Chronic Otitis Media
Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity that is characterize by discharge from the middle ear through a perforated tympanic membrane for at least 6 weeks.
- Overview
- Causes
- Types
- Sign & Symptoms
- What to eat
- Diet and Regiment
- Homeopathic Treatment
- FAQ
- Reference
Incidence of CSOM is higher in developing countries because of poor socioeconomic standards, poor nutrition and lack of health education. It affects both sexes and all age groups. In India, the overall prevalence rate is 46 and 16 persons per thousand in rural and urban population, respectively. It is also the single most important cause of hearing impairment in rural population.
CSOM occurs following an upper respiratory tract infection that has led to acute otitis media. This progresses to a prolonged inflammatory response causing mucosal (middle ear) oedema, ulceration and perforation. The middle ear attempts to resolve this ulceration by production of granulation tissue and polyp formation. This lead to increase discharge and failure to arrest the inflammation, and to development of CSOM, which is also often associated with cholesteatoma. There may be enough pus that it drains to the outside of the ear (in other words, otorrhea), or the pus may be minimal enough to be seen only on examination with an otoscope or binocular microscope. Hearing impairment often accompanies this disease.
[1] Tubotympanic
The disease starts in childhood and is therefore common in that age group.
1. It is the sequela of acute otitis media usually following exanthemata’s fever and leaving behind a large central perforation. The perforation becomes permanent and permits repeated infection from the external ear. Also, the middle ear mucosa is exposed to the environment and gets sensitized to dust, pollen and other aeroallergens causing persistent otorrhea.
2. Ascending infections via the eustachian tube. Infection From tonsils, adenoids and infected sinuses may be responsible for persistent or recurring otorrhoea. Ascending infection to middle ear occurs more easily in the presence of infection.
3. Persistent mucoid otorrhoea is sometimes the result of allergy to milk, eggs, fish, etc.
[2] Atticoantral.
Aetiology of atticoantral disease is same as of cholesteatoma and has been discussed earlier. It is seen in sclerotic mastoid, and whether the latter is the cause or effect of disease is not yet clear.
Tubotympanic.
Also called the safe or benign type; it involves anteroinferior part of middle ear cleft, i.e., eustachian tube and mesotympanum and is associated with a central perforation. There is no risk of serious complications.
2.Atticoantral.
It involves posterosuperior part of middle ear cleft (attic, antrum, posterior tympanum and mastoid) and is associated with cholesteatoma, which, because of its bone eroding properties, causes risk of serious complications. For this reason, the disease is also called unsafe or dangerous type.
A. Tubotympanic.
1.Ear discharge. It is non-offensive, mucoid or mucopurulent, constant or intermittent. The discharge appears mostly at time of upper respiratory tract infection or on accidental entry of water into the ear.
2.Hearing loss. It is conductive type; severity varies but rarely Exceeds 50 dB. Sometimes, the patient
reports of a paradoxical effect, i.e., hears better in the presence of discharge than when the ear is dry. This is due to “round window shielding effect” produced by discharge which helps to maintain phase differential. In the dry ear with perforation, sound waves strike both the oval and round windows simultaneously, thus cancelling each other’s effect (see physiology of hearing). In long standing cases, cochlea may suffer damage due to atticoantral absorption of toxins from the oval and round windows andhearing loss becomes mixed type.
3. Perforation. Always central, it may lie anterior, posterior or inferior to the handle of malleus. It may be small, medium or large or extending up to the annulus, i.e., subtotal.
4. Middle ear mucosa. It is seen when the perforation is large. Normally, it is pale pink and moist; when inflamed it looks red, oedematous and swollen. Occasionally, a polyp may be seen.
B. Atticoantral.
1.Ear discharge. Usually scanty, but always foul-smelling due to bone destruction. Discharge may be so scanty that the patient may not even be aware of it. Total cessation of discharge from an ear which has been active till recently should be viewed seriously, as perforation in these cases might be sealed by crusted discharge, inflammatory mucosa or a polyp, obstructing the free flow of discharge. Pus, in these cases, may find its way internally and cause complications.
2.Hearing loss. Hearing is normal when ossicular chain is intact or when cholesteatoma, having destroyed the ossicles, bridges the gap caused by destroyed ossicles (cholesteatoma hearer). Hearing loss is mostly conductive but sensorineural element may be added.
