A variety of health beliefs and practices—including the use of alternative medicine—are evident in different cultures throughout the world. The use of home remedies has become an important consideration for physicians and hearing professionals who provide services to individuals from a variety of backgrounds who may use such remedies to prevent and treat hearing or ear problems.
Although there are numerous materials about folk and home remedies available to the general public, professional literature rarely discusses this treatment approach. As professionals who recognize the necessity for multicultural understanding, we also must be knowledgeable about nontraditional health beliefs. Although this article focuses specifically on individuals with communication disorders, understanding of nontraditional health beliefs and practices is essential across a variety of disciplines, since these beliefs and practices are used by numerous populations.
Defining Alternative Treatments
Home remedies, folk remedies, homeopathy, and alternative medicine are all terms associated with alternative treatment practices. A broad, functional definition of alternative therapies encompasses interventions that are not typically taught in medical school or used in medical facilities in the United States.
Home remedies denote practices that are outside of mainstream culture, ideas, and values. Increased knowledge regarding the scope of these treatments and where they fit into Western medicine will help to establish a clearer definition and an improved understanding of potential benefits in the prevention and treatment of hearing or ear problems.
Information from a variety of sources suggests that home remedies and folk therapies originated in ancient civilizations for various reasons. In many cultures, these remedies derived from the role of spiritual healers who blended religious practices with the treatment of illnesses. Home remedies continue to be used today. In a 1993 study, it was estimated that approximately one-third of the population in the United States used at least one alternative form of health practice (see Eisenberg).
The issue of cultural transmission—the process of passing on culturally relevant knowledge, attitudes, and values from person to person—is important because what was once passed on by word of mouth has graduated to easy accessibility on the Internet, television talk shows, in natural food health stores, and various types of print media. For example, numerous Web sites describe the process of ear candling or other methods to alleviate ear discomfort. Additionally, natural food health stores offer a variety of literature and products available to the general public to aid in treating a variety of ailments.
In order to gain a better understanding of why patients continue to use alternative therapies and treatments, research on cultural beliefs has been conducted and several theories have been proposed. One study by John A. Astin tested three primary hypotheses: dissatisfaction with conventional treatments, personal autonomy issues, and compatibility with patients’ value systems. He found that most users of alternative forms of medical treatment are not dissatisfied with conventional approaches but prefer alternative options because these are more closely aligned with their own values and beliefs. Each culture is unique in bringing its own traditional beliefs and practices into today’s standard medical practices.
The Need for Cultural Clinical Competence
With the increasing popularity of home remedies, health care professionals are more likely to encounter some of these procedures. It is thus vital that professionals develop an understanding of various cultural beliefs and practices in order to better serve culturally diverse populations. But how does one advise patients who seek alternative treatments?
Campinha-Bacote proposed using progressive stages of cultural awareness, knowledge, and skills to prepare professionals for their encounter with people of different cultures in their practice. First professionals must become culturally aware and sensitive to cultural differences. Next they must seek cultural knowledge on appropriate treatment approaches and use this knowledge to develop skills that accurately assess their patient’s needs in a culturally sensitive framework. Finally, professionals put their research into practice by providing patients with culturally relevant services and individualized treatment plans recognizing their cultural variations.
Regardless of the efficacy of the remedies, the cultural beliefs of the patients or clients have caused them to incorporate these treatments into their daily lives. Although our own belief systems may differ from that of our patients, we need to be sensitive to their cultural beliefs and practices. Knowing how to address deficits within a context of a client’s culture is beneficial to establishing a positive professional-patient relationship.
We conducted a survey in 2001 that investigated Illinois otolaryngologists’, audiologists’, hearing aid dealers’, and family practitioners’ knowledge and perceptions of alternative medicine related to the treatment of hearing or ear problems. Respondents were asked to rate their familiarity with a number of proposed home remedies, including the use of olive oil, sweet oil, castor oil, steam, cottonballs, smoke, Mentholatum, vinegar, rubbing alcohol, sardine oil, warm urine, tobacco juice, ear candling/coning, hot onions, hot candle wax, molasses, garlic juice, hair dryers, breast milk, and aloe. Additional questions included requesting more information about the age group, race or culture, and geographical location of patients who reportedly use alternative medicine; formal or informal training received by the professionals; and the advice given to their patients.
Familiarity with remedies was similar for all professions. A large percentage (>50%) of audiologists, hearing aid dealers, otolaryngologists, and family practitioners were most familiar with the following remedies: sweet oil, cottonballs, rubbing alcohol, vinegar, and olive oil. These professionals were also familiar with ear candling/coning, hair dryer, and hot candle wax as alternative ways patients may deal with hearing or ear problems. All of these remedies are placed in or near the external auditory canal. The use of heat and/or oil that the remedies provide is said to soften the earwax within the canal.
Regarding training in home remedies, both formal and informal, otolaryngologists, hearing aid dealers, and audiologists reported attending lectures and institutes or reading literature for formal training. Informally, they garnered information from brochures, the Internet, and patients. Family practitioners, on the other hand, reported that their degrees (i.e., M.D. or F.P.) were their formal training. They reported no informal training.
When asked to report the ethnicity or culture of the patients using home remedies, respondents mentioned many different cultures and ethnicities. Responses to questions regarding geographical area were similar: Populations in all geographical areas reported use of home remedies.
Respondents were asked to identify how frequently clients in various age groups shared information about home remedies used for hearing or ear problems. All respondents stated that patients 61 years and older most frequently reported using home remedies. However, all age groups reported some use of home remedies.
One-third of the professionals reported seeing damage caused by use of home remedies and advised patients to be cautious of unproven remedies. Professionals reported observing packed cerumen, excessively wet/dry external auditory canals, fungus in the external auditory canal, and even complete occlusions of the external auditory canal due to candle wax buildup. Many stated, however, that they would not encourage discontinuing use of a home remedy if it was not potentially dangerous.
Results indicate that the use of home remedies for the prevention and treatment of hearing or ear problems is common in today’s society. The population who uses home remedies and reports use is ethnically, culturally, and geographically varied. As professionals, we need to consider the implications of these findings. Professionals must be prepared to work with people with alternative beliefs and who engage in alternative health practices.
Current and Future Needs
It is clear that development of cultural clinical competence is necessary for hearing professionals, but further scientific research on the efficacy of home remedies for the treatment of hearing and ear problems also is needed before these approaches can be extensively accepted into Western medicine. Recent research that surveyed physicians and internists indicated that 94% of these professionals were willing to recommend at least one form of alternative therapy (see Blumberg et al.). Although the use of folk treatments remains controversial, health care professionals should be aware of their existence, uses, benefits, and dangers so that they may counsel their patients accordingly.