कर्ण रोग.pptx

ayurved education

1. कर्णगत रोग

2. संख्या सुश्रुत/भा.व./यो.र. – 28 चरक – 4 वागभट – 25 शांर्गधर – 18 कर्ण स्त्रोत – 15 कर्ण शष्कुली – 3 कर्ण पाली – 7 कर्ण पाली – 7 कर्ण मूलगत - 5

3. 28 कर्णशूलं (शु) कर्णप्रणाद / नाद (ना) कर्णपाकः (पा) कर्णस्राव (सा) बाधिर्यं (बा) कर्णक्ष्वेड (वे) कर्णकण्डू (क) पूतिकर्ण (पूति) कर्णप्रतिनाह ( प्रति ) कृमिकर्ण ( कृमि ) कर्णवर्च ( गूथ ) 2 - कर्णविद्रधि 4 - कर्ण शोफ 4 – कर्ण अर्श 7 - कर्णार्बुदं

4. प्रतिश्याय जलक्रीडाकर्णकण्डूयनैर्मरुत् मिथ्यायोगेन शब्दस्य कुपितोऽन्यैश्च कोपनैः प्राप्य श्रोत्रसिराः कुर्याच्छूलं स्रोतसि वेगवत् (वा) अवश्याय जलक्रीडा कर्णकण्डूयनैर्मरुत् मिथ्यायोगेन शस्त्र स्य कुपितोऽन्यैश्च कोपनैः प्राप्य श्रोत्रसिराः कुर्याच्छूलं स्रोतसि वेगवत् (सु) सामान्य निदान

5. समीरणः श्रोत्रगतोऽन्यथाचरः समन्ततः शूलमतीव कर्णयोः करोति दोषैश्च यथास्वमावृतः स कर्णशूलः कथितो दुराचरः कर्णशूल दोष - वात भेद – 5 वागभट – v ,p,k ,r,s लक्षण – सामान्य (सुश्रुत ) वातज कर्णशूल अर्धावभेदकं स्तम्भं शिशिरानभिनन्दनम् चिराच्च पाकं पक्वं तु लसीकामल्पशः स्रवेत् श्रोत्रं शून्यमकस्माच्च स्यात्सञ्चारविचारवत्

6. पितज कर्णशूल शूलं पित्तात् स दाहोषाशीतेच्छा श्वयथुज्वरम् आशुपाकं प्रपक्वं च स पीतलसिकास्रुति सा लसीका स्पृशेद्यद् यत्त त्तत्पाकमुपैति च कफज कर्णशूल कफाच्छिरो हनुग्रीवागौरवं मन्दता रुजः कण्डूः श्वयथु उष्णेच्छा पाकात् श्वेतघनस्रुतिः रक्तज कर्णशूल करोति श्रवणे शूलमभिघातादि दूषितम् रक्तं पित्तसमान अर्ति किञ्चिद्वाऽधिकलक्षणम् सनिपातज कर्णशूल शूलं समुदितैर्दोषैः सशोफज्वरतीव्ररुक् पर्यायादुष्णशीतेच्छं जायते श्रुतिजाड्यवत् पक्वं सितासितारक्त घनपूय प्रवाहि च

7. कर्णशुल उपद्रव - 6 मूर्च्छा, दाह, ज्वर, कास, क्लम, वमथु चिकित्सा सामान्य चिकित्सा – कर्ण रोग सामान्यं कर्णरोधेषु घृतपानं रसायनम् अव्यायामोऽशिरःस्नानं ब्रह्मचर्यम अकत्थनम् कर्णशूले प्रणादे च बाधिर्य क्ष्वेड योरपि चतुर्णामपि रोगाणां सामान्यं भेषजं विदुः सामान्य चिकित्सा – 4 रोग

8. स्निग्धं वातहरैः स्वेदन – नाडी / पिण्ड स्नेहविरेचितम् भक्तोपरि हितं सर्पि बस्ति कर्म च पूजितम् निरन्नो निशि तत्सर्पिः पीत्वोपरि पिबेत् पयः कर्ण पूरण अश्वत्थपत्रखल्लं वा विधाय बहुपत्रकम् तदङ्गारैः सुसम्पूर्णं निदध्याच्छ्रवणोपरि यत्तैलं च्यवते तस्मात् खल्लादङ्गारतापितात् तत् प्राप्तं श्रवणस्रोतः सद्यो गृह्णाति वेदनाम् सर्षप तेल अर्कांकुर स्वरस समुद्रफेन चुर्ण कुकुटवसा पूरण दीपिका तेल महतः पञ्चमूलस्य काण्ड अष्टादशाङ्गुलम् | क्षौमेणावेष्ट्य संसिच्य तैलेनादीपयेत्ततः ||२०|| यत्तैलं च्यवते तेभ्यो धृतेभ्यो भाजनोपरि | ज्ञेयं तद्दीपिकातैलं सद्यो गृह्णाति वेदनाम् कर्ण धूपन – क्षौम गुग्गुलू अगुरु सघृतैर्धूपयेच्च वातज कर्णशूल - वातव्याधि प्रतिश्यायविहितं हितमत्र

