ABSTRACT– Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity.Clinical features of CSOM are otorrhoea through a tympanic perforation ,otalgia. The pathology of CSOM is a continue inflammation ,ulceration ,infection and granulation .From the perspective of certain journals ,the goal was to determine the impact of homoeopathic management in CSOM.
KEYWORDS-Chronic Suppurative Otitis Media ,Homoeopathy, Otorrohea.
We are in twenty first century but the prevalence of CSOM is increasing day by day throughout the world. CSOM is on the rise all over the world .It was observe that many people were suffering from CSOM but they were not aware of the efficacy of homoeopathic system of medicine and were depending on other system of medicine like allopathy etc.So this is an attempt to ascertain the effectiveness of homoeopathic medicines in CSOM.
CSOM isdefined as a chronic inflammation of the middle ear which presents with recurrent ear dischargeor otorrhoea through a tympanic perforation .Generally patients with tympanic perfoarations which continue to discharge mucoid material for period of from 6 weeks to 3 months despite medical treatment are recognised as CSOM cases.
The WHO definition reqiures only 2 weeks of otorrhoea ,but otolaryngologist tend to adopt a longer duration eg: more than 3 months of active disease.
ROUTE OF INFECTION-
1)Via Eustachian tube
2)Via External ear
3)Via Blood borne
Infection passes through 5 stages-
1)CATARRHAL STAGE-It is characterised by occlusion of Eustachian tube and congestion of middle ear.
2)STAGE OF EXUDATION-Exudates collects in middle ear and drum is pushed laterally.
3)STAGE OF SUPPURATION-Pus in middle ear collects under tension ,stretches the drum ,and perforates it by pressure necrosis and the exudates start escaping into the external auditory canal.
4)STAGE OF HEALING-Usually infection clears up completely without leaving any sequale.
5)STAGE OF COMPLICATION-Infection may spread to mastoid antrum through aditus.
TYPES OF CSOM-
TUBOTYMPANIC TYPE OR SAFE TYPE CSOM-
• It usually starts in childhood and is relatively much commoner .
• In many cases the presenting or reccuring infection spreads via Eustachian tube to tympanic cavity.
• Perforation is in the centre of the tympanic membrane.
DANGEROUS OR ATTICOANTRAL TYPE-
• Perforation is at the top of tympanic membrane.
• It is associated with bone erosion.
• It is characterised by thick,purulent, scanty,’foul smelling ,blood stained ,persistent discharge.
• SEVERE PAIN.
• EAR DISCHARGE.
• HEARING LOSS.
• SYMPTOMS LIKE FEVER AND MALAISE.
• HEAVINESS OF EAR.
• Possibly life –threatening spread(eg:MENINGITIS,INTRACRANIAL ABSCESS,FACIAL PARALYSIS).Rarely occurs with adequate treatment.
• TYMPANOSCLEROSIS Or Scarring of the tympanic membrane due to recurrent ear infection or otitis media with effusion .
• White calcified plaques in the tympanic membrane seen on otoscopy.
In india overall prevalence rate is 46 and 16 person per thousand in rural and in urban population .
It affects both sexes and all age groups. Mostlychildrens are affected.
People with low socioeconomic status.
• Test of Hearing.
• Tuning fork test.
Weber test-The base of vibrating tuning fork is placed on the middle of the forehead and the sound is heard equally in the both ears in a normal person.The sound is lateralized to the healthy ear(heard louder)in nerve deafnessof the other ear and is lateralized to the diseased ear in case of conductive deafness.
Rinne test-The base of the vibrating tuning fork is placed on the mastoid process until the patient does not hear.Then the prongs are held in front of the ear 2 to 3 cm keeping the acoustic axis in line with the external meatus.
- If the patient can hear,it is stated as AC>BC(air conduction>bone conduction)or Rinne test positive,which means normal hearing.
- If the patient can not hear,it indicates BC>AC(bone conduction >air conduction)or Rinne teat negative and indicates conductive deafness.
Both the tests together help to find out the defective ear and the type of deafness.
• OTITIS MEDIA WITH EFFUSION.
• ACUTE OTITIS EXTERNA.
Homeopathic remedies are helpful in treating the case of CSOM. Basically constitutional remedy effects more and some are therapeutically based.
