Otitis Media In Pediatric Age Group And Homoeopathic Management

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 -by Dr Sneha John, Assistant Professor, Department of Surgery, Yenepoya Homoeopathic Medical College.

Abstract

Otitis media can be well treated with homoeopathic remedies. It is important to remember that there are no homoeopathic specifics for otitis media, only remedies for patients who suffer from it. Because patients can have completely different symptoms of otitis media and their treatment depends upon the particular symptoms that each of them experiences. It is imperative to remember that each patient must be treated as a unique individual. Depending upon susceptibility, the dosage and repetition differ from each person.

Keywords: Otitis Media, Individualization, Miasms, Potencies

Introduction

Otitis media is a common early childhood infection. The peak incidence and prevalence of OM is during the 1st 2 yr of life. More than 80% of children will have experienced at least 1 episode of OM by the age of 3 yr.OM is also the most common cause of hearing loss in children. OM has a propensity to become chronic and recur. The earlier in life a child experiences the first episode, the greater the degree of subsequent difficulty the child is likely to experience in terms of frequency of recurrence, severity, and persistence of middle-ear effusion.

Anatomic features that make young children particularly, susceptible to ear infections include shorter, more horizontal and compliant eustachian tubes and bacterial carriage in the adenoids. Other risk factors include exposure to cigarette smoke, overcrowding, bottle feeding, cleft-palate, Down syndrome, allergy and immune dysfunction. These risk factors contribute to the pathophysiology of the two common varieties of otitis media, acute otitis media and otitis media with effusion. Accurate diagnosis of AOM in infants and young children may be difficult. Symptoms may not be apparent, especially in early infancy and in chronic stages of the disease.

Otitis media (OM) has 2 main categories: acute infection, which is termed suppurative or acute otitis media (AOM), and inflammation accompanied by middle-ear effusion (MEE),termed non-suppurative or secretory OM, or otitis media with effusion (OME). These 2 main types of OM are interrelated: acute infection usually is succeeded by residual inflammation and effusion that, in turn, predispose children to recurrent infection. MEE is a feature of both AOM and of OME and is an expression of the underlying middle-ear mucosal inflammation. MEE results in the conductive hearing loss (CHL) associated with OM, ranging from none to as much as 50 dB of hearing loss.

Aetiology

The common etiologic organisms in order of frequency are S. pneumoniae, H. influenzae and Moraxella catarrhalis (these three are responsible for 75% of the cases),S. aureus,              group             A               Streptococcus,                       Alpha    Streptococcus,P.    aeruginosa    and    group    B Streptococcus. In neonates who are hospitalized or who are under 2 weeks, gram-negative pathogens, S. aureus and group B Streptococcus are most frequent. In a proportion of the cases, viral infection may be the cause. The condition is usually associated with an upper respiratory infection (25% of pediatric URI cases develop it), measles, influenza or rubella) Clinical Features

Manifestations include pain, restlessness, discharge and fever. Eardrum appears lustreless, rough and red initially. Later, collection of pus causes loss of its landmarks and its bulges outwardly. Perforation may occur, resulting in accumulation of pus in the canal. All infants with unexplained pyrexia and/or screaming should have AOM excluded.

Prognosis

Most cases recover completely. These children often carry a collection of sterile secretions in middle ear between acute attacks and are noted to constantly rub their ears.

 Diagnosis:

Diagnosis can be established by inspecting the  eardrum with an otoscope.     The following can be seen according to stages.

  1. Loss of light reflex and hyperemia of the
  2. As the exudate accumulates in the middle ear, the drum bulges outwards. So the landmarks are first obscured and then
  3. Dusky red (angry) colour of the drum, if accumulation still
  4. Yellow grey appearance prior to the rupture /

The bulge of the drum is generally in the upper and posterior portion. When the short process of the malleus is no longer seen, the drum is said to be fully bulged.

Complications

Complications include, recurrent otitis media, perforation of the drum, acute mastoiditis with or without chronic otitis media, meningitis and cerebral abscess. The term otitis media with effusion refers to the middle ear effusion lacking the clinical manifestations of acute infection like earache and pyrexia. The effusion may be serous, mucoid or purulent. No treatment is usually indicated as in 90% of cases it clears by 3 months after the first episode of otitis media. If the effusion persists beyond 3 months (chronic OME).Chronic otitis media is characterized by perforation of the tympanic membrane with otorrhea and hearing loss (active COM) or only hearing loss (inactive COM).

