Clinical observation of Xuanfei Conger Decoction combined with auricular point sticking pressure on secretory otitis media and its effect on auricular effusion

Ming Gao, Xiong Zhang

1 Shaanxi University of Chinese Medicine, Xianyang, Shaanxi Province, China

2 First Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi Province,China

Abstract

Key words: Xuanfei Conger Decoction; auricular point sticking pressure; secretory otitis media; auricular effusion; impact

Introduction

Secretory otitis media, also called non-suppurative otitis media, is characterized by severe hearing loss, tinnitus,otalgia, ear distension, tympanic cavity effusion.Its triggers include immune response, infection and eustachian tube dysfunction, ultimately leading to the dilation of blood vessels in middle ear mucosa, increasing vascular permeability, and inducing plasma proteins exudate[1].Secretory otitis media belongs to the aspect of “ear distension”, “deafness” and “wind deafness” in the theory of traditional Chinese medicine (TCM).It is mainly caused by invasion of wind evil, stagnated fire in the liver, decreased lung function, deficiency of qi and blood, deficiency of spleen, yang and qi, and obstruction of collaterals.The main clinical symptoms are severe hearing loss and non-suppurative exudate accumulated in the middle ear.The disease is prevalent in spring and autumn, and children are more prone to develop the disease than adults[2].Secretory otitis media is a relatively common disease in clinical otolaryngology, and severely affects the physical and mental health of patients.Western medicine treatment is predominant in clinical practice,showing good short-term effect, but long-term treatment may induce various adverse reactions.The application of TCM treatment can effectively reduce the incidence of adverse reactions, and achieve good outcome after long-term treatment[3].In the treatment of patients with secretory otitis media, the curative effect of Xuanfei Conger Decoction and auricular point sticking pressure is satisfactory, as reported below.

Materials and Methods

General information

Sixty patients with secretory otitis media treated in our hospital from February 2016 to August 2017 were randomly divided into two groups and the inclusion criteria were as follows: (1) the onset of the patients in two groups was within recent 1-2 weeks; (2) all patients in two groups had symptoms such as hearing loss,otalgia, and tinnitus; (3) all patients in two groups were informed of the study proposal and consented to the study.Exclusion criteria were as follows: (1) patients allergic to the therapeutic drug; (2) patients with eustachian tube dysfunction due to other reasons; (3) patients with poor cooperation; (4) patients with systemic diseases;(5) pregnant patients.There were 30 cases in the control group, including 21 male and 9 female, they aged 10-60 years, with an average age of (40.1±4.2) years; and 30 cases in the study group, including 24 male and 6 female,they aged 13-66 years, with an average age (40.3±3.8)years.The general information of patients in the two groups was comparable (P＞0.05).

Methods

Control group

The patients in control group were treated with conventional western medicine to ensure smooth nasal cavity and eustachian tube.The patient was orally given 300 mg eucalyptus enteric capsule and 150 mg roxithromycin,twice per day.Tympanic cavity effusion was extracted through the puncture in middle ear; and chymotrypsin solution was injected prior to the extraction when the effusion is relatively viscous.The treatment course was two weeks[4].

Study group

The patients in study group were treated with Xuanfei Conger Decoction combined with auricular point sticking pressure.(1) Xuanfei Conger Decoction was orally given, including licorice 6 g, white mulberry root bark 6 g, sweetgum fruit 10 g, poria 10 g, plantain seed 10 g,bupleurum 12 g, stiff silkworm 6 g, radix pueraria 10 g,magnolia flower 12 g, radix angelicae 10 g, platycodon grandiflorum 10 g.1 dose/d, decoction, twice per dose[5].(2) Auricular point sticking pressure: the patient’s auricle,subcortex, Shenmen, inner ear, kidney, liver and other acupoints were massaged, and the patient’s lateral auricle was fixed, then a probe was inserted to find the tender point from top to bottom, the point where obvious pain is observed was the optimal treatment point.The sterilized magnetic beads were sticked to the patient’s auricular acupoints, and then compressed at an interval of 0.5 s,once per day, 20-30 compressions per point.The treatment could be terminated when the patient feel obvious pain at the sticking point.The treatment course was two weeks[6].

