{"id":10947,"date":"2025-10-02T14:54:52","date_gmt":"2025-10-02T11:54:52","guid":{"rendered":"https:\/\/www.atlasterapi.com\/en\/?p=10947"},"modified":"2025-10-02T15:01:06","modified_gmt":"2025-10-02T12:01:06","slug":"use-of-osteopathic-manipulation-techniques-for-management-of-acute-otitis-media-middle-ear-infection-in-pediatric-patients-a-scoping-review","status":"publish","type":"post","link":"https:\/\/www.atlasterapi.com\/en\/use-of-osteopathic-manipulation-techniques-for-management-of-acute-otitis-media-middle-ear-infection-in-pediatric-patients-a-scoping-review\/","title":{"rendered":"Use of Osteopathic Manipulation Techniques for Management of Acute Otitis Media (Middle Ear Infection) in Pediatric Patients: A Scoping Review"},"content":{"rendered":"

Abstract<\/h3>\n
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Objective<\/h4>\n

To map and summarize the existing literature on the use of osteopathic manipulative techniques (OMT) in the management of acute otitis media (AOM) in pediatric patients, with an emphasis on reported outcomes and identifying gaps in the current evidence.<\/p>\n

Data sources<\/h4>\n

CINAHL, PubMed, and SCOPUS.<\/p>\n

Review methods<\/h4>\n

A comprehensive literature search was conducted across multiple databases following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Studies were charted and summarized based on key characteristics, including study design, population, types of OMT applied, and reported outcomes on management of AOM and recurrent AOM in pediatric patients using OMT. No formal meta-analysis was performed, and all outcome measures were descriptively synthesized.<\/p>\n

Results<\/h4>\n

Three randomized controlled trial (RCT) studies and one pilot cohort study (N<\/i>\u2009=\u2009205) pertaining to application of OMT in pediatric patients with otitis media were included. Mean age for OMT and control (either sham OMT or standard of care) groups were 19.1 months and 16.8 months; proportions of males were 53.2% and 55.9%, respectively. In the pilot cohort study done by Degenhardt and Kuchera, 62.5% of the subjects experienced no documented recurrence of AOM symptoms at one year post-OMT intervention follow-up; however, since no control group was available for this study, any statistical comparison of recurrence-free rate was unfeasible. In the RCT study by Mills et al., the OMT group showed statistically significant effects on reducing frequency of mean monthly AOM episodes, resulting in fewer surgical procedures, delaying surgical interventions, increasing resolution of middle ear effusion and better tympanogram readings based on mean sum of types A and C tympanograms, and higher parental satisfaction with overall experience and perceived effectiveness of the OMT on their children on a scale of 0 to 5 when compared to the control group. While statistical interpretation showed some significance in various aspects, OMT\u2019s clinical significance remained questionable, especially considering natural course of healing in AOM. In the other RCT study by Steele et al., at the second-week visit during the 3-week OMT intervention period, the OMT group showed a significantly higher likelihood of middle ear effusion resolution based on tympanogram findings and acoustic reflectometer measurements, respectively. However, at one month follow-up visit, there was no statistical significance, alluding to the limited effects of OMT. Finally, in the last RCT study by Whal et al., the OMT group failed to show any significant effects on prevention of recurrence of AOM.<\/p>\n

Conclusion<\/h4>\n

Current literature on the use of OMT for acute and recurrent otitis media in pediatric patients suggests, with low certainty, that OMT may provide modest benefits in reducing recurrence rates and improving middle ear function. However, the existing evidence is limited in scope and quality. Further research with larger sample sizes and rigorous randomized controlled trial designs is needed to better understand the potential role of OMT in the management of AOM in pediatric patients.<\/p>\n<\/div>\n

Original Source:<\/strong> Kim, Cs., McCray, L.R., Nguyen, S.A. et al. Use of osteopathic manipulation techniques for management of acute otitis media in pediatric patients: a scoping review. Eur Arch Otorhinolaryngol (2025). https:\/\/doi.org\/10.1007\/s00405-025-09492-9<\/a><\/p>\n

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Introduction<\/h3>\n
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Osteopathic manipulative treatment (OMT) is a holistic approach to patient care that involves physical manipulation of the musculoskeletal and lymphatic systems to facilitate diagnosis and treatment of various medical conditions. This non-invasive therapy is based on the principle that the body has the inherent ability to heal itself, and OMT aims to optimize this process by addressing underlying structural and functional imbalances. Although children\u2019s developing anatomy differs from that of adults, OMT has been found to be safe and well-tolerated in both pediatric and adult populations [1<\/a>].<\/p>\n

However, evidence regarding the effectiveness of OMT in treating various pediatric conditions has been mixed. A recently published systematic review and meta-analysis on the use of OMT for pediatric conditions concluded that while the quality of trials has improved in recent years, the effectiveness of OMT for the studied conditions remains unproven due to the overall low quality of the available evidence [1]. This underscores the need for more high-quality research to better understand the potential benefits of OMT in the pediatric setting.<\/p>\n

