Professional Documents
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Sinusitis and Its Treatment and Management
Sinusitis and Its Treatment and Management
by
In partial fulfillment
Doctor of Medicine
in
Deralakatte,
Mangalore
2010
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
DECLARATION
I here by declare the work contained in this dissertation / thesis entitled is “STUDY OF
carried out by me under the guidance of Prof. DR. SRINATH RAO, MD (Hom).
I have not previously submitted this work (partial or full) to any other degree or
diploma.
Place: Mangalore.
CERTIFICATE BY GUIDE
SRIDHAR RAJANA during the year 2007 -2010, as a partial fulfillment of the
I have satisfied myself regarding the authenticity of his observations noted in this
Sciences, Karnataka, Bangalore. It has not been submitted this work (partial or full) to
GUIDE:
Derlakatte, Mangalore.
ENDORSEMENT BY THE HOD,
DR. SRIDHAR RAJANA during the year 2007-2010, as a partial fulfillment of the
I have satisfied myself regarding the authenticity of his observations noted in this
Sciences, Karnataka, Bangalore. It has not been submitted this work (partial or full) to
Bangalore shall have the rights to preserve, use and disseminate this dissertation/ thesis
Place: Mangalore
achieve this humble task through the following persons who have been of immense help
and guide Dr. Srinath Rao, Principal and Head of the Department of Homoeopathic
Materia Medica, Fr. Muller Homoeopathic Medical College, Mangalore for providing
support and encouragement throughout my post graduate course and during the
I would like to express my gratitude and love to my parents Dr. R.A. Naidu &
Mrs. Sarojini for their constant support, care and encouragement. My special thanks to
my dear sibilings Chandu & Ravi and my wife, Dr.Aparna. I am immensely thankful to
my relatives, in law and my dear and near ones for their constant support and
Institutions, The Administrator, Rev. Fr. Wilfred Prakash D’souza, and Former
Administrator, Rev. Fr. Stany Tauro, Fr. Muller Homoeopathic medical college,
Mangalore for providing me an opportunity and adequate facilities to carry out this work
medical college, Mangalore for his valuable guidance and extending all necessary
facilities to take up this endeavor. I also express my gratitude to our Former Principal
I also express my heartfelt thanks and gratitude to Prof. Dr. Shiva Prasad,
Vice Principal, PG coordinator & Head of the Department of Organon of Medicine and
Dr.Deepa, Dr.Anitha for their constant support, encouragement and for giving me the
Dr.Sahana and Dr.Mamatha, Naveen, & Usman whose co-operation and timely help
I thank all the members of non-teaching staff of Fr. Muller Homoeopathic Medical
College and the staff of outpatient department who has provided me with the case
Last but not the least, my sincere thanks to all the Patients on whom the study was
conducted and A1 solutions, Kankanady for taking pains to complete this work in time.
Place: Mangalore
1. < : Aggravation
2. > : Amelioration
3. 0 : Absent
4. ↑ : Increased
5. ↓ : Decreased
6. + : Present
7. A : After
8. Ac : Acute
10. B : Before
11. C : Christian
15. H : Hindhu
17. F : Female
19. Fq : Frequent
22. G : Good
23. IF : Infrequent
25. M : Male
26. MU : Muslim
28. No ii : Placebo
32. P : Packet
33. PS : Psora
34. R : Regular
36. Rx : Prescription
39. SP : Syphilis
41. SY : Sycosis
42. TB : Tubercular
44. wk : Week
01. INTRODUCTION 1
02. OBJECTIVES 3
04. METHODOLOGY 78
05. RESULTS 81
10. ANNEXURES
Annexure – I 113
Annexure – II 115
Annexure – III
137
LIST OF TABLES
Miasmatic expressions
04. 49
Posterior rhinoscopy
03. 15
X-ray positions
04. 16
Background:
Of all the respiratory infections, sinusitis is one of the most common illnesses that
infections. This can lead to chronic head ache and in turn lead to more missed work days.
As the treatment offered by the modern medicines like Antihistamines and other
medications can cause decreased mental alertness and drowsiness. So in this context to
evaluate the scope of homoeopathic medicines with its drug source and optimum
repetition is relevant.
Objectives:
cases of sinusitis.
Methods:
without using any control group. The diagnosis was made on strong clinical presentation
and examination findings. The cases for the study were selected randomly after fulfilling
The remedy selection in individual cases was based on the analysis of etiological
factors, reportorial references and Materia Medica. For the assessment of the clinical
status before and after treatment scores were used which is mentioned in annexure I and
Results:
Maximum prevalence was noticed in age group between 15-25 yrs (13 cases).
Maximum cases (10) were diagnosed as chronic frontal sinusitis. Maximum remedies
which were used in the study were belongs to Mineral kingdom and Natrum muriaticum
was indicated in majority of the cases as a constitutional remedy. Majority of cases were
managed by constitutional remedy with infrequent repetition. After the treatment 28 cases
Conclusion:
The scale used for assessment and effectiveness of treatment showed significant
improvement after treatment. From the analysis of the above results obtained it is obvious
Paranasal Sinus Disease is one of the commonest diseases prevalent all over the
world. It is one of the leading causes for absenteeism from work, frequent revisits to the
medication.
Sinusitis is diagnosed more frequently than hypertension, arthritis, and all other
adult respiratory diseases. It has become the number one chronic illness for all age groups
according to the national center for disease statistics. According to modern medicine
sinusitis requires only medical line of treatment in first stage of disease. When it progress
has been observed that medical and surgical line of treatment fails to give permanent
cure.
Homoeopathy is an effective alternative for the patients who are suffering with
sinusitis. Homoeopathy as a science of medical treatment has a philosophy of its own and
its therapeutics is based on certain fundamental principles which are quite distinct and
different from those of other school of medical science. Homoeopathic system does not
entirely depend on one principle “similia similibus curantur.” Along with this the
physician should follow remaining basic concepts like law of simplex, law of minimum,
Physician’s mission is not only selecting the Similimum, but also selection of
1
But unfortunately there is no systemization regarding potency and repetition.
Most of the beginners and some experienced physicians also have confusion regarding
repetition. A well selected remedy may fail or may even harm, because of an
inappropriate dosage. So many factors influence the selection of potency and repetition of
the dose. The repetition of dose also depends on the nature of the remedy such as deep
acting and short acting according to the source of the drug and the duration of action.
Even duration of action varies from one drug to another drug. All these things are inter
Opinion about optimum time for repetition varies from physician to physician
based on their philosophy. Even our founder Hahnemann also stated different opinions
about repetition in different editions of his works. Improper repetition of similimum can
not be changed without very good reasons, it is probable that the remedy may be repeated
at the necessary intervals through a whole range of potencies, securing the full amount of
in sinusitis with the help of knowledge of drug source and proper repetition.
2
OBJECTIVES…
OBJECTIVES
of sinusitis.
3
REVIEW OF
LITERATURE…
REVIEW OF LITERATURE
“In a person having a painful spot in the head with intense headache, pus or fluid
Three ectodermal elevations appear in the primitive nasal cavity on its lateral
surface. The mesenchyme migrates into these elevations which form the turbinates. The
sinuses develop in late embryonic life and some develop during the early postnatal life
The maxillary sinus develops as a mucosal depression below the middle turbinate,
which invades the maxilla. Its growth is complete by about nine years of age. The
sphenoid sinus is present at birth but reaches adult size at puberty. The frontal and
ethmoid sinuses are represented by diverticula at birth. The frontal sinus develops as an
4
extension of mucosal pouch that forms the anterior ethmoid cells. The sinus invades the
frontal bone by the first year of life and reaches the adult size at puberty. The ethmoid
Paranasal sinuses are air- filled chambers within the skull bones and that surround
the nasal cavity. Clinically the paranasal sinuses are divided into
1. Anterior group :
• Frontal
• Maxillary
2. Posterior group :
• Sphenoid sinus.3
pyramidal in shape with base towards lateral wall of nose and apex directed laterally into
the zygomatic process. On an average, maxillary sinus has a capacity of 15ml in an adult.
Relations:
Anterior wall: Is formed by facial surface of maxilla and is related to the soft tissues of
cheek.
Medial wall: Is related to the middle and inferior meatuses. At places, this wall is thin
and membranous.
