Osteopathy: Playing it by Ear..

Posted on March 15, 2011

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Playing it by ear certainly seems to be the way some (but by no means all) osteopaths  view the evidence for treating Otitis Media, particularly in the way it is advertised on many websites.

The latest edition of  The Osteopath has a couple of very interesting articles. One called Encouraging Advertising Standards (pg 6), gives (yet more) guidance on advertising regulations and says that the GOsC will be conducting a review of websites to advise where changes may need to be made.

There is also an interesting evidence based article produced by NCOR (National Council for Osteopathic Research) on osteopathy as a treatment for Otitis Media (pg 13-18).  This would appear to be the first of a number of articles covering the evidence base for a range of childhood conditions often seen and treated by osteopaths.  Another very positive move!

Not only does this NCOR article discuss the available evidence, but it briefly covers the evidence hierarchy and the standards of evidence required by the ASA.

The article gives a description of Otitis Media (including the different types) and links to a number of studies on the subject. The research items listed range from RCT’s to Case Reports and also some letters and editorial content. I acknowledge that NCOR state this in not an exhaustive list and only includes research from 1990 onwards.

Otitis Media is often referred to as ‘glue ear’ or simply ‘ear infections’.

A number of problems are reported with the design or methodology of these studies, including the RCT’s. These problems include a lack of control group, lack of blinding and high drop out rates.

None of the studies listed would seem to reach the standards required to support treatment claims and indeed the article does not state that any are. I think it is safe to assume that if NCOR had found any robust evidence of the required standard, they would have made it known.

NCOR are still conducting a literature/evidence review, so there is the possibility (however remote) that something robust will turn up.

Lacking any reliable evidence, the important parts of this article from an osteopathy/evidence/treatment point of view are the following statements: (in all cases Bold emphasis added by myself)

(Page 13)

“While most cases of OME will resolve spontaneously, some children will need intervention because of the effects of hearing loss. This intervention may take the form of educational and social action or the provision of a hearing aid to minimise the impact of the hearing loss. No non-surgical intervention has yet been shown conclusively to be of benefit.

OME = Otitis Media with effusion.

Worth noting the comment that most cases of OME will resolve spontaneously.  However it is always worth seeking properly qualified medical advice (your GP).   It also states the view taken by NICE..

(page 18)

“Despite the evidence reviewed above, the NICE guidelines quoted do not recommend the use of a range of non-surgical treatments for the management of otitis media with infusion. These treatments currently include antibiotics; topical or systemic antihistamines; topical or systemic decongestants; topical or systemic steroids; homeopathy; cranial osteopathy; acupuncture; dietary modification, including probiotics; immunostimulants; and massage”.

It is worth noting the list of other conventional and CAM treatments that are not recommended to treat this condition. (antibiotics, homeopathy etc)

The NICE document it referred to can be found HERE, it contains a flow chart for assessing Otitis Media and suggesting treatments.   FLOW CHART

It also includes the following statement:

So having read the article, I don’t think it is unfair or biased of me to say that there would appear to be a lack of robust evidence to support any claims that Osteopathy should be offered as a treatment for Otitis Media.  However it remains one of the most common conditions advertised on Osteopathy websites.  It is quite clear that unless individual osteopaths are aware of research that has not been covered and meets the required standard, these claims should not appear on websites or other advertising literature.

A quick Google search on osteopathy and Otitis Media, glue ear, ear infections etc shows just how common these claims are.

Hopefully the NCOR series of evidence articles, the GOsC’s move to review website content and an increasing understanding of the ASA’s extended remit will see these claims diminish.

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Posted in: ASA, Osteopathy