Chronic Suppurative Otitis Media Is Classified Into Two Types
6.1 / Need for the study:
- Chronic suppurative otitis media(CSOM) is chronic infection of the middle ear cleft mucosa and it is a long standing infection of a part or whole of the middle ear cleft characterized by ear discharge and permanent perforation.
- The overall prevalence rate in India is 46 and 16 persons per thousand in rural and urban population. It affects both sexes and all the age groups.
- It can be caused by the failure of an acute infection to resolve completely or some times appears to be chronic from the very start, and the causative organisms like streptococci, pneumococci.
- Chronic suppurative otitis media is classified into two types,
b)Dangerous or attico-antral.
- The Cardinal features of CSOMare Otorrhoea, Deafness, Earache, Tinnitus, Giddiness and Perforation.
- The Complication of CSOM may manifest Chronic Mastoiditis, Brain abscess, Petrositis, Facial nerve palsy and Labyrinthitis.
- The important treatment of CSOM has been to provide the removal of septic foci and aural toilet. In conventional system of medicine prolonged use of antibiotic ear drops may give rise to sensitization, formation of resistant strains of bacteria, fungus infection and ototoxicity.
- Homoeopathy has been said to be having much efficacy in treating CSOM because of its holistic approach and concept of individualization, so as to reduce the suffering of the patient. It is also claimed that the complications of CSOM are reduced.
6.2 / REVIEW OF LITERATURE :
- Chronic otitis media may be suppurative or non-suppurative. The patient presents with continuous discharge of pus and varying degree of deafness following an attack of acute otitis media.1
- Incidence of CSOM is higher in developing countries, because of poor nutrition and lack of health education. In India, the overall prevalence rate is 46 and 16 persons per thousand in rural and urban population. It affects both sexes and all age groups.2
- The usual source of infection is via the Eustachian tube and the common causative organisms are streptococcus pneumoniae and haemophilus influenzae.3
- CSOM may be classified as follow:
a) Serous otitis
b) mucous otitis or glue ear
2) Suppurative
a) Tubo tympanic suppuration
b) Attico antral disease
3) Tuberculosis.4
- The main pathological condition of tubo tympanic otitis media is a perforation of the eardrum resulting from acute otitis media. The perforation does not heal after the initial acute attack because there has been persistence of the infection. The three basic pathological findings in the attico-antral type are cholesteatoma, granulation tissue with ostetis and cholesterol granuloma.5
- Cholesteatoma is a sac lined by keratinizing stratified squamous epithelium in the middle ear cleft, and contains desquamated epithelium arranged like onion skin layer. A cholesteatoma is soft, pultaceous and has the consistency of a toothpaste, but it possesses a great destructive power, capable of destroying the surrounding bone. Hence it is defined as ‘non-malignant bone destroying disease of the ear’.6
- The most common presenting features of CSOM are otorrhoea, deafness, earache, tinnitus, giddiness, bleeding, swelling and signs like perforation and tenderness.7
- Complications; Extracranial complications include hearing loss, labyrinthitis, vertigo and facial nerve palsy. Intracranial complications include epidural abscess, dural venous thrombophlebitis,meningitis and brain abscess.8
- Bayes recommends Aconite 1x in the maddening pains of otitis, claiming it to be far superior to Chamomilla or Pulsatilla. Copeland says: “ it differs from ferrum phosphoricum, which has a much longer period of usefulness”.9
- Ears: Eustachian Tube –Agar., Ars. Iod., Bar.m.,Gel., Iod., Merc., Nit.ac., Petrol., Phos., Phyt., Sul.ac., Sil., Spig., Stram.10
- Ear: Hearing Deafness: Amb., Ant-c., agar-n., arn., ars-io., bar-c., bell., calc-c., caus., dul., grap., hyo.,kali-bi., merc., petr., pul., sul., Ver-a., verb.11
6.3 / AIMS AND OBJECTIVES OF THE STUDY
1) To study the clinical presentation of CSOM.
2) To study the efficacy of Homoeopathic remedies in CSOM .
