Pediatric Sinus Drainage OMT Module

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Pediatric Sinus Drainage OMT Module

• American College of Osteopathic Pediatricians
• Robert Hostoffer, DO,FACOP, FAAP

edited by Eric Hegybeli, DO, FACOP
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Background
Andrew Taylor Still, was born in Virginia in
1828, the son of a Methodist minister and
physician. At an early age, Still decided to
follow in his father's footsteps as a physician.
After studying medicine and serving an
apprenticeship under his father, Still became a
licensed M.D. in the state of Missouri. Later, in
the early 1860's, he completed additional
coursework at the College of Physicians and
Surgeons in Kansas City, Missouri. He went on to
serve as a surgeon in the Union Army during the
Civil War.
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Background

• After the Civil War and following the death of
  three of his children from spinal meningitis in
  1864, Still concluded that the orthodox medical
  practices of his day were frequently ineffective,
  and sometimes harmful. He devoted the next ten
  years of his life to studying the human body and
  finding better ways to treat disease.

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Background

• His research and clinical observations led him to
  believe that the musculoskeletal system played a
  vital role in health and disease and that the
  body contained all of the elements needed to
  maintain health, if properly stimulated. Still
  believed that by correcting problems in the
  body's structure, through the use of manual
  techniques now known as osteopathic manipulative
  treatment, the body's ability to function and to
  heal itself could be greatly improved. He also
  promoted the idea of preventive medicine and
  endorsed the philosophy that physicians should
  focus on treating the whole patient, rather than
  just the disease.
• http//www.aacom.org/OM/history.html

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Toddler and Children OMT
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Review Sinus Anatomy
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Review Anatomy of Ear
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Respiratory SystemOtitis Media

• Goals Considerations
• Encourage proper Eustachian tube mechanics
• Tube positioning
• Promote drainage of the middle ear via lymphatic
  channels
• Central drainage

• Acute Otitis Media (AOM)
• The use of osteopathic manipulative treatment as
  adjuvant therapy in children with recurrent acute
  otitis media. Mills MV, Henley CE, Barnes LL,
  Carreiro JE, Degenhardt BF. Arch Pediatr Adolesc
  Med. 2003 Sep157(9)861-6.

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Eustachian tube difference
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Hands-On Approach Treating Otitis Media

• Treatment Options
• Thoracic Muscular Assessment and Treatment
• Thoracic Inlet/Outlet Release (emphasizing the
  right side, which drains the entire head and
  neck)
• Occipitoatlantal (OA) Release
• Rib Raising (T1-4)
• Chapmans Points
• Auricular Drainage Technique
• Mandibular Drainage of Galbreath
• Miller Thoracic Pump
• Contraindications Rib fracture and dislocation,
  malignancy of lymphatic system
• Relative Contraindications Decreased cough
  reflex

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Respiratory SystemPharyngitis

• Goals Considerations
• Improve venous and lymphatic drainage
• Promote arterial blood flow
• Normalize cranial and spinal nerve afferents and
  efferents affecting function of the throat
• Relieve pain
• It is important to note that most of the
  cranial nerves which innervate the pharynx pass
  through the suboccipital area

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Hands-On Approach TreatingPharyngitis

• Treatment Options
• Cervical Thoracic Muscular Assessment and
  Treatment
• Thoracic Inlet/Outlet Release
• OA Release
• Rib Raising (T1-4)
• Chapmans Points
• Cervical Chain Drainage
• Miller Thoracic Pump
• Contraindications Rib fracture and dislocation,
  malignancy of lymphatic system
• Relative Contraindications Decreased cough
  reflex

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Hands-on Sinus Drainage Techniques
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Sinus Effleurage

• To effleurage is to move in a stroking massage
  movement to move lymphatic fluids. Excessive
  mucus production, and decrease of cilliary
  motility can all be modified using effleurage.
  Effleurage will promote lymphatic drainage in
  both allergic or infective pathology. Effleurage
  of the anterior cervical chain towards each
  lymphatic duct and ultimately the heart will
  eventually promote health.

