At this point I gave Lycopodium 10M, Sulphur 10M a month later, and almost a third remedy after that, but I heard that the parents had separated and were vying angrily over the child. From then on, she did very well on infrequent doses of Sulphur, despite a violent gastroenteritis following a DT-polio booster, and a tendency to relapse when she stayed with her father, who let her eat her fill of dairy products and took her to the doctor for her regular quota of vaccines and antibiotics. I have continued to see this child at long intervals for more than nine years, and although she has long since outgrown her ear infections, her underlying health issues have not changed very much. Since the acute, vigor-ous responses of her infancy, her basically strong constitution and maturing immune system have enabled her to bounce back more quickly when she does fall ill. While very fond of milk and cheese and somewhat allergic to them as well, she continues to grow and develop normally in the face of her conflicted heritage that she can as yet neither understand nor change.

In short, this is a child of strong vitality, representing the opposite side of the same issues already discussed: 1) an innate ability to respond acutely and vigorously, and rebound quickly from illness; 2) a tendency to relapse following vaccination (and milk allergy, often associated with it); and 3) the classic signs and symptoms of acute otitis media that were the rule in the pre-vaccine era.

With these representative cases in mind, I will try to summarize my experience with otitis media in children, giving special emphasis to the practical issues of diagnosis, treatment, prognosis, and long-term case management. As with my allopathic colleagues, middle-ear infection is one of the commonest presenting complaints of children in my practice. In an average week I will triage several acute episodes over the phone, and see at least one new and probably two or three established patients with chronic or recurrent otitis that has been diagnosed and treated on a long-term basis or repeatedly with antibiotics or tympanostomy or both.

What most of these patients have in common is the absence or paucity of strong symptoms like high fever or violent earache that would indicate an acute, vigorous response to their illness. With a few notable exceptions, like the last case I presented, their symptoms even during acute flareups are typically vague or nondescript in character, e. g., fussy or cranky behavior, whining or picking at the ear, congestive hearing loss, poor appetite, and the like. In quite a few cases, there are no symptoms whatsoever, and the child behaves and functions normally, but at the well-baby visit the pediatrician detects fluid in the ear, signs it off as an "ear infection," and begins or continues the cycle of antibiotics that often proves so difficult to break.

Similarly, although the symptoms often recede during treatment, relapse is common, and even when the child appears clinically well, the presence of fluid is regularly interpreted as continuing infection and cited as a mandate for further treatment. In this way, a child who may never have been that sick never gets entirely well, and continues to relapse until the doctor recommends antibiotics for months at a time and later surgical drainage as well, if the condition persists despite these lesser measures, as indeed it often does. In short, the most striking and dis-turbing feature of these cases is precisely their chronicity, their tendency to develop smoldering or persistent responses to illness and to relapse more and more easily, resulting in a failure to heal or resolve them in a clearcut or timely fashion.

Breaking this cycle of chronicity proves quite easy if parents and caregivers can suspend the conventional wisodm that reduces the art of diagnosis to the specialized detection of abnormalities and the goal of treatment to the killing of our resident bacteria. As much as finding the correct remedy, the critical requirement for success in treating these kids is to re-educate the parents and develop an alternative model that works and makes sense to everyone.

First, it is necessary to redefine the illness and how best to detect it, beginning with basic anatomy and the clinical and pathological features of a URI with ear involvement (congestion, earache, etc.), in contrast with classic acute otitis media. In my own practice I emphasize the signs and symptoms that parents themselves are aware of, i. e., how each child feels and functions in his or her own special world, or what homeopaths like to call the "totality of symptoms." If they are willing to trust me thus far, I'll take the next step and propose that we not look in the ear unless the illness is acute and intense, or hasn't resolved after giving remedies, or either of us is so panicked that we just have to know. Since any URI can produce detectable fluid or congestion behind the eardrum, and the homeopath does not need or even want to treat illness all the way to the end, the totality of symptoms is what best defines the illness, and the otoscope is useful primarily to confirm or qualify what the alert observer already knows.

With significant ear involvement, it is helpful to assure the parents that antibiotic treatment is no more effective than placebo, [notes 8, 9, 10] and that it produces more frequent relapses than giving symptomatic treatment or simply allowing the children to recover on their own. [note 11] At that point it makes sense to offer homeopathic remedies, both as needed for the acute episodes, and preventively, to minimize their number and severity.

