1. कर्णगत रोग

2. संख्या
• सुश्रुत/भा.व./यो.र. – 28
• चरक – 4
• वागभट – 25
 शांगणधर – 18
o कर्ण स्त्रोत – 15
o कर्ण शष्क
ु ली – 3
o कर्ण पाली – 7
o कर्ण पाली – 7
o कर्ण मूलगत - 5

3.  28
• कर्णशूलं (शु)
• कर्णप्रर्ाद / नाद (ना)
• कर्णपाकः(पा)
• कर्णस्राव (सा)
• बाधधयं (बा)
• कर्णक्ष्वेड(वे)
• कर्णकण्ड
ू (क)
• पूधतकर्ण (पूधत)
• कर्णप्रधतनाह (प्रधत)
• क
ृ धमकर्ण (क
ृ धम)
• कर्णवचण (गूथ)
• 2 - कर्णधवद्रधध
• 4 - कर्ण शोफ
• 4 – कर्ण अशण
7 - कर्ाणबुणदं

4. प्रधतश्याय जलक्रीडाकर्णकण्ड
ू यनैमणरुतत
धमथ्यायोगेन शब्दस्य क
ु धपतोऽन्यैश्च कोपनैः
प्राप्य श्रोत्रधसराः क
ु याणच्छ
ू लं स्रोतधस वेगवत (वा)
अवश्याय जलक्रीडा कर्णकण्ड
ू यनैमणरुतत
धमथ्यायोगेन शस्त्रस्य क
ु धपतोऽन्यैश्च कोपनैः
प्राप्य श्रोत्रधसराः क
ु याणच्छ
ू लं स्रोतधस वेगवत (सु)
सामान्य धनदान

5. समीरर्ः श्रोत्रगतोऽन्यथाचरः समन्ततः शूलमतीव कर्णयोः
करोधत दोषैश्च यथास्वमावृतः स कर्णशूलः कधथतो दुराचरः
कर्णशूल
 दोष - वात
 भेद – 5 वागभट – v ,p,k ,r,s
 लक्षर् – सामान्य
(सुश्रुत)
 वातज कर्णशूल
अधाणवभेदक
ं स्तम्भं धशधशरानधभनन्दनम
धचराच्च पाक
ं पक्व
ं तु लसीकामल्पशः स्रवेत
श्रोत्रं शून्यमकस्माच्च स्यात्सञ्चारधवचारवत

6.  धपतज कर्णशूल
शूलं धपत्तात सदाहोषाशीतेच्छा श्वयथुज्वरम
आशुपाक
ं प्रपक्व
ं च स पीतलधसकास्रुधत
सा लसीका स्पृशेद्यद यत्त त्तत्पाकमुपैधत च
 कफज कर्णशूल
कफाच्छच्छरो हनुग्रीवागौरवं मन्दता रुतजः
कण्ड
ू ः श्वयथु उष्णेच्छा पाकात श्वेतननस्रुधतः
 रक्तज कर्णशूल
करोधत श्रवर्े शूलमधभनाताधद दू धषतम
रक्तं धपत्तसमान अधतण धकधञ्चद्वाऽधधकलक्षर्म
 सधनपातज कर्णशूल
शूलं समुधदतैदोषैः सशोफज्वरतीव्ररुतक
पयाणयादुष्णशीतेच्छं जायते श्रुधतजाड्यववत
पक्व
ं धसताधसतारक्त ननपूय प्रवाधह च

7. कर्णशुल उपद्रव - 6
• मूच्छाण, दाह, ज्वर, कास, क्लम, वमथु
धचधकत्सा
 सामान्य धचधकत्सा – कर्ण रोग
सामान्यं कर्णरोधेषु नृतपानं रसायनम
अव्यायामोऽधशरःस्नानं ब्रह्मचयणम अकत्थनम
कर्णशूले प्रर्ादे च बाधधयण क्ष्वेड योरधप
चतुर्ाणमधप रोगार्ां सामान्यं भेषजं धवदुः
सामान्य धचधकत्सा – 4 रोग

