Otitis Media

WESTERN MEDICINE: Otitis media is an inflammation of the middle ear (tympanum), either unilateral or bilateral. In most cases, the middle ear becomes infected by microorganisms from the nasopharynx, which enter via the eustachian tube. Middle ear infection may follow scarlet fever, measles, mumps, pneumonia, or influenza. 

SYMPTOMS AND SIGNS: 

Acute Serous Otitis Media: The patient usually complains of earache, often preceded or accompanied by a feeling of fullness, impaired hearing and rarely, tinnitus. 

Acute Purulent (Suppurative) Otitis Media: The usual initial complaint is constant or intermittent earache, which may radiate over the entire affected side of the head. Often, there is a feeling of fullness in the ear, with tinnitus and /or deafness. Constitutional symptoms of fever (up to 105 F. in children), chills, and meningismus may be present. Tenderness over the mastoid antrum is sometime present. The tympanic membrane is red and bulging, landmarks are absent, and there is no light reflex. 

Chronic Congestive Otitis Media: This condition follows repeated nasopharyngeal infections involving the eustachian tube, or attacks of acute otitis media. Onset is insidious, there is gradual hearing loss, usually with tinnitus, earache is rare, vertigo common. Patients often state that they hear well over the telephone, through to them their own voices sound unnatural. Examination discloses a thickened, lusterless, retracted tympanic membrane; absence or alteration of the light reflex and sometimes, presence of a fluid level. The patient has conductive loss of hearing. 

Chronic Purulent Otitis Media: Acute otitis media and acute mastoiditis usually precede this disease. The outstanding symptom is a chronic purulent, fetid discharge from the ear (otorrhea). Pain, impaired hearing and tinnitus may be present. Low-grade fever often accompanies exacerbations. Examination of the drum discloses a perforation, through which pus exudes. Polyps and cholesteatomas may be found. 

ETIOLOGY AND PATHOLOGY: Chinese medicine considers that the otitis media is caused by the interior fire from the liver and gallbladder and san jiao (they all have channels or branches that go to the ears or around the ears); wind heat plus dampness from the exogenous factor may attack the ear causing this disease. 

DIFFERENTIATIONS: 

1. The Acute Type due to the Liver and Gallbladder Fire:

Indications: Symptoms of acute serous otitis media and acute purulent otitis media. Red tongue, white or yellow coating, wiry and rapid or slippery and rapid pulse. 

Treatment & Formulas: Eliminate the damp heat of the liver and gallbladder. 

Products:

    • Long Dan Xie Gan Tang (Gentiana Combination, Item No. 2267): This is a very good formula for otitis media at the acute stage because of its strong functions of clearing the liver and gallbladder and eliminating the damp factor at the same time. 
    • Shan Huang Xie Xin Tang (Coptis and Rhubarb Combination, Item No. 2026): This is a good to use when there is constipation plus the interior flaming fire. 
    • Huang Lian Jie Du Tang (Coptis and Scute Formula, Item No. 2212): This is a good formula to clear the interior fire flaring up from san jiao. 

2. The Chronic Type due to the Deficient Fire:

Indications: Symptoms of chronic congestive otitis media and chronic purulent otitis media. Red tongue, scant tongue coating, thready and rapid pulse. 

Treatments & Formulas: Tonify the kidney and liver Yin and clear the deficient fire. 

Products:

    • Zhi Po Ba Wei Wan (Anemarrhena, Phellodendron and Rehmannia Formula, Item No. 2123): This is for the chronic stage due to the kidney Yin deficiency plus the interior deficient fire.
    • Jia Wei Xiao Yao San (Bupleurum and Paeonia Formula, Item No. 2068): This is for the chronic stage due to the liver Yin deficiency plus the interior deficient fire. 
    • Qian Jin Nei Tuo San (Astragalus and Platycodon Formula, Item No. 2041 ): This is good at the chronic stage for otitis media symptoms plus the Qi deficiency signs. 

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