Capsicum Annum In Chronic Suppurative Otitis Media- A Case Report
Abstract
Chronic suppurative otitis media (CSOM) is a long standing infection of a part or whole of the middle ear cleft characterized by ear discharge and a permanent perforation. In India it is a significant cause of hearing impairement . There are various Homoeopathic remedies for different suppurative diseases. This is a showcase of Capsicum annum for an 18 year old girl suffering from bilateral CSOM . Capsicum annum is red pepper producing a burning effect. It affects the whole system especially mucous membranes, ear, eyes and throat. This article explains the management of CSOM using an individualized homoeopathic remedy.
Keywords
CSOM, individualization, Capsicum annum
Introduction
Chronic suppurative otitis media (CSOM) is a long standing infection of a part or whole of the middle ear cleft characterized by ear discharge and a permanent perforation (1). Incidence of CSOM is higher in developing countries because of poor socioeconomic standards, poor nutrition and lack of health education. Symptoms include ear discharges which are non offensive, and mucopurulent; hearing loss of conductive type; perforation which could be small, medium or large but always central; and polyp may be seen occasionally. Some other symptoms could be-ear pain or discomfort, itching or irritation, tinnitus and sense of fullness. Although the majority of acute otitis media in children is due to viral infections, bacterial infections are most frequently implicated in chronic suppurative otitis media. Staphylococcus aureus, Pseudomonas aeruginosa, Proteus, Klebsiella, Bacteroides, and Fusobacterium are common pathogens in these cases. Fungi, like Aspergillus and Candida, may also be the aetiology in the immunocompromised. In regions where tuberculosis is endemic, CSOM could be secondary to tubercular infection. (2)
Case History
An 18 year old female patient presented to the POPD of Bakson Hospital with recurrent bilateral ear discharge since childhood , accompanied by ear pain and diminished hearing in both ears and headache with heaviness in the head.
Chief Complaints
Recurrent episodes of discharge from both ear since childhood , Diminished hearing in both ear since then
Earache – present in both ear
Onset- gradual site- both ears
Duration- only during discharges
History Of Presenting Complaints
She developed ear discharges from childhood. As per the attendant she started having otalgia also. Whenever she takes allopathic treatment it gets relieved for a few days but then reappears. She complains of hearing loss only when she is having discharges.
Discharge at that time –
Frequency of discharge- once in 2-3 months
Character of discharge- whitish- yellowish colour
Consistency- thick and sticky
Odor- present but not offensive
Quantity- profuse
Flow- was present in past but not now
Location- from both ear
All complaints aggravate from cold food and drinks
The patient is having difficulty hearing in both ears. Onset gradual. Speech discrimination decreased, voices got mixed and can’t understand. Ringing sound in the right ear when in a noisy environment. She had recurrent cold and cough and during the episodes of cold and cough complaints aggravate. Patients used to clear the ear with matchstick or seek . H/o cleaning with matchsticks when itching and discharge present.
No history of bleeding present
History of itching present – bilateral, when she was having discharges , she had allopathic treatment for the same.
Past History
Itching and discharge in both ear took allopathic t/t
scratching both ear -present
throat irritation with swelling – 8years back- treated with allopathic medicines
Recurrent cold and cough
No h/o any surgical illness/ accident/trauma
H/o trauma in the right ear in childhood at age of 15 yr took allopathic t/t.
No H/o any other chronic illness
Family History
Father- dead (history of seizures)
Mother- alive (having diminished hearing )
Personal History
Occupation- none
Academic- illiterate
Diet- Vegetarian
Habbit/Addiction- None
Mental Generals
Desire for company ++
Anger- not present , very calm nature (as per observation)
She likes consolation
Irritability -present
Comprehension weak
Physical Generals
Appetite- good , 3-4 meals/day
Desire- sweet and sour food
Aversion- ghee, feels nausea
Tongue- coated white
Thermal- chilly
Thirst- Thirstless
Urine- N/S
Stool- N/S
Menses – regular
Sleep- 8-10 hr, sound, refreshing
Dreams- N/S
General Physical Examination:
Built- mesomorphic
Height- 5ft 3in
Weight- 48kgs
Decubitus- sitting
Pallor- absent
Icterus- absent
Lymphadenopathy- absent
Cyanosis- absent
Pigmentation- absent
Edema/ swelling- absent
Temperature- afebrile
On Examination
Rinne test negative left ear negative right ear
Webber test towards right ear
ABC normal in both ear
Ear– otoscopy- Bilateral subtotal tympanic membrane perforation ( CSOM with conductive hearing loss) , Handle of malleolus necrosed
Audiometry Done- Rt: 46.25 Db Hl, Lt: 50 Db Hl
Diagnosis
CSOM with conductive hearing loss
Analysis & Evaluation Of Symptoms
Repertorial Totality
Ear discharges -thick
Ear discharges-yellowish
Ear perforation-tympanum
Ear perforation, tympanum-cavity filled with yellow pus
Repertorial Analysis
Repertory or software used – synthesis repertory app 1.3 [v.135]
Selection Of Medicine
Based on symptom similarity and repertorization, the selected remedy was Capsicum annum.
Prescription
16/01/2024
Rx Capsicum 30/ 6 doses/ OD/ 6DAYS
Sac lac 30/ BD/15 days
Selection of Dose And Potency
The homoeopathic medicine was selected based on symptom totality. The patient was prescribed Capsicum 30C , followed by sac lac 30 for 15 days. The case is repertorized by synthesis repertory. The final selection of the medicine is based on homoeopathic Materia Medica. The medicine was prescribed in minimum doses as per the need and followed by sac lac 30.
Follow Ups
| FOLLOW UP | DATE | SYMPTOMS | CHANGES | PRESCRIPTION |
| 1st | 5/02/2024 | Discharge reduced | Not much changes in hearing | Sac lac 30, 1 week BD |
| 2nd | 20/02/2024 | No discharge | Slight betterment in hearing | Sac lac 30 OD, 1week |
| 3rd | 09/03/2024 | No recurrence | Hearing improved | – |
Discussion
As per prior knowledge CSOM is very recurrent and difficult to manage with conventional treatment alone. In this case homoeopathic intervention based on individualization resulted in improvement in both local and general symptoms.
Conclusion
This case highlights the effectiveness of individualized homoeopathic treatment in managing chronic suppurative otitis media & improving QOL without surgical intervention.
References
- Dhingra PL, Dhingra S. Diseases of Ear, Nose & Throat and Head & Neck Surgery. 7th ed. New Delhi: Elsevier India; 2017
- https://www.doctutorials.com/guide/csom
- Kent James Tyler. Repertory of Homeopathic Materia Medica; enriched Indian edition.
- Allen H.C. Keynotes and characteristics with comparisons of some of the leading remedies of the Materia medica with bowel nosodes. B. Jain Publishers,2008
- Synthesis repertory app 1.3 [v.135]
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