5
Floor: Is formed by alveolar and palatine processes of the maxilla and is situated about
1cm below the level of floor of nose. Depending on the age and pneumatisation of the
sinus, the roots of all the molars, some times the premolars and canine, are in close
relation to the floor of maxillary sinus separated from it by a thin lamina of bone or even
no bone at all. Oroantral fistulae can result from extraction of any of these teeth. Dental
infection is also an important cause of maxillary sinusitis. Ostium of the maxillary sinus
is situated high up in medial wall and opens in the posterior part of ethmoidal
Roof: Of the maxillary sinus is formed by the floor of the orbit. It is traversed by
Frontal Sinus:
Each frontal sinus is situated between the inner and outer tables of frontal
bone, above and deep to the supra orbital margin. It varies in shape and size and is often
loculated. The two frontal sinuses are often asymmetric and the intervening bony septum
is thin and often obliquely placed or may even be deficient. Frontal sinus may be absent
on one or both sides or it may be very large extending into orbital plate in the roof the
orbit.
Anterior wall of the sinus is related to the skin over the forehead: inferior wall, to
the orbit and its contents; and posterior wall, to the meninges and frontal lobe of the
brain. Opening of frontal sinus is situated in its floor and leads into the middle meatus
directly or through a canal called frontonasal duct. In the middle meatus, frontal sinus
drains in to frontal recess(55%), above but not into the infundibulum (30%), into the
6
Ethomoidal Sinuses (Ethmoid Air Cells):
Ethmoidal sinuses are thin walled air cavities in the lateral masses of ethmoid
bone. Their number varies from 3to 18. They occupy the space between upper third of
lateral nasal wall and the medial wall of orbit. Clinically ethmoidal cells are divided into
anterior ethmoidal group which opens into the middle meatus, and posterior ethmoidal
group which opens into the superior meatus and sphenoethmoidal recess.
Each ethmoid labyrinth has important relations. Roof is formed by anterior cranial
fossa, lateral to the cribriform plate. Meninges of brain form important relations here.
Lateral wall is related to the orbit. The thin paper like lamina of bone (lamina papyracea)
separating air cells from the orbit can be easily destroyed leading to spread of ethmoidal
infections into the orbit. Optic nerve forms close relationship with the posterior ethmoidal
Sphenoid Sinus:
It occupies the body of sphenoid. The two, right and left sinuses, are rarely
symmetrical and are separated by a thin bony septum which is often obliquely placed and
may even be deficient. Ostium of the sphenoid sinus is situated in the upper part of its
anterior wall and drains into sphenoethmoidal recess. The relations of the sinus differ in
In the anterior part: Roof is related to the olfactory tract, optic chiasma and frontal lobe
while the lateral wall is related to the optic nerve, internal carotid artery and maxillary
nerve and these structures may stand in relief in the sinus cavity.
7
In the posterior part: Roof is related to the pituitary gland in the sella turcica while each
lateral wall is related to cavernous sinus, internal carotid artery and CN III,IV,VI and all
the divisions of V.
and the structures related to it. Sinus cavity may be large and extend into the wings of
Paranasal sinuses are lined by mucous membrane which is continuous with that of
the ostia of sinuses. It is thinner and less vascular compared to that of the nasal cavity.
Histologically it is ciliated. Columnar epithelium with goblet cells which secrete mucus.
Cilia are more marked near the ostia of sinuses and help in drainage of mucus into the
nasal cavity.
Ventilation of Sinuses:
Ventilation of paranasal sinuses takes place through their ostia. During inspiration,
air current cause negative pressure in the nose. This varies from, 6mm to 200mm of H20
depending on the force of inspiration. During expiration positive pressure is created in the
nose and this sets up eddies which ventilate the sinuses is paradoxical, they are emptied
Mucus secreted in the Paranasal sinuses travels to the ostium in a spiral manner.
Here the cilia are very active and propel mucus into the meatuses from where it is carried
to the pharynx. The mucus from anterior groups of sinuses travels along the respective
8
lateral pharyngeal gutter situated behind the posterior pillar, and that from posterior
group is spread over the posterior pharyngeal wall to be finally swallowed. In infections
of the anterior group of sinuses, lateral lymphoid bands, situated behind the posterior
1. Warming and moistening of inspired air may be partly done by the large
2. The air filled sinus cavities probably add resonance to the laryngeal voice.
3. The temperature buffers: it is regarded that these chambers probably protect the
contents of orbits and cranial fossae from intra nasal temperature variations.
4. Probably sinus formation in the cranial bones helps in reducing the weight of
5. The sinus mucosa may act as donor site for reconstructive procedures, e.g. for
subglottic stenosis and implantation of maxillary sinus mucosa into the nasal
9
Figure No 1: Paranasal sinuses
10
Common Symptoms of Nasal and Paranasal Sinus Diseases:
The nose and paranasal sinuses are closely related anatomically, so are their
Nasal Discharge
Nasal Obstruction
The common conditions of the nose and paranasal sinuses which result in nasal
Nasal and paranasal sinuses are frequently blamed for headaches and facial pain.
Pain due to inflammation of the frontal sinus is usually localized over the
forehead. The pain is more during early hours of the day and subsides or diminishes
Pain due to involvement of the maxillary sinus is more over the maxillary region.
11
Ethmoid sinus: Pain usually occurs along sides of the nose or in the orbits.
The pain is referred to the vertex or occiput or may be present behind the eyes.
Facial pain due to other nasal and paranasal lesions may occur as in furunculosis,
Epistaxis
Bleeding from the nose may be unilateral or bilateral and may be due to a variety
Postnasal Drip
Normally the secretions from the nose and nasopharynx are carried to the
oropharynx by the mucociliary mechanism of the nose, where from these are
swallowed. Many times the patient complains of excessive nasal discharge coming
Post nasal drip occurs commonly in allergic and infective diseases of the nose and
Speech Defect
Disorders of the nose and nasal sinuses may result in loss of the resonating
function and this may give a nasal tone to voice like a closed nose speech as occurs in
obstructive lesions.
1. Sneezing
2. Snoring
3. Sleep apnoea1
12
Examination of the Nose and Para nasal Sinuses:
This is done to detect any deformity, asymmetry or swelling of the nose and face.
A sinus in the midline of the nasal dorsum is usually congenital. The nose must also be
Anterior Rhinoscopy :
This initial examination of the nasal vestibule without nasal speculum is necessary as
other wise blades of the speculum may obscure papillomas, cysts and bleeding points in
this region.
commonly used for examination. The floor, lateral wall, septum and posterior
portions of nasal cavities are viewed. The color of the nasal mucosa is noted.
lesions while pale or bluish mucosa is seen in allergic conditions. Septal deviations or
• Postural Test
13
If the discharge does not immediately reaccumulate, the patient’s head is turned to the
side of the normal maxillary sinus and the patient kept in this position for some time.
The patient is made to sit upright again and reaccumulation of discharge in the middle
On examination of the oral cavity in relation to nasal and paranasal sinus disease, it is
Oroantral fistula is a communication between the maxillary sinus and the oral cavity.
This may be the result or an aetiological factor of maxillary sinus disease. A probe is
Posterior Rhinoscopy
This procedure permits the examination of the posterior aspects of nose and
nasopharynx. The posterior edges of the inferior, middle and superior turbinates are seen
on the lateral side of the nasal cavity. Hypertrophied posterior ends of the inferior
turbinates appear as rounded, mulberry swelling on each side in the posterior choanae.
Discharge may be seen trickling from the meati over the turbinate ends. Discharges from
the maxillary sinus may be seen over the inferior turbinate while discharge from the
posterior ethmoidal sinuses and the sphenoid sinuses appear above the superior turbinate.
