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Introduction

Chronic Suppurative Otitis Media (CSOM) is a persistent infection of the middle ear cleft characterized by recurrent or continuous ear discharge (otorrhea) through a perforated tympanic membrane, often associated with conductive hearing loss1. According to the World Health Organization (2025), CSOM affects nearly 297 million individuals globally, with a substantial number experiencing clinically significant hearing impairment.2 Chronic inflammation may result in destruction of the middle ear mucosa, erosion of the ossicles, and tympanic membrane perforation, ultimately impairing auditory function.3

In Ayurveda, CSOM is closely related to Putikar?a, a type of Karna Roga described by Acharyas in classical texts like the Sushruta Samhita and Ashtanga Hridaya.4The defining feature of Putikar?a is Puyasrava (purulent ear discharge). The term is derived from “Puti” (foul-smelling or putrid) and “Kar?a” (ear), collectively denoting a condition characterized by offensive purulent discharge. Sushruta describes it as a Kapha–Pitta predominant disorder presenting with thick, foul-smelling discharge that may be accompanied by pain or may remain painless—features that closely resemble the clinical manifestations of CSOM.5 According to the treatment protocols described by Sushruta and Vagbhata, the management includes Sirovirechana (therapeutic head purgation), Dhumapana (inhalation therapy), Svedana (sudation), Gandu?a (retaining medicated liquid in mouth), Du??a Vra?a Chikitsa, Pramarjana (cleansing), Kar?a Dhupana(ear fumigation therapy), Kar?a Pura?a (ear instillation), and Kar?a Avachur?a(insufflation of medicated powder into the ear).6,7 These procedures help to eliminate vitiated Do?as, cleanse the ear, promote healing, and prevent recurrence through both systemic and local therapeutic approaches.

Case Study

A 65-year-old female with a known history of hypertension, CAD, and hypothyroidism presented to the OPD of Government Ayurveda Medical College, Tripunithura, in December 2024 with complaints of occasional foul-smelling pus discharge from the left ear for the past four years. The symptoms began in 2021 following intense itching in the left ear, after which she inserted an earbud and subsequently developed aural fullness and bleeding. On further medical consultation, tympanic membrane perforation was reported. The patient was under allopathic treatment but had no significant improvement. As an alternative management, she approached our OPD and was admitted to our IP on 1st January 2025.

Table 1: Clinical Findings: OTOSCOPY

General Examination 1/1/2025

• Vital Signs: BP – 138/90 mmHg; Pulse Rate – 75/min
• Romberg’s Sign: Negative
• Tragus Sign: Negative (Bilateral)
• Mastoid Examination: No tenderness on either side.

OTOENDOSCOPY (LEFT EAR) 1/1/25

• Left ear shows granulation tissue and purulent discharge through tympanic perforation.
• Right ear canal and tympanic membrane are normal.

• LABORATORY INVESTIGATIONS 1/1/25

• Routine hematological and biochemical parameters: Within normal limits.

•  

  DRUG HISTORY

  Ecosprin – 0-0-1

  Repace 50 mg – 1-0-0

  Thyronorm 50 µg – 1-0-0

   

AYURVEDIC EXAMINATION

According to Ayurvedic assessment, the condition was identified as Kapha-predominant Sannipataja, indicating a vitiation of all three Do?as with a dominance of Kapha. The primary Du?yas involved were Rasa, Rakta, and Ma?sa Dhatus, and the Srotas affected included Rasavaha, Raktavaha, and Ma?savaha, reflecting both systemic and local channel derangements contributing to persistent discharge and granulation. Based on the chronicity and classical features such as Puyasrava (purulent discharge), Putigandha (offensive smell), and Kleda (moistness), the diagnosis was established as Putikarna.

Table 3 : PROCEDURES DONE

Table 4: INTERNAL MEDICATION

Pathya-Apathya (Dietary and Lifestyle Recommendations)

The patient was advised pathya (wholesome and beneficial dietary measures) to support systemic and local healing. Easily digestible, protein-rich, and light foods such as Mu?ga (green gram) were prescribed to strengthen the Rasa and Ma?sa Dhatus, promoting local tissue repair while avoiding excessive Kapha aggravation. Heavy (guru), Kapha-increasing like abhishyandi ahara(channel blocking food items), and incompatible (viruddha) foods were strictly avoided8, as well as headbaths during the treatment period, to prevent further aggravation of the vitiated Do?as. These dietary modifications complemented pharmacological and procedural interventions, creating a conducive internal environment for wound healing and discharge reduction. Abhishyandi is a core concept in Ayurveda referring to specific dravyas endowed with Abhishyandi guna, which leads to enhanced secretion and obstruction within the body. 9Such properties are believed to play a role in the development of Eye and ENT disorders marked by discharge and oozing. Studies carried out at Government Ayurveda College, Tripunithura, have further substantiated the significance of this concept.10,11

RESULT

Following the Ayurvedic intervention, the patient showed marked clinical improvement. There was a significant reduction in the frequency and quantity of ear discharge, along with noticeable regression of granulation tissue. However, the tympanic membrane perforation did not resolve during the course of treatment. On subsequent follow-up, no recurrence of discharge or associated symptoms was observed, indicating sustained therapeutic benefit despite the persistence of perforation. The outcome underscores the synergistic role of Sodhana (purificatory therapies), appropriate local therapeutic measures, and pathya–apathya (dietary and lifestyle modifications) in promoting Balance of doshas and local tissue healing in chronic suppurative conditions.

Discussion

This case illustrates the chronicity and treatment-resistant nature of Chronic Suppurative Otitis Media (CSOM). The Ayurvedic diagnosis of Putikarna correlated well with clinical features, including persistent purulent discharge (Puyasrava), offensive odour (Putigandha), and chronic tissue involvement. Dosha assessment revealed Kapha-predominant Sannipata, and the primary Du?hyas were Rasa, Rakta, and Ma?sa, with involvement of Rasavaha, Raktavaha, and Ma?savaha Srotas, guiding the treatment plan.

Classical interventions referenced from Susruta Sa?hita and A??a?ga H?daya were employed, including Saptavidha Vra?a Chikitsa and Karna Roga Chikitsa (local ear therapies). Procedures, such as Achha Snehapana(internal oelation), Virechana(purgation), and Nasya(errhines), facilitated dosha shodhana(elimation of doshas), while local therapies, including Kar?apramarjana(ear cleansing), karnavarti(medicated wick), and karnadhoopana(ear fumigation), enhanced tissue healing and reduced discharge. This integrative approach demonstrates the importance of tailoring interventions based on both classical principles and modern clinical assessment for effective management of chronic otological conditions.

Conclusion

The present case demonstrates that a comprehensive Ayurvedic management approach integrating Shodhana (purificatory) and Shamana (palliative) therapies can effectively address chronic suppurative ear conditions. The combined use of internal medications and local therapies facilitated Dosha-Samana, promoted wound healing, and restored normal ear function. The sustained relief during follow-up further validates the efficacy of classical interventions, such as Saptavidha Vra?a Chikitsa and Karna Roga Chikitsa, as described in Ayurvedic texts. This case underscores the clinical relevance of individualized Ayurvedic treatment protocols in managing chronic otological disorders and highlights their potential as holistic, safe, and sustainable therapeutic options.