9. OTALGIA (EARACHE) Pain in the ear called otalgia . LOCAL CAUSES External ear. Furuncle, impacted wax, otitis externa, otomycosis, myringitis bullosa, herpes zoster and malignant neoplasms. Middle ear. Acute otitis media, eustachian tube obstruction, mastoiditis, extradural abscess, aero-otitis media and carcinoma middle ear. CAUSES

10. As ear receives nerve supply from Vth (auriculotemporal branch) IXth (tympanic branch) Xth (auricular branch) cranial nerves - from C2 (lesser occipital) and C2 and C3 (greater auricular), REFERRED CAUSES Vth Vth Vth Xth IXth IXth

11. PSYCHOGENIC CAUSES Via Vth cranial nerve (a) Dental. Caries tooth, apical abscess, impacted molar, malocclusion. 1 (b) Oral cavity. Benign or malignant ulcerative lesions of oral cavity or tongue. (c) Temporomandibular joint disorders - osteoarthritis, recurrent dislocation and ill-fitting denture Via IXth cranial nerve (a) Oropharynx. Acute tonsillitis, peritonsillar abscess, tonsillectomy. Benign or malignant ulcers of soft palate, tonsil and its pillars. (b) Base of tongue. Tuberculosis or malignancy. (c) Elongated styloid process Via Xth cranial nerve. Malignancy or ulcerative lesion of vallecula, epiglottis, larynx or laryngopharynx and oesophagus. Via C2 and C3 spinal nerves. Cervical spondylosis, injuries of cervical spine and caries spine.

12. यदा तु नाडीषु विमार्गमागतः स एव शब्दाभिवहासु तिष्ठति शृणोति शब्दान् विविधांस्तदा नरः प्रणादमेनं कथयन्ति चामयम् निदान दोष - वात लक्षण – कर्णनाद शब्दवाहिसिरासंस्थे शृणोति पवने मुहुः| नादानकस्माद्विविधान् कर्णनादं वदन्ति तम् भेरी मृदहग शंखनां कर्णनाद सः उच्यते (मा,नि )

13. श्रमात् क्षयाद् रुक्षकषायभोजनात् समीरणः शब्दपथे प्रतिष्ठितः विरिक्तशीर्षस्य च शीतसेविनः करोति हि क्ष्वेडमतीव कर्णयोः कर्ण क्ष्वेड निदान दोष - वात - सनिपत (मा.नि.) लक्षण – वायुः पितादीभि युक्तों वेणु घोषोंपमं स्वनम करोति कर्णयोः क्ष्वेड कर्णक्ष्वेड स उच्यते ( मा.नि .) क्ष्वेड का वर्णन वागभट ने नहीं किया चिकित्सा – कर्णनाद समान

14. चिकित्सा सामान्य चिकित्सा – कर्ण रोग सामान्य चिकित्सा – 4 रोग कर्ण पूरण – कर्ण शूल समान अरंड शिग्रू वरुण मूल स्वरस योग रत्नाकर – अपामार्ग तेल पूरन वातज शूल समान

15. Tinnitus Tinnitus is ringing sound or noise in the ear. The characteristic feature is that the origin of this sound is within the patient. Usually, it is unilateral but may also affect both ears. It may vary in pitch and loudness and has been variously described by the patient as roaring, hissing, swishing, rustling or clicking type of noise. Tinnitus is more annoying in quiet surroundings, particularly at night, when the masking effect of ambient noise from the environment is lost TYPES OF TINNITUS Two types of tinnitus are described: Subjective - which can only be heard by the patient. Objective - which can even be heard by the examiner with the use of a stethoscope

16. CAUSES OF TINNITUS Otologic Impacted wax Fluid in middle ear Acute otitis media Chronic otitis media Ménière’s disease Presbycusis Noise-induced hearing loss sudden SNHL Acoustic neuroma Metabolic Hypothyroidism Hyperthyroidism Obesity Hyperlipidaemia Vitamin deficiency Subjective tinnitus Neurologic Head injury Postmeningitic Brain haemorrhage Cardiovascular Hypertension Hypotension Anaemia Cardiac arrhythmias Arteriosclerosis Pharmacologic All ototoxic drugs Psychogenic Anxiety Depression

17. Objective tinnitus seen less frequently Vascular lesions glomus tumour carotid artery aneurysm cause swishing tinnitus synchronous with pulse. Temporarily abolished by pressure on the common carotid artery Patulous eustachian tube Tinnitus synchronous with respiration Idiopathic stapedial or tensor tympani myoclonus Dental Clicking of TM joint tinnitus is psychogenic and no cause can be found in the ear or central nervous system.

18. TREATMENT OF TINNITUS Tinnitus is a symptom and not a disease. Where possible, its cause should be discovered and treated. Sometimes, even clicking clock or a similar device may mask the tinnitus and help the patient to go to sleep TINNITUS MASKERS can be used in patients who have no hearing loss. They are worn like a hearing aid. TINNITUS INSTRUMENT It is a combination of a hearing aid and a masker in one device.