This procedure is done in a dark room. The light source is placed in the oral
cavity for testing the maxillary sinuses. The light transmitted through the sinus is seen as
glowing of pupils and the infraorbital crescent. For the frontal sinus, the light source
14
Figure No 3: Posterior Rhinoscopy
is placed against the floor of the sinus. The light transmitted is seen as a glow on the
anterior wall of the sinus. The test is not of much help as thickened mucosa, mucopus,
pus or tumour, all show an opaque sinus. The test is not possible for sphenoids and is
Sinoscopy:
The X- ray is taken in the nose-chin position with an open mouth. The film
demonstrates mainly the maxillary sinuses, nasal cavity, septum, frontal sinuses and
few cells of the ethmoids. The view taken in the standing position may show fluid
15
2. Occipitofrontal view (Caldwell view):
The patient’s forehead and tip of the nose are kept in contact with the film. This
view is particularly useful for frontal sinuses. A portion of the maxillary antrum and
The neck and head are fully extended so that vertex faces the film and the rays
are directed beneath the mandible. The view is useful for demonstrating sphenoid
sinuses, ethmoids, nasopharynx, petrous apex, posterior wall of the maxillary sinus
4. Lateral View
The patient head is placed in a lateral position against the film and the ray is
directed behind the outer canthus of the eye towards the film.
The maxillary, ethmoidal and frontal sinuses superimpose each other but this film
is useful for demonstrate the extent of pneumatisation of the sphenoid and frontal
sinuses.On plain radiography, the normal sinuses appear as air filled translucent
cavities. Opacity of the sinuses can be caused by fluid, thickened mucosa or tumours.
Occipitomental
16
CT Scan of the Paranasal Sinuses:
CT is the most sensitive technique for evaluating sinus disease. It is very useful in
Angiography:
SINUSITIS
Inflammation of the mucosa of the paranasal Sinuses is called sinusitis. A sinusitis may
cavity can drain freely into the nasal cavity through a natural ostia or not. A ‘closed’
sinusitis causes more severe symptoms and also likely to cause complications2.
Types
1. Acute sinusitis
2. Chronic sinusitis
ACUTE SINUSITIS:
weeks duration.4
Aetiology:
1. Infections :
the sinuses by way of their natural ostia which open into the nasal
17
cavity. Foreign bodies in the nose may also set up acute rhinitis and
iii. Tooth infections: The 1st and 2nd molar teeth are separated from maxillary
lymphatics.
clots.
ii. Baro-trauma of sinuses during flight, especially during the descent of aero
18
iv. Anatomical obstructions such as deviated nasal septum (DNS),
and allergic conditions of the nose also lead to mucosal swellings causing
obstruction of the natural ostia of the sinuses. Polypi and tumours also
cause sinusitis.
Bacteriology:
i. Viruses :
• Rhinovirus
• Parainfluenza I & II
• Coxackie A21
ii. Bacteria :
Pneumococci Strephylococci
Streptococci H. influenzae
Pathology:
The mucous membrane of sinuses passes through all the stages of inflammation.
The exudate is first serous, but rapidly becomes purulent. At first there is increased
ciliary activity, but later on ciliary action becomes ineffective. Thickening of the mucosa
19
occurs to such an extent that it may become polypoid. Pathological changes are enhanced
Clinical Factors:
Patient usually gives history of cold. After three four days when symptoms should
discharge.
2. There is pain over the infected sinus – stabbing or aching in character. This is
made worse by bending or coughing. Headache and sense of heaviness are present
• Antral / maxillary pain: It is along the infra orbital margins and referred to
nature; it starts an hour or two after getting up from bed and vanishes
during afternoon.
20
• Sphenoidal pain: It gives rise to occipital or ventral headache and
sometimes is referred to mastoid process. Pain may be felt behind the eye
8. Anterior Rhinoscopy: The nasal mucosa is congested and there may be trickle of
pus under the middle turbinate and in the post nasal space.
9. There is tenderness over the frontal or the maxillary sinus and overlying soft
10. Trnsillumination test is of help in maxillary and frontal sinusitis. This is seldom
used now-a-days.
11. Radiology of paranasal sinuses: Will show haziness of the affected sinus or all
sinuses. In cases of empyema, fluid line can be seen in the maxillary sinus.
Investigations:
3. Transillumination Test.
21
General Management / Treatment:
b. Hot fomentation : Local to the affected sinus is often soothing and helps in the
resolution of inflammation
c. Diet : Plenty of fluid and nourishing diet and vitamins are essential
e. Steam inhalation: Steam alone provides symptomatic relief land encourages sinus
drainage.
f. Proof puncture.
2. Orbital cellulites.
intracranial absess
5. Chronic sinusitis
7. Pharyngitis.
8. Laryngitis / Tracheobronchitis
9. Mucocele/ Pyocele
22
Acute Maxillary Sinusitis:
nose or dental sepsis from upper jaw as the roots of premolar and molar teeth lie close to
the floor of the maxillary antrum.3 It frequently occurs with acute rhinitis, influenza,
measles, scarlet fever, and other infectious diseases, as well as following an injury to the
paranasal sinus.5
Clinical Features
Symptoms
1. Pain: May be present over the sinus, or the upper jaw. It may be referred to the frontal
area, temple or above the ear or to the teeth. Pain is due to oedema of the ostium
2. Purulent nasal discharge: Purulent yellowish nasal discharge may exude from anterior
nares.
3. Post nasal drip: Occurs when excessive purulent discharge drains through the
posterior choanae.
5. Headache and Constitutional symptoms: Headache, fever, malaise and body ache may
6. Pressure and Tension in the region of the affected sinus and unilateral nasal
obstruction.5
Signs
23
3. On Anterior rhinoscopy, nasal mucosa is red, oedematous with engorged turbinates.
Purulent secretions may be seen in the posterior part of middle meatus. Use of
4. On Posterior rhinoscopy, pus is seen in the middle meatus. Post nasal drip is present.
Diagnosis:
1. Transillumination test: the effected sinus is opaque and no crescent of light is seen
infraorbital rim.
2. X-ray nose and paranasal sinuses: water’s view – will show haziness, opacity or fluid
Complications:
c. Orbital cellulitis.6
This is usually associated with ethmoidal and maxillary sinusitis. This follows
Clinical Features
Symptoms
24
midday and gradually subsides in the afternoon. Headache is due to blockage of
sinus ostia causing absorption of air and creates a vacuum, or it may be due to
Signs:
2.Anterior rhinoscopy may show congested nasal mucosa with presence of mucopurulent
3.Tenderness over the anterior wall or the floor of the sinus is characteristic.
Diagnosis:
Water’s and Caldwell’s views will demonstrate haziness and opacity of the frontal
Complications:
2. Orbitalcellulitis
3. Frontal osteomyelitis
of other sinuses.
25
Clinical Features:
Symptoms:
1. Pain: Is present mainly over the bridge of the nose or at the inner canthus.
Posterior ethmoidal sinusitis gives rise to pain behind the eye. Some times pain
2. Periorbital Oedema: May be present partially at he inner canthus and lower eyelid
Signs:
Diagnosis:
Complications:
1. Orbital cellulites.
26
Acute Sphenoidal Sinusitis :
Clinical Features:
Symptoms:
1. Characteristic pain is the form of deep seated central headache. The pain
Signs:
Diagnosis:
1. X-ray of the sphenoid sinus – lateral view in supine or prone position will
CHROINIC SINUSITIS:
Definition:
Aetiology:
27
¾ In addition, chest conditions, such as asthma, chronic bronchitis and chronic
3. Hypersensitivity
4. Dental sepsis
5. Poor resistance
6. Alcohol
7. Dusty environment
Inflammatory products itself may act as allergens inducing further changes in the
PATHOPHYSIOLOGY:
Acute infection destroys normal ciliated epithelium impairing drainage from the
sinus. Pooling and stagnation of secretions in the sinus invites infection. Persistence of
infection causes mucosal changes, such as loss of cilia, oedema and polyp formation, thus
28
PATHOLOGY :
Loss of cilia
Infection
Clinical Features:
These are often vague and similar to those of acute sinusitis but lesser in intensity.
Nasal symptoms:
Nasal obstruction
29
Nasal discharge
Postnasal drip due to chronic rhinitis ---- dryness and burning at the
Pharyngeal Symptoms:
¾ Pharyngitis
¾ Dryness of throat
¾ Tonsillitis
¾ Lymphadenitis
Ear Symptoms:
Headache:
during night and then draining away as the patient takes up erect posture.
Eye Symptoms:
• Conjunctivitis.
Respiratory Symptoms:
• Cough
• Hoarseness of voice.
