HOMOEOPATHIC STUDY & MANAGMENT OF CHRONIC

SUPPURATIVE OTITIS MEDIA

Presented by:-
PATEL PRIYANKA D.
INTERN STUDENT,
[ J.N.H.M.C.H ]

INTERNSHIP BATCH: 2019- 2020

ABSTRACT
Chronic suppurative otitis media (CSOM) is a long standing infection of a part or whole of the
middle ear cleft with ear discharge and perforation of tympanic membrane. It is predominantly a
disease of developing world. Because of the nature and stage of disease, an anti-miasmatic
treatment is more effective for reducing the recurrence and preventing complications. Random
selection of 10 cases of patient with chronic suppurative otitis media and the case been analyzed
and the totality been erected. Then the remedy prescribed based on totality and miasmatic
background of each case. The result of this study showed that anti-miasmatic remedies were
effective in managing such cases. Syphilis was the most predominant miasm.

☆ INTRODUCTION
• Now a days CSOM condition is a very comman condition in people . this disease is a long
standing , chronic condition. So with the help of homoeopathy we give a relief and cure of patient.
• In our Homoeopathy many remedies are there that help the patient remove the pus formation and
healing of tympanic membrane.
• It is a painless treatment.
• It help to prevent the surgery.
• Many children suffering from this condition so we give a permanent and painless cure with the
help of Homoeopathy.
•It is a case of surgery department.
• In morden science ; more use and heavy Dose of medicines that cause a side effects and in some
cases perform a surgery.
• So with the help of Homoeopathy we give a peaceful treatment to prevent side effects of medicine
and prevent surgery.

☆ CHRONIC SUPPURATIVE OTITIS MEDIA

◇ DEFINATION
■ Chronic suppurative otitis media (CSOM) is a long-standing infection of a part or whole of
the middle ear cleft characterized by ear discharge and a permanent perforation.
▪A perforation becomes permanent when its edges are covered by squamous epithelium and it does
not heal spontaneously.
▪A permanent perforation can be likened to an epithelium-lined fistulous track.
 ●EPIDEMIOLOGY

Epidemiology is the study of the origin and causes of diseases in a community .The
investigation would identify the cause of the outbreak and lead to interventions to prevent further
cases of the disease.
Epidemiology identifies the distribution of diseases, factors underlying their source and cause,
and methods for their control; this requires an understanding of how political, social and
scientific factors intersect to exacerbate disease risk, which makes epidemiology a unique
science.
• CSOM incidence rate is 4.76%, equating to 31 million cases, with 22.6% of cases occurring
annually in the under-5s. 50% of CSOM patients have hearing impairment.

• Worldwide, there are between 65-330 million people affected, of whom 60% develop
significant hearing loss. This burden falls disproportionately on children in developing
countries[3].
• There is an association between CSOM and poor educational performance

▪ 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 .

● TYPES OF CSOM
• Clinically, it is divided into two types:

1. 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.
• Also called unsafe or dangerous type;
•it involves posterosuperior part of the cleft (i.e. attic, antrum
and mastoid) and is associated with an attic or a marginal
perforation.
• The disease is often associated with a bone-
eroding process such as cholesteatoma, granulations or
osteitis.

• Risk of complications is high in this variety .

This photo shows the more serious condition: chronic mucous discharge through a large central
perforation.
A. TUBOTYMPANIC TYPE
▪ AETIOLOGY
• The disease starts in childhood and is therefore common in that age group.
• 1) It is the sequela of acute otitis media usually following exanthematous 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 sensitised to dust, pollen and
other aeroallergens causing persistent otorrhoea.
• 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 ingestants such as milk, eggs,
fish, etc.

☆ PATHOLOGY
• The tubotympanic disease remains localized to the mucosa and, that too, mostly to anteroinferior
part of the middle ear cleft. Like any other chronic infection, the processes of healing and
destruction go hand in hand and either of them may take advantage over the other, depending on
the virulence of organism and resistance of the patient. Thus, acute exacerbations are not
uncommon.

The pathological changes seen in this type of CSOM are:

1. Perforation of pars tensa. It is a central perforation and its size and position varies
2. Middle ear mucosa. It may be normal when disease is quiescent or inactive. It is oedematous
and velvety when disease is active.
3. Polyp. A polyp is a smooth mass of oedematous and inflamed mucosa which has protruded
through a perforation and presents in the external canal. It is usually pale in contrast to pink, fleshy
polyp seen in atticoantral disease
4. Ossicular chain. It is usually intact and mobile but may show some degree of necrosis,
particularly of the long process of incus.
5. Tympanosclerosis. It is hyalinization and subsequent calcification of subepithelial connective
tissue. It is seen in remnants of tympanic membrane or under the mucosa of middle ear. It is seen
as white chalky deposit on the promontory, ossicles, joints, tendons and oval and round windows.
Tympanosclerotic masses may interfere with the mobility of these structures and cause conductive
deafness.
6. Fibrosis and adhesions. They are the result of healing process and may further impair mobility
of ossicular chain or block the eustachian tube.

