Homoeopathy in acute otitis media: a review

Dr Sana Desai, Dr Muddassir M Mulla

 ABSTRACT
cute otitis media is an acute inflammation of middle ear cleft. Acute otitis media is most commonly seen in infants and children. Which Characterized by pain over affected ear, fever, malaise and discharges. Exclusive breast-feeding can reduce the risk of acute otitis media. If not treated promptly at proper age can leads to hearing impairments.

KEY WORDS: Otitis media, Acute otitis media, Eustachian tube, homoeopathy, Otitis media externa

INTRODUCTION:

Acute otitis media (AOM) is a very common illness seen in infants and toddlers.1 Three out of four children will have ear infection within three years of their birth. The importance of AOM lies in the fact that its subsequent progression of dysfunction of the Eustachian tube may lead to chronic serous Otitis Media (‘glue ear’).2

Otitis media is inflammation of middle ear space. The middle ear is a small air-filled cavity which is part of nasopharynx, Eustachian tube, and the mastoid air cells. The Eustachian tube is derived from the first pharyngeal pouch. It can be divided as two parts, an osseus intra- temporal portion and a cartilaginous nasopharyngeal portion. Eustachian tube protects the middle ear from reflux of nasopharyngeal secretions into the middle ear. It is commonly believed that otitis media results in part from poor ventilation and clearance of secretions by the Eustachian tube (eg, Eustachian tube dysfunction). Infants and children have important anatomic differences in their Eustachian tubes compared with adults: the tube is shorter, and the cranial base is flatter in children than adults, describing a more horizontal course providing less protection.3

The most important cause is viral upper respiratory tract infection followed by other opportunistic infections like Streptococcus pyrogen, Streptococcus pneumonia, Hemophilus influenza and Moraxella catarahalis.2

Otitis media it includes a range of spectrum of diseases, which includes middle ear fluid collection (Otitis Media with effusion, Otitis Media Externa), to purulent fluid behind the tympanic membrane (acute otitis media, Acute Otitis Media) and recurrent Acute Otitis Media (Recurrent Acute Otitis Media).4

According to the American Academy of Paediatrics (AAP) and the American Academy of Otolaryngology and Head and Neck Surgery,

acute otitis media (AOM) is defined as

1. a history of acute onset of signs and symptoms,
2. the presence of middle ear effusion, and
3. signs and symptoms of middle ear inflammation.3

Eighty percent of AOM cases resolve without treatment within 3 days, and the most sensitive and specific way to diagnose it is with pneumatic otoscopy.3

In 2004, as part of their guidelines, the American Academy of Paediatrics and the American Academy of Family Physicians recommended initial observation of AOM in selected patients:

6 months to 2 years: no severe illness at presentation and uncertain diagnosis

21 years: no severe illness at presentation or uncertain diagnosis

If symptoms do not resolve in 24–48 hours, they should then be treated with antibiotics.3

TERMINOLOGIES:

Acute Otitis Media -the rapid onset of signs and symptoms of inflammation in the middle ear.

Uncomplicated AOM-AOM without otorrhea

Severe AOM-AOM with the presence of moderate to severe otalgia or fever equal to or higher than 39°C.

Non-severe AOM-AOM with the presence of mild otalgia and a temperature below 39°C.

Recurrent AOM-3 or more well documented and separate AOM episodes in the preceding 6 months or 4 or more episodes in the preceding 12 months with at least 1 episode in the past 6 months.

Otitis Media with Effusion –inflammation of the middle ear with liquid collected in the middle ear; the signs and symptoms of acute infection are absent.

Middle Ear Effusion -liquid in the middle ear without reference to aetiology, pathogenesis, pathology, or duration9

Otorrhea—discharge from the ear, originating at 1 or more of the following sites: the external auditory canal, middle ear, mastoid, inner ear, or intracranial cavity

Otitis externa—an infection of the external auditory canal

Tympanometry—measuring acoustic immittance (transfer of acoustic energy) of the ear as a function of ear canal air pressure.5

RELATION BETWEEN ACUTE OTITIS MEDIA (AOM) AND OTITIS MEDIA EXTERNA (OME):
Distinguishing Acute Otitis Media Acute Otitis Media (AOM) From Otitis Media Externa (OME).  OME may occur after an episode of AOM, or as a consequence of Eustachian tube dysfunction. However, OME can progress, later can lead to the development of AOM. These 2 forms of OM may be considered segments of a disease continuum. How ever, because OME does not represent an acute infectious process that benefits from antibiotics, it is of utmost importance for clinicians to become proficient in distinguishing normal middle ear status from OME or AOM. Doing so will avoid unnecessary use of antibiotics, which leads to increased adverse effects of medication and facilitates the development of antimicrobial resistance.5