30
Other symptoms:
SIGNS:
1. Anterior Rhinoscopy: Will reveal dull colour of nasal mucosa. Trickle of pus is
seen under the middle meatus, if the anterior group of sinuses are involved. The
2. Posterior Rhinoscopy: Will show pus in the middle meatus in maxillary and
3. Transillumination Tests: They are done for maxillary and frontal sinuses by a
special torch in a darked room. They are 15% less accurate than x-rays.3
INVESTIGATIONS:
1. Blood routine tests like TLC, DLC, esionophil count should be checked.
31
iii. Polypoid hypertrophy of lining mucosa
v. Osteitis or osteosclerosis
6. Imaging studies :
Complications:
1. Orbital Complications :
2. Osteomyelitis :
i. Osteomyelitis of maxilla
3. Intracranial Complications :
32
4. Descending Infection
5. Focal Infection
Definition:
Aetiology:
Pathology:
The mucous shows hypertrophy, atrophy or papillary changes. It may be pale and
Clinical Features:
1. Nasal obstruction.
aetiology.
5. Sore throat
due to post nasal drip
6. Hawking
33
7. Change of taste
Signs:
Investigations:
1. X- Ray paranasal sinus – Water,s view is specific for maxillary sinuses. It will
4. Postural test – Patient is in sitting position and the pus from middle meatus is
cleaned and if it is doesn’t reappears, the patient’s head is placed sideward with
the affected sinus up. As the maxillary ostium becomes dependent, pus will
34
Chronic Frontal Sinusitis:
Aetiology:
2. As a part of pansinusitis.
Pathology:
Clinical Features:
Symptoms:
1. Nasal obstruction.
Signs:
Investigations:
3. Pus seen in the anterior part of the middle meatus which is cleaned. The pus well
reappear in a few minutes it is from the frontonasal duct, when patient is in the
sitting position.
35
Chronic Ethmoidal Sinusitis:
This is usually associated with ethmoidal polyp formation, DNS, nasal mass,etc.
a. Conservative treatment
b. Surgical treatment.
a. Conservative treatment :
36
• Irregular of the nose, with normal saline often helps.Local heat to the sinus by
b. Surgical Treatment :
Sinusitis ).6
SINUSITIS IN CHILDREN:
most frequently involved, next to the ethmoid and least the frontal.
Aetiology:
1. Neglected head cold, recurrent upper respiratory infection, catarrhal child and nasal
allergy.
2. Enlarged adenoids; is one of the most important factor in causing nasal obstruction
and sinusitis.
37
6. General cause : a. Poor nutrition
c. Endocrinal disorder.
Bacteriology:
Clinical Features:
1. Frequent cough and cold with nasal discharge and nasal obstruction are
characteristic.
Diagnosis:
Sinusitis PreventionS:
impossible objective, but there may be ways to reduce the frequency and severity of a
• Moisten the air at home - sinuses can drain better when air is moist. Humidifiers
can better increase moisture in the air. Air conditioners are also good way of
38
• Filters - Electrostatic filters attached to heating and air conditioning equipment
irritate the nasal passages and aggravate sinusitis. Chemicals and strong fumes
• Eliminate smoking habits - Tobacco and smog are famous for causing irritation
of the sinus lining which causes bad drainage of mucus, as well as causing sinus
to become congest.
alcohol can cause nasal and sinus membranes to swell, exposing them to irritation
• Reduce air travel - Air travel may cause a problem for an individual suffering
from acute or chronic sinusitis. A bubble of air trapped within the body expands
as the air pressure in a plane reduces. This expansion causes pressure on the
surrounding tissues and can result in the blockage of the Eustachian tubes. The
result may lead to a discomfort in the sinuses or in the middle ear during the
• Drink lots of water - Water increases the amount of moisture in the body and
helps to prevent congestion. It also helps to thin the mucus for proper drainage.
treated swimming pool as it irritates the lining of the nose and sinuses.
sinus infection, where water is forced into the sinuses from the nasal passages.
39
• Good hygiene - Bacterial and viral infections are the most common causes of
monitoring hygiene, such as frequent hand wash with soap and water.
products may thicken mucus and cause nasal passages to narrow down which
• Take many hot showers and inhale steam - This will loosen mucus and moisten
• Eat plenty of fruits and vegetables - must eat fruit and vegetables that are rich in
antioxidants and other chemicals that could boost immune system and help body
resist infection.
• Reduce stress - Even though some of us don't notice it, stress makes sinusitis
symptoms worse. If patient have sinusitis in the past, stress can trigger it or make
it worse.8
40
HOMOEOPAHIC APPROACH
1. DRUG SOURCE:
Diseases were born with Man and drugs came into existence since a very early
period to remove the pain of diseases and to cure them. Thus the story of history of drugs
is as old as mankind.
Since the dawn of civilization, primitive man went in search of food and ate
random plants or parts of plants. If he found that no harmful effects were observed, he
considered them as edible and used as food. If he found they were considered inedible,
then, according to actions, he used them in treating symptoms and diseases. The
knowledge was empirical and was obtained by trail and error. Thus a number of drugs in
use owe their origin to folklore of different people, in primitive rites. Many drugs have
1. Plant kingdom
2. Animal kingdom
3. Mineral kingdom
4. Nosodes
5. Sarcodes
6. Imponderabilia
7. Synthetic source
41
General Characteristics of Individual Source:
This is the largest source of homoeopathic medicines. The basic quality of a plant
needs to be sensitive to changes in the external environment and also capable of adapting
to these changes, for it cannot move away. These features are also descriptive of those
needing a plant remedy. They are of a sensitive nature, affected by many things and
adjusting/adapting to these.
Common to the animal remedies is a "conflict" which has its basis in a split
within the self. There are two different sides to such personalities: the animal side and the
human side. The animal side is concerned with competition (which is the key to survival
in the animal world). There is a need to attract attention, and these personalities are
attractive in their behavior and appearance. They can also be deceitful, malicious and
aggressive - and all these qualities can be attributed to their animal side. Their human
side on the other hand seems to have contempt for the animal within. The main problems
for animal remedies arise from this conflict; they are usually affected by disappointments
in love and performance, from being looked down upon, from being attacked. Among the
animal remedies, different groups and classes, e.g. snakes, insects, mammals, etc., will
The central themes common to remedies of the mineral kingdom are structure and
42
this structure and organization, breaking of relationships or failure in performance. As
Metals:
Among the mineral remedies, the metals have to do with performance and
defense. The first line of metals in the Periodic Table is concerned with defense more
than with performance. This line consists of Manganese, Iron, Cobalt, Nickel, Copper
and Zinc. The second line has more to do with performance than with defense, and
includes Rhodium, Palladium, Silver, Cadmium and Indium. The elements belonging to
the third line have the strongest defense/performance issues. This line consists of the
heaviest metals and includes Osmium, Iridium, Platinum, Gold, Mercury and Thallium.
Thus the degree of defense/performance concern increases from the first to the third line.
Cations:
The main theme of the cations is the need for a relationship, but this theme gets a
relationships. The cations are Sodium and Potassium. For the cations of Group IIA, i.e.
Magnesium, Calcium, Strontium, Barium, the theme is a need for support. Group-III
elements Boron and Aluminium have in common a feeling of confusion and a sensation
Anions:
The main theme among the anions is the effort to keep or maintain a relationship.
unloved and alone. The symptoms common to elements of this group are: "Fear of being
43
alone", "Desire for company", "Clinging".
