Clinical Cases

Chronic Suppurative Otitis Media with Mastoiditis and Conductive Hearing Loss

basu sept image

Dr. Nilanjana Basu presents a case of chronic suppurative otitis media with Mastoiditis and hearing loss

Abstract:

Chronic suppurative otitis media (CSOM) is a major cause of acquired hearing impairment especially in the developing countries. Most approaches to treatment have been unsatisfactory or are expensive and difficult. The repair of the tympanic membrane requires surgery. Mastoiditis is the most common complication of chronic otitis media. The usual practice in otorhinolaryngology for mastoiditis is hospitalization, I.V. antibiotics, analgesics/antipyretics and later on surgery such as mastoidectomy.1 Homoeopathy has a significant role in treating such cases. This case of a 33 year old male, adds significant proof in efficacy of homoeopathy in treating CSOM with mastoiditis and conductive hearing loss. A keynote prescription of Capsicum in centesimal potency was done.

Keywords: Homoeopathy, CSOM, mastoiditis, conductive hearing loss, keynote prescription, healed tympanic membrane

Introduction:

Chronic otitis media is a long standing infection of a part or whole of the middle ear cleft characterized by ear discharge and a permanent perforation. It is one of the most common causes of deafness, especially in children. If not recognized properly it can lead to mutism. Mastoiditis is the most common complication of otitis media. Though it is seen in children as a complication of acute otitis media, it is also found in adults having acute exacerbations of chronic otitis media. As a homoeopathic physician it is necessary to diagnose such cases properly. The anatomy and physiology of the ear is intricate so it becomes difficult for history and examination to be carried out.

Case:

Chief complaints:

  • Discharge from right ear since 15 years.
  • Hearing difficulty since 15 years.
  • Burning pain in right ear since 3 days.

 

History of presenting illness:

A male patient aged 33 years presented with discharge from right ear since 15 years. The discharge was profuse, offensive, thick, sticky and whitish in colour. There was associated difficulty in hearing. He can hear but with difficulty. All the words of speech are clear. Patient complains of burning pain at the back of right ear with heaviness of the head since 3 days. There is history of fever associated with pain. Patient did not give any specific modalities to his complaints. There is no history of tinnitus and vertigo. He has history of recurrent attacks of cough and cold.

 

Past history:

  • History of hydrocele which was operated 8 years ago

 

Family history:

  • Mother – has cardiac disease
  • Father –  has osteoarthritis

Personal history:

  • Diet – regular, non-vegetarian
  • Tobacco chewing – 3-4 packets a day for 10 years
  • Bowel habits – regular
  • Marital status – married
  • Of children – 2

 

General Physical examination:

  • Mental state and consciousness- Conscious and Well oriented with time, place and person
  • Build / Nutrition: well built, well nourished
  • Gait- Normal
  • Decubitus: Of choice
  • Facies- Normal
  • Pallor- Absent
  • Icterus- Absent
  • Cyanosis- Absent
  • Oedema- Absent
  • Clubbing- Absent
  • Pulse- 80/min
  • Respiration- 15/min
  • Temperature- Normal
  • P.- 130/80 mm of Hg

Local examination:

EAR

Physical examination

  • Pinna and surrounding areas – appears normal on inspection and palpation.
  • External auditory canal – discharge muco-purulent reappears again after few minutes of cleaning (Reservoir sign). The discharge is also pulsatile (Light house sign).
  • Tympanic membrane – small sized perforation of anterio-inferior quadrant. Sagging of posterior-superior part of meatal wall.
  • Middle ear – Congested
  • Mastoid – Post auricular tenderness on palpation
  • Facial nerve – normal sensory and motor function

Functional examination

  • Auditory function- Tuning fork test

Rinne’s test – negative in right ear

Weber test – lateralized to right ear

ABC – normal

  • Vestibular function- normal

NOSE – Normal

THROAT – Normal

Systemic examination:

  • Nervous system –   Cranial nerves – normal

Motor functions – normal

Sensory system – normal

Cerebellar function – normal

  • I.System – normal
  • Cardiovascular system – S1 and S2 normal, no added sound
  • Respiratory system – normal breath sounds, no added sound.
  • Locomotor system – normal

 

Special investigation:

  • Video otoscopy (Image 1) as on 19/11/10
basu-sept14-image002basu-sept14-image001

(Image 2) After cleaning

basu-sept14-image003basu-sept14-image005basu-sept14-image004

 

  • Pure Tone Audiometry
  • Diagnosis: Right-sided CSOM complicated with mastoiditis and conductive hearing loss

 basu-sept14-image006

Physical generals:

  • Appetite-good
  • Desire- sour, warm food
  • Thirst- large quantities at short intervals
  • Tongue- clean, moist
  • Stool- regular but hard, burning while defecation
  • Urine-clear
  • Sweat- armpits, non-offensive, non-staining
  • Sleep-sound, lies on back, unrefreshed
  • Chilly patient

Mental symptoms:

