Abstract- Mastoiditis is the inflammation of the mastoid bone and mastoid air cells which are the epithelium lining marked as septations in the bone continuous with the middle ear cavity. Mastoiditis is a common complication of acute otitis media. Here is a case of mastoiditis suggested for surgery, treated successfully by homoeopathic individualised medicine, Pulsatilla nigricans within a short period of time through proper case taking and careful analysis of case and selecting remedy on the totality.
Keywords – mastoiditis, homoeopathy, Pulsatilla nigricans
Abbreviations – OPD – outpatient department, BP – blood pressure, PDF – potential differential field, bpm – beats per minute
Introduction- Mastoiditis is one of the commonest complications of otitis media which is caused due to the spread of infection of the middle ear into the area of bone underneath the ear.1 It is commonly found in children rarely in adults, in which the adult patient will typically complain of severe earache, fever, and headache. Physical examination in both children and adults will show erythema, post auricular tenderness, bulging over mastoid, warmth over affected area followed by fluctuance.2
Presenting complaints: A female patient aged 52 years came to seek treatment at OPD of YPSM Homoeopathic medical college and hospital, Alwar (Rajasthan) on 5 October 2021, presented with the complaint of intolerable pain and swelling in left post auricular region, redness extended up to left side occipital region for 5 months. Pain aggravated by even a slight movement of neck, and not even allowing the physician to examine too.
History of presenting complaints: Complaint started with mild pain in left ear for which she took antibiotics and analgesics without any consultation for 2 months and got temporary relief but the complaints soon recurred, after few months swelling appeared in left post auricular region, which was followed by erythema and fever on and off , for which she was diagnosed with mastoiditis and took allopathic treatment for 2 months, but she didn’t get any relief instead the complaints were getting worse gradually so, she was advised for surgery. Further, to avoid or to seek consultation in a conservational therapy she opted to take homoeopathic treatment.
Past history: Suffered with otitis media 1 year ago according to the attendant (without evidence) taken allopathic treatment got temporary relief as pain persists on and off.
Physical generals: Her appetite was variable depending on her mood, had no desire for drink water during the daytime but becomes thirsty at night. Had aversion to butter, couldn’t eat cakes and pastry due to diarrhoea. Patient was thermally hot, she could not tolerate heat in any form, desired for open air usually, even in winters she covered herself with only one piece of thin woolen or majority of the times didn’t require too.
Restlessness during sleep due to severe pain, so sleeps lying on unaffected area.
When interrogated for menstrual history, she attained menopause 3 years ago.
Mentals revealed that she became too much excited whenever something was going to happen whatever she desired for, but became too much sad if not happened, and then used to isolate herself in a room for few minutes, couldn’t stay alone for longer period as she was much fond of people around her. Too much caring for everyone, did not let anyone stay alone.
General examination: Appearance- fair, fleshy, with flushed face; B.P.-130/90mm Hg; Pulse-104bpm; Respiratory rate-20/min. Temperature-100 ℉.
Clinical findings: an extended erythema on left post auricular region, swelling and tenderness around the region even a slight motion of head. (Fig.2)
Diagnosis –based upon clinical observation2 mentioned in international classification disease code (ICD code) H70.90.
Analysis of case: the case was analysed as per the Kentian approach as generals were prominent in the case. (Table 1)
Table 1. Case analysis
|Becomes too much excited whenever something is going to happen whatever she desires.+++||Appetite is variable depending on her mood.++||Intolerable pain and swelling in left post auricular region.+++|
|Cannot stay alone for longer period as she is much fond of people.++||Becomes thirsty at night.+||Redness extended up to left side occipital region.|
|Too much caring for everyone, does not let anyone stay alone.++||Aversion to butter++||Pain aggravated by even a slight movement of neck, and not even allowing the physician to examine too.++|
|Cannot eat cakes and pastry due to diarrhea.+++|
|Restless sleep due to severe pain.|
|Thermal reaction- hot+++|
- MIND – EXCITEMENT – anticipating events, when
- MIND – COMPANY – desire for
- MIND – SYMPATHETIC
- GENERALS – FOOD and DRINKS – pastry – agg.
- GENERALS – FOOD and DRINKS – butter – aversion
- STOMACH – APPETITE – capricious appetite
- STOMACH – THIRST – night
- EAR – PAIN – Behind the ear – left
- EAR – SWELLING – Behind the ear
- EAR – PAIN – Behind the ear – moving head
- EAR – INFLAMMATION – Mastoid
Note: Thermal reaction was considered as the potential differential field (PDF) for yielding the exact simillimum.
