Otitis Media Theraps
NATIONAL JOURNAL OF HOMOEOPATHY 1996 May / Jun Vol V No 3.
Kasivishwanathan T K.
Therapeutics.

Diagnosing and utilizing clinical subgroups in otitis media simplifies the task of selecting the correct remedy by narrowing the choice. Some pointers to diagnosis of otitis media are:-.

1. Any child suspected of having otitis should be examined by Otoscope. Key points to observe are the translucency position, colour and mobility of the tympanic membrane.
2. Suspect otitis media in (a) any child with ear pain; (b) any child with fever; (c) any child exhibiting recent insomnia.

Once otitis media is diagnosed, the following subgroups should be distinguished.

1. Otitis media without effusion. It is an inflammation of the tympanic membrane which is red and opaque. There is no liquid behind the tympanic membrane. The mobility is normal and usually found in an acute otitis.
2. Acute and acute suppurative otitis media. The tympanic membrane is bulging and opaque. Mobility is limited or absent. Occasionally pus can be visualized through the TM.
3. Chronic otitis media: chronic suppurative otitis media. There is persistent discharge from the middle ear either from perforation of the TM or otherwise.
4. Recurrent otitis media. Homoeopathy is effective in treating all these conditions.
5. Otitis media with effusion: serous otitis. There may be serous fluid or pus behind the T M Mobility is limited. The membrane is typically transparent with no sign of inflammation.

1. OTITIS MEDIA WITHOUT EFFUSION

This condition is easy to treat. The child usually presents with pain, fever and sleeplessness.

Dr Stephen N. Messer has compiled a flow chart (Chart I) for arriving at the appropriate remedy by following the arrows.

In using this Chart I first ask whether the child has high fever (above 103 degrees) {left side of the chart}. If the answer is yes, follow the arrow that says yes. If the fever is not high follow the arrow that says no. Follow the arrow till one arrives at the remedy. Then it has to be checked with the materia medica for its appropriateness to the case. If not, one to consult the repertory.

2. ACUTE OTITIS MEDIA

In this condition the child looks ill with fever malaise and insomnia. Otorrhoea may or may not be present. Due to antibiotic suppression afebrile acute otitis media is common. Another flow chart prepared by Dr. Messer is given below (Chart II) with short rubrics of the most typical remedies to consider. The procedure to be followed for the chart is the same as for the earlier one ie begin from the left hand corner and ask the questions. The materia medica has to be consulted for differentiation between the remedies. The most likely remedies as per the Chart for otitis media with fever are Pulsatilla and Hepar sulph and the materia medica to be consulted before prescribing, based on the symptoms. If not one should go to the next remedies in the line i e Lycopodium and Silicea. If the remedies in the chart do not meet the situation one has to refer to the repertory.

3. CHRONIC OTITIS MEDIA

Chronic otitis media child is usually asymptomatic and the parents tell of otorrhoea and hearing loss. It is a condition of low reactivity of the defence mechanism and sometimes due to allopathic suppression and probably due to poor nutrition. The prominent remedies useful in this condition are Calc carb., Merc., LYc., Sulph, Caust, Nat mur, Tell, Caps and Psor. One has to note the local symptoms to differentiate between these remedies. Mostly in these cases the constitutional remedy for the child will correct the illness. Tuberculinum and Medorrhinum may also have to be considered here.

4. RECURRENT OTITIS MEDIA

Mongoloid children are usually prone to this condition; the most frequently used remedies are Baryta Carb, Calc carb, and Baryta Mur. In other children the recurrent otitis media often arises from antibiotic suppression. After stopping the antibiotics and treating one episode of earache with homoeopathic remedy, the acute otitis media does not recur.

5. OTITIS MEDIA WITH EFFUSION (OME)

It is produced by the dysfunction of the eustachian tube drainage. A classical approach will be to find the constitutional remedy, possibly supplemented at a later stage with a specific remedy based on the local pathology. Remedies with proved symptoms of hearing loss, ear discharge, obstructed feeling in the ears are valuable guides in prescribing. Based on clinical experience and based on the rubrics on ear-catarrh of Eustachian tube, hearing impaired, suppuration of middle ear, inflammation of media and eustachian tube. Dr Neustaedter has found Calc carb, Puls, and Silicea as more prominent. Others of particular importance are Asarum., Iodum, Kali-bich, Kali-chlor, Kali sulph, Manganum, Merc, Nitric Acid, Petroleum, Phos and Sanguinaria.

Therapeutic indications of remedies in OME.

CALC-CARB

It is noted for collection of fluids in various parts of the body and it is not therefore surprising it covers many cases of OME. The mentals, generals, and history will usually lead to consideration of this remedy along with physical symptoms. The ear conditions include hearing loss from effusion and chronic perforations of the drum with white muco-purulent, viscid or offensive, discharge. Development of granulation tissue at the edges of perforations which may enlarge to form polyps and also there may be accompanying enlargement of submandibular, cervical and post-auricular nodes. Some of the cases treated by Neustaedter with Calcarea were generally younger than cases where Silicea was prescribed and exhibited typical Calcarea symptoms like being chubby or big for their age in height and weight, had sweats during sleep, obstinate and some had temper tantrums. In older children there was desire for milk, eggs, fruit and salt. These children were slow.