Among the elements of Group VI, i.e. Sulphur and Selenium, we see the common
symptoms "Aversion to company" and "Incapacity to work". The theme here is one of
Group VII contains the halogens Fluorine, Chlorine, Bromine, Iodine. They have a
Group IV contains the non-metallic elements Carbon and Silica. The feature common to
Salts:
A salt represents the union of two qualities which balance each other and together
are appropriate in certain life situations. Of the two components of a salt, the cations need
Acids:
The main theme of the acid group is a struggle followed by collapse. The acid of a
4. Nosodes:
sphere of the life of a person who requires one of these remedies. His way of looking at
Nosodes are prepared from diseased tissue. This tissue is completely under the spell of
the infection, overwhelmed by the infection, so that the very basic qualities of the
infection or the infectious process are manifest in the nosode. The nosode thus represents
44
5. Sarcodes:
In Greek, the term ‘sarcode’ means fleshy. Sarcodes imply protoplasm of animals as
distinguished from vegetable protoplasm. They are obtained from healthy endocrine or
ductless gland secretions of living human organs and lower animals. The secretions are
mostly hormones.11
Sarcodes are mainly stated to be the organopathic drugs, which act on the particular
organs and their action generally limited to the functions of that organ. All sarcodes are
deep acting remedies and they responds to suffering due to deficient functioning as well
as hyperfunctioning of that particular organ. These are well indicated for cases of
6. Imponderabilia:
homoeopathic medicines. These energies have been tapped into potential homoeopathic
medicines for the cure of the sick and is unique to homoeopathic pharmacy.9 Hahnemann
observes in his Organon, Aphorism 280 footnote that “even imponderable agencies, can
produce most violent medicinal effects upon man. They are two types:
a. Natural : Eg- Magnetis poli ambo, Magnetis polus arcticus , Magnetis polus australis
medicine, are poetized, proved on healthy provers and administered on the similia
45
remembered here that these are not used or advocated in the form as used in ‘modern
46
Some Drugs with Their Duration of Action14
47
MIASMATIC APPORACH:
“The character of the miasm yields the character of the disease or the form of
The miasm must be understood in its broadest sense as a true chronic disease.
Predisposing condition or morbid constitutional state which will unfailingly give rise to
determining causes. Such an approach will permit the homoeopathic physician to assist
efficiently in eliminating a large part of the individuals miasmatic burden by applying the
true “SIMILIMUM” corresponding precisely to the totality of the symptoms which are
The homoeopath must be a true physician; the true physician must understand the
true ultimate end of therapeutic action. This should never and with alleviation of an
individual’s suffering but must represent the attainment of his genuine expression and
integral rectification freeing him as much as possible from his miasmatic burden or
load.15
R.P Patel chronic miasms in homoeopathy and their cure with classification of
Pain forehead middle frontal sinus from chronic coryza – psora and sycosis.
48
Miasmatic Expressions
49
bands around
the head.17
Modalities • Worse during • Aggravated • Worse from • Aggravated at
the morning as after midnight, motion and night, by the
the sun ascends from lying down from preparing warmth of bed,
and decreases in and from for by rest, while
the afternoon physical or examinations18 attempting to
with the Sun’s mental • There is also sleep, riding
descent.19 exertion.18 exacerbation and Exertion.19
• Amelioration Amelioration from heat.19 • Better in the
is may result from • Relived by morning until
from rest, gentle Motion.19 rest, quite, the evening
quite sleep, eating and worse
and sleep and and by again at
hot epistaxis.19 night.17
application.17 • Cold
• Psoric applications,
patients cannot changing
bear places, motion
much heat about & nose bleeds
the head ameliorates.
although they • Head feels
like heat in better before
general.19 sleep.
50
a.Characteristics veruccas in the colds in destruction of
nostrils. tubercular the nasal
• Oedematous miasm.19 septum and
swelling of the ulcers may
nasal turbinate.19 occur inside
the nostrils.19
• Sensation of • Bland • Epistaxis • Clinkers
dryness in the discharges with which is bright (thick crusts
nose.18 a fish brine red, may occur which are dark
smell are from any green, black
characteristic of trivial cause or brown ) can
Sycosis. 19 such as over be offensive
heating or over and often have
exercise or to be moved19
during fever.19 • Manifest
with offensive
breath.19
• Psoric cold • Difficulty in • Flushing of
begin with breathing the face, eyes
Sneeging, though the nose and nose.
redness and can be caused by
heat. various growths
• Sensitive or oedema19
nose.18
• Discharges are • Moist snuffles • Snuffles are
thin and watery with a purulent periodic and
and can be scanty associated
acrid.19 discharges with with
the odour of fish haemorrhage.
brine and no
formation of
crust.19
• Stoppage of • Dr. Roberts • A thick
one suggests that, yellowish
nostril causes sycotic nasal discharge with
mouth discharges are an odour of old
breathing.19 acrid and cheese or
corrode the skin. sulphur
However ameliorated by
acridity of cold
discharge is application is
generally constantly
syphilitic.19 dropping down
the throat
( post nasl drip
). 19, 20
51
b. Modalities • Psoric nasal • Sycotic nasal • In the • In syphilis,
symptoms are complaints are tubercular nasal
aggravated in aggravated by miasm, nasal symptoms are
the damp and from conditions are aggravated at
morning from changes in the aggravated in a night and from
cold and during weather. close room. the warmth of
sleep. • Amelioration • Ameliorated the bed.
• Amelioration from abnormal in open air.19 • Ameliorated
from warmth discharges by abnormal
and by natural though various Discharges.19
discharges.19 mucus
membranes such
as coryza.19
c. Septum • There is • Thickening of • Tubercular • Destruction
redness of the the membranes nostrils are of the septum
mucus or enlargement narrow and is characteristic
membrane of of the turbinate have small of the syphilitic
the nasal orifice bones due to openings miasm.17,20
and a sooty, congestion may leading to
dirty cause nasal
appearance of stoppages.20 blockages and
the thereby mouth
septum. breathing.20
• In rhinitis, the
septum is often
dry, hot and
burning. 20
d. Hay fever • Psoric hay • In sycotic hay • Tubercular • Syphilitic
fever is fever the hay fever is discharges
characterized by discharges is periodic and from hay fever
sneezing, scanty but the recurrent with are acrid,
redness and patient cannot much sneezing Putrid and
heat and by breath through and various Offensive.20
sensitiveness the nose or blow allergic
and a watery any mucus from manifestations
discharge.20 it.20 20
17, 18,19,20
52
THERAPEUTICS FOR SINUSITIS:
1. Aconitum napellus:
Best suited for sudden cold with congestion of the nose, dry, suffocative cold,
nose stopped up, scanty watery coryza, sinusitis due to influenza, patient suffering from
dry, cold weather, from choked perspiration and also complaints from very hot weather.21
Pains are intolerable, they drive him crazy; he becomes very restless; at night.22 Sinusitis
2. Ammonium carbonicum:
of sharp burning, water, nose bleed. Nose is stuffy at night with long continued coryza,
ozena.21Nosebleed when washing the face and hands in the morning, from left nostril;
after eating. Stopping of nose, mostly at night; must breathe through the mouth, long-
3. Ammonium Phos:
Sneezing with excessive running from nose and eyes, only in morning.23
4. Arsenicum album:
Fluent coryza, with frequent sneezing without relief, headache, with beating in the
5. Arsenicum iodatum:
Suits well to those who suffer from hay fever, chronic nasal catarrh, swollen nose,
sneezing, severe coryza with catarrhal tendency.24 pungent irritation about nose and eyes
53
6. Belladona:
Throbbing frontal headache, also occiput, and temples. Facial neuralgia with
twitching muscles and flushed face.25 Headache on right side, worse by least movement,
lying down, touch, jar noise, draught, afternoon, lying down in semi-erect position.
Photophobia, coryza with mucus and blood.27, frequent sneezing when dry, with tickling,
7. Bryonia:
Severe dry coryza with catarrh of the frontal and maxillary cavities and severe
beginning with violent and frequent sneezing, accompanied by stitching headache when
8. Calcarea Carbonica:
Dry, nostrils sore, ulcerated, Stoppage of nose, also with fetid, yellow discharge.
Offensive odor in nose. Polypi; swelling at root of nose, Coryza25 Takes cold at every
change of weather.23Headache from over lifting, from mental exertion, with nausea. Head
feels hot and heavy. Frequent attacks of cold, nausea. Headache with vertigo, better in
dry climate, lying on painfulside. Lachrymation in open air and early in morning.27
9. Calcarea Sulphuricum:
Chronic sinusitis with thick yellow discharge.27 Cold in the head, with thick,
yellowish, purulent secretion, frequently tinged with blood. One-sided discharge from
nose. Yellowish discharge from posterior sinus.23 Burning pains in palms and soles.
54
10. Hepar Sulph:
Sinusitis of allergic origin with patient being very sensitive to cold. Chilly patient
yet burning heat and flushes of heat. Allergic rhinitis, sneezing culminating into sinusitis.
