Pediatric Sinus Drainage OMT Module
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American College of
Osteopathic
Pediatricians
Robert Hostoffer,
DO,FACOP, FAAP
edited by
Eric Hegybeli, DO,
FACOP
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.
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.
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
Toddler and Children OMT
Review Sinus Anatomy
Review Anatomy of Ear
Respiratory System:
Otitis Media
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Goals & Considerations
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Encourage proper
Eustachian tube
mechanics
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Tube positioning
Promote drainage of the
middle ear via lymphatic
channels
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Central drainage
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Acute Otitis Media (AOM)
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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 Sep;157(9):861-6.
Eustachian tube difference
Hands-On Approach Treating
Otitis Media
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Treatment Options
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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)
Chapman’s Points
Auricular Drainage Technique
Mandibular Drainage of Galbreath
Miller Thoracic Pump
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Contraindications: Rib fracture and dislocation, malignancy of
lymphatic system
Relative Contraindications: Decreased cough reflex
Respiratory System:
Pharyngitis
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Goals & Considerations
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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
Hands-On Approach Treating
Pharyngitis
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Treatment Options
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Cervical & Thoracic Muscular Assessment and Treatment
Thoracic Inlet/Outlet Release
OA Release
Rib Raising (T1-4)
Chapman’s Points
Cervical Chain Drainage
Miller Thoracic Pump
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Contraindications: Rib fracture and dislocation, malignancy of
lymphatic system
Relative Contraindications: Decreased cough reflex
Hands-on Sinus Drainage
Techniques
Sinus Effleurage
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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.
Positioning
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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.
Demonstrate the procedure on
patient in front of director
Demonstrate the procedure on
patient in front of director
Demonstrate the procedure on
patient in front of director
Demonstrate the procedure on
patient in front of director
Mandibular Drainage of Galbreath
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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.
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.
Demonstrate the procedure on
patient in front of director
Ear Pull Technique
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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.
Positioning
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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.
Demonstrate the procedure on
patient in front of director
Chapman’s Reflexes
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Discovered by Frank Chapman, D.O.,
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Chapman's Reflexes are painful palpated points
located all over the body.
These reflexes are clinically useful in three
principal ways:
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1) for diagnosis,
2) for influencing the motion of fluids, mostly lymph, and
3) for influencing visceral (organ) function through the
nervous system.
Innervation Table
Organ/System
EENT
Parasympathetic
Sympathetic
Ant.
Chapman's
Post.
Chapman's
T1-T4
T1-4, 2nd ICS
Suboccipital
Heart
Cr Nerves (III, VII, IX,
X)
Vagus (CN X)
T1-T4
T3 sp process
Respiratory
Vagus (CN X)
T2-T7
T1-4 on L,
T2-3
3rd & 4th ICS
Esophagus
Vagus (CN X)
T2-T8
---
T3-5 sp
process
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Foregut
Vagus (CN X)
T5-T9 (Greater Splanchnic)
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Stomach
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Liver
Vagus (CN X)
Gallbladder
T6-7 on L
T5-T9 (Greater Splanchnic)
5th-6th ICS on
L
Rib 5 on R
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Rib 6 on R
T6
Spleen
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Rib 7 on L
T7
Pancreas
Vagus (CN X)
Rib 7 on R
T7
Midgut
Vagus (CN X)
T5-T9 (Greater Splanchnic), T9T12 (Lesser Splanchnic)
Thoracic Splanchnics (Lesser)
Small Intestine
Vagus (CN X)
T9-T11 (Lesser Splanchnic)
Ribs 9-11
T8-10
Tip of 12th Rib
T11-12 on R
Appendix
Hindgut
Ascending Colon
Transverse Colon
T12
Pelvic Splanchnics (S24)
Vagus (CN X)
Vagus (CN X)
Lumbar (Least) Splanchnics
T9-T11 (Lesser Splanchnic)
T5-6
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--T10-11
T9-T11 (Lesser Splanchnic)
R Femur @
hip
Near Knees
L Femur @ hip
T12-L2
Descending Colon
Pelvic Splanchnic (S2-4)
Least Splanchnic
Colon & Rectum
Pelvic Splanchnics (S24)
T8-L2
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Print out the answer sheet to use
with the following questions.
Circle the correct answer and review
with director:
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Question1: A, B, C, D, E.
Question2: A, B, C, D, E.
Question3: A, B, C, D, E.
Post Test
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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 mother’s
nipple. Which procedure would be the most
appropriate for this patient:
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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:
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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:
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A. Mandibular drainage of Galbreath
B. Ear pull tugging
C. Sinus Effleurage
D. HVLA to the thorax
E. Occipital release
Certificate of Completion
I, _________________________,
successfully completed the Pediatric OMT
Module on __ __ 20__
Signatures:
 Pediatric Resident ____________________
 Pediatric Residency Director____________
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( Please print and give to program director.)
Congratulations