19. TINNITUS RETRAINING THERAPY (TRT) basis for habituation therapy. It occurs at two levels. Habituation of reaction . It is uncoupling of brain and body from negative reactions to tinnitus Habituation of tinnitus . It is blocking the tinnitus-related neuronal activity to reach level of consciousness Therapy consists of two major components: ( i ) counselling (ii) sound therapy . TRT needs a long period of 18–24 months but gives a significant improvement in more than 80% of patients

20. कर्णनाद दोष – केवल वात लक्षण – भेरी मृदहंग शंखान चिकित्सा – वात शामक कर्ण क्ष्वेड वात के साथ दोष संसर्ग वात के साथ पितादी संसर्ग वेणु घोषोपम

21. कर्ण बाधिर्य निदान दोष - वात- कफ लक्षण – स एव शब्दानुवहा यदा सिराः कफानुयतों व्यनुसृत्य तिष्टति तदा नरस्य अप्रतिकार सेविनो भवेतू बाधिर्य असंशयं खलु श्लेष्मणा अनुगतों वायुर् नादों वा समुपेक्षितः उच्चेः कृच्छाद कुर्याद बधिरत्वं क्रमेण च (वा.) कर्ण नाद ऊच्चे श्रुति कर्णबाधिर्य

22. वागभट ने कर्णनाद की उपेक्षा से कर्णबाधिर्य की उत्पाती मानी है बालक वृद्ध तथा एक वर्ष पुराना बाधिर्य - असाध्य चिकित्सा सामान्य चिकित्सा – कर्ण रोग कर्णशूले प्रणादे च बाधिर्य क्ष्वेड योरपि । चतुर्णामपि रोगाणां सामान्यं भेषजं विदुः वातज शूल समान चिकित्सा – कफ का अनुबंध होने पर वमन कर के धूमपान प्रतिस्याय की समस्त चिकित्सा वागभट अनुसार चिकित्सा क्रम स्नेहन – स्वेदन – नस्य – सिरोबस्ती – बस्ती कर्म कर्ण पूरण बिल्वादी तेल हिंगवादी तेल निर्गुण्डी तेल

23. Hearing Loss Peripheral( VIIIth nerve) Central(Central auditorypathways CLASSIFICATION Hearing Loss Organic Nonorganic Conductive Sensorineural Sensory ( cochlear ) Neural

24. CONDUCTIVE HEARING LOSS Any disease process which interferes with the conduction of sound to reach cochlea causes conductive hearing loss. The lesion may lie in the external ear and tympanic membrane , middle ear or ossicles up to stapediovestibular joint

25. AETIOLOGY The cause may be congenital or acquire d Meatal atresia Fixation of stapes footplate Fixation of malleus head Ossicular discontinuity Congenital cholesteatoma congenital External ear Any obstruction in the ear canal, e.g. wax, foreignbody , furuncle, acute inflammatory swelling, benign or malignant tumour . acquire d Middle ear Perforation of tympanic membrane Fluid in the middle ear, e.g. otitis media, Mass in middle ear, e.g. benign or malignant tumour Disruption of ossicles, e.g. trauma to ossicular chain, cholesteatoma Fixation of ossicles, e.g. otosclerosis, tympanosclerosis, Eustachian tube blockage, e.g. retracted tympanic membrane, serous otitis media

26. MANAGEMENT characteristics of conductive hearing loss Negative Rinne test, i.e. BC > AC. Weber lateralized to poorer ear. Normal absolute bone conduction. Low frequencies affected more. Audiometry shows bone conduction better than air conduction with air-bone gap. Greater the air-bone gap, more is the conductive loss . Loss is not more than 60 dB. Speech discrimination is good Frequency in Hertz 125 250 500 1 k 2 k 4 k 8 k Hearing loss in dB 10 20 30 40 50 60 70 80 90 Most cases of conductive hearing loss can be managed by medical or surgical ly

27. Removal of canal obstructions impacted wax, foreign body, osteoma or exostosis, keratotic mass, benign or malignant tumours. Removal of fluid . Myringotomy with or without grommet insertion . Removal of mass from middle ear. Tympanotomy and removal of small middle ear tumours or cholesteatoma behind intact tympanic membrane. Stapedectomy otosclerotic fixation of stapes footplate. Tympanoplasty Repair of perforation, ossicular chain or both. Hearing aid. In cases, where surgery is not possible, refused or has failed

28. SENSORINEURAL HEARING LOSS Sensorineural hearing loss (SNHL) results from lesions of the cochlea , VIIIth nerve or central auditory pathways. It may be present at birth (congenital) or start later in life (acquired).