8. • धस्नग्धं
• वातहरैः स्वेदन – नाडी / धपण्ड
• स्नेहधवरेधचतम
• भक्तोपरर धहतं सधपण बच्छस्त कमण च पूधजतम
• धनरन्नो धनधश तत्सधपणः पीत्वोपरर धपबेत पयः
• कर्ण पूरर्
 अश्वत्थपत्रखल्लं वा धवधाय बहुपत्रकम
तदङ्गारैः सुसम्पूर्ं धनदध्याच्छ
र वर्ोपरर
यत्तैलं च्यवते तस्मात खल्लादङ्गारताधपतात
तत प्राप्तं श्रवर्स्रोतः सद्यो गृह्णाधत वेदनाम
 सषणप तेल
 अकांक
ु र स्वरस
 समुद्रफ
े न चुर्ण
 क
ु क
ु टवसा पूरर्
 दीधपका तेल महतः पञ्चमूलस्य काण्ड अष्टादशाङगुलम |
क्षौमेर्ावेष्ट्य संधसच्य तैलेनादीपयेत्ततः ||२०||
यत्तैलं च्यवते तेभ्यो धृतेभ्यो भाजनोपरर |
ज्ञेयं तद्दीधपकातैलं सद्यो गृह्णाधत वेदनाम
• कर्ण धूपन – क्षौम गुग्गुलू अगुरुत सनृतैधूणपयेच्च
• वातज कर्णशूल - वातव्याधध प्रधतश्यायधवधहतं धहतमत्र

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 धवमागणमागतः स एव शब्दाधभवहासु धतष्ठधत
शृर्ोधत शब्दान धवधवधांस्तदा नरः प्रर्ादमेनं कथयच्छन्त चामयम
 धनदान
 दोष - वात
 लक्षर् –
कर्णनाद
शब्दवाधहधसरासंस्थे शृर्ोधत पवने मुहुः|
नादानकस्माधद्वधवधान कर्णनादं वदच्छन्त तम
भेरी मृदहग शंखनां कर्णनाद सः उच्यते (मा,धन )

13. श्रमात क्षयाद रुतक्षकषायभोजनात समीरर्ः शब्दपथे प्रधतधष्ठतः
धवररक्तशीषणस्य च शीतसेधवनः करोधत धह क्ष्वेडमतीव कर्णयोः
कर्णक्ष्वेड
 धनदान
 दोष - वात
 - सधनपत (मा.धन.)
 लक्षर् –
वायुः धपतादीधभ युक्तों वेर्ु नोषोंपमं स्वनम
करोधत कर्णयोः क्ष्वेड कर्णक्ष्वेड स उच्यते (मा.धन.)
क्ष्वेड का वर्णन वागभट ने नहीं धकया
धचधकत्सा – कर्णनाद समान

14. धचधकत्सा
 सामान्य धचधकत्सा – कर्ण रोग
सामान्य धचधकत्सा – 4 रोग
कर्ण पूरर् – कर्ण शूल समान
अरंड धशग्रू वरुतर् मूल स्वरस
योग रत्नाकर – अपामागण 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 – क
े वल वात
• लक्षर् – भेरी मृदहंग शंखान
• धचधकत्सा – वात शामक
कर्णक्ष्वेड
• वात क
े साथ दोष संसगण
• वात क
े साथ धपतादी संसगण
• वेर्ु नोषोपम

21. कर्ण बाधधयण
 धनदान
 दोष - वात- कफ
 लक्षर् –
स एव शब्दानुवहा यदा धसराः कफानुयतों व्यनुसृत्य धतष्टधत
तदा नरस्य अप्रधतकार सेधवनो भवेतू बाधधयण असंशयं खलु
श्लेष्मर्ा अनुगतों वायुर नादों वा समुपेधक्षतः
उच्चेः क
ृ च्छाद क
ु याणद बधधरत्वं क्रमेर् च (वा.)
कर्णनाद ऊच्चे श्रुधत कर्णबाधधयण

22.  वागभट ने कर्णनाद की उपेक्षा से कर्णबाधधयण की उत्पाती मानी है
 बालक वृद्ध तथा एक वषण पुराना बाधधयण - असाध्य
धचधकत्सा
 सामान्य धचधकत्सा – कर्ण रोग
 कर्णशूले प्रर्ादे च बाधधयण क्ष्वेड योरधप । चतुर्ाणमधप रोगार्ां सामान्यं भेषजं धवदुः
 वातज शूल समान धचधकत्सा – कफ का अनुबंध होने पर वमन कर क
े धूमपान
 प्रधतस्याय की समस्त धचधकत्सा
 वागभट अनुसार धचधकत्सा क्रम
स्नेहन – स्वेदन – नस्य – धसरोबस्ती – बस्ती कमण
 कर्ण पूरर्
 धबल्वादी तेल
 धहंगवादी तेल
 धनगुणण्डी 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
acquired
• 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.
acquired
 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 1k 2k 4k 8k
Hearing
loss
in
dB
0
10
20
30
40
50
60
70
80
90
 Most cases of conductive hearing loss can be managed by medical or
surgically

