References:

1. Use of Osteopathic Manipulative Therapy for the Treatment of Acute Otitis Media in the Emergency Department and Effect on Duration of Illness. Poster by Patrick Connolly DO, Jory Bulkley DO and Joseph Dougherty DO Introduction Results The results of this study are disappointing. During the period of October 2012 through March of 2014 a mere 27 patients were enrolled. Of these patients 1 had to be dropped from the results analysis due to age exceeding the study requirements upon enrollment. Amongst the total patients enrolled in the study, none of the patients completed the attached symptom tracker scoring sheet. Amongst the patients whom received OMT, 15% completed their survey. The clinical symptoms from the ER documentation showed ear pain and fever as the most common symptoms with fussiness, feeding difficulties, and sleep problems found less consistently at no more than 16%. Most common documented HEENT finding by the ER physician was erythema of the tympanic membrane. Antibiotics were commonly prescribed in this study at a staggering 88%. Amoxicillin served as the drug of choice taking in 50% of the cases with Azithromycin second most popular. Otitis media is the most common bacterial infection diagnosed in children.8-9 Estimated annual costs exceed 5 billion dollars.10 This illness is most common between the ages of 6 months and 6 years. During these years it is hypothesized that the anatomy of the middle ear may be a predisposing factor to the infection. Some studies lend evidence to Eustachian tube dysfunction as the underlying problem leading to otitis media.11,12 There are many factors that are believed to play a role in the pathogenesis of otitis media, but it appears that dysfunction of the Eustachian tube may be most amenable to osteopathic manipulative therapy. Osteopathic physicians have numerous years of anecdotal reports of successfully using (OMT) to manage many childhood illnesses, including otitis media.7 Traditional therapies have focused on the use of antihistamines, antibiotics, steroids and surgery as the solution to this painful and costly disease. These therapies have wide range of therapeutic efficacies while still exposing the patient to the expense and possible adverse complications of each medication or procedure. The Galbreath technique was first described in 1929 by osteopathic physician Dr. William Galbreath. This technique is simple, safe and theoretically sound in its proposed mechanism of treatment. By gently manipulating the mandible, a lymphatic pump of sorts is stimulated aiding the primary drainage path of the middle ear and Eustachian tube.2 In the present study, we hypothesized that the Galbreath technique may speed recovery of the patient and be useful to the parent in comforting children with acute otitis media symptoms. Discussion It is important for patients to feel as though they are well serviced and comfortable with instruction of the ER physician as this is commonly the difference between treatment success and bounce back to the department. The willingness of the patients to learn and recommend treatments to a friend may help to foster the use of Osteopathic manipulative techniques as an alternative to routine antibiotic usage in the treatment of acute otitis media. Average number of treatments performed by the parents numbered 2.5 in total duration of the illness. This number is small and consistent between the two patients. This may indicate that the addition of the OMT to the already recommended therapies will result in expedited treatment success. Major limitations include patient compliance, too numerous data points, reliability of follow-up, heavy antibiotic usage and need for standard physical exam data points. The present study suffered from a drastic drop out rate in the patient population in spite of follow-up efforts. This type of study was very difficult to complete well in the ER clinical setting and the lack of reviewable data limited the conclusions and the utility. Findings suggest re-evaluation of design and continued research into use of Osteopathic Teachings as a supplemental in home therapy would be beneficial to the patients’ health and the education of the community. Materials/Methods Children ages 6 months to 6 years who presented to the emergency department with complaints consistent with AOM(ear tugging, fever, decreased oral intake, difficulty sleeping, fussiness) or whom were given a diagnosis of AOM were included in the study. Alternating patients received either recommended therapy by American Academy of Pediatrics or the same therapy combined with the Galbreath. Antibiotics were at discretion of the physician. All residents and attendings received training on the proper diagnosis of AOM and instruction on Galbreath Technique. Parents were given personal instruction, paper instruction and Youtube video link of authors performing the Galbreath Technique. Parents were given symptom tracker scoring sheet to log patient recovery and Galbreath Technique survey to complete on their experience. Pre-addressed and stamped envelopes were enclosed for ease of return. Call backs were scheduled at 1 week post ER visit to answer questions and encourage compliance. References: 2. Harrington DP. Galbreath Technique: a manipulative treatment of otitis media revisited. JAOA. 10/2010;Vol100.No10 7. Magoun HI. Osteopathy in the Cranial Field. 3rd ed. Kirksville,Mo; Journal Printing Co; 1976 8. Ruuskanen O, Heikkinen T. Otitis media: etiology and diagnosis. Pediatr Infect Dis J 1994;13:S23-26 9. Agency for Health Care Policy and Research. Otitis Media with Effusion in Young Children. Rockville, Md: US Department of Health and Human Services, 1994 10. Bondy J, Berman S, Glazner J, Lezotte D. Direct expenditures related to otitis media diagnosis: explorations from a pediatric Medicaid cohort. Pediatrics. 2000;105:E72 11. Sakurai T, Rokugo M. Pathophysiology of otitis media with effusion: clinical evaluation through some qualitative methods. Auris Nasus Larynx 1985;12:S111-S113 12. Wright CG, Meyerhoff WL. Pathology of otitis media. Ann Otol Rhinol Laryngol Suppl 1991;103:24-26