BACTERIOLOGY
•Pus culture in both types of aerobic and anaerobic CSOM may show multiple organisms.
• Common aerobic organisms are Pseudomonas aeruginosa, Proteus, Escherichia coli and
Staphylococcus aureus, while anaerobes include Bacteroides fragilisand anaerobic Streptococci.
☆ ALTERNATIVE CLASSIFICATION OF CHRONIC OTITIS MEDIA
Tubotympanic disease of middle ear is a mucosal disease with no evidence of invasion of
squamous epithelium. It is called “active” when there is a perforation of pars tensa with
inflammation of mucosa and mucopurulent discharge. It is called
“inactive” when there is a permanent perforation of pars tensa but middle ear mucosa is not
inflamed and there is no discharge. Permanent perforation implies that squamous epithelium on
the external surface of pars tensa and mucosa lining its inner surface have fused across its edge.
Healed chronic
otitis media is the condition when tympanicmembrane has healed (usually by two layers), is
atrophic and easily retracted
if there is negative pressure in the middle ear. Healed otitis media may also have patches of
tympanosclerosis in tympanic membrane, or in middle ear involving promontory, ossicles,
tendons of stapedius and tensor tympani. Fibrotic tissue may appear in middle ear. It is always
associated with some degree of conductive hearing loss. Atticoantral disease has been called
squamosal disease of middle ear. It may be “inactive” when there are retraction pockets in pars
tensa (usually the posterosuperior region) or pars flaccida. There is no discharge but there is a
possibility of
squamous debris in retraction pockets to become infected and start discharging. Some retraction
pockets are shallow and self-cleansing. “Active” squamosal disease of middle ear implies
presence of cholesteatoma of posterosuperior region of pars tensa or in the pars flaccida. It erodes
bone, forms granulation tissue and has purulent offensive discharge

▪CLINICAL FEATURES
1. Ear discharge.
It is nonoffensive, 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
In long standing cases, cochlea may suffer damage due to absorption of toxins from the oval and
round windows and hearing 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.

• INVESTIGATIONS

1. Examination under microscope. It is essential in every case and provides useful information
regarding presence of granulations, in-growth of squamous epithelium from the edges of
perforation, status of ossicular chain, tympanosclerosis and adhesions. An ear which appears dry
may show hidden discharge under the microscope. Rarely, cholesteatoma may coexist with a
central perforation and can be seen under a microscope.
2. Audiogram. It gives an assessment of degree of hearing loss and its type. Usually, the loss is
conductive but a sensorineural element may be present.
3. Culture and sensitivity of ear discharge. It helps to select proper antibiotic ear drops.
4. Mastoid X-rays/CT scan temporal bone. Mastoid is usually sclerotic but may be pneumatized
with clouding of air cells. There is no evidence of bone destruction. Presence of bone destruction
is a feature of atticoantral disease.

TREATMENT

The aim is to control infection and eliminate ear discharge and at a later stage to correct the hearing
loss by surgical means.
1. Aural toilet.
Remove all discharge and debris from the
ear. It can be done by dry mopping with absorbent cotton buds, suction clearance under microscope
or irrigation (not forceful syringing) with sterile normal saline. Ear must be dried after irrigation.
2. Ear drops.
Antibiotic ear drops containing neomycin, polymyxin, chloromycetin or gentamicin are used.
They are combined with steroids which have local anti-inflammatory effect. To use ear drops,
patient lies down with the diseased ear up, antibiotic drops are instilled and then intermittent
pressure applied on the tragus for anti-biotic solution to reach the middle ear. This should be done
three or four times a day. Acid pH helps to eliminate pseudomonas infection, and irrigations with
1.5% acetic
acid are useful.
Care should be taken as ear drops are likely to cause
maceration of canal skin, local allergy, growth of fungus or resistance of organisms. Some ear
drops are potentially ototoxic.
3. Systemic antibiotics.
They are useful in acute exacerbation of chronically infected ear, otherwise role of systemic
antibiotics in the treatment of CSOM is limited.
4. Precautions.
Patients are instructed to keep water out of
the ear during bathing, swimming and hair wash. Rubber inserts can be used. Hard nose blowing
can also push the infection from nasopharynx to middle ear and should be avoided.
5. Treatment of contributory causes.
Attention should be paid to treat concomitantly infected tonsils, adenoids, maxillary antra and
nasal allergy.
6. Surgical treatment.
Aural polyp or granulations, if present, should be removed before local treatment with antibiotics.
It will facilitate ear toilet and permit ear drops to be used effectively. An aural polyp should never
be avulsed as it may be arising from the stapes, facial nerve or horizontal canal and thus lead to
facial paralysis or labyrinthitis.
7. Reconstructive surgery.
Once ear is dry, myringoplasty with or without ossicular reconstruction can be done to restore
hearing. Closure of perforation will also check
repeated infection from the external canal.
B. ATTICOANTRAL TYPE

• 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 rea-son, the disease is also called unsafe or dangerous
type.

▪ Aetiology
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.

▪ PATHOLOGY
Atticoantral diseases are associated with the following pathological processes:
1. Cholesteatoma.
2. Osteitis and granulation tissue. Osteitis involves outer attic wall and posterosuperior margin
of the tympanic ring.
A mass of granulation tissue surrounds the area of osteitis and may even fill the attic, antrum,
posterior tympanum and mastoid. A fleshy red polypus may be seen filling the meatus.
3. Ossicular necrosis. It is common in atticoantral disease. Destruction may be limited to the long
process of incus or may also involve stapes superstructure, handle of malleus or
the entire ossicular chain. Therefore, hearing loss is always greater than in disease of tubotympanic
type.
Occasionally, the cholesteatoma bridges the gap caused by the destroyed ossicles and hearing loss
is not apparent .
5.Cholesterol granuloma. It is a mass of granulation tissue with foreign body giant cells
surrounding the cholesterol crystals.
It is a reaction to long-standing retention of secretions or haemorrhage, and may or may not coexist
with cholesteatoma .
When present in the mesotympanum, behind
an intact drum, the latter appears blue.
BACTERIOLOGY

Same as in tubotympanic type.

SYMPTOMS

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.