Desires company. Patient is a plumber by profession from Odissa and was residing away from his family for 3 months. (Home-sickness)

Symptoms of the case:

  • Profuse, offensive, thick, sticky and whitish in colour discharge from right ear
  • Difficulty in hearing
  • Burning pain in right ear
  • Desire for sour and warm food
  • Stools hard
  • Desire company
  • Homesickness

Analysis and Evaluation of symptoms

  • Homesickness
  • Difficulty in hearing
  • Burning pain in right ear
  • Profuse, offensive, thick, sticky and whitish in colour discharge from right ear

Totality of symptoms

  • Homesickness
  • Difficulty in hearing
  • Burning pain in right ear
  • Profuse, offensive, thick, sticky and whitish in colour discharge from right ear

Selection of remedy with consultation of Materia Medica:

According to H.C. Allen, Capsicum is indicated in mastoiditis, with swelling and burning pains behind the ear.2

Hering narrates the use of Capsicum in cases of tympanum perforated with cavity filled with thick yellow pus. There will be painful swelling behind the ear, caries of mastoid process.3

Boericke says Capsicum is used in cases where patient gets homesickness easily. They have burning pains and general chilliness. Capsicum has marked tendency to suppuration in every inflammatory process. Capsicum is indicated in mastoiditis.4

Prescription:

Capsicum 1M, 3 doses, 12 hourly was given on 19/11/10, followed by placebo. Ear toileting was done. Patient was advised for steam inhalation.

 

Follow-up:

  • 26/11/10

The patient felt relief in pain behind the right ear following medication. The discharge persisted. Heaviness of the head persisted. There was no fever. On examination there was pulsatile discharge and posterio-superior quadrant bulge of TM. Placebo was given with advice to take steam inhalation.

  • On 3/12/10

Discharge was better. No pain and heaviness of the head was present. On examination PSQ bulge absent. The image as on 3/12/10 was as below. Placebo was given.

Image 3

basu-sept14-image008basu-sept14-image007

 

  • On 24/12/10

Patient was better. On examination ear was dry. Placebo was given.

  • On 7/1/11

There was relapse in symptoms. On examination pulsatile discharge in right ear. 3 doses of Capsicum 1M was repeated 12 hourly followed by placebo.

  • On 21/1/11

Patient better. No discharge. Placebo was given.

  • On 11/2/11

Patient better. No discharge. Placebo was given.

  • On 4/3/11

Patient had discharge from right ear. TM was congested. 3 doses of Capsicum 1M was repeated 12 hourly followed by placebo.

  • On 22/3/11

Patient better. No discharge. Placebo was given.

  • On 15/4/11

Patient better. No discharge. Placebo was given.

  • On 3/6/11

Patient better. No discharge. Placebo was given.

  • On 26/8/11

Patient had discharge from right ear after an attack of cold. TM was congested. 2 doses of Capsicum 10M was repeated 12 hourly followed by placebo.

  • On 1/10/11

Patient better. No discharge. Placebo was given.

  • On 17/4/12

Perforation healed.

 

Image 4

basu-sept14-image010basu-sept14-image009

Pure Tone Audiometry after healing

 

basu-sept14-image011

 

Discussion and conclusion :

The case showed relief in symptoms and pathology, i.e. healing of the tympanic membrane with homoeopathic medicine prescribed on totality of symptoms. The importance of diagnosis is very much obvious in this case. A physician not only requires to prescribe but also has to diagnose a case to cater to the total need of the patient. The prescription was done on the basis of “characteristic”, the “red strand of the rope” of the medicine — a Keynote Prescription.2

Mastoiditis—Homesickness—Burning pains

arrow-down

CAPSICUM

High potency was prescribed on the basis of acute stage of the case followed by placebo. The potency was repeated when there was a standstill. Lastly, a higher potency was used.

References:

  1. Dhingra P L. Diseases of Ear, Nose and Throat. Elvsevier.5th 2010: ch 11, 12.
  2. Allen H C. Allen’s Keynotes and Characteristics with comparisons of some of the leading remedies of the materia medica with nosodes. B Jain Publishers Pvt. Ltd. 8th 1994: 81-82.
  3. Hering C.Thae Guiding Symptoms of Our Materia Medica. B Jain Publishers Pvt Ltd. Reprint ed.2000: vol III.
  4. Boericke W. Pocket Manual of Homoeopathic Materia Medica & Repertory Comprising of the Characteristic and Guiding Symptoms of all Remedies (Clinical and Pathogenetic) Including Indian Drugs. B Jain Publishers Pvt Ltd. Reprint ed.2002:166-168.
  5. Boenninghausen’s Lesser writing
  6. Kent J T. Philosophy

RELATED POSTS

About the author

Nilanjana Basu

Nilanjana Basu

Dr. Nilanjana Basu, - B.H.M.S. (C.U.) is a lecturer at Department of Surgery, Bakson Homoeopathic Medical College, Greater Noida.

3 Comments

Leave a Comment