Outcome measures

(1) The curative effect of patients in two groups was compared: markedly effective, clinical symptoms completely disappear and the function of tympanic membrane recovers to normal after inspection; effective,clinical symptoms are significantly improved and the function of tympanic membrane is significantly improved after inspection; ineffective, clinical symptoms are not significantly improved and the function of tympanic membrane is not significantly improved.(2) The incidence of adverse reactions such as tympanic membrane perforation, middle ear bleeding, middle ear infection,and persistent vertigo were compared between the two groups.(3) The symptoms improvement of patients in two groups was compared, including clinical symptom score, average air conduction threshold, and hearing improvement.(4) Serum levels of inflammatory factors in the two groups were compared, including interleukin-6(IL-6), interleukin-10 (IL-10) and tumor necrosis factor-α(TNF-α).(5) Secretion levels of inflammatory factors in the two groups were compared, including IL-6, IL-10 and TNF-α.

Statistical analysis

Data were analyzed using SPSS 19.0 software, in which the count data were tested byx2(%) test and the measurement data were tested by t test (±s).AP＜0.05 level indicated a significant difference.

Results

Comparison of curative effects between two groups

The curative effect of the study group was better than that of the control group (P＜0.05), as shown in Table 1.

Table 1 Comparison of curative effect between two groups (n, %)

Comparison of the incidence of adverse reactions between two groups

The incidence of adverse reactions in the study group was lower than that in the control group (P＜0.05), as shown in Table 2.

Table 2 Comparison of the incidence of adverse reactions between two groups (n)

Comparison of symptoms improvement between two groups

The symptom improvement in the study group was better than that in the control group (P＜0.05), as shown in Table 3.

Table 3 Comparison of symptoms improvement time between two groups ( ±s)

Table 3 Comparison of symptoms improvement time between two groups ( ±s)

Group n Clinical symptom score (points) Mean air conduction threshold (db) Hearing improvement (db)Control 30 13.5±5.5 26.2±7.2 14.2±7.1 Study 30 6.8±4.1 17.1±6.9 23.2±8.1 t/13.321 20.452 19.332 P/＜0.05 ＜0.05 ＜0.05

Comparison of serum levels of inflammatory factors between two groups

The serum levels of inflammatory factors in the study group were lower than those in the control group (P＜0.05),as shown in Table 4.

Table 4 Comparison of serum levels of inflammatory factors( ±s)

Table 4 Comparison of serum levels of inflammatory factors( ±s)

Group n IL-6 (ng/L) IL-10 (ng/L) TNF-α (ng/L)Control 30 4.5±1.8 8.8±2.8 2.9±1.2 Study 30 4.4±1.7 8.1±2.6 2.4±1.3 t / 11.329 11.426 14.432 P / ＜0.05 ＜0.05 ＜0.05

Comparison of secretion levels of inflammatory factors between two groups

The secretion levels of inflammatory factors in the study group were lower than those in the control group (P＜0.05),as shown in Table 5.

Table 5 Comparison of secretion levels of inflammatory factors ( ±s)

Table 5 Comparison of secretion levels of inflammatory factors ( ±s)

Group n IL-6 (ng/L) IL-10 (ng/L) TNF-α (ng/L)Control 30 22.4±4.3 12.5±6.2 3.3±0.8 Study 30 6.5±1.9 5.2±2.1 2.1±0.7 t / 11.329 11.426 14.432 P / ＜0.05 ＜0.05 ＜0.05

Discussion

Secretory otitis media is a common disease in clinical practice.In the TCM theory, this disease is caused by the infections of wind evil in ears.It is characterized by long course and damage on the hearing[7].The principle of treatment is to support healthy energy and eliminate evil.For excess of pathogenic qi, the treatment should focus on the elimination of pathogenic qi; for cold air or pathogenic heat in the patient’s body, the treatment should disperse the cold or clear heat; for the deficiency of spleen and stomach, the treatment should emphasize on the support of healthy energy and resistance; for both excess of pathogenic qi and deficiency of energy, the symptomatic treatment should be given to support the energy and eliminate pathogenic qi[8].