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,

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
 Rehabilitation 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:
(i) Total hearing loss in both ears
(ii) total loss in only one ear
(iii)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

37. कर्णस्राव
 धनदान
 दोष -
 लक्षर् –
धशरो अधभनातद अथवा धनमज्जतों जले प्रपाकाद अथवा अधप धवदधेः
स्त्रवेतू पूयं श्रवर्ो अधनलवृतः स कर्ण सस्त्राव इधत प्रकीतततेः
 वागभट ने वर्णन नहीं धकया है

38. धचधकत्सा
 धशरोधवरेचन
 धूपन
 पूरर्
 प्रमाजणन
 धावन
प्रमाजणन
 राजवृक्षादी गर्
 सुरसादी गर्
 पंचक्षीरीगर्
 पूरर्
 शेवालादी तेल
 धप्रयन्गवादी तेल
 स्त्री दू ध + रसंजन + मधु
 समुद्रफ
े न चूर्ण
 शंबूक तेल – कर्णनाड़ी नाशक
 गंध तेल
नाड़ीव्रर्वत / दुष्ट व्रर्वत
धूपन – गुगगलू अगरू
कर्णस्त्राव,पूधतकर्ण,क
ृ धमकर्ण – समान धचधकत्सा

39. 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

40. PREDISPOSING FACTORS
• Recurrent attacks of common cold, upper respiratory tract infections and
exanthematus 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

41. 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

42.  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.

43. 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

44.  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.

45.  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

46. 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.

47.  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

48. 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

49. पूधतकर्ण
 धनदान
 दोष - कफ धपत
 लक्षर् –
च्छस्थतेः कफ
े स्रोतधस धपत तेजसां धवलायमाने भ्रंश सम्प्रतापवान
अवेदनों वाअप्य अथवा सवेदनों ननं स्त्रवेत पूधत च पूधत कर्णकः
कर्ण धवद्रधध पाक
े न कर्े वा वाररपूरर्ात
पूयं स्त्रवधत यः पूधत स पूधतकर्णक ःः (भा. प्र )
 धचधकत्सा
 सामान्य
 कर्णस्त्राव समान
 कर्ण पूरर् – स्त्री दुग्ध + रसंजान

50. 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

51. 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,

52. 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

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

54. 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
- Avoid Hard nose blowing
- Surgical treatment.

55. 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

56. SIGNS
 Perforatio
n - 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

57. 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

58. 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

59. कर्णधवद्रधध
 धनदान
 प्रकार - 2 – आगंतुज+ दोषज
 लक्षर् –
क्षत अधभनात प्रभवस्तु धवद्रधध भवेत तथा दोष क
ृ तों अपरः पुनः
स रक्त धपत अरुतर्ं अस्त्रं स्त्रवेत प्रतोद धूमयान दाहचोषवान
 धचधकत्सा
 सामान्य धवद्रधधवत
 आम धवद्रधध धचधकत्सा – व्रर्शोथ उपक्रम – धवरेचन से अपतपणर् तक
 पक्व धवद्रधध धचधकत्सा – भेदन पीड़न – व्रर्वत
 सधन्नपात धवद्रधध – असाध्य
 क्षतज धवद्रधध – धपतज कर्णशूलवत

60. 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.
Symptoms
• Severe ear pain and tenderness
• Movements of the pinna are painful. Jaw
movements, as in chewing, also cause pain in the
ear.
Sign
• posterior meatal wall causes oedema over the
mastoid with obliteration of the retroauricular
groove.
• Periauricular lymph node enlarged

61. 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,

62. कर्णपाक
 धनदान
 दोष - धपत
 लक्षर् – भवेत प्रपाकः खलु धपत कोपतो धवकोथ क्लेदकरश्च कर्णयो
कर्ण पाकस्तू धपतेन कोथ धवक्लेदक
ृ त भवेत
कर्ण धवद्रधध पाकाद वा जायते च अंबु पुरर्ात (मा.धन.)
- वागभट ने वर्णन नहीं धकया है
 धचधकत्सा
 धपतज धवसपण समान
 गोयाणधद नृत
 शीतल लेप
 उत्पल चंदन मंधजष्टा लेप

63. 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
Aetiolog
y • 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.