Prevention

  1. Keep the sick child away from the other
  2. Do not expose the child to a secondhand
  3. Always hold an infant in an upright, seated position during bottle
  4. Breastfeeding for at least 6 months can make a child less prone to ear
  5. Do not use a
  6. Encourage children to wash their hand

Miasmatic Analysis

  • PSORIC: Otitis with dryness of the meatus; Constant itching, a sensation of crawling, dryness and pulsation in the ears. Cannot tolerate noise, due to oversensitivity and much sound cause pain in the ears Nervous restlessness and anxiety.
  • PSYCHOTIC: Profuse exudation; Stitching,pulsating,wandering pains. Agg.during day and by changes in the weather; Physical restless
  • SYPHILITIC: With ulceration, Burning , bursting, and tearing ear pains. Offensive discharges of pus is aggravated at night and from the warmth
  • TUBERCULAR: With exudation mixed with blood, cheesy or curdled; Sensation of Flushing about the ears; Agg.at night and ameliorated during the daytime. Peculiar carrion like odour and discharges are often cheesy and curdled.The ear may look flushed and red.even when there are foetid and copious discharges from the ears, the tubercular child feels alright and says that there is nothing the matter with

Scope & line of treatment

  • Acute case: The line of treatment regarding an acute stage is a symptomatic one, mostly an indicated Dosage and repetition of medicine depends on the susceptibility of the

patient and the severity of the case. In acute diseases, case taking will be easier because the symptoms will be fresh in the patient‟s memory and still new and striking. Often you will not have a “never well since” or mental/emotional symptoms in acute cases. However, if present, remember that they rank higher than the physical symptoms. Finding the acute totality which should include complete symptom with its characteristic location, peculiar sensation and qualifying modalities. Concomitants, if present is invaluable gift for a homoeopathic physician to find the correct prescription. These differentiating factors are referred to, as singular, uncommon, striking, any peculiar features of the case, by Dr Hahnemann.

  • Example 1: A child of highly sensitive, irritable, thirsty, hot and want to be carried with the complaint of stitching earache with soreness < stooping; discharge of thin pus from ears.

Mode of treatment: This case has to be treated with lower potency of „CHAMOMILLA‟ i.e., of 30 potency with repetition.

The cycle of remedies: If this case(example 1) goes for a standstill, and the inflammation has not yet subside the next step is to give a complementary remedy. ie, which completes the action of the previous remedy with symptom similarity,i.e „BELLADONNA‟. It produces active , acute, and violent congestion and inflammation.

It is a rule after you have gone through a series of potencies, never to leave that remedy until one or more dose of higher potencies has been given and tested. But when this dose of a higher potency has been given and tested , without effect, that is the only means you have of knowing that this remedy has done all the good it can for this patient and that a change is necessary. A second prescription is sometimes necessary to complement the former and this is always a change of remedy.

  • Example 2: A child with pain in ears and fetid discharge; throbbing in the ears; hardness of hearing.Heat, redness, and itching in the ears; Hardness of hearing, with pulsations and buzzing in the ears, especially in the evening in

Mode of treatment: This case has to be treated with lower potency of „HEPAR SULPH‟ ie, of 30 potency with frequent repetition till the symptoms subside.

  • Chronic case: A detailed case history is necessary as it should individualize the patient. So, according to that basis remedy should be selected. And have seen in most of the cases an intercurrent remedy (anti-miasmatic) is necessary to arrest the recurrence, along with the constitutional Each case differs, so the duration of treatment differs in each individual. The main thing to be observed in each follow up is the frequency and intensity of the symptoms. As it lessens this means the way of treatment is in a correct path.
  • Example 3:- “A child who is of lean, poorly built, headstrong, yielding in nature with lack of confidence; who perspires easily especially in axillae, palms and soles which is offensive in nature and who is highly sensitive to cold along with the complaint of old offensive, thick yellow otorrhoea ,worse in cold- wet weather .”

In this case, the totality of symptoms helps us to finalize a constitutional remedy.

„Silicea‟ is the remedy that fits to this totality. According to the susceptibility of the patient, potency should be selected (Law of minimum dose and single remedy). Treatment mode is from lower potency to higher potency as the case indicates. Here, I suggest for a lower potency that is of „200 potency 1 dose‟. If the patient is improving, wait and watch till the action of remedy gets completed. Depending upon the intensity of symptoms and recurrence the second prescription is done. Repetition is done if the case goes to a standstill state and potency should be increased as the requirement of the case, i.e. 1M, 10M etc.