3) To study the utility of Reportorial approach in management of CSOM.
7. / Materials and methods:
7.1 / PRIMARY SOURCE:
The subject for this study will be collected from OPD/IPD/Rural OPD’s and camps of Dr. B.D. Jatti Homoeopathic Medical College, Hospital and Post Graduate Research Centre, Dharwad.
7.2 / METHOD OF COLLECTION OF DATA (including sampling procedure, if any,)
Definition of study subject:
Patients are considered on the basis of clinical presentation like otorrhoea, earache, deafness. By interrogation of individual case and local examination.
Following are Inclusion criteria:
- Patients of all age groups and both sexes.
- Patients clinically diagnosed to be having uncomplicated CSOM.
- Patients with any other chronic diseases on active treatment.
- Patients having complications like chronic mastoiditis and brain abscess.
Prevalence rate of CSOM in our hospital is 2% considering the 95% confidence interval at 5% permissible error, sample size works out to be 32 cases. Since it is a time bound study, all admitted and OPD cases are included in my study period.
Study design :
Simple random method, Hospital Based time bound study.
Follow up :
Patients will be seen every15 days for first 3 months and then monthly once subsequently as per the requirement of the case.
Parameters used are :
a) Routine investigations Hb%, CBC ,ESR.
b) Hearing test.
c) Bacteriological examination. (If necessary).
d) Radiological findings (if necessary).
Study period: December- 2007 to June- 2009.
Statistical tests:
Appropriate test will be used depending upon the data available at the end of the study.
7.3 / DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO DESCRIBE BRIEFLY.
The study requires any following investigations to be conducted on patients, wherever necessary.
a) Routine investigations Hb%, CBC ,ESR.
b) Hearing test.
c) Bacteriological examination. (If necessary).
d) Radiological findings (if necessary).
7.4 / HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
Yes, ethical clearance has been obtained from the institution.
8. / LIST OF REFERENCES:
1) T.N. Patel A system of surgical diagnosis published by
Jitendra. P.vij. Jaypee brother’s medical publishers (P) Ltd.
3rd edition. 1997 Page no 174.
2) Dhingra P.L. Diseases of ear, nose, and throat, New Delhi. B.L. Churchill living stone 1998.Page no 71.
3) Mohan harsh. The text book of pathology, reprint edition .Jaypee brothers medical publishers (P) Ltd. New Delhi.2002 Page no 486.
4) Collam H.B. Hall and Colman’s disease of the nose, throat, ear, head and neck. A handbook for students and practitioner. Reprint edition U.K. Churchill, Livingstone. 1992 Page no 231.
5) Morgan AGD Logan turners. Diseases of the nose, throat and ear.10th oxford Butterworth Heinemann ltd. 1998. Page no 283 & 285.
6) Bhargav K.B., Bhargav K.S., Shah T.M. A short textbook of ENT Disease, 6th edition, Mumbai, Usha Publications 2002.Page no 53.
7)Bhargav K.B., Bhargav K.S., Shah T.M. A short textbook of ENT Disease, 6th edition, Mumbai, Usha Publications 2002. Page no 54, 55 & 56.
8) Kasper, Braunwald, Fauci, Hauci, Hauser, Longo, Jameson. Harrison’s et al. Principles of Internal Medicine.15th edition. New Delhi: McGraw-Hill Medical Publishing Division; 2003. vol-1 Page no 191
9) Dewey W.A. MD practical homoeopathic therapeutics. Reprint edition B.Jain publisher’s Pvt. Ltd. New Delhi, India 1993.Page no 129
10) Allen T.F. Boeninghausen’s Therapeutic pocket book reprint edition B .Jain Publishers (P) Ltd.2006 Page no 40.
11) Boger C.M. Boeninghausen’s Characteristics MateriaMedica and Repertory reprint edition B. Jain Publishers (P) Ltd. March 2000 Page no 358.
12) Kent J.T. Repertory of the Homoeopathic Materia Medica, Reprint edition, B. Jain publishers, (P) Ltd, 2001. Page no 290