The conventional treatment method used in clinic is western medicine and achieves good short-term effect,however, the long-term effect is not satisfactory[9].According to the TCM theory, the root cause of secretory otitis media is associated with the lungs, although the symptoms are reflected in the ears.Once pathogenic qi invades, the lung qi is insufficient to effectively resist the invasion of pathogenic qi, which accordingly enters the meridians and gradually affects the ears, resulting in poor blood circulation and congestion in the meridians,so the basic treatment is to supplement the lung qi[10].There are many active ingredients in Xuanfei Conger Decoction.Bupleurum can effectively replenish lung qi and eliminate blood stasis.Platycodon grandiflorus can relieve cough, reduce phlegm, and smooth the lung qi.Stiff silkworm can clear heat, relieve cough and alleviate swelling.Radix angeliae can dispel wind, clear heat, and eliminate dampness.Magnolia flower exerts analgesic effect.White mulberry root bark functions to relieve cough, relieve asthma, reduce swelling and ventilate lungs.These ingredients effectively exert their effects to improve clinical symptoms of patients and accelerate the expelling of effusions[11].The function of auricular point sticking pressure therapy is to activate blood circulation, clear blood stasis, and dredge the collaterals.The ears are closely related with internal organs and meridians of the human body.Any lesion in the human body will be reflected on the ears, and could be treated or alleviated through effective massage on ears[12].Stimulation on the related acupoints may promote blood circulation, eliminate stasis,dredge meridians and collaterals.The combination of Xuanfei Conger Decoction and auricular sticking pressure therapy can effectively achieve therapeutic effects against for secretory otitis media.In this study, the curative effect of the study group is better than that of the control group(P＜0.05).Therefore, this method is effective for patients with secretory otitis media, it obviously improves the patients’ symptoms and enhances the curative effect.

Secretory otitis media is prone to develop deafness,and it becomes a hot spot in clinical treatment due to complex causes and rapid progression.Conventionally used western medicine treatment mainly involves the exudation of auricle effusion through puncturing the middle ear, thereby effectively restoring the function of eustachian tube and improving the nasal ventilation of the patients.Although western medicine treatment exerts certain effects, this approach has a higher probability of adverse reactions and the curative effect is not satisfactory,as shown in previous studies.Therefore, an ideal treatment that both effectively improves the curative effect and reduces the incidence of adverse reactions is urgently required in the treatment of secretory otitis media.In this study, the incidence of adverse reactions in the study group is lower than that in the control group (P＜0.05), which sufficiently demonstrate that Xuanfei Conger Decoction combined with auricular sticking pressure plays a critical role in lowering the incidence of adverse reactions, for treating secretory otitis media.With the continuous advancement of medical technology in recent years, TCM treatment of secretory otitis media is proved to an effective approach.

The existing treatments of western medicine commonly used in clinical practice are not ideal, and the recurrence rate of patients after treatment is relatively high.Meanwhile, some patients have poor compliance with tympanic puncture, which greatly affects curative effect and reduces the safety of treatment[13].In recent years, the therapeutic effect of TCM treatment has been gradually approved.In this study, the included patients of secretory otitis media were treated with Xuanfei Conger Decoction and auricular sticking pressure, and results showed that clinical symptoms of patients were much improved.TCM treatment effectively promoted the blood circulation in the ears and reduced effusion.Moreover, clinical symptom score, average air conduction threshold, and hearing improvement levels of the study group were better than those of the control group (P＜0.05).This evidence suggested that the treatment of secretory otitis media with Xuanfei Conger Decoction and auricular sticking pressure can significantly enhance the curative effect, improve the symptoms of patients, and promote the recovery of patients’ hearing.Compared with western medicine, TCM treatment has more superiority.