Finally, it is imperative to take a careful vaccine history, and to look for familial influences or other factors that may aggravate a pre-existing chronic state, such as traumatic birth, food allergy, emotional upset, and the like. Quite often, the first episode can be traced to the time of a DPT, MMR, or other vaccine, even though no acute or obvious reaction was noted at the time, [note 12] or an old pattern of chronic or recurrent otitis is activated by a booster after a long period of remission. [note 13] Such apparent-ly speculative connections have also been verified by the successful use of homeopathic "nosodes" prepared from the vaccines themselves in re-solving difficult cases. [note 14] Drawing on these experiences, I routinely ask parents not to vaccinate their children until they are cured, and refer them to my various publications on the subject for further study. While I have also seen chronic otitis in unvaccinated kids, the crucial importance of vaccines lies in the fact that they are compulsory for all and regarded as so uniformly safe and beneficial that the possibility of chronic, long-term problems from them is seldom investigated or taken seriously. [note 15]

With this educational work in progress, it is appropriate to proceed with homeopathic remedies. Both the procedure that I follow and the remedies I use are much the same as would be found in any homeopathic practice involving children, and I see no need to elaborate on them here. If the child is not acutely ill at the time of the first visit, I may begin with one dose of the indicated constitutional remedy, or perhaps three weekly doses. In addition, it is reassuring to give parents a strategy and a list of remedies to have on hand for acute flare-ups, and to see the child or at least coach the parents through these episodes with words of encourage-ment, changing the remedy as needed. Often these acute remedies will include the constitutional plus a few others that are complementary to it.

Once remedies help them through this critical phase of the illness without antibiotics, the rest of the treatment is likely to proceed very smoothly. But if the child has never responded so acutely or intensely before, it is useful to prepare the family for such an eventuality as the underlying condition improves. By no means cause for discouragement, relapses many months or even years later are much easier to treat, since precipitating factors are usually much more obvious after a long period of good health, and remedies that worked well before will most likely do so again, as the children often know and will ask for it themselves. Indeed, this uncanny clarification and ordering of cases over time is a major and predictable benefit of successful treatment, and the awe and wonder it inspires in doctor and patient alike are among our highest rewards.

What is mysterious and problematic about ear infections in children thus lies not so much in their treatment, which is not particularly difficult and involves many of the same remedies as for other chronic ailments, as in the disturbing fact of that chronicity itself. As a medical student in the early 1960's, I encountered otitis media promarily as an acute disease, usually presenting in the Emergency Room with high fever and piercing screams of pain, both of which subsided dramatically once the eardrum burst and discharged its infected contents. While certainly not a pleasant experience for doctor or patient, it didn't last very long, indeed had often taken care of itself before we had a chance to do anything about it, and was unlikely to come back for a long time to come. In every way it close-ly resembles the kind of flare-up which, when I see it in a patient today, I have learned to recognize as a favorable sign.

After 1982, when I moved to Boston, stopped attending births, and limited my practice to homeopathy, I began to see large numbers of the sort of chronic otitis patient that I have just described. Why the sporadic acute infections I knew in medical school had mushroomed into a chronic disease of colossal proportions was also precisely the question with which I began this article. Both my clinical experience and the research I have conducted to try to make sense of it have strongly corroborated my "gut" feeling that the modern epidemic of chronic ear disease must largely be attributed to two colossal public health blunders that carry on the same outmoded militaristic philosophy:

1) the war on the nasopharyngeal bacteria, fought with antibiotics, tympanostomy tubes, and the systematic cultivation of fear; and

2) the vaccination of entire populations against a growing list of diseases, with no end in sight, and no inclination or strategy to consider the possible long-term consequences.

Based on Koch's postulates and their immense predictive power, the war on bacteria is nevertheless unwinnable even in thought. As the most basic life form on the planet, bacteria reproduce themselves in about six hours, and through natural selection rapidly become resistant to even the most lethal antibiotics. In clinical medicine, some major examples include hospital-borne epidemics of resistant Staphylococci and E. coli, and the emergence of infections with L-forms, Mycoplasma, and PPLO organisms, all lacking cell walls, neat adaptations to penicillin-rich environments. In a recent Newsweek cover story, the spread of resistant strains made U. S. hospitals look like centers of germ warfare from which many types of virulent organisms are disseminated into a general population more or less helpless to stop them. [note 16]