The present impasse creates the opportunity and the obligation for anyone with a better idea to share it with the medical community and the general public. Nobody need take my word for it that homeopathic remedies are inexpensive, nontoxic, and effective even in advanced cases, or that parents, children, and their caregivers deeply appreciate the non-invasive philosophy governing their use. I will feel generously rewarded if more laypeople and professionals will only try them and see for them-selves.

The following cases of childhood ear infections are intended to show how the homeopathic viewpoint can assist both clinically, in the diagnosis and treatment of these all-too-common ailments, and in the design of ex-perimental research into the causal factors that promote and influence them.

The cases that I have chosen are noteworthy not for any particular skill in choosing the correct medicine, but in precisely the opposite sense, that excellent results are regularly attainable with common remedies and case-taking methods already well known to the serious student. Indeed, the exemplary success of homeopathic remedies in treating such children is itself an important clue to the mystery of pediatric otitis media in our time.

Case 1. C. Z., a girl of 3, had had recurrent ear infections since the age of 5 or 6 months, typically associated with colds and the production of thick, green mucus, and requiring antibiotics more or less continuously for several months at a time. With no fever and at most a slight earache, she often became irritable and cranky as the cold ended, when the pediatrician often made the diagnosis by otoscope. Apart from mild eczema, the child was seldom ill other-wise, and rarely had the fevers or acute illnesses to be expected at her age. A strapping 8 lb. at birth, she fell short of 16 lb. at 1 year and had remained small for her age. Teething was late, painful, and difficult. She had had all the usual vaccines with no acute reaction.

I chose Calcarea Sulph.. 200, and two months later her mother reported the best winter ever, with no ear infections and two light colds that were quickly aborted with Calc. Sulph. 12C. I next saw her a year later, several weeks after an acute episode of wheezing in the middle of a cold, for which Pulsatilla 30X prescribed over the phone had worked splendidly. But though she had been free of ear infections in all that time, she had had a fever or two and was still plagued by quantities of thick greenish-yellow phlegm in her nose and throat. After one dose of Sulphur 200, she never came back. When I called recently, over five years later, in preparation for this talk, her mother told me that she had had no more ear infections, and there was no need to bring her back, since her general health had remained good, and the usual first-aid remedies had been very effective for the usual colds, fevers, and URI's that had developed along the way.

I want to add a few comments about this rather typical case. First, as I reread it now, I doubt that either Calc. Sulph. or Sulphur was the best remedy for this patient, since she was on the chilly side, and even after treatment she continued to produce thick green phlegm and be subject to rather frequent colds. I can't really defend or explain either prescription at this point. Yet her mother was more than satisfied. The ear infections disappeared and never came back, the long-term or constitutional issues stayed in the background, and the remedies she herself came up with continued to help without further assistance.

Notwithstanding the small remedies and "cured" cases that we like to parade at our conferences, I must admit that the bulk of my reputation is built on stories as generic and unspectacular as this one. I feel deeply grateful to a method that adds feathers to my cap even when I bumble or fall short.

Second, my experience confirms numerous reports in the European literature that most kids eventually outgrow their ear infections anyway, if simply allowed to do so without further allopathic interference. [note 6]

Case 2. K. G.-S., a boy of 16 months, had already had five ear infections and five rounds of antibiotics when I first saw him. Only the first episode at six months was associated with fever (102.8? F.) and acute earache, which subsided promptly once the eardrum had perforated and discharged the pus that had accumulated behind it. Although weighing 7 lb. and appearing normal and healthy at birth, he was slow to nurse, fell behind in his gross motor development, had considerable discomfort with teething, and weighed only 20 lb. by the time I first saw him. His only other complaint was a chronic diarrhea that began on antibiotic treatment and had never gone away. Despite intense, prolonged crying after the first and second DPT's, the third was uneventful, as was the MMR.

One month after Sulphur 10M, his mother reported that the diarrhea had worsened, becoming acute the first week after the remedy, but that, ever since a fever of 103? F. on the third day, his highest so far, he had had no symptoms of a cold or ear infection at all. Because of the diarrhea, I gave him Calc. Carb. 10M, and by the next visit, two months later, he was well, and had made good pro-gress developmentally, with no ear infections, one brief cold for which Calc. Sulph. 12C worked well, and no more diarrhea.

I did not see him again for more than a year, four months after an episode of acute otitis with no earache but a fever of 103?F. that had lasted a full week on antibiotics. Apart from a few colds and a reappearance of diarrhea at these times, he had had no more ear infections and was continuing to grow and develop normally. Repeating Sulphur 10M, I had no further news of him until I asked my receptionist to call recently, more than five years later, and learned that he had been healthy, had had no ear infections, and needed no antibiotics throughout that time. After buying a remedy kit and studying on her own, the mother had found Belladonna to be highly effective for his various colds and acute illnesses, and no longer needed my help.