The cycle of medicine: In the above case, if there is an acute exacerbation, the best medicine to be thought of is “PULSATILLA”. It is the acute of “SILICEA”. The presentation of the acuteness of symptoms is as similar to that of silicea.

  • Red Line Symptoms: A patient with a peculiar symptom i.e. a striking one which indicates a specific

Example 4: If a child suffering from burning pain in the ear, which is relieved by warmth and aggravated at midnight.

Mode of treatment: The remedy to be thought is „ARSENICUM ALBUM ‟ in lower potency with repetition.

  • Nosological based: It is particularly based on the disease diagnosis. Certain medicines are more specific to some pathological condition. It doesn’t mean that medicine has only acted in a particular organ. So according to the action of medicine in a particular organ/site, it is classified as nosological treatment. A case of otitis media can be treated with the most specific remedy. A remedy to be thought of is the one which acts well in the middle ear infection. This method is useful in case of a sector treatment where there we can apply for a first prescription (i.e., in case of acute management). If there is any recurrence it should be treated with the constitutional remedy for the complete

Example 5: A case of chronic catarrh of the middle ear with symptoms of bloody and offensive discharge from the right ear with tearing pain. Agg: night, cold and wet weather.

„MERCURIUS‟ – In chronic catarrhal inflammation of the middle ear; Mercury is one of our best remedies, and probably the best remedy we have, and the most suitable preparation to use is the Mercurius Dulcis.

Auxiliary measures

Along with the Homoeopathic remedy, some measures are needed for faster recovery.

It includes:

  1. Keeping the child well
  2. Eliminate dairy products which thicken the mucus, making it more difficult for an infected ear to
  3. To promote drainage prop the child at a 300 angle, this will reduce
  4. Apply cold compression, if your child feels comfortable with.
  5. Never use an instrument or cotton-tipped applicator to clean the
  6. Lastly, a good nutritional program including proper supplementation is imperative to enhance immune system functioning.

Homoeopathic Therapeutics

Aconite., Ars.Alb., Belladonna., Chamomilla., Calc carb., Capsicum., Dulcamara., HeparSulph., Kali. Bich., Graphites., Sanguinaria., Nitric acid., Natrum carb., Lycopodium., Lachesis Phosphorus., phosphoric acid., Mercurius dulcis., Merc sol., Pulsatilla., Silicea., Tuberculinum., Sulphur, Verbascum Thapsus etc.

Arsenicum album: Thin excoriating, offensive otorrhoea. Squeezing, sharp pains, shooting, voluptuous, tickling and burning in the ears. Agg: wet weather, after midnight, from cold, cold drinks or foods, Seashore. Right side, Amel: from heat, from head elevated; warm drinks.

Belladonna: Tearing pain in the middle and external ear. otitis media. The child cries out in sleep; throbbing and beating pain in deep in-ear synchronous with a heartbeat. Agg: touch, noise, jar, draught.

Chamomilla: Infantile earache; Oversensitive to pain. Pain drives him to despair, aggravates from heat; great aversion to wind and open air.

Hepar Sulphuris Calcareum: Discharge of fetid pus from the ears. Darting pain in the ears. The hardness of hearing, with pulsations and buzzing in the ears, esp. in the evening in bed. Worse: dry cold winds, cool air, touch. Better, in damp weather, from wrapping head, from warmth. Suppurative otitis media.

Kalium Muriaticum: Chronic, catarrhal conditions of the middle ear. Glands about the ear swollen.

Mercurius Dulcis: Otitis media; ear troubles of scrofulous children; catarrhal inflammation of the middle ear.

Mercurius Solubilis: Thick yellow discharge; fetid and bloody; otalgia worse warmth of bed; at night sticking pains; pain extends to the ear; from teeth, throat etc. As if cold water is running from the ear.

Pulsatilla: Thick bland discharges. Offensive odour. External ear is swollen and red. Catarrhal otitis. Otalgia. worse at night. Diminishes acuteness of hearing. Agg: from heat, towards evening, warm room. Amel: open air, from the cold application.

Silicea: It begins as a dry catarrh of the middle ear; offensive, watery, curdy, with soreness of inner nose and mastoid process.

Reference

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