UNSAFE CHRONIC SUPPURATIVE OTITIS MEDIA (UNSAFE CSOM) & SEROUS OTITIS MEDIA (SOM)

UNSAFE CHRONIC SUPPURATIVE OTITIS MEDIA (UNSAFE CSOM) & SEROUS OTITIS MEDIA (SOM)

UNSAFE CHRONIC SUPPURATIVE OTITIS MEDIA (UNSAFE CSOM)

ETIOLOGY

AYURVEDIC PERSPECTIVE

• Referred under Karṇasrava in Ayurveda.

• Causes include:

  • Abhighāta (trauma)

  • Dūṣita Kapha-Pitta prakopa

  • Pravāhita doṣa from Nāsa and Śīrṣa

  • Jalakrīḍā (swimming or water contamination)

  • Agnimandya leading to mala sanchaya

MODERN PERSPECTIVE

• Repeated upper respiratory infections

• Poor Eustachian tube function

• Persistent tympanic membrane perforation

• Entry of pathogens (anaerobes like Pseudomonas aeruginosa, Proteus, Klebsiella)

• Cholesteatoma formation due to squamous epithelium growth in middle ear

PATHOLOGY

• Persistent infection of middle ear cleft with:

  • Cholesteatoma formation (keratinizing squamous epithelium)

  • Bone erosion

  • Spread to mastoid, labyrinth or intracranial structures

• Mastoid air cells involved

• May lead to complications like mastoiditis, facial nerve palsy, brain abscess

CLINICAL FEATURES

AYURVEDIC DESCRIPTION

• Described under Karṇasrava, Karṇa Roga

• Sloka from Aṣṭāṅga Hṛdaya Uttara Tantra (AH. Ut. 20.9):
  "शीतोष्णवातजलतोऽभिघातात् पित्तकफात् कृमिजात् च शूलः।
  पाकोऽर्थतः स्रावशिरः कपोलयोः शिरोरुजः स्वेदनतः प्रवृद्धिः॥"
  —AH Uttara Tantra 20/9

  (Causes include trauma, dosha vitiation, leading to pain, pus discharge, and swelling of head and cheek)

MODERN FEATURES

• Profuse foul-smelling ear discharge

• Conductive hearing loss

• Retraction pocket or marginal perforation of tympanic membrane

• Presence of cholesteatoma

• May have vertigo, facial palsy, or intracranial symptoms

MEDICAL MANAGEMENT

AYURVEDIC MANAGEMENT

• Srotoshodhana (cleansing channels)

• Karna Shodhana with taila/kashaya dhoopan

• Karna Pramarjana (ear cleaning)

• Putapaka taila or Karnapurana with:

  • Bilvadi taila, Nirgundyadi taila, Dashamooladi taila

• Internal medications:

  • Guggulu panchapala churna

  • Kaishora guggulu, Yogaraja guggulu

  • Punarnavadi Kashaya, Guduchi churna

• Nasya: to clear upward site causes

MODERN MANAGEMENT

• Aural toilet (microsuction of discharge)

• Topical antibiotics: Ciprofloxacin, Neomycin

• Systemic antibiotics for acute exacerbation

• Surgical treatment:

  • Modified radical mastoidectomy (MRM)

  • Canal wall down procedures

  • Tympanoplasty after clearance

SEROUS OTITIS MEDIA (SOM) / OTITIS MEDIA WITH EFFUSION (OME)

ETIOLOGY

AYURVEDIC PERSPECTIVE

• Implied under Karṇanāda, Badhirya, Karṇakṣveda

• Kapha and Vata dosha predominant

• Blockage of Srotas (Eustachian tube) due to:

  • Pratishyaya (rhinitis)

  • Kaphavrita Vata in head region

• Vega dharana (suppression of natural urges)

MODERN PERSPECTIVE

• Eustachian tube dysfunction leading to:

  • Negative middle ear pressure

  • Accumulation of sterile serous fluid

• Allergic rhinitis, adenoids, sinusitis

• Barotrauma

• Post-viral upper respiratory infection

PATHOLOGY

• Obstruction of Eustachian tube → air absorption → negative pressure → transudation of fluid into middle ear

• Effusion remains non-purulent

• May persist as “glue ear”

CLINICAL FEATURES

AYURVEDIC DESCRIPTION

• Karṇanāda: Abnormal sounds in ear

• Badhirya: Reduced hearing

• Karṇakṣveda: Itching or uneasiness in the ear

Sloka from Sushruta Samhita Uttara Tantra (SUS. UT. 21/18):
"बाधिर्यं तु विनिर्दिष्टं वायोर्दोषबलोद्भवम्।
शब्दश्रवणह्रासश्च नादश्रवणमेव च॥"
—Sushruta Samhita Uttara Tantra 21/18
(Describes hearing loss and abnormal sound perception due to vata dosha)

MODERN FEATURES

• Hearing loss (conductive, mild to moderate)

• Blocked ear sensation

• Popping/crackling sounds on swallowing

• No active discharge

• Retracted tympanic membrane, fluid level or bubbles seen

MEDICAL MANAGEMENT

AYURVEDIC MANAGEMENT

• Nasya with Anu Taila or Shadbindu Taila

• Gandusha and Kavala with ushna drava

• Internal medicines:

  • Dashamoola kashayam, Vacha churna, Punarnava Mandura

  • Pathyadi kashaya, Haridra Khandam

• Yoga & Pranayama: helpful in improving inner pressure equilibrium

MODERN MANAGEMENT

• Watchful waiting (up to 3 months) in asymptomatic children

• Nasal decongestants, antihistamines, steroids

• Valsalva maneuver or auto-inflation

• Myringotomy with grommet insertion if persistent >3 months

• Adenoidectomy if adenoids obstructing the Eustachian tube

PROGNOSIS

• Unsafe CSOM has poor prognosis without surgical intervention

• Can lead to life-threatening complications if neglected

• SOM usually resolves spontaneously in children, but chronic cases require ventilation tubes

PREVENTIVE MEASURES (COMMON TO BOTH)

• Avoid upper respiratory infections

• Treat allergies and sinus infections early

• Avoid water entry into ear in chronic cases

• Maintain nasal hygiene

• Prevent exposure to smoke and allergens

IMPORTANT COMPLICATIONS TO BE NOTED (MODERN ENT)

UNSAFE CSOM

• Mastoiditis

• Labyrinthitis

• Facial nerve palsy

• Brain abscess

• Meningitis

• Lateral sinus thrombosis

SOM

• Speech delay in children

• Tympanosclerosis

• Retraction pocket → Cholesteatoma (rare)