64. 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.

65.  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
 Antibiotics.
• Broad-spectrum systemic antibiotics.
 Analgesics- For relief of pain.
Treatment

66. कर्णगूथ
 धनदान
 दोष - k p
 लक्षर् –
धवशोधषत श्लेष्मर्ी धपततेजसां नृर्ा भवेत स्त्रोतधस कर्णगुथकः
 धचधकत्सा
• प्रक्लेधन – तेल – अपामागण क्षार तेल
• धवलायन - स्वेदन से
• शोधन – शलाका से – आहरर् कमण

67. 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.

68. Etiology
• people sweat more
• narrow and tortuous ear canal
• stiff hair
• Obstructive lesion of the canal
Symotoms
 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

69. 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

70. कर्णक
ं डु
 धनदान
 दोष - k
 लक्षर् –
कफ
े न क
ं डु प्रधचतेन कर्णयो भ्रशं भवेत स्त्रोतधस कर्ण संधनत
 धचधकत्सा
 ना – नाड़ी स्वेद
 व – वमन
 न – नस्य
 धु – धूमपान
 मु – मूधण धवरेचन

71. Otomycosis
 Otomycosis is a fungal infection of the ear canal
Common organism
 Aspergillus niger,
 A. Fumigatus
 Candida albicans.
Mostly 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

72. Clinical features
 itching,
 discomfort or pain in the ear,
 watery discharge with a musty odour
 ear blockage.
Sign
• fungal mass may appear white, brown or black
o A niger - black headed
o A fumigatus - pale blue or green
o Candida - white or creamy
Treatment
 ear toilet - By syringing, suction or mopping
antifungal agents  Nystatin - Candida.
 broad-spectrum antifungal - clotrimazole

73. क
ृ धम कर्ण
 धनदान
 दोष - s
 लक्षर् –
यदा तु मूच्छण न्त्यथवाऽधप जन्तवः सृजन्त्यपत्यान्यथवाऽधप मधक्षकाः |
तदञ्जनत्वाच्छ
र वर्ो धनरुतच्यते धभषच्छिराद्यैः क
ृ धमकर्णको गदः
तदञ्जनत्वात् क
ृ मिलक्षणत्वात्| आद्यैमभिषग्भिः मिदेहामदमभिः| अयं रोगिः सामिपामतकिः
वाताधद दू धषतं श्रोत्र मांस असृक क्लेदजा रुतजम
खादन्तों जन्तवः क
ू युणस्तीव्रां स क
ृ धम कर्णकः (वा)

74.  शागणधर ने क
ृ धम कर्ण को कर्ण हच्छल्लका नाम से धलखा है
पतंगः शतपदश्च कर्णश्रोत प्रधवश्य धह
अररत व्याक
ु लत्वं च भ्रशं क
ु वणच्छन्त वेदनां
कर्ो धनस्तूधते तस्य तथा फरफरायते
कीटचरधतरुतक तीव्रा धनष्पन्दे मंद वेदना
धचधकत्सा
क
ृ धमनाशक धचधकत्सा
• अपकषणर्
• प्रक
ृ धत धवधात
• धनदान पररवजणन
• कर्णपूरर् – सषणप तेल , गोमूत्र+हरताल, सुयणमुखीस्वरस, धनगुंडी स्वरस

75. Foreign bodies of ear
(a)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

76. 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
Living 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 dsescribed

77. कर्णप्रधतनाह
 धनदान
 दोष - kv /s
 लक्षर् –
स कर्णधवटको द्रवतां यदा गतो धवलाधयतो घ्रार्मुखं प्रपद्यते
तदा स कर्णप्रधतनाहसच्छञज्ञतो भवेधद्वकारः धशरसोऽधभतापनः
स कर्णगुथो द्रवतां गतो यदा धवलाधयतो घ्रार्मुखं प्रपद्यते
तदा स कर्णप्रधतनाहसच्छञज्ञतो भवेधद्वकारः धशरसोऽर्ध्भेदक
ृ त (मा.धन.)
अथ कर्णप्रतीनाहे स्नेहस्वेदौ प्रयोजयेत |
ततो धवररक्तधशरसः धक्रयां प्राप्तां समाचरेत
 स्नेह
 स्वेदौ
 धशरो धवरेचन