Fig.1 Repertorisation of case with the help of RADAR version 10.0 using Synthesis repertory.3
Pulsatilla nigricans was selected as simillimum on the basis of repertorisation with the consideration of PDF selected where it covers the maximum rubrics (7) with marks (16) (Fig.1). Here, repertorisation clearly justifies that Pulsatilla nigricans covering the prominent mentals as well as physical generals and the particulars as well. The Review of Materia Medica,4 signifies that it has great affinity for ear complaints and due to its yielding nature and also the thermal concludes to be the most similar remedy to be chosen for the complaints. Therefore, Pulsatilla nigricans 200 potency, once a day followed by rubrum thrice a day is prescribed for 7 days as due to acuteness of symptoms, it was prescribed on 5th October 2021. Follow up maintained as per the principles of Organon of medicine.5 Repetition of doses was done to accelerate the cure 6 as the patient was in too much agony, and wants to get rid off the complaint as she doesn’t want to approach for surgery. Dr Hahnemann stated in aphorism 248 of 6th edition of Organon of medicine that “…. every correctly chosen homoeopathic medicine, even those whose action is of long duration, may be repeated daily for months with ever increasing success”. 5
Table 2 Follow up of case
|Date||Change in symptomatology||Prescription||Justification|
|12/10/2021||Status quo, Patient took allopathic medicine once as the temperature elevated to 120 ℉as per the attendant. Temperature : 99.8 ℉ Pulse: 100 bpm||Pulsatilla nigricans 200/ OD; Rubrum three times a day for 14 days.||Neither changes nor specific aggravation observed.5,7|
|26/10/2021||Mild swelling reduced, redness persists with tenderness. Temperature: 99 ℉ Pulse: 98 bpm||Pulsatilla nigricans 200/OD; Rubrum three times a day for 14 days||Towards improvement5|
|16/11/2021||Swelling along with redness reduced to some extent, now can move head slowly and allowing to examine with fine touch on affected area. Temperature: 98.7 ℉ Pulse: 90 bpm||Pulsatilla nigricans 200/OD; Rubrum three times a day for 14 days||Improvement observed5|
|30/11/2021||Patient now able to move her head freely, but mild pain persists over the swelling region, redness reduced to a localised area.(Fig.3) Patient informed that this time after eating cake on her granddaughter’s birthday she didn’t have any complaint of diarrhea. Temperature: 98.6 ℉ Pulse: 88 bpm||Pulsatilla nigricans 200/OD; Rubrum three times a day for 14 days||Improvement in general complaints5|
|14/12/2021||Pain in left ear reappeared but the patient is in general relief. Temperature: 98.6 ℉ Pulse: 89 bpm||Pulsatilla nigricans 200/OD; Rubrum three times a day for 14 days||Old complaint reappeared with general relief, depicts a good sign towards cure.5,7|
|28/12/2021||Complaints got relieved Temperature: 98.6 ℉ Pulse: 86 bpm||Rubrum three times a day for 14 days||As the patient got relieved therefore, put under observation.5|
|11/01/2022||Complaints completely cured as the swelling disappeared , redness disappeared , tenderness relieved (Fig.4) Temperature: 98.6 ℉ Pulse: 82 bpm||Rubrum three times a day for 14 days||Patient had no further complaints and was cured.5|
Conclusion– The case has progression towards surgical intervention but with individualized homoeopathic treatment further progression had been ceased and hence got cured in short period of time without any such operation. The case report thus concluded that Homoeopathy can be opted as a safe alternative in cases of primary surgical diseases, which can prevent further complication as well as recurrence of the symptoms hence, proved that individualized homoeopathic constitutional remedy Pulsatilla nigricans prescribed on the basis of totality is effective in cases of mastoiditis and motivates for more research to be done in such cases for further evaluation of the constituitional approach.
- National Health Portal. Otitis Media. India: NHP CC DC; 2015. Available at https://www.nhp.gov.in/disease/eye-ear/otitis-media
- D Sahi, H Nguyen, KD Callender. Mastoiditis. Treasure Island (FL): StatPearls Publishing; 2021
- RADAR Version 10.0. Using Synthesis Repertory 9.0 Version. Belgium: Archibel; 2009.
- Kent JT. Lectures on Homœopathic Materia Medica. New Delhi: B Jain Publishers Pvt Ltd; 1985.
- Hahnemann S. Organon of Medicine. 6th ed. New Delhi : B. Jain Publishers Private Ltd.;2003.
- Curie PF. Practice of Homoeopathy- Of the Repetition of the Medicament [CD ROM]. France: Homeopathe International;1999
- Kent JT. Lectures on Homoeopathic Philosophy. New Delhi: B Jain Publishers Pvt Ltd; 2008.
About the authors
Dr Chirag Mishra1, Dr Seema kumari Meena2
1 Assistant professor, Department of Surgery, YPSM Homoeopathic Medical college, Alwar, Rajasthan.
2 Assistant professor, Department of Pharmacy, YPSM Homoeopathic Medical college, Alwar, Rajasthan.