▪ SIGNS
1. Perforation.
It is either attic or posterosuperior marginal
Type A small attic perforation may be missed
due to presence of a small amount of crusted discharge.
Sometimes, the area of perforation is masked by a small granuloma.
 2. Retraction pocket.
An invagination of tympanic membrane is seen in the attic or posterosuperior area of pars tensa.
Degree of retraction and invagination varies. In early stages, pocket is shallow and self-cleansing
but later when pocket is deep, it accumulates keratin mass and gets infected.
Stages of retraction pockets. There are four stages of tympanic membrane retraction.
(a) Stage I.
Tympanic membrane is retracted but does not
contact the incus. It is a mild form of retraction.
(b) Stage II.
Tympanic membrane is retracted deep and
contacts the incus; middle ear mucosa is not affected.
(c) Stage III.
Also called middle ear atelectasis. Tympanic
membrane comes to lie on the promontory and ossicles.
Middle ear space is totally or partially obliterated but middle ear mucosa is intact. Tympanic
membrane can be lifted from the promontory with suction tip. It also balloons up when N2O is
used during anaesthesia.
Tympanic membrane is thin because its collagenous middle layer has been absorbed due to
prolonged retraction.
In these cases long process of incus and stapes superstructure are absorbed. Placement of a
ventilation tube helps to restore the position of tympanic membrane.
(d) Stage IV.
• Also called adhesive otitis media.
• Tympanic membrane is very thin and wraps the promontory and ossicles.
• There is no middle ear space, mucosal lining of the middle ear is absent and tympanic membrane
gets adherent to the promontory. Retraction pockets are formed which may collect keratin plugs
and form cholesteatoma. Erosion of the long process of incus and stapes superstructure is common
in such cases.
3. Cholesteatoma.

Pearly-white flakes of cholesteatoma can be sucked from the retraction pockets. Suction clearance
and examination under operating microscope forms an important part of the clinical examination
and assessment of any type of CSOM.

INVESTIGATIONS

1. Examination under microscope.

All patients of chronic middle early disease should be examined under microscope
It may reveal presence of cholesteatoma, its
site and extent, evidence of bone destruction, granuloma, condition of ossicles and pockets of
discharge.
2. Tuning fork tests and audiogram.
They are essential for preoperative assessment and to confirm the degree and type of hearing loss.
3. X-ray mastoids/CT scan temporal bone.
They indicate extent of bone destruction and degree of mastoid pneumatization.
They are useful to indicate a low-lying dura or an
anteposed sigmoid sinus when operation is being contemplated on a sclerotic mastoid.
Cholesteatoma causes destruction in the area of attic and antrum (key area), better seen in
lateral view. CT scan of temporal bone gives more information and is preferred to X-ray mastoids.
4. Culture and sensitivity of ear discharge.
It helps to select proper antibiotic for local or systemic use.

FEATURES INDICATING COMPLICATIONS IN CSOM

1. Pain. Pain is uncommon in uncomplicated CSOM. Its presence is considered serious as it may
indicate extradural, perisinus or brain abscess. Sometimes, it is due to otitis externa associated
with a discharging ear.
2. Vertigo. It indicates erosion of lateral semicircular canal which may progress to labyrinthitis
or meningitis. Fistula test should be performed in all cases.
3. Persistent headache. It is suggestive of an intracranial complication.
4. Facial weakness indicates erosion of facial canal.
5. A listless child refusing to take feeds and easily going to sleep (extradural abscess).
6. Fever, nausea and vomiting (intracranial infection).
7. Irritability and neck rigidity (meningitis).
8. Diplopia (Gradenigo syndrome) petrositis.
9. Ataxia (labyrinthitis or cerebellar abscess).
10. Abscess round the ear (mastoiditis).
It is not uncommon for a patient of CSOM, residing in a far-flung village, where medical
facilities are poor, to go to
a doctor for the first time, presenting with complications.
It then demands urgent attention and emergency medical or surgical treatment.

▪ TREATMENT
1.Surgical.
It is the mainstay of treatment.
Primary aim in surgical treatment is to remove the disease and render the ear safe, and second in
priority is to preserve or reconstruct hearing but never at the cost of the primary aim.
Two types of surgical procedures are done to deal with cholesteatoma:
a)Canal wall down procedures.
They leave the mastoid cavity open into the external auditory canal so that the diseased area is
fully exteriorized. The commonly performed operations for atticoantral disease are atticotomy,
modified radical mastoidectomy and rarely, the radical mastoidectomy .
b)Canal wall up procedures. Here disease is removed by combined approach through the meatus
and mastoid but retaining the posterior bony meatal wall intact, thereby avoiding an open mastoid
cavity.
It gives dry ear and permits easy reconstruction of hearing mechanism. However, there is
danger of leaving some cholesteatoma behind. Incidence of residual or recurrent cholesteatoma
in these cases is very high and therefore long-term follow-up is essential. Some surgeon’s even
advise routine re-exploration in all cases after 6 months or so. Canal wall up procedures are
advised only in selected cases. In combined approach or intact canal wall mastoidectomy,
disease is removed both permeatally, and through cortical mastoidectomy and posterior
tympanotomy approach, in which a window is created between the mastoid and middle ear,
through the facial recess, to reach sinus tympani
2.Reconstructive surgery.
Hearing can be restored by myringoplasty or tympanoplasty. It can be done at the time of primary
surgery or as a second stage procedure.
3.Conservative treatment.
It has a limited role in the management of cholesteatoma but can be tried in selected cases,when
cholesteatoma is small and easily accessible to suction clearance under operating microscope.
Repeated suction clearance and periodic checkups are essential. It can also be tried out in elderly
patients above 65 and those who are unfit for general anaesthesia or those refusing surgery. Polyps
and granulations can also be surgically removed by cup forceps or cauterized by chemical agents
like silver nitrate or trichloroacetic acid. Other measures like aural toilet .
▪ DIFFERENTIAL DIGNOSIS
• Otitis externa :- inflamed, eczematous canal without a perforation .
• Foreign body.
• Impacted earwax. too much wax build up can cause problems. This build up is called impacted
earwax. Special glands in your ear make secretions that combine with dead skin cells to
form earwax. The earwax travels with slowly growing cells of your skin.
• Cholesteatoma : A cholesteatoma is an abnormal, noncancerous skin growth that can develop
in the middle section of your ear, behind the eardrum. It may be a birth defect, but it's most
commonly caused by repeated middle ear infections. A cholesteatoma often develops as a cyst,
or sac, that sheds layers of old skin.

