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
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.
CAUSES
[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.
TYPES
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.
SIGNS AND SYMPTOMS
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.
WHAT TO EAT
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.
DIET AND REGIMEN
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
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FAQ
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
REFFERNCE
[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/
[5]https://www.mtatva.com/en/disease/otitis-media-treatment-diet-and-home-remedies/