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Positioning

• The patient is supine. With repetitive strokes,
  the thumbs are brought across the frontal
  maxillary sinuses from medial to lateral
  finishing at a point near the ear lobes. The
  thumbs should be used to milk the lymphatic fluid
  down the anterior aspect of the
  sternocleidomastoid muscle belly along the
  anterior cervical lymphatic chain towards the
  heart. Repeat this technique for complete
  drainage.

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Demonstrate the procedure on patient in front of
director
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Demonstrate the procedure on patient in front of
director
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Demonstrate the procedure on patient in front of
director
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Demonstrate the procedure on patient in front of
director
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Mandibular Drainage of Galbreath

• A passive soft tissue technique is used to induce
  jaw motion to create increased drainage of middle
  ear and tonsillar areas via the eustachian tube
  and lymphatics. This technique can be used for
  chronic otitis media.

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Positioning

• The patient is supine and the dcotor is behind
  patient, while stabilizing the head and placing
  traction on the mandible. With a pumping
  action, the fascia of the eustachian tube via
  the mandible is brought anteriorly and medially
  across the face a short distance, multiple times
  on each side of the head. The procedure is done
  for 30 seconds on each side for up to three times
  a day.

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Demonstrate the procedure on patient in front of
director
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Ear Pull Technique

• A gentle bilateral ear pull will help mobilize
  the underlying fascia and the temporal bones. The
  physician will notice that one side may be less
  mobile and may require longer to feel a release.
  The side that is more medial often correlates
  with an internally rotated temporal bone.

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Positioning

• The patient is supine. The doctor is behind the
  patient. A gentle force is applied to the
  bilateral pinnae until the pinnae becomes more
  mobile. The earpull is helpful in infants but may
  not be useful in children that are moving around.
  

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Demonstrate the procedure on patient in front of
director
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Chapmans Reflexes

• Discovered by Frank Chapman, D.O.,
• Chapman's Reflexes are painful palpated points
  located all over the body.
• These reflexes are clinically useful in three
  principal ways
• 1) for diagnosis,
• 2) for influencing the motion of fluids, mostly
  lymph, and
• 3) for influencing visceral (organ) function
  through the nervous system.

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Innervation Table
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Print out the answer sheet to use with the
following questions.
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Circle the correct answer and review with
director

• Question1 A, B, C, D, E.
• Question2 A, B, C, D, E.
• Question3 A, B, C, D, E.

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Post Test

• A 2 day old male is seen in the newborn nursery
  for initial examination. The nurses note that the
  newborn is having difficulty nursing and latching
  onto mothers nipple. Which procedure would be
  the most appropriate for this patient
• A. Ear pull tugging
• B. Mandibular Drainage of Galbreath
• C. Occipital release
• D. Sinus Effleurage
• E. Maxillary release

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• A 2 year old male presents for chronic otitis
  media with effusions. At the present visit he has
  no active infection but as bilateral effusions.
  Which procedure would be most appropriate
• A. Occipital-temporal release
• B. Cervical HVLA
• C. Mandibular Drainage of Galbreath
• D. Cranio-sacral maneuvers
• E. Sinus Effleurage

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• A 18 year old female presents to your office with
  pressure and pain over the face. The patient is
  afebrile without evidence of infection. These
  symptoms have been present for 2 years and
  worsens with change of seasons. The most
  appropriate osteopathic treatment would be
• A. Mandibular drainage of Galbreath
• B. Ear pull tugging
• C. Sinus Effleurage
• D. HVLA to the thorax
• E. Occipital release

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Certificate of Completion

• I, _________________________, successfully
  completed the Pediatric OMT Module on __ __ 20__
• Signatures
• Pediatric Resident ____________________
• Pediatric Residency Director____________
• ( Please print and give to program director.)

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Congratulations