Acute otitis media (AOM) is the infection of the middle ear and most common cause of pain in ear in infants and young children. One of the most reliable indicators of the ear infection in children is when a child who had a cold, runny nose for 3 to 7 days suddenly develops sleeplessness and inconsolability during the night along with increased fussiness during the day time. 94 % of the children get at least one episode in first three years, 3 episodes minimum in first and second year, and 2% will develop the sequelae, like acute suppurative otitis media.
With the exception of the common cold, otitis media is the most common disorder for which children and their parents seek paediatric care.Homoeopathy is the system of medicine that treats patients considering the individualisation of every case and adopts a holistic approach. Therefore, it is essential to understand the importance of various homoeopathic remedies in the treatment of acute otitis media in children.
- To understand acute otitis media and its presentation in children.
- To understand the Homoeopathic management of acute otitis media with the help of Materia medica and Repertory.
KEYWORDS: Acute otitis media, Children, Homoeopathy medicines
AOM is characterized by the presence of middle ear effusion together with an acute onset of signs and symptoms caused by middle ear inflammation. Studies around the world have reported that the prevalence of AOM varies from 2.3% to 20%, CSOM 4% to 33% .The prevalence rate of AOM in India is around 17 to 20%,and CSOM1 is 7to 8%. Otitis media is highly prevalent worldwide and is the main cause of hearing impairment in developing countries.
World health organization has reported that hearing impairment in 42 million people (above 3 years) in the world was mainly caused by otitis mediaThe pathogenesis is multifactorial, including infection, impaired Eustachian tube function, immature immune status, and allergy2.The impairment of normal tubal function, including middle ear ventilation, ciliary clearance, and drainage result the pathogens to multiply and colonize in the nasopharynx which may gain access to the middle ear and multiply, then leading to the acute symptoms of the acute otitis mediaIf acute otitis media is left untreated, may develop chronic suppurative otitis media, otitis media with effusion which further leads to hearing loss, malodorous discharge; this has a considerable effect on the quality of life of a child.
Acute Otitis Media Severity of Symptoms (AOM-SOS) scale is used for tracking the severity of symptoms of children with AOM. The current version of the scale consists of 7 discrete items: tugging of ears, crying, irritability, difficulty sleeping, diminished activity, diminished appetite, and fever.In the management of acute diseases, certain medicines that possess the exact symptomatology of certain disease shall be called as nearly specific for that disease. Such medicines shall cut of the duration of acute illness and prevent complication too.
According to ICD-10 Criteria, subjects with the presenting complaints of3
- Associated with decreased sleep and feeding habits.
In infants who can’t express the pain will be presenting with unusual crying, fussiness, irritability especially during night.
The signs of acute inflammation in acute otitis media can be demonstrated by otoscope, the findings will be.
- Bulging of tympanic membrane
- Whitish or reddish or yellowish appearance of the tympanic membrane.
Throbbing and beating pain in ear, child cries out in sleep. Sudden and violent attack of pain with redness, over sensitiveness to slightest draft of air/touch, rush of blood to head and face. Pain causes delirium. Burning heat, bright redness and dryness are very marked. The pain comes and goes in repeated attacks.Noises in ear and Autophony- hearing one’s voice in the ear.
Earache with soreness; swelling and heat driving patient frantic. Stitching pain and ears feel stopped. Sensitive to cold wind about ears, or noise. Earache amelioration from warmth. Roaring in the ears as of rushing water.
Ear ache, buzzing and stitches. Ache with nausea; whole night, preventing sleep. Ailments from exposure to cold and damp weather.
Noises and throbbing. First stage of otitis. Membrana tympani red and bulging. Acute otitis when belladonna fails prevents suppuration. Deafness from colds. Tinnitus aggravated on lying.
- Hepar Sulphur:
Whizzing and throbbing in the ears, with hardness of hearing. Discharge of fetid pus from the ears. Chilliness, hyper sensitiveness, craving for cold and strong things are very characteristic. Slightest pain causes fainting. All the discharges are profuse; foul; like old cheese, sour. Sweats profusely, easily without any relief.
Otorrhoea is thick, bland, yellowish green and offensive. Otalgia is worse at night, diminishes acuteness of hearing. Thirst less, peevish and chilly. Hearing difficulty, as if the ear were stuffed.
- Rhus tox:
Pain in ear with sensation as if something were in them. Lobules swollen and discharge of pus. Fever is associated with otalgia.
- Verbascum Thapsus:
Otalgia with a sense of obstruction, stoppage of ears. Tearing in ears, sometimes when eating, with lancinations.Numbness sensation in the ear.
RUBRICS OF ACUTE OTITIS MEDIA UNDER VARIOUS REPERTORIES:
- Homoeopathic repertory by William Boericke
EARS, Pain (Otalgia)
ACON, Apis, BELL, Borx,CAPS, CHAM, Coff, Dulc, FERR-P, Gels, HEP, Iod, Kali-bich, Kali-I, Mag-phos, MERC, Naja, PULS, Sang, Ter, Valer, VERB, Viol-o.
EARS, Tympanum (middle ear), Catarrhal, acute
ACON, BELL, Cham, FERR-P, Gels, Hep, KALI-MUR, MERC, PULS, Rhus-t, Sil.
- A Concise Repertory of Homoeopathic medicines by S.R. PHATAK
CHAM, dulc, FERR-P, nux-v, plan, PULS, sulph, tell.
EARS, Aching, both, in
- Synthesis treasure edition by Fredrick Schroyens
EAR, PAIN, acute
aloe, Ambr, anac, Arn, Bell, bry, calc, cann-s, caust, Cham, colch, colo, con, dulc, euph, hell, Hep, iod, kali-c, Kreos, lyc, merc, mez, mur-a, nat-c, nit-acid, nux-m, Nux-v, petr, phos, plat, Puls, Ran-b, Rhod, rhus-t, sabad, sep, sil, Spig, Sulph, teucr, thuj, valer, verb.
- Homoeopathic Medical Repertory by Robin Murphy
EARS, OTITIS media, infection, middle ear
Apis, arn, bar-c, BELL, bor, CALC, CALC-S, caps, caust, CHAM, dulc, ferr-p, gels, HEP, KALI-BI, kali-c, kali-i, kali-m, LYC, MERC, PULS, rhus-t, SIL, SULP, tell, thuj, tub, zinc.
1) Manche Santhoshi kumari, Akka Jyothi , Prevalence and associated risk factors of otitis media and its subtypes in South Indian population, Science Direct Volume 17 , 2016:-62.
2) David H. Darrow, Nariman Dash, Craig S. Derkay, Otitis media: concepts and controversies Current Opinion in Otolaryngology & Head and Neck Surgery: 416 -423.
3)Heather. L.Burrows, Alexander.R.Blackwood et al, Otitis Media, UHMS Otitis Media Guideline, 2013: 1-13.
PGT Department of Paediatrics,
Government Homoeopathic Medical College& Hospital,Bangalore.