• Difference between Acute and chronic otitis media

Chronic suppurative otitis media causes recurrent or persistent discharge (otorrhea) through a
perforation in the tympanic membrane, and can lead to thickening of the middle ear mucosa and
mucosal polyps. It usually occurs as a complication of persistent acute otitis media (AOM) with
perforation in childhood.
▪ Miasamatic evaluation of CSOM

• Chronic suppurative otitis media consist of ear discharge and perforation which comes under
syphilitic miasm.

• Syphillis is a distructive miasm.

• Syphillis complaints get aggravated at night and amiliorated during morning hours.

• Syphillit miasm includes depression ; alcoholisam ; ulcerations ; suicidal tendency ; hate;

blindness ; sulky which words describe by syphillis.
• The starting stage of otitis media in ASOM there is a psoric miasm but in CSOM there is a
syphillitic miasm.

• Syphilis can not directly express the disease but remains in its inner state but the fear get broke
out the disease.

HOMOEOPATHY MEDICINES OF CSOM :-

▪ Mercurius solubilis
Thick ; yellow discharge ; fetid and bloody . Otalgia worse warmth of bed ; at nights stiking pain
.Worse at night; damp wheather ; warm room; warm bed lying on right side memory weakened
slow in answering questions.
Merc. Sol. Is Use for the CSOM because it has a TENDENCY TO THE FORMATION OF
PUS.
▪ PULSATILLA
Thick ; bland discharge offensive odour. External ear swollen and red. Cattarhal otitisOtalgia ;
worse at Night. Sensation as if something where being forced outword. Hearing difficult ; as if the
ear were stuffed. Worse from heat ; lying on left ;Better in open air; clod application Weep easily
and like sympathy

▪ Heparsulph
Discharge of fetid pus from the ear. Wheezing and throbbing in ear with, hardness of Hearing
Worse from dry cold winds , cold air ,touch , lying on painful side Better in damp weather, warm
, from wrapping head up. The slightest cause irritate him Anguish in the evening and night with
thoughts of suicide.

▪ Kalium sulphuricum
Discharge of yellow matter ; Eustachian deafness
Worse evening , heated room
Better cool , open air

▪ Tellurium
Discharge from the ear acrid, smells like fish – pickle. Itching, swelling , throbbing in meatis ;
Deafness ; Catarrh of middle ear ; Worse at rest at night , cold weather , lying on painful side ,
Touch

▪ kalium Bichromicum

Thick ; yellow ;stringy ; fetid discharge ; Sharp stichies in left ear. Swollen with tearing pain ;
Worse morning ; hot wheather ; Better from heat .

▪ Syphilinum
Carries of ossicles in ear of syphilitic origine ; Worse at night and sundown to sunrise ; Better
during day , moving sbout slowly ; Hopeless ; Loss of memory .

▪ Arsenicum Album
Thin , excoriating , offensive otorrhoea ; Roring of ears during a paroxysam of pain ; Skin within
raw and burning
Worse from wet weather , midnight , cold weather
Better from heat , warm drink , Head elivated Restlessness ; Fear of death.

▪ calcarea carbonica
Throbbing ; cracking in ears; stitches ; pulsating pain as if something would pressed out.
Scrofulous inflammation with muco – purulant otorrhoea; Hardness of hearing
Cracking noises of ear ; Worse from cold , wet weather , washing ; Better from Dry climate , lying
on painfull side
Forgetfull, confused .

▪ Sulphur
Bed effects from the suppuration of otorrhoea. Wheezing in ears ; Deafness ; Worse from morning
, periodically , washing ; Better from dry weather , lying on right side .
☆ METHOD; PROCEDURE
The data has been collected from the cases of jnhmc. The case record contain age column,
through which we can depict the common age group suffer. The method in collecting data was
that first of all symptoms from the patient was collected ,moving forth past history was collected
so that we can know the duration of suffering, after all personal history was been collected. It
helped in analysing and forming the totality of symptoms. Audiogram is use for a hearing loss.
On the basis of totality homoeopathic medicine were prescribed. The most commonly prescribed
medicine in jnhmc was heparsulph and was mostly given in 30th potency due to age factor and
pathological changes in the ear. Again the follow up was taken of same patient after some days,
it showed somewhat relief but not the complete cure. This case has been repeated till the patient
is fully cured.
All this data has been recorded into the computers, through which we can know that from how
many years the patient is taking medicine and how much time has taken to the fullest cure.