3.Bleeding. It may occur from granulations or the polyp when cleaning the ear.
For chronic otitis media, a diet rich in nutrients that support the immune system and reduce inflammation can aid recovery. Here’s a point-wise breakdown:
- Hydration: Drink plenty of water to keep the body hydrated and support the immune system.
- Vitamin C-rich Foods: Citrus fruits, strawberries, and bell peppers help boost immunity and fight infections.
- Vitamin A: Carrots, sweet potatoes, and spinach support mucosal health and immunity.
- Omega-3 Fatty Acids: Fatty fish like salmon, walnuts, and flaxseeds reduce inflammation.
- Probiotics: Yogurt, kefir, and fermented foods promote gut health and may support the immune system.
- Garlic and Ginger: Both have natural anti-inflammatory and antimicrobial properties.
- Avoid Dairy: Excessive dairy may increase mucus production, worsening symptoms.
Consult a healthcare provider for personalized advice.
Foods to be taken
- Eat plenty of fruits, vegetables, and whole grains, and healthful snacks, such as homemade smoothies and dried fruits.
- Vitamin C aids immune health by helping the white blood cells to destroy germs faster. Include vitamin c rich foods like peppers, green leafy vegetables, berries etc.
- Vitamins A and Zinc (carrots, tomatoes) also reduce ear infections due to their antioxidant properties.
- Eat only extra virgin olive oil, fish oils and coconut oil as your only sources of dietary oil. Coconut oil is especially health as an anti-infective. Increase raw foods and protein.
- Use only pure water for drinking and cooking (no well water or water containing fluoride or chlorine.
- Make sure you eat a healthy and balanced diet to include vitamins A, C, and E, and zinc. A daily multivitamin is good if you do not eat a healthy diet.
Foods to be avoided
- Eliminate all dairy products, gluten containing grains, canned, processed and frozen foods
Homeopathic Medicines for Chronic otitis media
The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.
So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).
Belladonna
This medicine is frequently useful where there is a rapid and violent onset of symptoms that involve mental excitement, anxiety, sensory hyperesthesia, pupil dilation, cold extremities, redness and acute inflammation. The tympanic membrane is often bright red and bulging, there may be a bright, dry, red throat, pounding, throbbing pain in the right ear, dry skin, an aching in the face extending to the neck, a high fever, and a bright red or flushed face. The otitis may be associated with teething and symptoms come and go quickly. The symptoms are usually worse from jarring, from a draught, from light or noise, and are usually better from bed rest and in a warm room.
Chamomilla
The Chamomilla sufferer is never pleased, is restless, angry and irritable, thirsty, hot, experiences night sweats, is impatient, rejects things that are offered, and strikes others. The prescriber may notice that one cheek is red and hot while the other is pale. Like Belladonna, the otitis here often occurs with teething. The otitis pain frequently causes screaming or whining. The symptoms are worse heat and at night, from teething, and better from being carried and from perspiration.
Calcarea Carbonica
The presence of offensive muco-purulent otorrhea, night sweats, photophobia, swollen tonsils, enlarged glands and deafness, particularly when teething is occurring at the same time or there’s been a history of delayed dentition, may indicate the need for Calc carb. There may be a desire for cold drinks, eggs, milk and things that are normally indigestible. The sufferer may appear to be obstinate, may perspire easily, particularly about the head and at night and exhibit a sour odour, and may complain of a sensitivity to cold around the ears and neck. The symptoms are worse from cold weather, from drinking milk or washing, and better from lying on the affected side and from dry weather.
Hepar sulph
Hepar sulph can be very useful for those suffering from chronic otitis with pharyngitis, deafness, perforations or ulceration of the tympanic membrane, and a yellow purulent cheesy offensive effusion, all of which may progress to mastoiditis. Often, pain can be felt shooting from throat to the ear on swallowing. Th e sufferer may be irritable and experience cold sweats, hyperesthesia, may be sensitive to touch. Injuries tend to suppurate and there may be a history of bacterial infections. Symptoms are often worse from cold air, dry cold wind and touch, and better from heat, damp weather, wrapping up, from rest and in the morning.