IMPORTANCE OF BREASTFEEDING IN AOM: according to multiple studies provide evidence that exclusive breastfeeding for at least 4 to 6 months reduces episodes of AOM and recurrent AOM. Two cohort studies, 1 retrospective study and 1 prospective study shows protection from partial breastfeeding and the greatest protection from exclusive breastfeeding through 6 months of age.5

Bottles and pacifiers have been associated with AOM. Bottles and pacifiers have been associated with AOM.5

CLINICAL FEATURES:

Signs and symptoms found are: sharp lancinating pain in ear, fever, increased pulse rate, malaise, signs include tugging, rubbing or holding of the ears, crying, fussiness or irritability, difficulty in sleeping, child becoming less playful or active, or eating less. Hearing impairment, clumsiness or problem with balance, discharges from ear (initially blood stained followed by mucopurulent) and tinnitus and voice resonance may follow.4 In addition, the changes in tympanic membrane including colour changes from pearly white to pinkish white followed by red; the reduced translucency, haziness and opacity; the reduced mobility of the membrane and the bulging of the membrane. 2

The relationship between upper respiratory tract infection (URTI) and acute otitis media (AOM) in children suggests that URTI can trigger disruption of Eustachian tube function, which then increases the risk of AOM. Factors such as child age, air pollution, and exposure to cigarette smoke worsen this condition, making children more susceptible to ear infections. Therefore, parental awareness of the signs and symptoms of AOM and the importance of prompt medical treatment are essential to reduce the negative impact of this condition.6

ACUTE OTITIS MEDIA SEVERITY OF SYMPTOM SCALE (AOM-SOS)
The AOM-SOS was used to follow-up the symptoms of children. This scale asks parents to indicate the severity of the following 7 directly observable behaviours: ear tugging, crying, fussiness, disturbed sleep, decreased play, eating less, and fever. A total score was calculated only when all 7 questions on the scale were completed.7

	NO	A- LITTLE	A LOT
over the past 12h has your child been tugging, rubbing or holding the ears(s) more than usual?
over the past 12h, has your child been crying more than usual?
over the past 12h, has your child been more irritable or fussy than usual?
over the past 12h, has your child been having more difficulty sleeping than usual?
over the past 12h, has your child been less playful or active than usual?
over the past 12h, has your child been eating less than usual
over the past 12h, has your child been having fever or feeling warm to touch?

DIAGNOSIS:
Diagnosis of AOM was based on the use of otoscope. It is a very old instrument with several known limitations which leads to difficult diagnosis. Unfortunately, the introduction of the oto-microscope, Pneumatic Otoscope has only slightly improved standard otoscopy ability to diagnose AOM, mainly because their use and the correct interpretation of findings are difficult.

The pneumatic otoscope is the standard tool used in diagnosing OM. Pneumatic otoscopy permits assessment of the contour of the TM (normal, retracted, full, bulging), its colour (Gray, yellow, pink, amber, white, red, blue), its translucency (translucent, semi-opaque, opaque), and its mobility (normal, increased, decreased, ab sent). The normal TM is translucent, pearly Gray, and has a ground-glass appearance.5

HOMOEOPATHIC MANAGEMENT:

1 BELLADONNA:

• Earache beginning suddenly with intense pain, with few prior symptoms of URTI (eg, watery rhinorrhoea)
• Signs of uncomplicated AOM: bright red outer ear, ear canal, or eardrum without pus formation, sudden high fever
• Ear pain extending down into the neck, or accompanied with sore throat.4
• Membrana tympani bulges and injected.
• Hearing very acute, otitis media
• Child cries out in sleep, throbbing and beating pain deep in ear.
• Acute and subacute conditions of ear.8

2. FERRUM PHOSPHORICUM:

• Early stages of earaches before pus has formed; symptoms similar to Belladonna, but not as sudden or severe
• Alternatively, if Belladonna did not improve symptoms.4
• First stage of otitis
• Membrana tympani red and bulging.
• Acute otitis; when belladonna fails, prevents suppuration. 8

3. HEPAR SUPHUR:

• Sharp, severe otalgia
• Earache with by thick rhinorrhoea or otorrhea
• Irritability
• Chilliness and aversion to the cold or uncovering; desire for warmth
• Earache worse in cold or open air or from cold applications better from warmth; worse at night.4
• Discharge of fetid pus from the ears
• Whizzing and throbbing in the ears.8