Also the patient are admitted in Ipd due to greater suffering. And observation was made on the
same.
Some of the cases has been illustrated from which the data has been collected and studied:-

☆ ANNEXURE
CASE NO: 1
Opd no : 200020200
Name : Nisarge Rathwa

Age : 27200020
Sex : Male
Occupation : shopkeeper
Martial statues : Married

Chief complaint:
Stiking type of pain in Right side of ear
Thick yellow discharge from ear
Worse at lying on Right side , night
Loss of appetite
Slightly Hearing loss at Right side of ear
ORIGIN,DURATION , PROGRESS :patient develop a compliant before 1 year. Stiking type of pain
in right side of ear since 10 days than develop a complaint of thick yellow discharge from ear
since 5 days and slightly loss of Hearing since 2 days. With loss of Appetite.
PAST HISTORY :
NO Major illness in past
FAMILY HISTORY :

No major illness in Family

Mother : healthy
Father : healthy
PERSONAL HISTORY:
• Appetite: Reduced
• Thirst: 6 - 7 glass/day
• Perspiration: present
• Urine: 5 - 6 times/day
• Bowel: once in a day
• Sleep: Disturbed
• Addiction : no addiction

GENERAL EXAMINATION:
• Built: average
• Nutrition: well nourished

• Sclera: white
• Conjunctiva: pink
• Skin eruption: not seen
▪ MENTALS:
Weak memory
Slow in answering question

▪ VITALS:
▪ Temperature : 100°F
▪ Pulse : 70/min
▪ B.P :110/80 mm of hg
 ▪ R.R : 17/min
▪ GIT : p/a soft
▪ R.S : BLAE clear
▪ C.V.S : S1S2 heard
▪ C.N.S : conscious and oriented
▪ G.U.S : NAD

DIFFERNTIAL DIAGNOSIS:
Foreign body
Impacted earwex

CSOM
cholesteatoma
PROVISIONL DIAGNOSIS:
CSOM
FINAL DIAGNOSIS:
CSOM
SURGICAL MANAGEMENT :
No need to surgery
SELECTION OF REMEDY:
MERCURIUS SOLUBILIS
SELECTION OF DOSE AND REPETATION:
30/BD×7DAYS
ADVICE :

Avoid exposure to cold; Noise.

Take proper rest.

CASE NO: 2

Opd no : 20002081
Name : Pravina Patel
Age : 21 year
Sex : female
occupation : student
Martial statues : UnMarried

Chief complaint:
• Thick bland discharge from left ear
•offensive odour
•external ear swollen and red

•sensation as if something being forces outside

• Hearing Difficulty
• worse from heat; lying on left side
• better in open Air

Origin,Duration,Progress: Patient complaint start before 4 year. every year complaint

repeated. Thick yellow , bland discharge from left side of ear since 15 days with external ear
swollen and red. Patient have a sensation as if something being forces outside. Hearing
difficulty since 5 days. Complaint worse at lying on left side and better in open air.

Past history:
Malaria before 10 year
Family history:
No major illness

PERSONAL HISTORY:
• Appetite: good
• ThirsNo6-7glass/day
• Perspiration: present

• Urine: 4-5 times/day

• Bowel: once in a day
• Sleep: sound
• Addiction : no addiction
 GENERAL EXAMINATION:
• Built: average

• Nutrition: well nourished

• Sclera: white
• Conjunctiva: pink
• Skin eruption: not seen

MENTALS:
Weep easily
Like sympathy

▪ VITALS:
Temperature: 98.7°F
Puls:80/min
B.P:120/80 mm of hg
R.R: 20/min

GIT: p/a soft

R.S: AeBe clear
C.V.S: S1S2 heard
C.N.S: conscious and oriented
G.U.S: NAD
DIFFERNTIAL DIAGNOSIS:
CSOM
Foreign body

Impacted eareax
Cholesteatoma
PROVISIONL DIAGNOSIS:
 CSOM
FINAL DIAGNOSIS:
CSOM

SURGICAL MANAGEMENT :
No need to surgery
SELECTION OF REMEDY:
PULSATILLA
SELECTION OF DOSE AND REPETATION:

200/ BD× 7 DAYS

ADVICE :
Take proper rest.

CASE NO:3

Opd no:20002218
Name : Natubhai Patel
Age:32 year

Sex: Male
Occupation: Business
Marital status: Married
Chief complaint:

• Throbbing pain in ear

• Discharge of fetid pus from ear
•Hardness of Hearing
• pain in frontal region of Head
• worse from cold air , touch , lying on painfull side

•Better by warm , from wrapping head up

 Origin,Duration,Progress:
Patient having a complaint since 3 year. Throbbing pain and discharge of fetid pus from ear
since 10 days. because of that complaint hardness of hearing is there. and pain in frontal
region of head is associated complaints. complaint worse by cold air , touch , lying on painfull
side and better by warm , from erapping head up.

Past history:
No major illness
Family history:
Mother: Hypertension

Father: no major illness

PERSONAL HISTORY:
• Appetite: Reduced
• Thirst:7-8glass/day
• Perspiration: scanty

• Urine: 5-6times/day
• Bowel: once in a day
• Sleep : Disturbed
• Addiction : no addiction

GENERAL EXAMINATION:
Built: lean & thin
Nutritional examination : mal nourished

Sclera: white
Conjunctiva : pale
Skin eruption: not seen
 MENTALS:
The slightest cause irritate him
▪ VITALS:

Temperature: 98.7°F
Pulse: 86/min
B.P:110/80 mm of hg
R.R: 18/min

GIT: p/a soft

R.S: AeBe clear
C.V.S: S1S2 heard
C.N.S: conscious and oriented

G.U.S: NAD
DIFFERNTIAL DIAGNOSIS:
Foreign body
Impacted earwax
CSOM

PROVISIONL DIAGNOSIS:
CSOM
FINAL DIAGNOSIS:
CSOM
SURGICAL MANAGEMENT :
No need to surgery
SELECTION OF REMEDY:
HEPAR SULPH
SELECTION OF DOSE AND REPETATION:
30/BD×7DAYS

ADVICE :
Avoid exposure to cold; Noise.
Take proper rest.

