Chronic Suppurative Otitis Media with Mastoiditis and Conductive 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

(Image 2) After cleaning

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

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

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