ter'a u5 [?al"reath 'aneu!er\ K3<L+ @e5ni5 [0uncie\ dan ['odified 0uncie\ 'eli"at5an (ene'(atan u&ung &ari di fo a -o en'uller atau (ilar (o terior ton il/ 'a ing3'a ing/ untu5 'e'"u5a ta"ung 4u tachio K3B337L+ 4fe5ti!ita (enelitian di 'a a de(an+ te5ni5 ini hanyalah ane5dot teta(i 'en&a'in

9+ Chiro(ractic Chiro(ractic dida ar5an (ada (rin i( tu"uh da(at 'enye'"uh5an dirinya endiri aat 5erang5a tu"uh "erada dala' 5e elara an yang "enar+ Chiro(ractor 'e'ani(ula i (ening5at5an (er arafan dan fung i ten or !eil (alatini/ yang 'e'"antu 'era*at atau 'encegah otiti 'edia+ >roehle 'engu&i efe5ti!ita dari chiro(ractic di <6 ana5 dengan O0; "eru ia 'a5 i'u' B tahun+ Pa ien di"eri 3 (era*atan (er 'inggu/ 5e'udian 2 (era*atan (er 'inggu/ dan 5e'udian 1 (era*atan (er 'inggu dengan (enghentian (ada titi5 'ana(un 5eti5a orang tua/ do5ter/ atau (ra5ti i chiro(ractic 'engangga( ana5 'e'"ai5+ 2e eluruhan/ O0; terda(at e"anya5 93O/ 7BO dari yang 'e'"ai5 dala' *a5tu 10 hari dan <3O dengan hanya 1 atau 2 (era*atan K39L+ %i 200</ Phang et al+ 'elihat re olu i otiti 'edia (ada 21 ana5 (u'ur 9 "ulan a'(ai 9 tahun) didiagno i dengan O0; (dinilai dari (ena'(ang 'e'"ran ti'(ani dan de'a')+ ;na53ana5 ini dira*at dengan [toftne \ (5e5uatan rendah) (enye uaian chiro(ractic ela'a 1< hari/ dan ecara 5e eluruhan/ 9BO 'e'"ran ti'(ani 5e'"ali nor'al dan (enurunan de'a' 'ere5a+ #ayangnya/ ada 5elo'(o5 5ontrol dan dengan de'i5ian 5e i'(ulan ulit K39L+ >allon K<0L 'eneliti 332 ana5 (u'ur 27 hari a'(ai B tahun) dengan diagno i otiti 'edia (a5ut atau 5roni ) untu5 efe5ti!ita 'ani(ula i chiro(ractic+ ;na53ana5 yang 'e'ili5i O0; (n Q 127) rata3rata < ^ 1/03 (enye uaian dan 'enca(ai te oto co(ic yang nor'al dan ty'(anogra' etelah 6+67 (^ 1/9) dan 9/3B (^2/99) hari/ 'a ing3'a ing+ ;na53ana5 ini &uga 'e'ili5i ting5at 5e5a'"uhan O0; 5e eluruhan hanya 11O dala' 6 "ulan+ Pa ien dengan 5roni O0 di(erlu5an B/0 ^ 1/B3 (enye uaian/ 'enca(ai u&ian oto co(ic nor'al 9/B7 ^ 1/96 hari/ dan 'e'ili5i ty'(anogra' nor'al 10/19 ^ 3/39 hari K<0L+ ;da "e"era(a 5e5ha*atiran ata 5e ela'atan chiro(ractic (ada (o(ula i (ediatri5+ ;na53ana5 'e'ili5i ri i5o cedera a5i"at gera5an rota i yang ce(at atau 5e5uatan chiro(ractor / 5etida5'atangan anato'i tu"uh ana5 itu endiri+ 4fe5 a'(ing eriu ini telah dila(or5an/ e(erti (ara(legia dan 5e'atian K<1L+ #ecara 5e eluruhan/ efe5ti!ita (engo"atan chiro(ractic dala' (engo"atan otiti 'edia

