A 2 year old boy with Acute Otitis Media

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A 2 year old boy with Acute Otitis Media Case
Presentation
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• Nilanjana Basu, Homoeopathic Physician
• Lecturer, Department of Surgery
• Sameer Rana E.N.T. Specialist,
• Professor, Department of Surgery
• Bakson Homoeopathic Medical College,
• Greater Noida
• Correspondence to niil2007_at_yahoo.co.in

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• Registration no. 4145/09
• Age/Sex 2years/Male
• Residence Gamma 1,Greater Noida

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Chief Complaints

• Recurrent nasal discharge and stuffiness since 1
  ½ months
• Itching in left ear since 10 days

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History of presenting illness

• 2 year old baby brought to the E.N.T. clinic on
  28.8.09 with recurrent nasal symptom of cold,
  stuffiness and rhinorrhoea since 11/2months.
• His mother complained 2 weeks back of an episode
  of left earache followed by discharge which was
  profuse and mucoid. Pain was severe at the
  middle of the night due to which he couldnt
  sleep.

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• History of hearing loss was not forthcoming. For
  the above complaints antibiotic and decongestant
  treatment was given by a local practitioner for
  10days. At the time of case taking patient only
  had nasal complaints and itching in the left ear
  general irritability.

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Past history

• Patient had recurrent attacks of Upper
  respiratory tract infections

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Family history

• Mother alive Susceptibility to cold
• Father - alive- Healthy

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General physical examination

• Mental state conciousness-Well oriented fully
  concious
• Built Nutrition well built
• Facies normal
• Pallor absent
• Icterus absent

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• Cyanosis absent
• Oedema absent
• Clubbing absent
• Temperature normal
• Pulse 100/min
• Respiration 20/min

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Examination of Head Neck

• EAR
• Bilaterally pinna normal, excoriation of the skin
  and external canal on left side. External canal
  of Right side was normal. Left tympanic membrane
  congested with a small central perforation. Right
  tympanic membrane appeared normal. Patient did
  not respond to Tuning fork test. Facial nerve was
  normal bilaterally and there was no nystagmus.

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NOSE

• Bilaterally muco-purulent discharge with pallor
  and oedema of turbinates.
• THROAT normal
• EXAMINATION OF NECK normal

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Otoscopic examination

• Left tympanic membrane congested with a small
  central perforation.

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Summary of the case

• A 2 year old boy presented with itching of left
  ear since 10 days. He had h/o upper respiratory
  tract infection since 1 ½ months followed by an
  episode of left earache followed by discharge
  which was profuse and mucoid 2 weeks ago. Pain
  was severe at the middle of the night due to
  which he couldnt sleep.

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• On examination the left tympanic membrane was
  congested with a small central perforation. The
  right ear was normal.

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Diagnosis

• Acute Otitis Media of left Ear

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Rubric selection

• The patient was irritable, restless, had itching
  in left ear at night. The rubrics selected
  likewise were from Kent Repertory.
• Mind, restless, nervousness, night
• Mind, irritability
• Ear, itching in, left
• Generalities, night

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4145/09
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Prescription

• All the rubrics covered Rhustox, which was
  prescribed in 0/1 potency thrice a day.
• Ear was regularly cleaned.

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Follow up

• After 7 days the babys nasal discharge
  decreased, irritability, restlessness and itching
  in ear were relieved. The medicine was continued
  for another 15 days.

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• Rhustox 0/2 was prescribed on 20.10.09. The ear
  was dry but the perforation started healing. The
  same medicine was continued for 7 more days. On
  10.11.09 the ear was examined with an otoscope
  which revealed that the perforation was healed.

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Discussions

• The importance of healing this perforation is
  utmost as the recurrent attacks of cough and cold
  complicates the perforation and it becomes
  chronic otitis media with hearing loss and
  discharging ear.

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• This age also coincide with the development of
  speech. If the patient cannot hear there will be
  improper development of speech.

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• Rhustox was given on account of the restlessness
  of the baby at night which was very marked.
• Fifty millesimal potency was prescribed as we
  required frequent repetition of the medicines in
  ever increasing dose.

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