CASE NO:4

Opd no :20002217
Name : kamlesh parmar

Age :30 year

Sex : Male
Occupation : Job
Marital status : UnMarried

Chief complaint:
• pain in ear
• yellow discharge from the ear
• mild fever
• loss of appetite

• Readness on external ear

• worse from evening , heated room
• better by cool , open air
Origin,Duration,Progress:
Patient well before 7 month than develop a complaint of pain in ear & yellowish discharge
from ear since 15 days. than develop a complaint of redness of ear and mild fever. complaint
worse from evening and heated room. Better by cool, open air.
Past history:

Complaint reoccurs since 7 month

Family history:
No major illness
PERSONAL HISTORY:
• Appetite: Decreased
• Thirst:9 -10 glass/day
• Perspiration: present

• Urine: 6-7 times/day

• Bowel: once in a day
• Sleep: Disturbed
• Addiction : no addiction

GENERAL EXAMINATION:
Built: average
Nutrition: well nourished
Sclera: white

Conjunctiva: pink
Skin eruption: not seen
MENTALS:
Irritable
▪ VITALS:

Temperature: 98.7°F
Pulse: 86/min
B.P:110/70 mm of hg
R.R: 20 /min
GIT: p/a soft
R.S: AeBe clear
C.V.S: S1S2 heard
C.N.S: conscious and oriented

G.U.S: NAD

DIFFERNTIAL DIAGNOSIS:
 Foreign body
Impacted earwax
CSOM

PROVISIONL DIAGNOSIS:
CSOM
FINAL DIAGNOSIS:
CSOM

SURGICAL MANAGEMENT :
No need to surgery
SELECTION OF REMEDY:
KALI SULPHURICUM
SELECTION OF DOSE AND REPETATION:
30/BD×7DAYS

ADVICE :
Avoid exposure to cold; Noise.
Take proper rest.

CASE NO:5
Opd no :20002219
Name : Ramlalabhai Vasava
Age :43 year

Sex : Male
Occupation : Job
Marital status : Married
Chief complaint:
• Acrid discharge from the ear

• discharge smell like fish pickle

 • mild deafness catarrh of middle ear
• worse at night, cold weather
Origin,Duration,Progress:

Patient having a complaint since 2year.Tthere is a Acrid discharge and smells like fish pickle.
Mild deafness and catarrh of middle ear. Since 10 days complain worse at night and cold
weather.
Past history:

No major illness
Family history:
Mother: Hypertension
Father: no major illness

PERSONAL HISTORY:
• Appetite: Reduced
• Thirst:7-8glass/day
• Perspiration: scanty
• Urine: 5-6times/day

• Bowel: once in a day

• Sleep : Disturbed
• Addiction : no addiction
GENERAL EXAMINATION:
Built: lean & thin
Nutritional examination : mal nourished
Sclera: white
Conjunctiva : pale

Skin eruption: not seen

MENTALS:
Irritable
▪ VITALS:
Temperature: 98.7°F
Pulse: 80/min
B.P:120/80 mm of hg

R.R: 17/min
GIT: p/a soft
R.S: AeBe clear
C.V.S: S1S2 heard

C.N.S: conscious and oriented

G.U.S: NAD
DIFFERNTIAL DIAGNOSIS:
Foreign body

Impacted earwax
CSOM
PROVISIONL DIAGNOSIS:
CSOM
FINAL DIAGNOSIS:

CSOM
SURGICAL MANAGEMENT :
No need to surgery
SELECTION OF REMEDY:
TELLURIUM

SELECTION OF DOSE AND REPETATION:

30/BD×7DAYS
ADVICE :
Avoid exposure to cold
Take proper rest.
CASE NO:6

Opd no :20002334
Name : Rohan Rana
Age : 35 year
Sex : Male

Occupation : job
Marital status : Married

Chief complaint:

• pain in ear
• Discharge of fetid pus from ear
•Hardness of Hearing
• pain in frontal region of Head
• worse from cold air , touch , lying on painful side

•Better by warm , from wrapping head up

Origin,Duration,Progress:
Patient having a complaint since 3 year. pain and discharge of fetid pus from ear since 10
days. because of that complaint hardness of hearing is there. and pain in frontal region of
head is associated complaints. complaint worse by cold air , touch , lying on painful side and
better by warm , from wrapping head up.
Past history:
No major illness

Family history:
Mother: no major illness
Father: no major illness
PERSONAL HISTORY:
• Appetite: Reduced
• Thirst:7-8glass/day
• Perspiration: scanty

• urine : 6-7 times/day

• Bowel: once in a day
• Sleep : Disturbed
• Addiction : no addiction

GENERAL EXAMINATION:
Built: lean & thin
Nutritional examination : mal nourished
Sclera: white

Conjunctiva : pale
Skin eruption: not seen
MENTALS:
The slightest cause irritate him
▪ VITALS:

Temperature: 98.7°F
Pulse: 86/min
B.P:110/80 mm of hg
R.R: 22/min
GIT: p/a soft
R.S: AeBe clear
C.V.S: S1S2 heard
C.N.S: conscious and oriented

G.U.S: NAD
DIFFERNTIAL DIAGNOSIS:
Foreign body
 Impacted earwax
CSOM
PROVISIONL DIAGNOSIS:

CSOM
FINAL DIAGNOSIS:
CSOM
SURGICAL MANAGEMENT :
No need to surgery
SELECTION OF REMEDY:
HEPAR SULPH
SELECTION OF DOSE AND REPETATION:
30/BD×7DAYS
ADVICE :

Avoid exposure to cold; Noise.