tida5 &ela ignifi5an+

5arena "e"era(a

tudi 'e'ili5i 5e5urangan 'etodologi

yang

10+ O"at cina dan tradi ional Je(ang O"at @radi ional Cina (@C0) 'eli(uti "anya5 'odalita (enye'"uhan/ ter'a u5 a5u(un5tur/ 'oCi"u tion (tera(i (ana )/ ;n'a atau @uina (te5ni5 (e'i&atan 5uno)/ diet/ dan her"al untu5 'enci(ta5an har'oni dan 5e ei'"angan dala' tu"uh+ O"at tradi ional Je(ang (2a'(o) "era5ar (ada @C0+ 2eduanya/ a5u(un5tur dan o"at3o"atan her"al Cina,Je(ang/ di etu&ui oleh Organi a i 2e ehatan %unia e"agai tera(i untu5 'engo"ati CO0 dan O0;+ ;5u(un5tur (ada da arnya 'enci(ta5an 5e5uatan energi tu"uh/ chi/ aliran yang da(at 'e'"lo5ir aru energi/ 5e'udian &aru' 5ecil di'a u55an untu5 'e'(er"ai5i aliran energi+ #e"uah (erco"aan aca5 ter5ontrol (ada an&ing telah 'enun&u55an 5e'an&uran a5u(un5tur di"anding5an dengan tera(i (al u dala' 'encegah otiti 'edia (93O (encegahan ! B0O)+ @iga (uluh atu an&ing dengan otiti 'edia "erulang ecara aca5 dengan (engo"atan 5on!en ional dengan "ai5 ha' a5u(un5tur ter"agi dala' e'(at e i+ #e(an&ang tahun "eri5utnya/ 1< (93O) an&ing dala' 5elo'(o5 a5u(un5tur "e"a dari otiti / di"anding dengan 7 (B0O) (ada 5elo'(o5 ha' (P R0/01) K<2L+ Ia 'enge'u5a5an "ah*a a5u(un5tur 'e'ili5i efe5 i'uno'odulator yang 'ung5in 'e'ain5an (eran dala' (e'"er ihan cairan telinga tengah+ 1anya5 5o'"ina i her"al yang ada dala' (engo"atan tradi ional Cina dan ter'a u5 5o(iah (#cutellaria "aicalen i )/ ;li 'a (;li 'a (lantago3aGuatica)/ (i ang (Plantago 'ayor)/ 1u(leuru' (1u(leuru' Cina)/ dan licorice (?lycyrrhiHa uralen i )+ Penelitian di"ata i oleh u5uran a'(el/ (engaca5an/ dan u5uran ha il/ dan "e"era(a tudi dala' "aha a Inggri + Penelitian (ada he*an yang le"ih "anya5 dengan 'ar'ut/ tu&uannya adalah untu5 'ening5at5an (e'"er ihan 'u5o iliar K<3L dan 'encegah endoto5 in indu5 i otiti K<<L+ 4ryanling 'engurangi infla'a i cairan e5 udat dan (e'"eng5a5an 'u5o a (ada 'ar'ut dan da(at 'ening5at5an i te' 5e5e"alan tu"uh ti5u K<BL+ Pada (a ien ta'(a5 adanya (ening5atan (endengaran teta(i ada (eru"ahan (ola nyeri telinga etelah 'engon u' i 5a( ul UingGiao K<6L+ ;llergina (5o'"ina i dari "anya5 tu'"uhan)

