OTALGIA
Otalgia is a very common symptom in ENT. Otalgia is defined as ear pain. It is also known as earache.
Primary otalgia is from pain that originates inside the ear. Referred otalgia is from pain that originates from outside the ear.
For further information, refer the section on earache on the home page, by clicking the 'Back' button on your browser.


POLYCYSTIC OVARIAN SYNDROME
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome. It is a hormonal disorder that affects an estimated seven percent of all women. It is the most common hormonal disorder among women. According to experts, the actual number of women affected by PCOS may be as high as one out of ten simply because so many cases remain undiagnosed.
It is a heterogeneous disorder characterized by a disruption of the regular processes leading to ovulation due to hormonal imbalance.
It is found in the age group of 12- 24 years of females.
 It is associated with hyperandrogenemia, normal or elevated estrogen levels, and elevated luteinizing hormone (LH) secretion, with a raised LH-to-follicle-stimulating hormone (FSH) ratio.

Cause-
No one is quite sure what causes PCOS. Although women with PCOS often have a mother or sister with the condition, there is not enough scientific evidence to prove that the condition may be inherited. The ovaries of women with PCOS frequently contain a number of small cysts, hence the name poly (many) cystic ovarian syndrome. A similar number of cysts may occur in women without PCOS. Therefore, the cysts themselves do not seem to be the cause of the problem. A malfunction of the body's blood sugar control system (insulin system) is frequent in women with PCOS, and researchers believe that these abnormalities may be related to the development of PCOS. It is known that the ovaries of women with PCOS produce excess amounts of male hormone known as androgen. This excessive production of male hormones may be a result of the abnormalities in insulin production.

Pathophysiology
The underlying cause of PCOS is an abnormality of ovarian androgen production that results from dysregulation of key enzymes involved in theca cell androgen biosynthesis. Hyperandrogenemia in PCOS could be due simply to increased follicle number or theca cell hyperplasia. Both insulin and insulinlike growth factors have been demonstrated to potentiate the actions of LH on theca cell androgen production.
Body mass index (BMI) is positively correlated to serum insulin and testosterone levels and is inversely related to sex hormone-binding globulin (SHBG) levels.

Symptoms-
1.  Abnormal, irregular, or scanty menstrual periods (oligomenorrhea),
2.  Absent menses (amenorrhea), usually (but not always) after having one or more normal
     menstrual periods during puberty (secondary amenorrhea),
3.  Weight gain, even obesity,
4.  Insulin resistance and diabetes,
5.  Infertility,
6.  Increased hair growth (hirsutism); distribution of body hair may be in a male pattern,
7.  Virilization - it is called as a development of male sex characteristics in a female. This
     may include an increase in body hair, facial hair, a deepening of the voice, male-pattern
     baldness, and clitoral enlargement,
8.  Decreased breast size,
9.  Aggravation of acne,
10. Weight gain,
11. Acne,
12. Oily skin,
13. Dandruff,
14. Infertility,
15. Skin discolorations,
16. High cholesterol levels,
17. Elevated blood pressure.

Investigations-
During a pelvic examination, the health care provider may note an enlarged clitoris (very rare finding) and enlarged ovaries.

Tests include:
 Blood tests that may be done include:
 Differential diagnosis-
1. Cushing syndrome (central obesity, moon face, plethoric complexion, buffalo hump,
    proximal myopathy, thin skin, abdominal striae)
2. Late-onset congenital adrenal hyperplasia
3. Adrenal tumors

Treatment-
Medical treatment of PCOS is tailored to the patient's goals. Broadly, these may be considered under four categories:
 Surgical Care- a surgical procedure known as ovarian drilling can help induce ovulation in some women who have not responded to other treatments for PCOS. In this procedure a small portion of ovarian tissue is destroyed by an electric current delivered through a needle inserted into the ovary.

Prognosis-
Pregnancy may be achieved with appropriate treatment.

Complications-
 Role of Homoeopathy
Homeopathy does not use any hormones but the remedies work by stimulating the glands to produce the required amount of hormones thus curing the problem at the root. Thus homeopathic treatment for hormonal imbalance is extremely safe and acts at the level of psycho-neuro-endocrinal axis.
By taking homeopathic medicines, ovulation and menses can be attained in a natural way.

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