78.  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.
 Symptoms
• Rhinitis – nasal discharge
• Ear ache
• feeling of the blocking of the ear
• Hearing loss
• Tinnitus
 Sign
• Tympanic membrane – retracted
• Conductive deafness sign
 Treatment
• According to cause
• Antibiotics
• Analgesic
• Chewing

79. कर्णशोफ /कर्ण अबुणद/ कर्ण अशण
 सामान्य शोफ,अशण तथा अबुणद समान धनदान ,लक्षर् , धचधकत्सा
• कर्ण शोफ – 4
• अशण – 4
• अबुणद – 7
शोफसमुत्थाना ग्रच्छिधवद्रध्यलजीप्रभृतयः प्रायेर् व्याधयोऽधभधहता अनेकाक
ृ तयः,
तैधवणलक्षर्ः पृथुग्रणधथतः समो धवषमो वा त्वङ्ांसस्थायी दोषसङ्घातः शरीरैकदेशोच्छत्थतः शोफ
इत्युच्यते
कर्णशोफ

80.  वातशोफः - क
ृ ष्णोऽरुतर्ो वा परुतषो मृदुरनवच्छस्थतास्तोदादयश्चात्र वेदनाधवशेषा भवच्छन्त;
 धपत्तशोफः - पीतो मृदुः सरक्तो वा शीघ्रानुसायोषादयश्चात्र वेदनाधवशेषा भवच्छन्त;
 श्लेष्मशोफ - श्लेष्मश्वयथुः पाण्डुः कधिनः धस्नग्धः शीतो धस्नग्धो मन्दानुसारी कण्डवादयश्चात्र
वेदनाधवशेषा;
 सधन्नपात शोफ - सवणवर्णवेदनः सधन्नपातश्वयथुः
• आदौ धवम्लापनं क
ु याणद
• द्दधवतीयमवसेचनम
• तृतीयमुपनाहं तु
• चतुथीं पाटनधक्रयाम
• पञ्चमं शोधनं क
ु याणत
• षष्ठं रोपर्धमष्यते
• सप्तमं वैक
ृ तापहम
धचधकत्सा

81. Perichondritis
 Etiology
• infection secondary to lacerations, haematoma or surgical incisions.
• diffuse otitis externa
• furuncle
• Pseudomonas and mixed flora are the common pathogens.
Inflamation 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

82. कर्ण अशण
 धनदान
 प्रकार – 4
 लक्षर् –
-धवणरुतद्धाध्यशनस्त्रीप्रसङ्गोत्कटुकासनपृष्ठयानवेगधवधारर्ाधदधभधवणशेषैः
तत्र कर्णजेषु बाधधयं शूलं पुधतकर्णता च
धचधकत्सा
- चतुधवणधोऽशणसां साधनोपायः
- भेषजं क्षारोऽधनः शस्त्र
 भेषजसाध्य – अधचरकाल जात अन्यल्पदोष धलङ्गोपद्रवाधर्
 क्षार – मृदु प्रसृत अवगाढ अन्य उच्छच्छ
र ताधन
 अधन – कक
ण श च्छस्थर पृथु कधिन
 शस्त्रेर् – तनुमूला अन्य उच्छच्छ
र ताधन क्लेदवच्छन्त च

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

84. Management
• Treat according to cause
• appropriate antibiotic therapy
• Surgery- polypectomy

85. कर्ण अबुणद
 धनदान
 प्रकार – 7
 लक्षर् – गात्रप्रदेशे क्वधचदेव दोषाः सम्मूच्छच्छण ता मांसमधभप्रदू ष्य
वृत्तं च्छस्थरं मन्दरुतजं महान्तमनल्पमूलं धचरवृद्ध्यपाकम
क
ु वणच्छन्त मांसोपचयं तु शोफ
ं तमबुणदं शास्त्रधवदो वदच्छन्त

86. 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

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