da(at 'enurun5an tanda3tanda otiti

'edia di"anding5an dengan anti"ioti5

e"agai a5i"at dari (eru"ahan dala' (rofil ito5in K<7L+ Penelitian lain telah 'enun&u55an 5ha iat dari @ongGiao K<9L dan "orneol35enari 'inya5 K<9L+ #e5ali lagi/ ini e'ua di"ata i oleh u5uran a'(el/ (engaca5an/ dan u5uran ha il+ 2a'(o/ 'enge!alua i 5etida5 elara an (ada (a ien 'elalui ri*ayat (enya5it dan (e'eri5 aan lidah dan nadi (a ien+ 4fe5ti!ita 2a'(o 'enduga (enye"a" 5enai5an e"agian tran (orta i ion yang 'ele*ati e(itel telinga KB0L+ :er" Ju en3@aiho3to (@J3<9) telah 'e'"u5ti5an (engurangan 5un&ungan 5e ru'ah a5it/ (era*atan anti"ioti5/ dan de'a' dala' 2< "ayi rentan otiti + #etelah (enghentian/ "anya5 yang O0 5a'"uhan/ ta(i ra io turun etelah dion u' i 5e'"aliKB1L+ 11+ @era(i lain ;ro'atera(i dengan e en i la!ender/ cha'o'ile/ 5ayu (utih/ 'inya5 e!ening (ri'ro e/ 'inya5 ra'i/ dan "orage telah diguna5an untu5 'engo"ati otiti 'edia na'un "elu' diteliti dengan "ai5 a'(ai aat ini+ Pengo"atan ;yur!edic/ di5e'"ang5an di India 5uno/ dida ar5an (ada (rin i( 5e ei'"angan+ Pada otiti 'edia/ 5elen&ar getah "ening di luar telinga yang di(i&at untu5 'e'"u5a ta"ung eu tachiu + #ering5ali 'inu'an yang di"uat dengan ra'uan a'la (yang 'engandung !ita'in C dan 'ung5in 'e'ili5i ifat anti!iru ) di"eri5an+ 12+ -ing5a an dan aran 0enurut ;;>P dan ;;P/ 'ana&e'en O0; di'ulai dengan (enga*a an 5etat+ O"at tete telinga her"al da(at 'e'"antu 'eringan5an ge&ala+ Pengo"atan ho'eo(ati da(at 'e'"antu 'engurangi ra a a5it dan 'enye"a"5an re olu i ce(at+ Pencegahan haru dite5an5an (ada (engha(u an fa5tor ri i5o e(erti 'en&adi (ero5o5 (a if dan (e'"erian u u dengan "otol/ erta 'en&aga nutri i dan !a5 ina i+ O teo(ati dan chiro(ractic da(at 'enye"a"5an (er"ai5an ge&ala/ na'un/ la(oran 5a u 'eragu5an 5ea'anan dari 'etode ini+ #u(le'en !ita'in da(at 'e'"antu+ Pro"ioti5 dan Cylitol da(at "er'anfaat &uga+ %ari e'ua tera(i C;0/ hanya Cylitol telah di(ela&ari yang dirancang dengan "ai5/ aca5/ (erco"aan

"uta/ 5e'ung5inan efe5tif teta(i "ata 5e(atuhan (enera(annya (erlu du&i5an 5e'"ali+ @era(i tradi ional Cina,Je(ang 'enun&u55an ha il yang 'en&an&i5an/ ta(i 'ere5a u'u'nya "elu' die!alua i dala' dou"le3"lind/ aca5/ tudi ter5ontrol dan dengan de'i5ian teta( (e5ulatif+ 2onfli5 5e(entingan @ida5 ada 5onfli5 5e(entingan yang ada dari (enuli + .a'(iran ; Pada tahun 200</ e"agai "agian dari (edo'an 'ere5a/ ;'erican ;cade'y of Pediatric dan ;'erican ;cade'y of >a'ily Phy ician / (enga'atan yang dire5o'enda i5an (ada (a ien O0; yang di(ilih) 6 "ulan a'(ai 2 tahun) (enya5it yang tida5 (arah dan dengan diagno i (a ti 2 M tahun) (enya5it yang tida5 (arah atau dengan diagno i (a ti Ji5a ge&ala tida5 ter ele ai5an dala' 2<3<9 &a'/ (a ien 5e'udian haru dio"ati dengan anti"ioti5+ .a'(iran 1 %aftar o"at ho'eo(ati yang u'u' diguna5an untu5 'engo"ati 5ondi i otiti 'edia+ 7 o"at yang (aling ering diguna5an+ 7 aconitu',aconite,aconitu' na(ellu ) untu5 nyeri telinga "erdenyut yang datang ti"a3ti"a etelah ter(a(ar dingin atau angin dan (ada ana5 dengan de'a' tinggi dan yang telinga 'erah terang atau dengan entuhan le'"ut+ 1ai5 (ada taha( a*al infe5 i telinga+ 7 "elladonna) untu5 nyeri teinga "erdenyut dan nyeri yang di ertai de'a'/ (ana tinggi/ dan di ira' di telinga luar dan e(an&ang i i *a&ah+ 1e"era(a 'enyaran5an le"ih "ai5 untu5 telinga 5anan+ Ini "era al dari e5 tra5 dari tana'an "eracun dari 5eluarga night hade dan haru diguna5an dengan hati3hati+ 7 ca( icu') untu5 (a ien dengan (ana tinggi/ (eradangan/ dan nyeri yang ignifi5an+