Take proper rest.

CASE NO:7

Opd no :19001696
Name : Khushbu Parmar
Age : 19 year
Sex : Female

Occupation : student
Marital status : UnMarried
Chief complaint:
• Stiking type of pain in Right side of ear
Thick yellow discharge from ear

Worse at lying on Right side , night

Loss of appetite
Slightly Hearing loss at Right side of ear
ORIGIN,DURATION , PROGRESS :patient develop a compliant before 3 year. Stiking type of pain
in right side of ear 7 days than develop a complaint of thick yellow discharge from ear since 5
days and slightly loss of Hearing since 2 days.
PAST HISTORY :
NO Major illness in past

FAMILY HISTORY :
No major illness in Family
Mother : healthy
Father : healthy

PERSONAL HISTORY:
• Appetite: Reduced
• Thirst: 6 - 7 glass/day
• Perspiration: present
• Urine: 5 - 6 times/day
• Bowel: once in a day
• Sleep: Disturbed
• Addiction : no addiction

GENERAL EXAMINATION:
• Built: average
• Nutrition: well nourished
• Sclera: white
• Conjunctiva: pink
• Skin eruption: not seen

▪ MENTALS:
Weak memory
Slow in answering question

▪ VITALS:
 ▪ Temperature : 100°F
▪ Pulse : 70/min
▪ B.P :110/80 mm of hg
▪ R.R : 17/min
▪ GIT : p/a soft
▪ R.S : BLAE clear
▪ C.V.S : S1S2 heard
▪ C.N.S : conscious and oriented
▪ G.U.S : NAD

DIFFERNTIAL DIAGNOSIS:
Foreign body
Impacted earwex
CSOM
cholesteatoma

PROVISIONL DIAGNOSIS:
CSOM
FINAL DIAGNOSIS:
CSOM
SURGICAL MANAGEMENT :
No need to surgery
SELECTION OF REMEDY:
MERCURIUS SOLUBILIS

SELECTION OF DOSE AND POTENCY

200 BD× 7 DAYS

ADVICE :
Take proper rest.

CASE NO:8
 Opd no :19001710
Name : Harsh Patel

Age : 25 year
Sex : Male
Occupation : job
Marital status : Married

Chief complaint:
• Throbbing pain in ear
• Discharge of fetid pus from ear
•Hardness of Hearing

• worse from cold air , touch , lying on painfull side

•Better by warm , from wrapping head up
Origin,Duration,progress :
Patient having a complaint since 3 year. Throbbing pain and discharge of fetid pus from ear
since 10 days. because of that complaint hardness of hearing is there. complaint worse by
cold air , touch , lying on painfull side and better by warm , from erapping head up.
Past history:
No major illness
Family history:
Mother: No major illness
Father: no major illness
PERSONAL HISTORY:
• Appetite: Reduced

• Thirst:7-8glass/day
• Perspiration : scanty
• Urine:6 – 7 times/day
• Bowel: once in a day
• Sleep : Disturbed
• Addiction : no addiction
GENERAL EXAMINATION:

Built : Average
Nutritional examination : mal nourished
Sclera: white
Conjunctiva : pale

Skin eruption: not seen

MENTALS:
The slightest cause irritate him

▪ VITALS:
Temperature: 98.7°F
Pulse: 76/min
B.P:110/70 mm of hg
R.R: 20 /min

GIT: p/a soft

R.S: AeBe clear
C.V.S: S1S2 heard
C.N.S: conscious and oriented
G.U.S: NAD
DIFFERNTIAL DIAGNOSIS:
Foreign body
Impacted earwax

CSOM
PROVISIONL DIAGNOSIS:
CSOM
 FINAL DIAGNOSIS:
CSOM

SURGICAL MANAGEMENT :
No need to surgery
SELECTION OF REMEDY:
HEPAR SULPH
SELECTION OF DOSE AND REPETATION:

200/BD×7DAYS
ADVICE :
Avoid exposure to cold; Noise.
Take proper rest.

CASE NO:9

Opd no :19001427
Name : Divyang Purohit

Age : 29 year
Sex : Male
Occupation : Business
Marital status Married

Chief complaint:
• Thick bland discharge from left ear
•offensive odour
•sensation as if something being forces outside
• Hearing Difficulty

• worse from heat; lying on left side

 • better in open Air
Origin,Duration,Progress: Patient complaint start bbefore3 year. every year complaint
repeated. Thick yellow , bland discharge from left side of ear since 15 days Patient have a
sensation as if something being forces outside. Hearing difficulty since 5 days. Complaint
worse at lying on left side and better in open air.
Past history:
No major illness

Family history:
Mother: no major illness
Father: no major illness
PERSONAL HISTORY:

• Appetite: Reduced
• Thirst:6 -7 glass/day
• Perspiration: average
• Urine: 5-6times/day
• Bowel: once in a day

• Sleep : Disturbed
• Addiction : no addiction
GENERAL EXAMINATION:
Built: lean & thin

Nutritional examination : mal nourished

Sclera: white
Conjunctiva : pale
Skin eruption: not seen

MENTALS:
The slightest cause irritate him
▪ VITALS:
Temperature: 98.7°F
Pulse: 86/min
B.P:110/80 mm of hg
R.R: 20 /min

GIT: p/a soft

R.S: AeBe clear
C.V.S: S1S2 heard
C.N.S: conscious and oriented

G.U.S: NAD
DIFFERNTIAL DIAGNOSIS:
Foreign body
Impacted earwax

CSOM
PROVISIONL DIAGNOSIS:
CSOM
FINAL DIAGNOSIS:
CSOM

SURGICAL MANAGEMENT :
No need to surgery
SELECTION OF REMEDY:
PULSATILLA
SELECTION OF DOSE AND REPETATION:

30/BD×7DAYS
ADVICE :
Take proper rest.