4. PULSATILLA:

• Mild disposition; craves affection and physical contact
• Purulent rhinorrhoea/otorrhea
• Ear pain worse at night, even in a warm room
• Worse in general from warmth, wants fresh air
• Little or no thirst.4
• Otorrhoea, thick bland discharge.
• Catarrhal otitis.
• Diminished acuteness of hearing.8

5. CHAMOMILLA:

• Extreme irritability
• Severe ear pain
• Symptoms are worse when stooping or bending over and improved by warmth or being wrapped in warm covers
• Watery rhinorrhoea.4
• Ringing in ears.
• Swelling and heat driving patient frantic.8

6. MERCURIUS SOLUBILIS:

• Apply when otorrhea is present
• Earache worse from warmth and worse at night
• Profuse, bad-smelling perspiration, head sweats
• Increased salivation, puffiness of the tongue. 4
• Thick, yellow discharge; fetid and bloody.8

7.SILICEA TERRA

• Later stages of an earache: physical weakness and tiredness, chilliness, desire for warm covering
• Pain behind the ear in the region of the mastoid
• Sweating about the head or on the hands or feet.4
• Loud pistol-like report.
• Sensitive to noise
• Roaring in ears.8

8. KALI- MURIATICUM:

• Chronic, catarrhal conditions of the middle ear
• Glands about the ear swollen
• Snapping and noises in the ear
• Threatened mastoid
• Great effusion about the auricle.8

9. VERBASCUM THAPSUS:

• Has a pronounced action on the inferior maxillary branch of the fifth cranial nerve; on the ear
• Otalgia, with a sense of obstruction.
• Deafness
• Dry, scaly condition of meatus (use locally).8

10. CAPSICUM ANNUM:

• Burning and stinging in ears
• Swelling and pain behind ears
• Inflammation of mastoid
• Tenderness over the petrous bone
• Extremely sore and tender to touch
• Otorrhoea and mastoid disease before suppuration.8

11. CALCAREA SULPHURICA

• Deafness, with discharge of matter from the middle ear
• Sometime discharge mixed with blood
• Pimples around ear.8

REFERENCES:

1. Frei H, Thurneysen A. Homeopathy in acute otitis media in children: Treatment effect or spontaneous resolution?. British Homeopathic Journal. 2001; 90: 180-182.
2. Sinha MN, Siddiqui VA, Nayak C, Singh V, Dixit R, Dewan D, Mishra A et al. Randomized controlled pilot study to compare Homeopathy and Conventional therapy in Acute Otitis Media. Homeopathy (2012) 101,5-12.
3. Jessica R. Levi, Robert O’Reilly. Complementary and Integrative Treatments Otitis Media. Otolaryngol Clin N Am 46 (2013) 309–327.
4. Marom T, Marchisio P, Tamir SO, Torretta S, Gavriel H, Esposito S et al. Complementary and Alternative Medicine Treatment Options for Otitis Media. Medicine Systematic review and meta-analysis. 2016,95(6):2695
5. Allan S. Lieberthal, Aaron E. Carroll, Tasnee C, Theodore G, Alejandro H, Jackson MA, Mark D. Joffe, Miller DT, Rosenfeld RM, Sevilla XD, Schwartz RH, Thomas PA, Tunkel et al. The Diagnosis and Management of Acute Otitis Media. American academy of paediatrics. March 2013, Volume 131(3) 3,.965-999.
6. Prawitasari N, Dahliah, Sari S, Hermiaty N, Rijal S. Relationship Between Upper Respiratory Tract Infection and Acute Otitis Media in Children. Journal Edu health Volume 16, Number 01 2025.178-188.
7. Shaikh N, Hoberman A, Paradise JL, Rockette HE, Kurs-Lasky M, Colborn DK, Kearney DH, Zoffel LM et al. Responsiveness and Construct Validity of a Symptom Scale for Acute Otitis Media. The Paediatric Infectious Disease Journal. 2009;28: 9–12).
8. Boericke W. Boericks new manual of homoeopathic Materia medica with repertory. 9^th New delhi: B Jain publishers; 2014

Dr Sana Desai, Dr Muddassir M Mulla
PG Scholars
Government Homoeopathic Medical College And Hospital, Siddiah Puranik Road, Basaweshwar Nagar, Bengaluru
Email : dsana496@gmail.com