29. AETIOLOGY CONGENITAL It is present at birth and is the result of anomalies of the inner ear or damage to the hearing apparatus ACQUIRED It appears later in life Infections of labyrinth—viral, bacterial or spirochaetal Trauma to labyrinth or VIIIth nerve surgery Noise-induced hearing loss Ototoxic drugs Presbycusis Ménière’s disease Acoustic neuroma Sudden hearing loss Familial progressive SNHL Systemic disorders, e.g. diabetes, hypothyroidism, kidney disease, autoimmune disorders, multiple sclerosis

30. characteristics of sensorineural hearing loss A positive Rinne test, i.e. AC > BC. Weber lateralized to better ear. Bone conduction reduced on Schwabach and absolute bone conduction tests. More often involving high frequencies. No gap between air and bone conduction curve on audiometry Loss may exceed 60 dB. Speech discrimination is poor. There is difficulty in hearing in the presence of noise

31. MANAGEMENT Early detection of SNHL is important as measures can be taken to stop its progress early rehabilitation programme, Syphilis of the inner ear is treatable with high doses of penicillin and steroids Ototoxic drugs should be used with care and discontinued Noiseinduced hearing loss can be prevented by removed from the noisy surroundings Rehabilitation of hearing impaired with hearing aids Air conduction hearing aid.

32. Bone conduction hearing aid. COCHLEAR IMPLANTS R ehabilitation TRAINING SPEECH READING - lip-reading AUDITORY TRAINING SPEECH CONSERVATION

33. NOISE TRAUMA excessive noise can be divided into two groups: - Acoustic trauma - Noise-induced hearing loss (NIHL) Acoustic trauma Permanent damage to hearing can be caused by a single brief exposure to very intense sound without this being preceded by a temporary threshold shift Noise-induced hearing loss (NIHL) Hearing loss, in this case, follows chronic exposure to less intense sounds

34. SUDDEN HEARING LOSS Sudden SNHL is defined as 30 dB or more of SNHL over at least three contiguous frequencies occurring within a period of 3 days or less. Mostly it is unilateral Remember the mnemonic “In The Very Ear Too No Major Pathology” Infections Trauma Vascular Ear (otologic) Toxic Miscellaneous Psychogenic PRESBYCUSIS Sensorineural hearing loss associated with physiological aging process in the ear is called presbycusis

35. NONORGANIC HEARING LOSS In this type of hearing loss, there is no organic lesion It is either due to malingering or is psychogenic Patient may present with any of the three clinical situations: Total hearing loss in both ears total loss in only one ear exaggerated loss in one or both ears Stenger test take two tuning forks of equal frequency, strike and keep them say 25 cm from each ear. Patient will claim to hear it in the normal ear. Now bring the tuning fork on the side of feigned deafness to within 8 cm, keeping the tuning fork on the normal side at the same distance The patient will deny hearing anything even though tuning fork on normal side is where it could be heard earlier Acoustic reflex threshold

36. कर्णस्राव निदान दोष - लक्षण – शिरो अभिघातद् अथवा निमज्जतों जले प्रपाकाद अथवा अपि विदधेः स्त्रवेतू पूयं श्रवणो अनिलवृतः स कर्ण सस्त्राव इति प्रकीर्तीतेः वागभट ने वर्णन नहीं किया है

37. चिकित्सा शिरोविरेचन धूपन पूरण प्रमार्जन धावन प्रमार्जन राजवृक्षादी गण सुरसादी गण पंचक्षीरीगण पूरण शेवालादी तेल प्रियन्गवादी तेल स्त्री दूध + रसंजन + मधु समुद्रफेन चूर्ण शंबूक तेल – कर्णनाड़ी नाशक गंध तेल नाड़ीव्रणवत / दुष्ट व्रणवत धूपन – गुगगलू अगरू कर्णस्त्राव,पूतिकर्ण,कृमिकर्ण – समान चिकित्सा

38. ACUTE SUPPURATIVE OTITIS MEDIA acute inflammation of middle ear by pyogenic organisms. middle ear implies middle ear cleft, i.e. Eustachian tube, middle ear, attic, aditus , antrum and mastoid air cells AETIOLOGY more common - infants and children lower socioeconomic group Typically disease follows viral infection of upper respiratory tract but soon the pyogenic organisms invade the middle ear ROUTES OF INFECTION Via eustachian tube - It is the most common route Via external ear Blood-borne - uncommon

39. PREDISPOSING FACTORS Recurrent attacks of common cold, upper respiratory tract infections and exanthemat us fevers like measles, diphtheria or whooping cough. Infections of tonsils and adenoids. Chronic rhinitis and sinusitis. Nasal allergy. Tumours of nasopharynx, packing of nose or nasopharynx for epistaxis. Cleft palate BACTERIOLOGY Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis

40. PATHOLOGY AND CLINICAL FEATURES 5 stages of ASOM : 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. There is retraction of tympanic membrane with some degree of effusion in the middle ear but fluid may not be clinically appreciable Symptoms . Deafness and earache are the two symptoms but they are not marked. no fever Signs Tympanic membrane is retracted Tuning fork tests show conductive deafness

41. Stage of pre - suppuration. tubal occlusion – prolonged - pyogenic organisms invade tympanic cavity causing hyperaemia of its lining. Inflammatory exudate appears in the middle ear. Tympanic membrane becomes congested Symptoms . marked earache which may disturb sleep and is of throbbing nature. Deafness and tinnitus are also present, but complained only by adults. Usually, child runs high degree of fever and is restless. Signs congestion of pars tensa . Leash of blood vessels appear along the handle of malleus and at the periphery of tympanic membrane cart-wheel appearance.

