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.  

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