7 cha'o'illa) untu5 ana53ana5 dengan otiti ter inggung/ 5e a5itan/ dan dihi"ur+

'edia yang

angat 'udah

>erru' (ho (horicu') Pada otiti 'edia a*al/ ini adalah o"at u'u' yang diguna5anE on et "ertaha(/ *a&ah (a ien 'e'erah/ e(erti 5e"i ingan/ ingin elalu "er"aring+ :e(ar ul(huricu') Ayeri (ada telinga teruta'a dengan 'enelanE di charge hi&au 5e5uningan/ angin atau 'enegu5 'e'(er"uru5 ra a a5it+ 2ali 'uraticu') uara letu an dan uara "erdera5 terdengar di telinga aat 'enelan dan dengan 'eniu( hidung/ 'endengar 'ung5in a5an 'enurun/ 'era a 5enyang dan 5e'acetan di telinga+ Juga diguna5an untu5 'e'"er ih5an tu"a eu tachiu 5eti5a cairan "erlan&ut etelah O0;+ .yco(ediu') 8ntu5 a5it telinga 5anan3 i i yang le"ih "uru5 di ore hari/ telinga tera a (enuh/ dering atau "erdengung (ada telinga+ 0agne ia (ho (horica) a5it telinga/ teruta'a etelah ter5ena angin dingin dan 'enegu5 'inu'an+ 0ung5in tida5 infe5 i a'a e5ali/ ta(i irita i araf/ telinga 5anan le"ih "ai5 dari 5iri/ nyeri "er5urang dengan 'enggo o5+ 0ercuriu ) 1ai5 untu5 infe5 i telinga 5roni / 5arena ra a a5it yang 'e'"uru5 di 'ala' hari dan da(at 'e'(er(an&ang hingga 5e dala' tenggoro5an/ a5it telinga da(at ter&adi 5eti5a (eru"ahan le'"a" atau 5a"ut atau cuaca ter&adi/ 'ung5in air liur atau "er5eringat+ 7 Pul atilla) 8ntu5 infe5 i etelah ter(a(ar cuaca dingin atau le'"a"/ telinga ering 'erah dan lendir 5e5uningan,5ehi&auan dari telinga atau hidung/ a5it telinga 'ung5in 'e'"uru5 etelah tidur dan dengan 5ehangatan/ da(at diata i dengan 5o'(re dingin+ #ilica) 8ntu5 infe5 i taha( 5roni atau ore hari aat ana5 'era a dingin/ le'ah/ dan lelah/ 5eringat &uga da(at ter&adi+ $er"a cu') @eruta'a otiti tenggoro5an &uga+ .a'(iran C %aftar (rodu5 5e ehatan ala'i yang u'u' diguna5an untu5 'engo"ati otiti 'edia+ Cha'o'ile (0atricaria 5a'o'il)) :al ini diangga( 'e'ili5i ifat 'edia i i 5iri/ 'ung5in "atu5 atau radang

anti!iru dan telah diguna5an untu5 "ayi/ gangguan (encernaan/ dan diare+ >ra5 i 'inya5 diya5ini 'e'ili5i ifat anti3infe5 i/ edang5an fla!onoid diangga( anti3 infla'a i+ ;da edi5it "u5ti untu5 diguna5an dala' otiti 'edia+ do i (133 '. tiga 5ali ehari/ "ayi) 133 tete ,l" "erat "adan tiga 5ali ehari) dan teh (1 cang5ir air 'endidih ela'a 1 d')+ 2adang35adang (a ien yang alergi terhada( itu+ Parang) %iguna5an untu5 'e'"antu li'fati5 (e'"er ihan ge&ala i a ela'a O0; atau otiti 'edia dengan erou + %o i 0/B32 '. tiga 5ali ehari+ @eh &uga diguna5an) 1 cang5ir dua atau tiga 5ali ehari+ Cod .i!er Oil) #e"uah u'"er o'ega33 a a' le'a5 dan !ita'in ; dan %+ Ini telah 'enun&u55an "ah*a (a ien dengan otiti 'edia "erulang 'e'ili5i ting5at rendah "e"era(a o'ega33 a a' le'a5/ !ita'in ;/ dan eleniu'+ 2e ela'atan 5on u' i &ang5a (an&ang 'inya5 i5an cod tida5 di5etahui/ (enelitian telah 'enun&u55an efe5 "uru5 5e ehatan dari (olychlorinated (olychlori3 ter5onta'ina i dan re idu dio5 in dite'u5an dala' 'inya5 i5an+ 4chinacea (4chinacea (ur(urea)) ;5ti!ita ini diya5ini a5ti!a i non (e ifi5 i te' 5e5e"alan tu"uh (ter'a u5 'enga5tif5an el (e'"unuh ala'i dan 'a5rofag dan 'ening5at5an ting5at ir5ula i interferon alfa)/ na'un ada "e"era(a "u5ti "ah*a e ter caffeic anti"a5teri dan anti!iru dan (olyacetylene yang diduga "a5terio tati5+ :al ini (aling ering diguna5an untu5 (engo"atan infe5 i aluran (erna(a an ata / teta(i tida5 di(ela&ari dengan "ai5 untu5 otiti 'edia 5hu u nya+ %o i echinacea) "ai5 dala' al5ohol atau glycerite / ter edia+ ;na53ana5) 13B '. tiga a'(ai li'a 5ali ehari/ "ayi) 1 atau 2 tete ,l" "erat "adan tiga 5ali ehari+ @a"let/ 5a( ul/ dan ra'uan dia'"il e"agai teh atau infu &uga diguna5an ecara oral+ 4lder =o*er,"erry (#a'"ucu nigra)/ 4ro(a alder (#a'"ucu canaden i )/ atau ;'eri5a (enatua (Ca(rifoliaceae)) %iguna5an (ada e5ret hidung "erle"ihan/ &uga 'e'ili5i a5ti!ita anti!iru / ter"ai5 untu5 O0;/ teruta'a &i5a terda(at infe5 i aluran (erna(a an+ %i'inu' 0/B33 '. 3 5ali ehari+ @eh &uga diguna5an) 1 cang5ir dua atau tiga 5ali ehari+ 4leca'(ane root (Inula heleniu')) a5ti!ita "a5terio tati5 dan anti!iru dan da(at 'e'(er5uat 5etahanan la(i an 'u5o a+ %a(at diguna5an (ada otiti 'edia ero a O0; atau 5roni + %o i 0/B32 '. tiga 5ali ehari+