42. Stage of suppuration. marked by formation of pus in the middle ear and to some extent in mastoid air cells. Tympanic membrane starts bulging to the point of rupture Symptoms Earache becomes excruciating Deafness increases child may run fever of 102–103°F. Signs Tympanic membrane appears red and bulging with loss of landmarks. Handle of malleus may be engulfed by the swollen and protruding tympanic membrane

43. Stage of resolution. The tympanic membrane ruptures with release of pus and subsidence of symptoms. Inflammatory process begins to resolve. If proper treatment is started early or if the infection was mild, resolution may start even without rupture of tympanic membrane. Symptoms . With evacuation of pus earache is relieved, fever comes down and child feels better. Signs External auditory canal may contain blood-tinged discharge which later becomes mucopurulent. small perforation is seen in anteroinferior quadrant of pars tensa .

44. Stage of complication. If virulence of organism is high or resistance of patient poor acute mastoiditis Subperiosteal abscess, facial paralysis, labyrinthitis, petrositis , Extradural abscess, meningitis, brain abscess lateral sinus thrombophlebitis

45. TREATMENT Antibacterial therapy indicated in all cases with fever and severe earache Amoxicillin Novamox , Biomox 40 mg/kg 3 Ampicillin Biocillin 50–100 mg/kg 4 Co-amoxiclav Augmentin, Enhancin 40 mg/kg 2–3 Erythromycin Emycin , Althrocin 30–50 mg/kg 4 Cefaclor (II generation) Keflor , Distaclor 20 mg/kg 2–3 Cefixime (III generation) Taxim-0, Biotax-0 8 mg/kg 1 or 2 Ceftibuten (III generation) Procadax 9 mg/kg 1 Drug Trade names Total daily dose Divided dose Antibacterial therapy must be continued for a minimum of 10 days , till tympanic membrane regains normal appearance and hearing returns to normal Early discontinuance of therapy with relief of earache and fever, or therapy given in inadequate doses may lead to secretory otitis media and residual hearing loss .

46. Decongestant nasal drops Analgesics and antipyretics. - xylometazoline ( Otrivin ) - Paracetamol Ear toilet. - dry-mopped with sterile cotton buds Myringotomy. All cases of acute suppurative otitis media should be carefully followed till drum membrane returns to its normal appearance and conductive deafness disappears

47. Review after 48–72 h Acute otitis media Antibacterial therapy Earache and fever persist or increase Good response Another antibacterial therapy for 10 days or myringotomy and culture and specific antimicrobial for 10 days Continue same for 10 days Persistent fluid but earache and fever abate Complete resolution Periodic checks for 12 weeks Complete resolution Persistent effusion Treat as otitis media with effusion

48. पूतिकर्ण निदान दोष - कफ पित लक्षण – स्थितेः कफे स्रोतसि पित तेजसां विलायमाने भ्रंश सम्प्रतापवान अवेदनों वाअप्य अथवा सवेदनों घनं स्त्रवेत पूति च पूति कर्णकः कर्ण विद्रधि पाकेन कर्णे वा वारिपूरणात पूयं स्त्रवति यः पूति स पूतिकर्णक ः (भा. प्र ) चिकित्सा सामान्य कर्णस्त्राव समान कर्ण पूरण – स्त्री दुग्ध + रसंजान

49. CHRONIC SUPPURATIVE OTITIS MEDIA Chronic suppurative otitis media (CSOM) is a long-standing infection of a part or whole of the middle ear cleft characterized by ear discharge and a permanent perforation. A perforation becomes permanent when its edges are covered by squamous epithelium TYPES OF CSOM two types Tubotympanic safe or benign type involves anteroinferior part of middle ear cleft, There is no risk of serious complications Atticoantral . unsafe or dangerous type involves posterosuperior part of the cleft (i.e. attic, antrum and mastoid) Risk of complications is high in this variety

50. TUBOTYMPANIC TYPE AETIOLOGY sequela of acute otitis media Ascending infections via the eustachian tube - tonsils, adenoids and infected sinuses - result of allergy to ingestants such as milk, eggs, fish, BACTERIOLOGY Pseudomonas aeruginosa, Proteus, Escherichia coli Staphylococcus aureus,

51. CLINICAL FEATURES Ear discharge. - mucoid or mucopurulent, - constant or intermittent Hearing loss. - conductive type; severity varies but rarely exceeds 50 dB - the patient reports of a paradoxical effect, i.e. hears better in the presence of discharge than when the ear is dry. This is due to “ round window shielding effect ” produced by discharge which helps to maintain phase differential Perforation Middle ear mucosa - seen when the perforation is large

52. INVESTIGATIONS - Examination under microscope - Audiogram. - Culture and sensitivity of ear discharge. - Mastoid X-rays/CT scan temporal bone

53. TREATMENT - Aural toilet Remove all discharge and debris from the ear. It can be done by dry mopping with absorbent cotton buds, suction clearance under microscope or irrigation - Ear drops Antibiotic ear drops containing neomycin, chloromycetin or gentamicin are used. combined with steroids + local anti-inflammatory effect. - Systemic antibiotics - Precautions keep water out of the ear during bathing, swimming and hair wash A void Hard nose blowing - Surgical treatment.

