ENT
CONDITIONS
Ear Infections
(ASOM, CSOM)
Acute Suppurative Otitis Media (ASOM)
Acute suppurative otitis media is a fairly common infection affecting the mucosa of the middle ear cleft, and it may cause severe pain which often wakes up the patient at night.
Chronic Suppurative Otitis Media (CSOM)
Chronic suppurative otitis media is a very common condition in our country. It may remain a benign condition or at times may lead to fatal intracranial complications.
Causes
Acute Suppurative Otitis Media (ASOM)
Age: It occurs at all ages, but is more common in children as the Eustachian tube in children is shorter, wider, more horizontal and opens at a lower level. In children, both ears may be involved.
Sex: It affects both sexes equally.
Geographic Distribution: It occurs all over the world.
Portals for Entry of Infection
- EUSTACHIAN TUBE: In majority of cases, the infection int he middle ear reaches via the Eustachian tube due to the following causes:
Anatomical obstruction caused by adenoids and nasopharyngeal tumours.
Infections like adenoids, tonsillitis, rhinitis (commonest being the common cold), sinusitis, allergic rhinitis, pharyngitis, influenza and infections secondary to cleft palate.
Hygiene: Often forcible blowing of the nose pushes the infection into the ear through the Eustachian tube.
Swimming: Water entering the nose under pressure may spread the nasal infection to the middle ear.
Iatrogenic: After postnasal packing and badly performed adenoidectomy.
Feeding bottle: The use of a feeding bottle for an infant in the supine position may allow contaminated milk to enter the Eustachian tube.
- EXTERNAL EAR: Trauma to the ear drum while cleaning the external ear canal or a slap on the ear may rupture the ear drum.
- HEAD INJURY may affect the middle ear if there is a fracture of the temporal bone involving the middle ear.
- BLOOD-BORNE INFECTION rarely reaches the middle ear
Predisposing Factors
- Reduced vitality
- Atmospheric pressure changes (Barotrauma) may occur during flying and diving. The infection reaches the middle ear via the Eustachian tube.
Causative Organisms: Usually Strptococcus haemolyticus, Staphylococcus aureus, Haemophilus influenzae, pneumococcus and other respiratory tract organisms are responsible.
Chronic Suppurative Otitis Media (CSOM)
Age: It occurs at all ages.
Sex: Both the sexes are equally affected.
Predisposing Factors
- Acute otitis media which fails to clear may persist as chronic otitis media. This happens when:
Upper respiratory tract problems are present with the sepsis or obstruction in the nasopharync, nose and throat; like adenoids, chronic tonsilitis and sinusitis.
Resistance of the body is low.
Infection is of a persistent and virulent type.
- Acute necrotic otitis media is a very common cause of chronic otitis media. It occurs when the resistance of the patient becomes low due to exanthemata like smallpox, chicken pox, typhoid and measles. At that time, even if a few organisms reach the middle ear via the Eustachian tube, they may produce massive destruction of the ear drum and the ossicular chain, especially in such areas where the blood supply is poor.
- Traumatic perforation of a large size often fails to heal, and results in chronic otitis media. Small perforations usually heal as a rule.
- Retraction: Due to Eustachian tube obstruction, retraction may occur in the pars flaccida or the posterosuperior quadrant of the pars tensa, and may result in the formation of a retraction pocket which may lead to a cholesteatoma.
- Congenital cholesteatoma may lead to chronic otitis media. It is very rare.
Causative Organisms are usually organisms like streptococco, pneumococci, staphylococci, Bacillus fragilis and Bacillus coli.
General Factors
Unhygenic conditions lead to recurrent respiratory tract infections.
Diseases of the nose and throat occuring recurrently may affect the ear.
Poverty and undernourishment lower the resistance.
Symptoms
Acute suppurative otitis media (ASOM)
Symptoms of an ear infection often begin after a cold. They include:
Ear pain.
Loss of appetite.
Trouble sleeping.
Trouble hearing in the ear that's blocked.
A feeling of fullness or pressure in your ear.
Yellow, brown or white drainage from your ear. (This may mean that your eardrum has broken.)
Chronic suppurative otitis media (CSOM)
Otorrhoea is the presenting symptom of chronic suppurative otitis media, and the discharge caused by the tubotympanic disease and the attico-antral disease show different features.
Deafness may range from mild to moderate degree. Very severe deafness may be due to the spread of infection to the labyrinth with atticoantral disease, causing sensori-neural deafness. In a benign perforation with intact ossicular chain, the hearing improves when the discharge covers the perforation, and temporarily closes it. The hearing may also improve if the round. window is covered with secretions, as this improves the phase difference.
Earache: An uncomplicated chronic otitis media is free from earache. Earache may be caused by complications like:
(a) Acute otitis media supervening on chronic otitis media.
(b) Acute otitis externa.
(c) Impending dangerous complications like mastoiditis or intracranial complications.
Hence any patient with chronic otitis media,
who has earache should not be neglected.
Tinnitus may be present and it is difficult to treat this symptom.
Giddiness may be present because of a complication like labyrinthitis, or it may have an independent aetiology.
Bleeding or blood-stained discharge may occur because of granulations or polyps which are often associated with a dangerous type of perforation.
Swelling in the mastoid region results from a mastoid abscess caused by the attico-antral disease. The swelling shows signs of acute infection and the pinna is pushed outwars, downwards and forwards. This is often described as 'the erection of pinna'.
Complications: Intracranial spread of infection may occur which will be indicated by symptoms like pain, fever, giddiness, facial paralysis, headache, vomiting, neck rigidity, localising neurological signs, loss of orientation, listlessness and gradual loss of consciousness.
Treatments
Acute suppurative otitis media (ASOM)
Acute otitis media commonly called as acute ear infection has various causative factors. This infection definately requires medical management or else it can progress more towards inner ear.
Homoeopathy has huge scope in such acute infections. It cures the infection and removes all the symptoms of infection completely.
Homeopathic medication which help in such patients are belladona, chamomilla, sulphur etc.
Chronic suppurative otitis media (CSOM)
Chronic suppurative otitis media definately requires medical care. Safest and quickest way to cure such infections is Homoeopathy.
Homeopathy cures the whole infection and prevents further progress and complications. It also prevents the recurrence of such infections.
Homoeopathic medications which help in such patients are calcarea sulph, kali sulph, alumina etc.