Once again, not for any elegant prescribing on my part, much less from any notion that the child was "cured," I treasure cases like this one,because our work together helped the mother to take charge of her son's health, and to perform competently in that role. When my own learned prescriptions fail, as they not seldom do, I have good reason to feel proud when the parents themselves find the remedies that work best for their child. Perhaps the most precious gift that homeopaths can offer is our relationships with our patients, which can continue to grow and flourish even when the search for the ideal remedy proves elusive.

Case 3. J. L., a girl of 6, had had frequent ear infections since the age of five months, especially when exposed to other kids in crowded day care or classroom settings. With little fever and no earache, the acute episodes were typically mild, with red cheeks, loss of appetite, and grumpy or irritable behavior. Also vulnerable to staying up late and to sudden changes of weather, she seldom ran fevers of any degree, the highest being around 102?F. with a "Strep throat," but she had already taken antibiotics over two dozen times. Although vaccinated at the usual times without any obvious reaction, she developed an ear infection soon after her last DPT shot that had lasted for four months despite continuous antibiotics, and had subsided only after chiropractic treatment.

Soon after Sulphur 10M, she developed a generalized rash that lasted several days, followed by a buoyant mood and more lively energy than she had shown in a long time. At her first follow-up, she had a cold, with the usual red cheeks, runny eye, temporary hearing loss, and the dreaded positive Strep culture. It required a considerable leap of faith for her mother to let this tiny cold run its course without antibiotics, using only Pulsatilla 30X as needed, and later buying a kit of remedies and a book to show her how to use them. Two months later, her pediatrician was happy to report and even take credit for the fact that her ears were uninfected for the first time that anyone could remember.

The following winter she returned with mild symptoms, a low fever, and a weakly positive Strep culture. As the illness subsided, I repeated Sulphur 10M, and by her next visit two months later the picture had changed to recurrent sore throats, foul breath, enlarged tonsils, dark circles under the eyes, and a loose, productive cough. This time I gave her Mercurius 1M, followed by the 10M a month later, with excellent results until her next cold many months later, when she developed the same swollen tonsils and loose cough as before. After the third dose of Sulphur 10M, I lost track of her for a few years, but the mother eventually called to report that she had been well the whole time, with no major colds and no ear infections, and a perfect attendance record at school for the year just finished. A few months ago, I called to check up and learned that she was doing splendidly in high school, with no more ear infections in the nine years since she had begun using remedies.

Again leaving aside my rather crude prescribing in this case, I want to point out a few of the methodological issues it poses, issues so obvious and fundamental as to be easily overlooked. First, equating fluid behind the eardrum with an ear infection requiring antibiotic treatment ignores what every pediatrician knows, that most colds or URI's with swelling of the tonsils or adenoids produce secondary congestion of the middle ear and temporary hearing loss as a result. The girl in this case was prone mainly to tonsillitis, and could be said to have ear infections only to the extent that pneumatic otoscopes can detect even minute amounts of fluid, and that years of deadly warfare against the nasopharyngeal bacteria have culminated in a Vietnam-like strategy of killing every living thing in the vicinity.

Second, her longest period of ear involvement followed a DPT shot, a connection that I have often verified in practice, but is rarely sus-pected by pediatricians, because vaccines are regarded as sacrosanct and almost risk-free, except for negligibly rare acute reactions developing within the first hours or days. [note 7]

Third, like most of my chronic otitis patients, this child seldom ran fevers during the time she received conventional treatment, and began to do so only as her general condition improved. Useful both for reassuring the family and for making a simple prognosis, this humble fact carries a profound implication for the natural history of the disease and its recent evolution.

Case 4. L. P., a girl of ten months, had already had four acute ear infections and received antibiotics for each one. The first began at two months, when her mother weaned her to go back to work, and the child developed a rash and unusually cranky behavior on a milk-based formula. These symptoms were also intensified for the week following her first DPT shot. A few weeks after that, the ear infection developed suddenly, with high fever and violent earache, like all the others. With the help of Calcarea Carb. 1M initially and Chamomilla 30X as needed acutely, she did quite well, with fewer colds and no acute episodes, but mild symptoms persisted and were aggravated by teething, when the remedies had to be repeated. She relapsed the following spring, six months later, with three acute ear infections and three rounds of antibiotics in the three months since her father had insisted on her long-overdue MMR shot.