54. ATTICOANTRAL TYPE AETIOLOGY - Aetiology of atticoantral disease is same as of cholesteatoma CLINICAL FEATURES Ear discharge - Usually scanty, - but always foul-smelling due to bone destruction - Discharge may be so scanty that the patient may not even be aware of it Hearing loss - Hearing is normal when ossicular chain is intact - when cholesteatoma caused by destroyed ossicles Bleeding

55. SIGNS Perforation - attic or posterosuperior marginal type Retraction pocket Cholesteatoma Pearly-white flakes of cholesteatoma INVESTIGATIONS - Examination under microscope - Audiogram. - Culture and sensitivity of ear discharge. - Mastoid X-rays/CT scan temporal bone

56. FEATURES INDICATING COMPLICATIONS IN CSOM Pain Vertigo Persistent headache Fever, nausea and vomiting Irritability and neck rigidity Diplopia Surgical TREATMENT Canal wall down procedures Canal wall up procedures. Reconstructive surgery Conservative treatment

57. Tubotympanic or safe type Atticoantral or unsafe type Discharge Profuse, mucoid, odourless Scanty, purulent, foul smelling Perforation Central Attic or marginal Polyp Pale Red and fleshy Cholesteatoma Absent Present Complications Rare Common

58. कर्णविद्रधि निदान प्रकार - 2 – आगंतुज+ दोषज लक्षण – क्षत अभिघात प्रभवस्तु विद्रधि भवेत तथा दोष कृतों अपरः पुनः स रक्त पित अरुणं अस्त्रं स्त्रवेत प्रतोद धूमयान दाहचोषवान चिकित्सा सामान्य विद्रधिवत आम विद्रधि चिकित्सा – व्रणशोथ उपक्रम – विरेचन से अपतर्पण तक पक्व विद्रधि चिकित्सा – भेदन पीड़न – व्रणवत सन्निपात विद्रधि – असाध्य क्षतज विद्रधि – पितज कर्णशूलवत

59. localized acute otitis externa ( Furuncle ) A furuncle is a staphylococcal infection of the hair follicle. As the hair are confined only to the cartilaginous part of the meatus, furuncle is seen only in this part of meatus. Usually single but may be multiple. S ymptoms Severe ear pain and tenderness Movements of the pinna are painful. Jaw movements, as in chewing, also cause pain in the ear. S ign posterior meatal wall causes oedema over the mastoid with obliteration of the retroauricular groove. Periauricular lymph node enlarged

60. Treatment systemic antibiotics, analgesics local heat. An ear pack of 10% glycerine provides splintage and reduces pain. If abscess has formed, incision and drainage should be done. recurrent furunculosis, diabetes should be excluded,

61. कर्णपाक निदान दोष - पित लक्षण – भवेत प्रपाकः खलु पित कोपतो विकोथ क्लेदकरश्च कर्णयो कर्ण पाकस्तू पितेन कोथ विक्लेदकृत भवेत कर्ण विद्रधि पाकाद वा जायते च अंबु पुरणात (मा.नि.) - वागभट ने वर्णन नहीं किया है चिकित्सा पितज विसर्प समान गोर्यादि घृत शीतल लेप उत्पल चंदन मंजिष्टा लेप

62. It is diffuse inflammation of meatal skin which may spread to pinna and epidermal layer of tympanic membrane Trauma - scratching the ear canal with hair pins or matchsticks, unskilled instrumentation to remove foreign bodies Common organisms Staphylococcus aureus, Pseudomonas pyocyaneus , Bacillus proteus and Escherichia coli but more often the infection is mixed. Diffuse otitis externa Aetiology commonly seen in hot and humid climate and in swimmers. Two factors commonly responsible for this condition are: ( i ) trauma to the meatal skin and (ii) invasion by pathogenic organisms.

63. Acute phase hot burning sensation in ear Pain aggravated by movements of jaw. Oozing thin serous discharge Meatal lining becomes inflamed and swollen. Conductive hearing loss. In severe cases, regional lymph nodes become enlarged and tender Chronic phase irritation and strong desire to itch. Discharge is scanty and may dry up to form crusts. Meatal skin which is thick and swollen show scaling and fissuring. Clinical features . Diffuse otitis externa may be acute or chronic with varying degrees of severity.

64. Ear toilet most important single factor in the treatment of diffuse otitis externa. All exudate and debris should gently removed. Ear toilet can be done by dry mopping, suction clearance or irrigating the canal with warm, sterile normal saline. Medicated wicks . wick soaked in antibiotic steroid and inserted in ear canal and patient Wick is changed daily for 2–3 days A ntibiotics . Broad-spectrum systemic antibiotics. Analgesics - For relief of pain. T reatment

65. कर्णगूथ निदान दोष - k p लक्षण – विशोषित श्लेष्मणी पिततेजसां नृणा भवेत स्त्रोतसि कर्णगुथकः चिकित्सा प्रक्लेधन – तेल – अपामार्ग क्षार तेल विलायन - स्वेदन से शोधन – शलाका से – आहरण कर्म

66. Impacted wax Wax is composed of secretion of sebaceous glands, ceruminous glands, hair, epithelial debris and dirt Sebaceous glands provide fluid rich in fatty acids while secretion of ceruminous gland is rich in lipids . Secretion of both these glands mixes with the epithelial cells and keratin to form wax. Wax has a protective function It has acidic pH and is bacteriostatic and Normally, only a small amount of wax is secreted, which dries up and is later expelled from the meatus by movements of the jaw.