Sulphur
This medicine may be required to be used as an intercurrent when other well-indicated medicines fail to act. The pointers here include restlessness, aggression, a dislike of bathing, frequent skin eruptions, relapsing complaints, itchy skin, tinnitus, deafness, ailments from milk, and a desire for sweets. The sufferer may experience morning diarrhoea, profuse urination, respiratory congestion, hot sweaty hands, as well as flushes of heat with dry skin. The body generally appears to be unclean. The symptoms here are commonly worse warmth in bed, in the early morning, from washing or bathing, and better during warm dry weather and in the open air.
Capsicum
The symptoms guiding the prescription of Capsicum include a high fever, chills, stinging, stabbing or burning ear pain with suppuration, a hot face, halitosis, red cheeks, pain and dryness in throat, inflamed fauces, uvula and palate, as well as mastoiditis. The body may appear to be unclean. Symptoms are worse from cold, on coughing in the open air and from draughts, and better from heat and eating.
Ferrum Phos
Ferrum Phos is frequently thought of as being useful in the early stages of all febrile and inflammatory disorders, and as such is useful in the early stages of otitis. Specific indications include inflammation and bulging of the tympanic membrane, lassitude, feverish and yet chilly at around 1pm, tinnitus and flushing of the face. Symptoms are worse on the right side, at night and from 4-6am, from touch or jarring, and better from cold applications.
Kali bich
Kali Bichromicum is often thought of in chronic situations involving a perforation of the ear drum accompanied by a muco-purulent discharge. Involved tissues are irritable, there may be a stringy or globular yellow nasal discharge, a dry mouth and throat, sinus headache and fever. Symptoms are worse on the left side, in the morning and from cold, and are better from heat.
Kali mur
Chronic otitis with mastoid involvement and excessive granulation occurring in the inner third of the auditory canal often respond well to this medicine. Swollen glands, flatulence, deafness, tinnitus and a history of glue ear and tonsillitis may also be noted here. Symptoms are worse from motion, open air, cold drinks, and are better from rubbing.
Lycopodium
In this instance, symptoms often start on the right side, then either stay there or travel to the left. Other indicators include tinnitus, deafness, thick yellow offensive otorrhoea, a desire for sweets and warm food, increased appetite, flatulence, cold extremities, dry skin, intermittent chills and sweats and hyperesthesia to noise. Symptoms are worse in the late afternoon to evening or on waking, from warmth and are better from motion, from cold applications and from being uncovered.
Mercurius Solubilis
A severe sore throat, prostration, fever, night sweats, moist skin, thick offensive yellow or green discharges, profuse sweating, swollen lymph nodes, ear pain and excessive salivation may be indicators for this prescription. The sufferer often experiences tremors in the extremities, is chilly, craves bread and butter and cold drinks. Symptoms are worse at night, from heat, a warm room, a warm bed, and from perspiration.
Tellurium
On examination, one may note a drum head that is dark purple, with elevated spots in the local area that form vesicles which break and produce a watery acrid excoriating discharge that smells of fish. Symptoms tend to develop slowly and deafness may occur. Symptoms are worse at night, from cold, touch, and lying on affected side. Symptoms are better from lying on the back
What is Chronic Otitis Media
Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity that is characterize by discharge from the middle ear through a perforated tympanic membrane for at least 6 weeks.
Homeopathic Medicines used by Homeopathic Doctors in treatment of Chronic Otitis Media
- Belladonna
- Chamomilla
- Calcarea Carb
- Hepar sulph
- Sulphur
- Capsicum
- Ferrum Phos
- Kali bich
- Lycopodium
- Mercurius Sol
- Tellurium
What are the symptoms of Chronic Otitis Media
- Ear discharge
- Hearing loss
- Perforation
- Middle ear mucosa- red, oedematous and swollen
- Bleeding
What are the causes of Chronic Otitis Media
- Following exanthemata’s fever
- Infection From tonsils, adenoids and infected sinuses
- Persistent mucoid otorrhoea
[1] https://en.wikipedia.org/wiki/Otitis_media
[2] Disease of EAR, NOSE, AND THROAT&HEAD AND NECK SURGERY 6TH EDITIONS BY P.L Dhingra, Shruti Dhingra.
[3]https://hpathy.com/homeopathy-papers/homeopathy-for-the-management-of-otitis-media/
[4]https://www.wikidoc.org/index.php/Otitis_media_physical_examination, risk factor-Differential diagnosis
[5]https://www.mtatva.com/en/disease/otitis-media-treatment-diet-and-home-remedies/