CASE NO:10
Opd no :19002397
Name : Jayant Padhiyar

Age :48 year

Sex : Male
Occupation : job
Marital status : Married

Chief complaint:
• Throbbing pain in ear
• Discharge of fetid pus from ear
•Hardness of Hearing

• pain in frontal region of Head

• worse from cold air , touch , lying on painful side
•Better by warm , from wrapping head up
Origin, Duration, Progress:
Patient having a complaint since 3 year. Throbbing pain and discharge of fetid pus
from ear since 10 days. because of that complaint hardness of hearing is there. and pain in
frontal region of head is associated complaints. complaint worse by cold air , touch , lying on
painful side and better by warm , from wrapping head up.
Past history:

No major illness
Family history:
Mother: Hypertension
Father: Diabetes

PERSONAL HISTORY:
• Appetite: Reduced
• Thirst:5-6 glass/day
• Perspiration : scanty
 • Urine: 3-4 times/day
• Bowel: once in a day
• Sleep : Disturbed

• Addiction : no addiction
GENERAL EXAMINATION:
Built: average
Nutritional examination :nourished

Sclera: white
Conjunctiva : pink colour
Skin eruption: not seen
MENTALS:

The slightest cause irritate him

▪ VITALS:
Temperature: 98.7° F
Pulse: 86/min
B.P:110/80 mm of hg

R.R: 18/min
GIT: p/a soft
R.S: AeBe clear
C.V.S: S1S2 heard
C.N.S: conscious and oriented
G.U.S: NAD
DIFFERNTIAL DIAGNOSIS:
Foreign body

Impacted earwax
CSOM
PROVISIONL DIAGNOSIS:
CSOM
FINAL DIAGNOSIS
CSOM

SURGICAL MANAGEMENT :
No need to surgery
SELECTION OF REMEDY:
HEPAR SULPH
SELECTION OF DOSE AND REPETATION:

30/BD×7DAYS
ADVICE :
Avoid exposure to cold; Noise.
Take proper rest.

☆ OBJECTIVES
CSOM is the chronic inflammation of part of whole Middle ear cleft characterised
by ear discharge and permanent perforation .Global burden of illness from csom
involves 65- 330 million individuals with draining ear ; 60% of whom suffer from
Significant hearing impairment . Surgical procedure like mastoidectomy with or
without tympanoplasty Costly and do not always lead to satisfactory hearing
improvement.
The risk of ototoxicity is one stumbling block in the wide spread use of topical
antibiotics. Antibiotic sensitivity has changed Over time and a continuous and
periodic surveillance is necessary and studies show most of the cases are poly
microbial. Homoeopathic approach is to treat the patient , evaluating health in
multiple level of each individual. This study is conducted to Understand the
effectiveness of constitutional medicine in the management of CSOM.
This study is to access the effectiveness of homoeopathic constitutional medicines
in the treatment of csom and also to compare the well being level and symptomatic
changes of the patient before and after treatment.
RESULT:-
The data collected from the cases show relation with the theory collected. The data shows that
the people who are exposure to cold and children are most sufferers. With the help of
homoeopathic medicine it showed that about 70% of people got cured. The choice of remedy
mostly used was Heparsulph and calcarea carb and other related remedy which affects the
CSOM. The CSOM of recent origin got cured in about 1 month and of long lasting without
pathological changes got cured in more than 15 days But the patient with pathological changes
and hearing loss only got relief around 6 month.

Age group

SUMMARY:
OM is one of the most common illnesses affecting children. In low-risk populations,
most illnesses are mild and will resolve completely without specific treatment. Unfortunately,
this is not always the case for Indigenous children in high-risk populations.
Multiple interventions have been assessed in the treatment of OM. None of the
interventions have had substantial absolute benefits for the populations studied.
Therefore, for low-risk children symptomatic relief and watchful waiting (including
education of the parents about important danger signs) is the most appropriate treatment option.
In our homoeopathy very good role in children with persistent bacterial infection, or
those at risk of complications. Even today, many Indigenous children will often fall
into these high-risk groups.

ANALYSIS:-
After 6 months, found amelioration of ear discharge is 75% ; aggravation in 10% ; and no changes
in ear discharge is 5% ; recurrence of ear discharge was decreased in 70% of patient.;CONCL30%
patient recurrence was same as before and is no case recurrence was increased. Calcarea carb and
Heparsulph was indicated in many cases and other related medicine also. 87 % patients with
hearing improvement had no change in hearing after treatment 13 % patient had improvement in
conductive deafness and no improvement was found in cases with mixed hearing loss. CSOM
More affecting age group is 15 -30 year.

CONCLUSION:- Results shows there is a significant improvement in the ear discharge of

patient. Character , volume and reoccurrence have improved after homoeopathic
constitutional medicine. Hearing impairment were not found to be improved in most of the
cases . Homoeopathic constitutional medicine are effective in management of CSOM.
☆References

1)Disease of ear nose and throat ; seventh edition

About the author
▪ PL Dhingra
▪ shruti dhingra

Assisted by :
• Deeksha Dhingra
2) chronic suppurative otitis media
Burden of illness and managment option

Child and adolescent Health and development prevantion of

Blindness and deafness
World Health Organization
Geneva ; Switzerland. 2004

3) Boerickes New Manual of Homoeopathic materia medica with

Repertory ; third revised and augmented edition
Based on ninth edition ( Garth William Boericke )
4)www.google.com
THANK YOU