67. E tiology people sweat more narrow and tortuous ear canal stiff hair Obstructive lesion of the canal S ymotoms impairment of hearing sense of blocked ear. Tinnitus and giddiness may result from impaction of wax against the tympanic membrane. Reflex cough due to stimulation of auricular branch of vagus onset of symptoms may be sudden when water enters the ear canal during bathing

68. Treatment syringing instrumental manipulation. Hard impacted - wax solvents . Cerumen hook, scoop or Jobson - Horne probe are often used First, a space is created between the wax and meatal wall, the instrument is passed beyond the wax, and whole plug then dragged out in a single piece If it breaks, syringing may be used to remove the fragments. 5% sodium bicarbonate + glycerine + water – 2/3 times a day Hydrogen peroxide, liquid paraffin Commercial drops - ceruminolytic agents - paradichlorobenzene

69. कर्णकंडु निदान दोष - k लक्षण – कफेन कंडु प्रचितेन् कर्णयो भ्रशं भवेत स्त्रोतसि कर्ण संघित चिकित्सा ना – नाड़ी स्वेद व – वमन न – नस्य धु – धूमपान मु – मूर्ध विरेचन

70. Otomycosis Otomycosis is a fungal infection of the ear canal C ommon organism Aspergillus niger , A . Fumigatus Candida albicans . M ostly seen in hot and humid climate Secondary fungal growth is also seen in patients using topical antibiotics for treatment of otitis externa or middle ear suppuration

71. C linical features itching, discomfort or pain in the ear, watery discharge with a musty odour ear blockage. S ign fungal mass may appear white, brown or black A niger - black headed A fumigatus - pale blue or green Candida - white or creamy Treatment ear toilet - B y syringing, suction or mopping antifungal agents Nystatin - Candida. broad-spectrum antifungal - clotrimazole

72. कृमि कर्ण निदान दोष - s लक्षण – यदा तु मूर्च्छन्त्यथवाऽपि जन्तवः सृजन्त्यपत्यान्यथवाऽपि मक्षिकाः | तदञ्जनत्वाच्छ्रवणो निरुच्यते भिषग्भिराद्यैः कृमिकर्णको गदः तदञ्जनत्वात् कृमिलक्षणत्वात्| आद्यैर्भिषग्भिः विदेहादिभिः| अयं रोगः सान्निपातिकः वातादि दूषितं श्रोत्र मांस असृक क्लेदजा रुजम खादन्तों जन्तवः कूर्युस्तीव्रां स कृमि कर्णकः (वा)

73. शार्गधर ने कृमि कर्ण को कर्ण हल्लिका नाम से लिखा है पतंगः शतपदश्च कर्णश्रोत प्रविश्य हि अरित व्याकुलत्वं च् भ्रशं कुर्वन्ति वेदनां कर्णो निस्तूधते तस्य तथा फरफरायते कीटचरतिरुक तीव्रा निष्पन्दे मंद वेदना चिकित्सा कृमिनाशक चिकित्सा अपकर्षण प्रकृति विधात निदान परिवर्जन कर्णपूरण – सर्षप तेल , गोमूत्र+हरताल, सुर्यमुखीस्वरस, निर्गुंडी स्वरस

74. Foreign bodies of ear Nonliving . Children may insert a variety of foreign bodies in the ear; a piece of paper or sponge, grain seeds (rice, wheat, maize), slate pencil, piece of chalk or metallic ball bearings. An adult broken end of matchstick (b) Living . Flying or crawling insects like mosquitoes, beetles, cockroach or ant

75. Methods of removing a foreign body include: ( i ) Forceps removal (ii) Syringing (iii) Suction (iv) Microscopic removal with special instruments (v) Postaural approach Soft and irregular foreign bodies removed by fine crocodile forceps . seed grains and smooth objects can be removed with syringing L iving objects – No attempt should be made to catch them alive. First, the insect should be killed by instilling oil (a household remedy), spirit or chloroform water. Once killed, the insect can be removed by any of the method d s escribed above

76. कर्णप्रतिनाह निदान दोष - kv /s लक्षण – स कर्णविट्को द्रवतां यदा गतो विलायितो घ्राणमुखं प्रपद्यते तदा स कर्णप्रतिनाहसञ्ज्ञितो भवेद्विकारः शिरसोऽभितापनः स कर्णगुथो द्रवतां गतो यदा विलायितो घ्राणमुखं प्रपद्यते तदा स कर्णप्रतिनाहसञ्ज्ञितो भवेद्विकारः शिरसोऽर्ध्भेदकृत (मा.नि.) अथ कर्णप्रतीनाहे स्नेहस्वेदौ प्रयोजयेत् | ततो विरिक्तशिरसः क्रियां प्राप्तां समाचरेत् स्नेह स्वेदौ शिरो विरेचन