There are many causes of secretory otitis media, which is closely related to the patient’s immune response, infection,and abnormal eustachian tube function.The immune response plays a very important role in the development of secretory otitis media[14].In the process of disease development and occurrence, a variety of inflammatory factors will be involved.Related studies show that the levels of IL-6, IL-10 and TNF-α in the serum and secretions of patients with secretory otitis media are significantly increased as compared with healthy people, which indicates that inflammatory factors can lead to damage on immune response.TNF-α participates in the immune response process, which will effectively inhibit the activity of T lymphocytes, and elevated levels of TNF-α will cause autoimmune diseases and inflammatory reactions; IL-10 may regulate the activity of effector T lymphocytes and regulatory T lymphocytes, and inhibit angiogenesis.IL-6 also has an anti-infective effect.In this study, serum levels of inflammatory factors in the study group were lower than those in the control group (P＜0.05), and the levels of inflammatory factors in the secretions were also lower than those in the control group (P＜0.05).This difference may attribute to the ingredients contained in Xuanfei Conger Decoction.Poria can effectively improve the patient’s physical immunity, suppress the inflammatory response, and accelerate the hearing recovery; meanwhile,acupoint massage can effectively promote the outflow of effusion in the ears, decrease the levels of inflammatory factors in serum and secretion.Therefore, Xuanfei Conger Decoction combined with auricular sticking pressure is effective in treating secretory otitis media, which not only effectively relieves the patient’s symptoms, but also effectively reduces the inflammatory response, promotes healthy recovery and improves the patient’s life quality.

Many causes contribute to trigger secretory otitis media.Clinically, the main causes are as follows: (1) The eustachian tube abnormality or blockage.The function of eustachian tube is to connect the middle ear cavity with the nasopharynx, ensure the drainage of secretions in middle ear, maintain the balance between the middle ear and the external atmospheric pressure.If the eustachian tube is abnormal or blocked, the middle ear cavity will be closed and the middle ear will be under negative pressure state.The middle ear mucosal blood vessels dilate and cause a series of ear lesions[15].Some scholars have found that obstruction of the eustachian tube leads to poor ventilation, which leads to hypoxia in the ear cavity.Subsequently the hypoxia induces inflammatory reactions and significantly increases the levels of inflammatory factors,which in turn causes the water imbalance in the ears, and promotes the formation of effusion.Therefore, it is clinically considered that the cause of secretory otitis media is mainly related to the hypoxia of eustachian tube.(2) Abnormal immune function is also one of the key causes of secretory otitis media.Some studies have shown that imbalance of T lymphocyte subsets and abnormalities of immunoglobulins can indirectly promote the development of secretory otitis media, and abnormal immune function is closely related to the pathogenesis of secretory otitis media.In children,various physical functions are not fully developed, and the body’s immunity is relatively low, so that children is more prone to secretory otitis media than adults.Even in adults under low immunity, secretory otitis media is also prevalent[16].Scholars have found that the cellular immune function of patients with secretory otitis media is very low,and the levels of interferon, nitric oxide and inflammatory factors in the effusion are very high.This evidence shows that the immune function of patients with secretory otitis media is not only abnormal, but may also be accompanied by inflammatory reactions.In this study, the level of CD4+/CD8+ in adenoid tissues of patients with secretory otitis media is also higher than that of normal people, so it is believed that abnormalities in adenoid tissues also cause secretory otitis media.

In modern clinical practice, secretory otitis media is equal to ear distension and deafness in TCM theory, characterized by the symptoms of deafness and tinnitus.A series of examinations showed that symptoms such as tympanic effusion and tympanic congestion were commonly observed in patients with secretory otitis media[17].According to the TCM theory,the treatment and understanding of secretory otitis media are different from conventional treatment approach, and TCM treatment has its unique advantages and effects[18].Although the TCM treatment is an effective option, the type of secretory otitis media should be accurately determined and distinguished, so that targeted treatment can be performed to improve the curative effect[19].In addition,greasy food is not recommended, while light diet and good mood are preferred for patients with secretory otitis media, so as to ensure the efficacy of treatment[20].

In summary, in the treatment of secretory otitis media,the combination of Xuanfei Conger Decoction and auricular acupressure is effective and has potential clinical application.