There are so many homoeopathic medicines which can be useful for treatment of CSOM.
Few of them are-
• ARSENICUM ALBUM-
Squeezing,Sharppains,Shootings,Voluptuous tickling and burning in the ears-Tinkling ,roaring,buzzing and sound as if the bells, in the ears sensation ,as if the ears were stopped,and hardness of hearing.
Thin ,excoriating ,offensive otorrhoea.
• LYCOPODIUM CLAVATUM-
Thic ,yellow,offensivedischarge.Eczema about and behind ears otorrhoea and deafness with or without tinnitus,afterscarlatina.Otalgia in open air .Tinkling and buzzing in ears.Roaring ,humming and whizzing in ears.Sensation as if hot blood rushed into ears.Congestion of blood in ears.
• HEPAR SULPHUR-
Darting pain in the ears .Shootings in the ears,on blowing the nose .Discharge of pus from the ears.which is sometimes foetid.Hardness of hearing ,with pulsation and buzzing in the ears.
Deafness after scarlet fever.Whizzing and throbbing in the ears,discharge of foetid pus from the ears.
• SILICEA TERRA-
Foetid discharge.Caries of mastoid.Sensitive to noise.
Otalgia with drawing pain.Boring and throbbing in the ears.Caries of the mastoid process.Discharge of pus accompanied by a sort of whistling .Otorrhoeaoffensive,watery ,curdy,withhoreness of inner nose.Rupture of the drum of the ear.
• PULSATILLA NIGRICANS-
Pain in ears ,as if something were about to protrude from them.Shootings with itching or sharp jerking pain and contraction in and around ear .Ear ache with shooting down to teeth of the lower jaw ,violent headache,frontal and occipital region .Bland nearly inoffensive discharge of mucus and pus from ear.
• MERCURIUS SOLUBILIS-
Otalgia worsens warmth of bed,at night sticking pains.Thick yellow discharge ,foetid and bloody.
Deafness ,preceded by exceedingly sensitive hearing ,catarrhal deafness .Whizzing in ears .Bad effects from the suppuration of an otorrhoea .
• NUX VOMICA-
Otalgia with tearing, stinging pains in ear aggravated after entering .
The room and in bed humming ,hissing ,whistling,tingling in ears,cracking when masticating.
• AURUM MET-
Obstinate foetid otorrhoea after scarlatina. External meatus bathed in pus caries of ossicula and of mastoid.
Chronic nerve deafness .Labyrinthine disease due to syphllis.
Caries of the nasal plating and mastoid bones ozaena, otorrhoea,excessively foetid discharge ,pains .Worse at night,drive to despair ,of mercurial or syphilitic origin .
• ANTIMONIUM CRUDUM-
Moist eruption on external ears and behind it ,scrofulous otorrhoea ,chronic catarrhal otitis media with heat and tension,aggravation by heat.
Researches show that homoeopathic remedies have more benefits to the people suffering from CSOM.
Homoeopathy by addressing all aspects of the individual and there complete set of symptoms throw the constitutional and holistic approach ,is superior to all method of treatment.
Homoeopathic treatment is based on the constitutional approach targeting the route cause and restoring the deviated immunity back to normal,there by cured the diseases.
In other system of medicines the treatment of CSOM is mainly suppressive or palliative treatment rather than curative.
1) Dhingra PL .Disease of Ear ,Nose and Throat .5 Edition .New Delhi:B.I Churchill Livingstone Pvt.Ltd;1998p.77
2) CSOM ,Burden of illness and management options-WHO 2004.
3) KennaMA.Treatment of Chronic Suppurative Otitis Media.OtolaryngolClinNorth Am .,1994,27(3):457-472.
4) Boericke W.New Manual Of Homoeopathic Materia Medica. New Delhi: B.Jain Publishers(P)Ltd;2011.
5) Clarke JH,A Dictionary Of Practical Materia Medica. New Delhi: B.Jain Publishers Pvt.Ltd;2015.
6) Kent JT,Lectures On Homoeopathic Materia Medica. New Delhi: B.Jain Publishers Pvt.Ltd;2007.
Dr. Yasmeen khan, MD. Scholar Pharmacy,
Guru Mishri Homoeopathic Medical College and Hospital.