77. Catarrhal inflammation of the Eustachian tube is one of the most common, unpleasant and long but not very grave illnesses of the fall, winter and spring months. Catarrhal inflammation of the Eustachian tube At change of altitude, for instance, during an airplane flight, especially at take-off and landing, we often feel  unpleasant pressure  and blocking in our ears. S ymptoms Rhinitis – nasal discharge E ar ache feeling of the blocking of the ear H earing loss T innitus S ign T ympanic membrane – retracted C onductive deafness sign T reatment A ccording to cause A ntibiotics A nalgesic C hewing

78. कर्णशोफ /कर्ण अर्बुद/ कर्ण अर्श सामान्य शोफ,अर्श तथा अर्बुद समान निदान ,लक्षण , चिकित्सा कर्ण शोफ – 4 अर्श – 4 अर्बुद – 7 शोफसमुत्थाना ग्रन्थिविद्रध्यलजीप्रभृतयः प्रायेण व्याधयोऽभिहिता अनेकाकृतयः, तैर्विलक्षणः पृथुर्ग्रथितः समो विषमो वा त्वङ्मांसस्थायी दोषसङ्घातः शरीरैकदेशोत्थितः शोफ इत्युच्यते कर्णशोफ

79. वातशोफः - कृष्णोऽरुणो वा परुषो मृदुरनवस्थितास्तोदादयश्चात्र वेदनाविशेषा भवन्ति; पित्तशोफः - पीतो मृदुः सरक्तो वा शीघ्रानुसार्योषादयश्चात्र वेदनाविशेषा भवन्ति; श्लेष्मशोफ - श्लेष्मश्वयथुः पाण्डुः कठिनः स्निग्धः शीतो स्निग्धो मन्दानुसारी कण्ड्वादयश्चात्र वेदनाविशेषा; सन्निपात शोफ - सर्ववर्णवेदनः सन्निपातश्वयथुः आदौ विम्लापनं कुर्याद द्द्वितीयमवसेचनम् तृतीयमुपनाहं तु चतुर्थीं पाटनक्रियाम् पञ्चमं शोधनं कुर्यात् षष्ठं रोपणमिष्यते सप्तमं वैकृतापहम् चिकित्सा

80. Perichondritis E tiology infection secondary to lacerations, haematoma or surgical incisions. diffuse otitis externa furuncle Pseudomonas and mixed flora are the common pathogens. Inf lamation of peri chondrium of pinna called perichondritis symptoms red, hot and painful pinna which feels stiff. Later abscess may form between the cartilage and perichondrium Treatment early stages - systemic antibiotics When abscess has formed – incision and drained

81. कर्ण अर्श निदान प्रकार – 4 लक्षण – -र्विरुद्धाध्यशनस्त्रीप्रसङ्गोत्कटुकासनपृष्ठयानवेगविधारणादिभिर्विशेषैः तत्र कर्णजेषु बाधिर्यं शूलं पुतिकर्णता च चिकित्सा - चतुर्विधोऽर्शसां साधनोपायः - भेषजं क्षारोऽग्निः शस्त्र भेषजसाध्य – अचिरकाल जात अन्यल्पदोष लिङ्गोपद्रवाणि क्षार – मृदु प्रसृत अवगाढ अन्य उच्छ्रितानि अग्नि – कर्कश स्थिर पृथु कठिन शस्त्रेण – तनुमूला अन्य उच्छ्रितानि क्लेदवन्ति च

82. A polyp is a smooth mass of oedematous and inflamed mucosa which has protruded through a perforation and presents in the external canal E ar Polyp It is usually pale in contrast to pink, fleshy polyp seen in atticoantral disease E tiology sequela of acute otitis media Cholesteatoma Foreign object Inflammation Tumor S ymptoms Patients usually present with  otorrhea , conductive  hearing loss , otalgia , bleeding and a sensation of a mass

83. Management T reat according to cause appropriate antibiotic therapy Surgery - polypectomy

84. कर्ण अर्बुद निदान प्रकार – 7 लक्षण – गात्रप्रदेशे क्वचिदेव दोषाः सम्मूर्च्छिता मांसमभिप्रदूष्य वृत्तं स्थिरं मन्दरुजं महान्तमनल्पमूलं चिरवृद्ध्यपाकम् कुर्वन्ति मांसोपचयं तु शोफं तमर्बुदं शास्त्रविदो वदन्ति

85. Tumours of External Ear Pinna Benign • Preauricular cyst or sinus • Sebaceous cyst • Dermoid cyst • Keloid • Haemangioma • Papilloma • Neurofibroma Malignant • Squamous cell carcinoma • Basal cell carcinoma • Melanoma Benign • Osteoma • Exostosis • Ceruminoma • Sebaceous adenoma • Papilloma • Malignant • Squamous cell carcinoma • Basal cell carcinoma • Malignant ceruminoma • Melanoma External ear canal

86. Tumours of Middle Ear Benign: Glomus tumour Malignant: Carcinoma, sarcoma