Acute sinusitis (frontal/maxillary) becoming chronic with the passage of time.27, First the
discharge is semi-liquid, then thick and offensive, tonsillitis, septic sore throat, hay fever,
etc.21
11. Iodum:
Sneezing. Sudden violent influenza. Dry coryza becomes fluent in open air, also
a fluent hot coryza with general heat of skin. Pain at root of nose and frontal sinus. Nose
stopped up. Loss of smell. Acute nasal engorgement associated with high blood pressure.
12. Kali-Bichromium:
Frontal sinusitis with pain in supra-orbital region or inner canthi of both the eyes
and at the root of the nose. Postnasal catarrh exciting cough, discharge from nose
relatively scanty but sticky, purulent, yellow.27. Coryza fluent, excoriating nose and lips;
discharge of mucus streaked with light-coloured blood. Profuse secretion from right
nostril.26
13. Kali.Iod:
The profuse, watery, acrid coryza that the drug produces serves as a sure guiding
symptom, especially when associated with pain in frontal sinus. Violent headache, Pain
intense over eyes and root of nose with severe pain. Facial neuralgia, Sneezing. Nasal
catarrh, involving frontal sinus. Stuffiness and dryness of nose, without discharge.
55
14. Lachesis:
Left sided chronic maxillary sinusitis. Nasal obstruction causing choking at night.
Highly offensive mucopurulent nasal discharge from left nostril. Some times discharge is
blood stained. Dryness of mouth during sleep.27 Stoppage of nose, as from an internal
Suits well when polyp and swollen turbinates are seen. It is useful in atrophic
discharge very abundant. Post-nasal dropping.23 Excessive catarrh with frequent sneezing
attacks.26
Frontal sinusitis, pain worse at night with nasal obstruction. Fever associated with
sweat, chilliness, worse at night. Mist, thickly coated indented tongue, foul breath, loose
offensive stool. Reddish eruptions all over the body with itching, worse from heat of
bed.27
Prescribed in chronic sinusitis with nasal obstruction, resulting in postnasal catarrh, the
Headache increases with sun. Bouts of sneezing and lachrymation. Pain worse
from reading, laughing and mental exertion. Chronic fronto-maxillary sinusitis with
56
supra-orbital headache, commencing in the morning around 9-10 am.27Violent, fluent
coryza lasting from one to three days. Sinus headache, especially right sided.21
20. Nuxvomica :
sneezing, running nose, mucoid discharge with sinusitis, nasal obstruction. Stuffy cold,
worse in morning.27
21. Psorinum:
Drawing pain extending up to frontal sinuses, with pain in eyes as if coryza would
set in, then discharge of fluid from nose. Dry coryza; nostrils nearly dry, and sensitive
when breathing through them. Scratching crawling towards root of nose as if coryza
22. Pulsatilla:
type of pain. Thick, purulent, greenish yellow catarrh. Low grade fever with chilliness
and thirstlessness. Nasal obstruction, worse indoors and better in open air. Found useful
pressing pain at root of nose and loss of smell. Stoppage in evening, yellow mucus;
57
23. Rhustox :
getting wet in rain. Pain in supra- orbital or paranasal region, associated with malaise,
24. Sabadilla :
Spasmodic sneezing with running nose. Copious watery discharge, drops oozing
from the tip of the nose, sneezing, running of the eyes with redness.21Itching and
irritation in nasal passage. Warmth in general, hot food, hot drinks, gives relief. Acute
especially of the respiratory tract. Sudden stopping of catarrh of respiratory tract followed
by diarrhoea. Worse right side, sun headache. Hay-fever,ozaena, with profuse, offensive
yellowish discharges. Nasal polypi. Chronic rhinitis; membrane dry and congested.25
26. Sepia:
Thick, greenish discharge; thick plugs and crusts. Atrophic catarrh with greenish
crusts from anterior nose and pain at root of nose. Chronic nasal catarrh, especially post-
nasal, dropping of heavy, lumpy discharges; must be hawked through the mouth.23
27. Silicea:
Chilly patient. Pain begins at occiput, and spreads over head and settles over
eyes.25 Sneezing in morning. Itching at tip of nose. Nose, dry obstructed with loss of
smell.23Cannot do with out covering the head. Uncovering the head aggravates catarrhal
symptoms and those pertaining to head. Icy coldness of hands and feet.27
58
28. Sulphur:
Acute sinusitis with pain and dryness of throat, thirst for cold water, feverish,heat
in body, burning pain in eyes, palms, and soles., flushes of heat from face. Chronic
sinusitis without any discharge from nose, burning sensation in palms and soles. Pain in
29. Thuja:
Dry coryza, which becomes fluent in open air, with continued headache. Fluent
coryza, with cough and hoarseness. Greenish and fetid discharge from the nose. Blowing
from the nose of a large quantity of thick green mucus, mixed with pus and blood; later of
dry, brown scales, with mucus, which comes from the frontal sinuses. Accumulation of
30. Tuberculinum:
Sensitive to cold yet desires cold open air. Least exposure to cold ,even walking
bare foot on cold surface precipitates sinusitis. Sinusitis associated with vertigo, irritation
in throat, dry cough, rhinitis and sneezing. Worse from change of weather.27
REPERTORIAL APPROACH:
Boeric’s Repertory:
NOSE - Sinuses - Affections in general: ars. Asaf. aur. bell. calc. camph. eucal. Hep.
Iod. kali-bi. Kali-i. kali-m. lyc. merc. Merc-i-f. mez. ph-ac. Phos. Sil. spig. Stict. teucr.
- Catarrh of frontal sinuses : ammc. ign. iod. Kali-bi. Kali-i. lyc. mentho. merc-i-f. nat-
59
Murphy’s Repertory
Nose - SINUSITIS, infection - catarrh, sinuses - extending to, antrum: berb. kali-c.
-infection - headache, from sinus catarrh : acon. aesc. All-c. Alum. am-m. ambr. Ars.
Ars-i. Aur. bell. Bry. Calc. CALC-S. camph. Carb-v. carbn-s. caul. cham. chin. chinin-ar.
Chlor. cic. cimic. cina DULC. EUPHR. Ferr. Ferr-ar. ferr-p. Gels. GRAPH. gymno.
hell. HEP. HYDR. ign. Iod. Kali-ar. KALI-BI. Kali-c. KALI-I. Kali-s. kalm. Lach.
laur. Lyc. Mang. MED. MERC. merc-i-f. mez. nat-act. Nat-m. NUX-V. Phos. Puls. ran-
b. rumx. sabad. samb. sang. sil. staph. Stict. still. Sulph. teucr. THUJ.
-from sinus catarrh - coryza, in : Ars. calc-p. cimx. Kali-i. Sil. Stict.
- chronic : aur. calc-f. elaps fago. Hydr. KALI-BI. kali-c. med. merc-c. pen. sep. Spig.
-infection - frontal sinuses :Ars. berb. bry. Calc. Cupr. ferr. HYDR. KALI-BI. Kali-chl.
Kali-i. LYC. MERC. merc-i-f. Nux-v. PULS. Sang. SIL. stict. THUJ. verb.
-infection - post-nasal, catarrh : acon. aesc. Alum. alumn. ant-s-aur. Arg-n. Aur. aur-m.
bar-c. bry. Calc. Calc-s. Canth. caust. cinnb. Cor-r. euphr. Ferr. FERR-P. HEP. HYDR.
Iod. KALI-BI. Kali-c. Kali-chl. Kali-i. kreos. lith-c. Lyc. mag-s. Manc. Mang. MED.
Merc-i-f. Merc-i-r. Merl. Mez. nat-act. NAT-C. NAT-M. Nat-s. Nit-ac. petr. phos. Phyt.
Plb. PSOR. Rhus-t. sang. Sel. SEP. Sil. spig. staph. Ther. THUJ. zinc.
-– acute :Acon. camph. cist. gels. kali-bi. mentho. Merc-c. nat-act. wye.
60
– chronic :aur. calc-f. elaps fago. Hydr. Kali-bi. kali-c. merc-c. pen. sep. Spig. Stict.
sulph. thuj.
- mucus, with dropping of :Alum. am-br. ant-c. ars-i. aur. calc-sil. Cor-r. echi. glyc.
Hydr. irid-met. Kali-bi. kali-m. lem-m. merc-i-r. nat-c. Pen. Phyt. Sangin-n. sin-n. Spig.
- mucus congestion - catarrh, sinuses, of : Cupr. ferr. hep. Hydr. KALI-BI. Kali-chl.