Silicea according to Dr Neustaedter is the most often indicated remedy. The indications are dull hammering in the ear, with difficult hearing and a sensation as if something was in the ear especially in the morning on rising. Clinically Sil has been used successfully both in cases of fluid collection and suppuration of the middle ear. Its uses include dry catarrh and fluctuating hearing loss where the ear seems to open with a snap and close again. Ear discharges may be thin and watery or offensive and persistent. The indications for Silicea will be based on constitutional picture. Those children treated with this remedy showed advanced mental development with a predisposition to intellectual display, an inquisitive nature and particular interest in creative activities. The majority were shy or insecure, cautious and staying or clinging to mothers rather than exploring. Some had night fears and fear of the dark. They were obstinate and stubborn. Some sweated during sleep.

MERCURIUS-DULCIS

Dr Houghton found in his practice that Kali mur and Mercurius Dulcis as most useful in treating OME cases. The indications for Mercurius dulcis were pathological signs of a retracted, thickened and immovable TM and a granular or hypertrophied condition of the pharyngeal mucus membrane and a benumbed and dull feeling between throat and ear, a pressure in the ear from without and humming, roaring and singing noises. Other symptoms of Mercury will clinch the choice.

KALI-MUR

The prescribing symptoms for this remedy are stuffy cold with greenish yellow discharge or the more chronic catarrhal ear conditions with whitish opaque mucous discharge, stuffy sensation and hearing loss. Objective symptoms include closed ET, retracted drums and enlarged tonsils. It acts more on the right rather than the left. There may be stitching drawing and pressing sensations and noises in the ear and cracking on blowing the nose and while swallowing. This remedy will prevent thickening of the TM after acute otitis media and may be indicated in cases which have prolonged for months but which have not manifested permanent tissue changes. Kali Mur has no provings and it was introduced by Dr Schussler as a tissue salt. Dr Bellows, on a review of 200 cases of Kali mur in chronic catarrhal conditions of the middle ear found it to be the most useful remedy. Its characteristic white discharges differs from yellow or watery discharge of Kali sulph.

KALI SULPH

It is one of the remedies listed in bold type in rubrics related to OME. Its ear symptoms are hearing loss from ET catarrh, thin, bright yellow or greenish, sticky and offensive discharge, dryness of the middle ear ringing, roaring, rushing noises in the ear, itching and evening pain. Quite unlike Pulsatilla this patient is easily angered and obstinate and very irritable. Warm coverings and warm room aggravates like Puls. Aversion to work, business and company. Concentration difficult and want of self confidence.

ASARUM

There is a sensation as if a membrane were stretched across the right meatus auditorius externus; worse during cold weather. Diminished hearing of the left ear as if closed with the hand or as if the ear has been blocked with cotton. Asarum will be indicated in OME without perforation. Other key note is hyper sensitivity of the nervous system to any noises such as the scratching of the linen or silk with a fingertip or nail or the rustle of paper. Chilliness and aggravation from cold are marked. Digestive symptoms such as nausea, vomiting and diarrhoea may confirm the choice.

IODINE

The middle ear is dry and there is ET dysfunction and the mucous membrane is atrophied. The typical symptoms of Iodine viz the warmth, nervousness, anxiety , restlessness and especially the glandular and lymphatic swellings are present along with failure to gain weight in children.

MANGANUM

Is similarly indicated in dry ears and retracted drums There are stitching pains with ear problems sensitivity of the ears to touch impaired hearing in cold weather, tinnitus and whizzing noises with chronic ear complaints and history of otorrhoea.

NITRIC-ACID

The suggested symptoms are a)humming in the ears as if water were in them b) pain as if the drum was pressed inward c)pain in the ear as if something in it would burst. These symptoms combined with hearing loss, sudden closure of the ear, throbbing in the drum and cracking noises on chewing led to the uses of Nit-acid in Et obstruction. It is also useful in cases of tissue destruction with invasive infections or inner ear damage.

PETROLEUM

Dr Hering places special emphasis on ET dysfunction with whizzing, roaring, cracking noises and hearing loss for choosing this remedy.

PULSATILLA

It is more often used in painful acute Otitis. The ear problems will be accompanied by profuse, thick, greenish Otorrhoea. Characteristic symptoms are a stopped sensation with or without bulging drums, noises and ear pain which are better in open air. If its constitutional type is identified and accompanying symptoms agree it can cure effusion also.

Homoeopathy provides a wide range of approaches to OME including for acute otitis episodes and constitutional treatment for the underlying susceptibility. Specific remedies can be prescribed for the localized symptoms in the middle ear.

Sources:-

1. Management of Otitis media with effusion in Homoeopathic practice-Randall Neustaedter-Journal of American Institute of Homoeopathy, Dec 1986.
2. Homoeopathic treatment for paediatric otitis media- Stephen Messer-Journal of American Institute of Homoeopathy, March 1987.
3. Kents Lectures on Materia Medica.

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