Chronic suppurative otitis media is in most cases the
result of inappropriate treatment of acute suppurative otitis media. It is a chronic
inflammation of the mucous membrane, periost and even osseous tissue of the middle
ear. The disease has the following clinical features: a long period of recurrent
otopyorrea which is very difficult to get cured, hypoacusis and perforation of
the tympanic membrane. This disease falls into the category of tympanic membrane.
This disease falls into the category of what the TCM calls "nong er",
that is, otitis media suppurativa.
Main Points of Diagnosis
1. There
is intermittent or continuous pyorrhea in the ear. The pus may be either thin
and clear or thick and sticky. The otopyorrhea will not come to and end within
a short period of time.
2. Mild or moderate sound-conductive hypoacusis may
occur.
3. The perforation is mostly in the membrana tensa, seldom at its rim
or Shrapnell's membrane, accompanied by the formation of granulation or polyp.
4. There may be retroauricular pyorrhea, facial paralysis and vertigo.
5.
Mastoid x-ray photographing may be helpful to the diagnosis.
Differentiation
and Treatment of Common Syndromes
1. Internal Treatment
1) The Type of
Sticky Pus due to Heat in the Lung
Main Symptoms and Signs: The patient has
intermittent otopyorrhea which may be recurrent due to a cold. The pus is white
and as sticky as nasal mucus. Deafness is sometimes serious and sometimes mild.
Perforation of membrana tensa occurs. The pus from it looks like sticky silk thread
if smeared. These symptoms may be accompanied with stuffy nose and rhinorrhea.
The fur of the tongue is thin and white and the pulse is slippery.
Therapeutic
Principle: Purging lung-heat, removing turbidity and promoting the flow of qi
to clear away obstruction from the upper orifices.
Recipe: Magnolia Decoction
for Purging Lung-Heat with additional herbs
magnolia flower
scutellaria
root
rhizome of anemarrhena
cimicifuga rhizome
xanthium
capejasmine
fruit
ophiopogon root
white tribulus fruit
lily bulb
loquat leaf
gypsum
dahurian
angelica root
licorice root
All the above herbs are to be decocted in water
for oral administration.
2) The Type of the Dampness Retention due to Hypo-Function
of the Spleen
Main Symptoms and Signs: There is continuous pyorrhea flowing
out from the ear. The discharge is thin and clear. A big perforation of membrana
tensa and hypoacusis occur, accompanied by dizziness, a heavy sensation in the
head and poor appetite. The fur of the tongue is thin and white and the pulse
soft and moderate.
Therapeutic Principle: Invigorating the function of the
spleen to remove pathogenic dampness and reinforcing qi and blood to discharge
pus.
Recipe: Powder of Ginseng, Poria and White Atractylodes
ginseng
white
atractylodes rhizome
pulp of lotus seed
poria
licorice root
amomum
fruit
platycodon root
Chinese yam
coix seed
white hyacinth bean
All
the above herbs are to be decocted in water for oral administration.
3) The
Type of the Deficiency of the Kidneys
Main Symptoms and Signs: There is a
little but continuous otopyorrhea which is dirty and smells stinking. Hearing
is distinctively worsened. Perforation of membrana tensa or Shrapnel's membrane
occurs and granulation may be seen, accompanied by soreness of waist, dizziness,
insomnia and palpitation, red tongue, with thin and white fur and thready and
rapid pulse.
Therapeutic Principle: Reinforcing the kidney and purging pathogenic
fire to eliminate pus.
Recipe: Pill of Anemarrhena, Phellodendron and Rehmannia
with additional ingredients
anemarrhena
yellow corktree bark
pulp of
dogwood fruit
prepared rehmannia root
poria
oriental water plantain rhizome
moutan
bark
prunella spike
Chinese yam
All the above herbs are to be decocted
in water for oral administration.
For those with yellow and thick pus, add
9 grams of scutellaria root, 6 grams of coptis root and 9 grams of bupleurum root.
For those with thin pus, add 15 grams of plantain seed which is to be wrapped
in a piece of cloth ,and 15 grams of coix seed. For those who have lot of pus
which comes out continuously, add 9 grams of flavescent sophora root, 9 grams
of xanthium and 9 grams of dahurian angelica root.
2. External Treatment
1)
Clean the external auditory canal. Do this whit white vinegar solution (white
vinegar mixed with the same amount of water for injection), three times a day.
2) Drip ear drops into the ear. Do this with Ear Drops of Coptis (the same
as used for acute suppurative otitis media), three times a day.
3) Other treatments.
If there is granulation in the ear, it can be removed with snare. When otopyorrhea
ceases to come out and inflammation is healed, and operation to restore hearing
can be considered. If x-ray photograph indicates any destruction of the bones,
and operational treatment should be carried out.
Dr. Ming's TCM Medical
Center,
Hua Xi Xiao Yuan, Hutian Developing Area,
Huaihua city, Hunan province
China