Kali-i. kali-m. kali-s. lach. LYC. med. MERC. merc-i-f. Nat-m. nat-s. Nux-v. Puls. Sang.
- BURNING, pain - post nasal:Aesc. arg-n. Cist. crot-t. Kali-bi. Merc-i-r. phos.
- INFLAMMATION, nose - post nasal, acute :Acon. camph. cist. gels. kali-bi. mentho.
-Chronic:aur. calc-f. elaps fago. Hydr. Kali-bi. kali-c. merc-c. pen. sep. Spig. Stict. sulph.
thuj.
-chronic - mucus, with dropping of : Alum. am-br. ant-c. ars-i. aur. calc-sil. Cor-r.
echi. glyc. Hydr. irid-met. Kali-bi. kali-m. lem-m. merc-i-r. nat-c. Pen. Phyt. Sangin-n.
- coughing : Carb-v.
- swallowing : Carb-v.28
61
Synthesis repertory
NOSE - SINUSES; complaints of: ars. cinnb. cloth. cot. fl-ac. hecla helodr-cal. hep.
hippoz. Hydr. kali-bi. kali-c. Kali-i. kali-n. lac-f. lach. lob. merc-c. morg-g. olib-sac.
FACE - PAIN - Sinuses – Frontal : Bell. kali-bi. kali-c. sang. sil. spig.
FACE - COMPLAINTS of face - Maxillary sinuses: aur. chr-ac. cist. jug-r. kali-bi. sil.
symph.
- PAIN - Sinuses – Maxillary : anh. arn. aur. bamb-a. Bell. chel. com. hecla hep. Kali-bi.
kali-i. kali-s. mag-c. merc. merc-c. mez. puls. pyrid. sil. syc.
Asaf. aur. aur-m. aur-m-n. bell. berb. Calc. calc-f. calc-s. camph. carb-ac. carc. caust.
cinnb. cor-r. cupre-l. distemp-vc. dulc. elaps eucal. euph. fl-ac. hecla Hep. Hydr. ign.
influ. Iod. Kali-bi. kali-c. kali-i. kali-m. kali-n. kali-s. lac-c. lob. luf-op. lyc. mag-c. mag-
f. mag-m. med. Merc. Merc-i-f. mez. morg-g. morg-p. mucoc. mucot. nat-m. nat-ox-act.
nat-s. nit-ac. nux-v. oscilloc. penic. ph-ac. Phos. prun-v. puls. pyrog. sal-fr. scut. sep.
- Chronic: carc. Cist. hed. Kali-bi. kali-n. Med. merc-k-i. oscilloc. penic. psor. Sil. thuj.
62
- Menses – during : am-c.
- suppressed: scut.
- Polysinusitis: sil.
Boger Boenninghausen’s.
- frontal - ars-i. asaf. aur. bell. calc. Cinnb. Hep. Hydr. iod. kali-bi. Kali-i. lyc. Merc. nat-
- turbinates : Ail. alum. ant-c. Aral. iod. kali-i. Rumx. spig. Zing.30
Kent repertory
HEAD,PAIN, forehead, middle frontal sinuses from chronic coryza : Ars., kali-bi.,
NOSE,CATARRH, extends to frontal sinuses : Ars., berb., bry., calc., cupr., ferr., kali-
bi., kali-chl., kali-i., Lyc., merc-i-f., Merc., nux-v., puls., sang., Sil., stict., thuj., verb.
-CORYZA, extending to frontal sinuses : Ars., calc-p., cimx., kali-i., sil., stict.
Pathak
N - Nose – sinuses - cinnb. hydr. kali-bi. kali-i. lach. merc. phos. syph.
63
HOMOEOPATHIC POSOLOGY:
“The use of the medicinal solution is an art as a science.” “It is wrong to attempt to
In homoeopathic practice, the selection of the proper remedy is probably the most
essential thing, but after the remedy has been selected and administered in the proper
potency, the homoeopathic physician should be able to watch out for, understand and
interpret the remedy reaction and should know the proper "period for repeating the
dose".33
The three essential elements of the homoeopathic system are the principle, the
remedy, and the dose.34 Homoeopathic Posology is based on the trinity of the principles
of the single simple remedy, minimum dose and minimum intervention. A homoeopathic
dose necessarily means the particular preparation of medicine, the quantity and form of
potency, dispensing (quantity and form) and repetition of the dose of the medicine.9
The proper dose is always the least possible dose which will effect a cure –
Hahnemann.34
Homoeopathic dosage is based upon law, as is the selection of the remedy based
upon the law of similars “action and reaction are equal and opposite”. This is
fundamental and it is this law that must guide us in the application of drugs.35
64
4. The stage and duration of the disease.
susceptibility in a patient before he selects the right potency. Any error in this is
individual to a remedy at different times also varies. The more similar the remedy, the
more clearly and positively the symptoms of the patient take on the peculiar and
characteristic form of the remedy, the greater the susceptibility to that remedy, and the
Jahr states- An essential difference between the action of the low and high potencies,
which consists, not in their strength or weakness, but in the development of the
peculiarities of the remedy, as we rise in the scale of potencies. Jahr also says the higher
vigorous persons, and diminishes with age. Children are particularly sensitive during
development, and the most sensitive organs are those which are being developed.
Therefore the medicines which have a peculiar affinity for those organs should be given
are best adapted to sensitive persons of the nervous, sanguine or choleric temperament; to
65
intelligent, intellectual persons, quick to act and react; to zealous and impulsive persons.
Lower potencies and larger and more frequent doses correspond better to torpid and
phlegmatic individuals, dull of comprehension and slow to act; to coarse fibred, sluggish
individuals of gross habits; to those who possess great muscular power but who require a
powerful stimulus to excite them. When ill they often require low potencies or even,
the power of the organism to react, even to the indicated homoeopathic remedy, may
long and severe labor out-of-doors, who sleep little and whose food is coarse, are less
medicines and usually require low potencies in the illnesses, except where their illness is
directly caused by some particular drug influence, when a high potency of the same or a
similar drug may prove to be the best antidote. Idiots, imbeciles and the deaf and dumb
i. Certain malignant and rapidly fatal diseases like cholera etc., may require material
66
ii. Diseases characterized by diminished vital reaction require the lower potencies;
At one stage of the disease when the vital reaction is low, the patient may need a low
In some cases due to abuse of many drugs in crude doses the patient seems to lose
all susceptibility for the time being. In such conditions it is advisable to cease all
medication for a few days and carefully regulate the diet and regimen. Then medication
can be started again according to the other factors, either a low or medium potencies.37
Certain Guidelines:
1. The closer the similarity a remedy bears to the picture presented by the patient,
the higher is the potency, provided no specific contra- indications to the use of
3. With remedies that are inert in the crude state, higher potencies give better results.
4. A potency which has helped a patient in the past should not be lightly changed;
5. In chronic cases when the highest potencies have been tried with progressively
decreasing responses, the 30th potency repeated to the point of reaction works
satisfactorily.
67
6. When a remedy is prescribed on poor indications or only for a particular effect,
the potency that acts best is the one in the lower range, at times even the mother
tincture. For this purpose, potencies beyond 30 should not ordinarily be used.
7. In acute illness affecting vital organs a differing response is seen according to the
potency employed :
Sensitivity:
It is an inherent capacity in all living things to react to stimuli in the environment at the
level of mind and nerves. It is assessed by the intensity and presence of characteristics at
both these levels. This can also be studied from the patient’s tendency to react (mentally
and physically) to the distress produced by the illness and the data can be obtained
through study of intensity of symptoms and the understanding of the mental state and
level of mind and nerves; will require high potency in infrequent doses. Moderate
mind and nerves; will require moderate potency in infrequent doses. Low sensitivity is
68
REPETITION
customary doses and repeated them at usual intervals, i.e. once or twice daily etc. But he
soon faced severe aggravation produced by the large doses of drugs. A few years later he
arrived at a conclusion, that “the repetition of the doses is regulated by the duration of
action of each medicine. He also realized that too frequent doses result in the production
Later he considered that drugs may act for days, weeks or months. In the first edition
of Organon of medicine in 1810, he had stated that the improvement of the patient might
continue after the remedy had ceased to act. If the medicine is repeated within this time it
will produce an aggravation. Thus he advises that no repetition until the improvement
ceases. This rule remains unchanged up to 4th edition of Organon of Medicine in 1829.
