Description

• An infection of the middle ear that typically follows an upper respiratory infection in children < 5years 
• Characterized by an acute onset of symptoms (Otalgia, fever, anorexia) with symptoms of middle ear inflammation ( Erythema, bulging tympanic membrane)
• It is an acute inflammation of the middle ear by pyogenic organisms

Types

Stage of Tubal occlusion

• Oedema and hyperaemia of nasopharyngeal end of Eustachian tube blocks the tube leading to absorption of air and negative intratympanic pressure
• Symptoms: Deafness and earache
• Signs: Tympanic membrane is retracted with the handle of malleus assuming a more horizontal position, Loss of light reflex

Stage of Pre suppuration

• If the tubal occlusion is prolonged, pyogenic organisms invade the tympanic cavity, causing hyperaemia of its lining
• Symptoms: Marked earache, High degree of fever
• Signs:Cart-wheel appearance of the tympanic membrane

Stage of Suppuration

• This is marked by the formation of pus in the middle ear
• Symptoms: Earache becomes excruciating, Deafness increases, Fever ( 102–103°F)
• Signs: A yellow spot may be seen on the tympanic membrane where rupture is imminent, Tenderness may be elicited over the mastoid antrum

Stage of Resolution

• The tympanic membrane ruptures with the release of pus and subsidence of symptoms 
• Symptoms: With the evacuation of pus, earache is relieved and fever comes down
• Signs: Usually, a small perforation is seen in the antero -inferior quadrant of Pars Tensa

Stage of complication

If resolution may not take place It may lead to 

• Acute mastoiditis
• Subperiosteal abscess
• Facial paralysis
• Labyrinthitis
• Petrositis
• Extradural abscess
• Meningitis
• Brain abscess 
• Lateral sinus thrombophlebitis

Investigation

• Otoscopy – Bulging tympanic membrane, Opacification, and loss of light reflex, Retracted and hypomobile Tympanic membrane
• Tuning fork tests - Weber test, Rinne test – to verify conductive hearing loss secondary to effusion
• Audiometry
• Impedance audiometry

Treatments

• Antibacterial therapy
• Decongestant nasal drops
• Oral nasal decongestants
• Analgesics and antipyretics
• Ear toilet
• Myringotomy

Ayurvedic Management

• Management of URTI
• Advice to avoid cold items 

Internal Medicines

For Associated Respiratory tract infections

• Dashamoola katutraya Kashaya 
• Vyoshadi vataka 

To relieve infection

• Panchathiktaka kashaya 
• Nirgundyadi Kashaya
• Guggulu pancha pala choorna
• Kaisora guggulu
• Kanchanara guggulu
• Vettumaran
• Vilwadi gutika
• Amrutarishta
• Punarnavaasava
• Maha tikthaka gritha 
• Guggulu thikthaka gritha 
• Maadhusnuhi rasayana

 Procedures

• Kabala - Triphala kashaya + Trikatu choorna 
• Ear toileting
• Karnadhoopana - Guggulu varthi / Haridra 
• Karnapichu - Surasa rasakriya 
• Jaloukavacharana over ear
• Oil for head (later) – Nirgundyadi Kera, Vilwa patradi Kera, Vilwam pachotyadi 

Department

Salakya - ENT