4ucaly(tu ) "ia anya e"agai inhala i ua( dan diguna5an teruta'a di tadiu' a5hir O0;+ ?olden eal (:ydra ti canaden i )) %iguna5an hanya ela'a O0; 5eti5a di ertainanah+ %o i 0/B32 '. tiga 5ali ehari+ 0ar h'allo* (;lthea officinali )) %iguna5an untu5 'enenang5an ela(ut lendir 'eradang dan 'e'"antu 'elonggar5an dan 'ele'"a"5an lendir te"al+ Pada otiti 'edia/ diguna5an teruta'a untu5 'e'"antu 'e'"u5a tu"a eu tachiu + %o i ) 1 tete (er 2 5ilogra' "erat "adan ( a'(ai 2 '.) 336 5ali ehari+ -e"u an) 1 d' a5ar dire"u dala' 1 gela air untu5 10 'enitE 1 a'(ai 3 d' cairan dia'"il dua a'(ai ena' 5ali ehari+ Ji5a 'enga'"il dengan o"at re e(/ 'enga'"il o"at etida5nya 1 &a' e"elu' atau 2 &a' etelah 'enga'"il a5ar 'ar h'allo* 5arena ra'uan da(at 'engurangi (enyera(an o"at+ 0ullein ($er"a cu' @ha( u )) 0engurangi lendir dan 'e'(er5uat 'u5o a (erna(a an dan "ertinda5 ecara to(i5al e"agai anti infla'a i lo5al+ :al ini da(at diguna5an e"agai 'inya5 telinga to(i5al untu5 otiti e5 terna+ 8ntu5 otiti 'edia/ ia di(ilih untu5 'e'"u5a "lo5ir tu"a eu tachiu dan untu5 'engurangi (eradangan+ do i ) 1 tete (er 2 5ilogra' "erat "adan etia( < &a'+ @eh) 132 dt ra'uan,cang5ir air 'endidih/ dicelu(1031B 'enit/ 13< cang5ir (er hari+ 8 nea (8 nea "ar"ata)) 0e'ili5i ifat anti!iru dan anti"a5teri/ diguna5an ela'a e(i ode a5ut otiti 'edia+ %o i ) 0+B3B '. tiga 5ali ehari+ Sylitol) %iguna5an e"agai (e'ani "uatan dala' (er'en 5aret dan telah ter"u5ti da(at 'engha'"at (ertu'"uhan #tre(tococcu (neu'oniae dengan 'engu"ah ultra tru5tur dari 5a( ul "a5teri+ 1anya5 (enelitian 'enun&u55an efe5ti!ita Cylitol ((er'en 5aret V iru() dala' 'encegah otiti 'edia 5eti5a di"eri li'a 5ali ehari+ :al ini da(at 'enye"a"5an a5it (erut dan 'encret/ yang 'engarah 5e ting5at dro( out yang "e ar dari "anya5 (enelitian dan 5e ulitan 'enari5 5e i'(ulan yang "erarti+ :al ini &uga 'encegah 5arie gigi+