Among various illnesses that affect children, acute otitis media (AOM) is the most common diagnosis during sick visits and a leading cause for antibiotic prescriptions in the pediatric population [1,\u00a02,\u00a03,\u00a04]. Its incidence peaks between six and 15 months of age, and up to 85% of children will have experienced AOM by three years of age [3]. Given the substantial morbidity associated with AOM and the increasing need for antibiotic stewardship, exploring complementary treatment modalities such as OMT becomes increasingly important. Children are particularly vulnerable to AOM due to the horizontal orientation of their eustachian tubes, which can hinder proper drainage and facilitate fluid accumulation in the middle ear; additionally, somatic dysfunctions of the temporal and sphenoid bones, along with tension in the pharyngeal muscles surrounding the eustachian tube, may also contribute to the development and recurrence of AOM [5]. OMT has the potential to address these underlying anatomic factors, potentially reducing the duration and recurrence of AOM.<\/p>\n

This scoping review aims to investigate the effectiveness of OMT on various clinical outcomes in the management of AOM and recurrent AOM in pediatric patients. The review will synthesize existing literature to evaluate the impact of OMT on symptoms, recurrence rates, and other clinical measures, ultimately aiming to identify gaps for future research in this area and assess potential role of OMT in management of AOM in pediatric patients.<\/p>\n<\/div>\n<\/div>\n<\/section>\n

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Materials and methods<\/h2>\n
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This comprehensive scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines and followed the five-stage framework outlined by Arksey and O\u2019Malley [6,\u00a07]. A preliminary search of PubMed, Scopus, and CINAHL was conducted, and no current scoping reviews on the topic were identified.<\/p>\n

Identify reseach question<\/h3>\n

This scoping review sought to investigate the potential role of OMT on AOM management in pediatric population. Furthermore, we want to highlight the clinical importance of the limitations in the current literature, as well as identify gaps in the current literature.<\/p>\n

Identify relevant literature<\/h3>\n

A systematic search was conducted with PubMed (US National Library of Medicine, National Institutes of Health), SCOPUS (Elsevier), and CINAHL (EBSC) on 19 July 2024, using the following keywords: osteopathic medicine; osteopathic manipulation; osteopathic manipulation technique; osteopathic manual manipulation; otitis media; ear diseases; effectiveness.<\/p>\n

All articles from the search were exported into Covidence (Veritas Health Innovation Ltd., Melbourne, Australia), the review management software, for screening. All identified citations were collated and uploaded in EndNote X20\/2021 (Clarivate Analytics, Philadelphia, PA, USA).<\/p>\n

Study selection<\/h3>\n

This study aimed to identify all published reports relevant to the use of OMT on treatment and prevention of AOM in children. The population of interest was pediatrics (<\u200916 years). This scoping review considered randomized controlled trials, non-randomized controlled trials, prospective and retrospective cohort studies, prospective and retrospective chart reviews, case\u2013control studies, and case series studies. Review articles were assessed but not included in the reporting of quantitative data to avoid redundancy. Other exclusion criteria were adults\u2009>\u200916 years, study protocols, and incomplete or inaccessible articles.<\/p>\n

Search process<\/h4>\n

This review was conducted in compliance with PRISMA-ScR scoping review methods [6]. The initial search yielded 341 reports with the removal of 39 duplicates. The remaining 302 titles and abstracts were screened by two independent reviewers (CHK and LRM) for assessment against the exclusion criteria, and conflicts were resolved by a third party (SAN). There were 22 full-text studies assessed for eligibility, with 18 being excluded at the full-text stage for only including adult population, wrong study design consisting of reviews and editorial letter, and full text being unavailable. Four full-text screenings were completed independently by the same reviewers (CHK and LRM) and any disagreements were resolved through discussion. The results of the study inclusion process are presented in a PRISMA-ScR flow diagram.<\/p>\n

Charting the data<\/h3>\n

Data extraction and level of evidence<\/h4>\n

Data extraction from the four reports included was performed by two independent reviewers (CHK and LRM) and any disagreements were resolved through discussion. The data extracted from reports included author; year of publication; study design; patient demographics, such as age and gender; recurrence of AOM; frequency of episodes of AOM; antibiotic use; surgical interventions; tympanometric, audiometric, and acoustic reflectometer readings; and resolution of somatic dysfunctions in entire body, including thoracic, rib, and cranial regions. When available, other relevant data, such as quality-of-life measures, duration of otorrhea, duration of otalgia and fever, language skills, and parental satisfaction of overall care were also extracted. In addition, all included reports were critically appraised to assess the level of evidence using the Oxford Center for Evidence-Based Medicine criteria [8].<\/p>\n

Collating, summarizing and reporting results<\/h3>\n

Review results are presented through descriptive statistics (frequency (%), mean\/median, and range\/95% confidence interval (CI)) of included studies and a narrative summary of findings. Implications of the analysis are then discussed.<\/p>\n<\/div>\n<\/div>\n<\/section>\n

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Results<\/h3>\n
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Publication characteristics<\/h3>\n

The four studies included were one pilot cohort study (N<\/i>\u2009=\u20098) and three randomized control trials (RCTs) (N<\/i>\u2009=\u2009197) published between 2003\u20132014 [9,\u00a010,\u00a011,\u00a012]. A PRISMA diagram outlining our search is provided in Fig.\u00a01. Descriptions of the individual studies and selected patient characteristics can be seen in Table\u00a01.<\/p>\n<\/div>\n<\/div>\n<\/section>\n

…<\/p>\n

Fig 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (\u2018PRISMA\u2019) diagram<\/h3>\n

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