In 1833, in the 5th edition of Organon these ideas again changed. In aphorism 246
he states that “the minutest and powerfull dose of the best selected remedy can be
repeated at suitable intervals” in general it states that in acute disease drugs may be
repeated in every 1-24 hours and in chronic diseases every 7-14 days.
In 1838, he again changed his opinion on repetition. He then stated that medicine
should be given in every 2-6 hours in acute disease, depending upon the intensity of the
In 1842, in the sixth edition of Organon, he made a great deviation from the
previous directions. In this edition he advises repetition of doses even several times daily
to cure chronic diseases, by changing the degree of potency and increasing it somewhat
69
To Hahnemann the repetition of dose was a subject of constant revision.39
4. The only indication for repetition is the return of the symptoms that have
1. Acute cases: the action of a remedy is known to exhaust early; therefore, frequent
2. Chronic cases: single dose stimulation should be rule. Multiple dose stimulation
either on the same day or on consecutive days – should be reserved for cases in
Dr. Kent says that hasty & indiscriminate administration of the correct remedy spoils
The early repetition of the medicine and the continued giving of the same medicine
will prevent anything like an opportunity for the making of a second prescription.
The second prescription pre-supposes that the first one has been a correct
one, that it has acted, and that it has been let alone. In such a case when the symptoms
return, when the patient has the same generals and particulars as formerly, it means
that the first prescription was a good one, that the case is curable, and that the second
70
SANKARAN.P’S VIEW:
In acute cases, the frequent repetition of doses, even of high potencies, seems to
In chronic diseases, there are two standard procedures. In one, repeated doses of a
low potency of the remedy are given till the patient is cured. In the other, a single
dose of high potency is administered and then a wait follows till its action is over,
Placebo being given in the meanwhile. The frequent repetition of low potencies in
It is an absolute rule that when favorable reaction sets in the administration of the
remedy must cease. The rule here is never repeated or change the remedy while the
patient him self is improving. When the improvement has apparently ceased in acute
diseases you may need to repeat the same remedy in the same or a higher potency,
but you must be sure that the cessation of improvement is not due to the emotional,
symptoms.
The only true guide to the duration of action of any remedy in a given potency on any
The duration of action of a remedy which acts (and no other counts) varies, with the
nature and rate of progress of the disease. In acute diseases the action of the indicated
remedy might be exhausted in five or ten minutes and another dose be required at the end
of that time. In a slowly progressing chronic disease, the action of a dose of a curative
remedy might continue for two or three months. Between these two extremes are all
degrees of variation.
71
The only rule which can be laid down with safety is to repeat the dose only when
produced by it is sustained is good practice, but to attempt to fix arbitrary limits to the
In Aphorism. 245 Hahnemann gives this general rule: every new dose of medicine would
doses) "are always to be determined by the more or less acute course of the disease and
by the nature of the remedy employed. The dose of the same medicine is to be repeated
several times, if necessary, but only until recovery ensues, or until the remedy ceases to
produce improvement; at that period the remainder of the disease, having suffered a
The repetition of dose also depends on nature of the remedy means deep acting and
and organic), minerals, and nosodes have longer duration of action and, hence,
2. Short-acting remedy: Medicines obtained from vegetable and animal have shorter
duration of action and, hence, their repetition had been more frequent.42
72
A remedy shows its action.
The curative dose, like the remedy, must be similar in quantity and quality to the dose
Dr. Wolf:
3. Repetition at long intervals, after one dose has effected improvement and
Dr. Aegidi:
infrequent repetitions.
Dr. Hering:
for enhanced action and named it as "repetition in alternation". Dr.hahnemann had also
spoken about remedies like causticum, natrum muriaticum, and sepia which can be
73
repeated with some other drugs in between. Hering called it as "repetition after other
asked to repeat the drug after the cessation of curative action of the previous dose, he
named it as “renewal of the dose”. he has often observed that the second dose of the
“Dr. Attomyr:
He starts with the following example: a bottle of wine will intoxicate a man if he
drinks it all at once, but he may drink four bottle of wine at twenty times without being a
1. That two identical doses given in rapid succession mutually increased one
2. Two identical doses given at long intervals repeat the medicinal action without
increasing it.
3. If a small dose be given a short time after a large one it increases the action of the
latter.
4. If a small dose be given a long time after a large one it neither increases nor
5. If a large dose be given shortly after a small one the action of the latter is thereby
increased.
6. If a large doses be given a long time after a small one the action of the latter is
74
7. The repetition of the dose are to be determined by the age, sex, temperament of
the patient, the character and duration of the disease, and so forth.
Dr. Koch:
In his work “On Homoeopathy”, Dr. Koch puts forward the following
guidelines.
1. The more similar the medicinal agent, the less requisite is its repetition.
Repetitions in very small quantities not only do no harm, but, on the contrary, are
2. The less similar the medicine, the oftener must the dose be repeated.
3. The more extensive the morbid process, the oftener dose be repeated.
4. The more acute the morbid process, the more frequent, must be the repetition; the
more chronic the morbid process the more rare must be the repetition.
5. The more similar the medicine, the more hurtful is the repetition of large doses.
Dr. Griesselich:
He says it is impossible to give fixed rules for the repetition of the dose for all
cases; the characteristics of each case must be well considered, and must be our guide
upon the subject. he, absurd to speak of the duration of the action of a medicine, we can
As a rule, the intervals between the doses may be longer in chronic diseases, and shorter
in acute. In many cases the success of a well-chosen remedy may be destroyed by too
frequent repetition.
75
Dr. Trinks:
rooted disease. The rule Trinks gives for the period of the repetition is, that a second dose
should not be given until the improvement effected by the first becomes stationary; and
Dr. Arnold:
1. The smaller the dose sooner is the repetition required. A large doses may produce
2. The shorter the duration of action of a medicine is, the more rapid must be its
repetition; the longer its action, the slower must its repetition be. The duration of
diseases.
may run its course in a few hours in acute diseases, while it may last days in
chronic maladies.
3. The duration of the action of a medicine is different in the same person in health
and in disease. It is generally shorter in the diseased than in the healthy body.
The more rapid the course of the disease is, the more frequent must the
repetition be, and vice versa. In acute diseases the dose must be repeated till crises
4. When anything occurs to disturb or stop the action of the medicine administered,
76
Kent’s advise:
are most useful. In chronic cases, very high doses seldom require repetition, if clearly
R. Gibson Miller:
a single dose, and then wait least ten or fifteen days, before concluding that one dose is
Quinton: The 30’s which are “medium”, are of great use when appropriately
prescribed, and may in certain cases be repeated frequently, violent reactions with them
being rare. He has reasons for believing that ‘repetition’ lessens the tendency to
aggravation.
Dr. M.L.Tyler :
Tyler considered giving three doses at short intervals in ascending series as a single
dose. The aim of such practice was to stimulate the vital dynamic to produce antibodies
77
METHODOLOGY…
METHODOLOGY
Sources of Data:
The subjects required for conducting the study on sinusitis were selected from Out
Patient Department and the various peripheral centers of Father Muller Homoeopathic
A total number of 30 cases were screened after fulfilling the inclusion as well as
exclusion criteria and were followed for a minimum period of two to six months. The
diagnosis was made on the basis of strong clinical presentation, examination findings as
well as investigations.
days.
Inclusion criteria:
examination findings.
Exclusion criteria:
- The data was collected from patients by interviewing them and from clinical
examination.
- All the data were recorded in standardized case record (SCR) and out patient
78
- Once the data was recorded, it was processed as per the guidelines adapted in the
Homoeopathy.
- A remedy was selected for each case after referring Homoeopathic Materia
presentation of symptoms.
- After following up cases, the inferences were drawn by analysis of the outcome.
The method used in the study was a clinical method for confirmation and the results
obtained has been scientifically analyzed and evaluated. There were no controls used in
the study and all the patients were treated on out-patient basis. Investigations were not
done in any of the cases as the clinical history and the examination findings were
medica sources. The potency selection was based on standardized case format of Fr.
Muller Homoeopathic Medical College, ranging from 6c-1M (Centesimal scale) have
been used in this study. Potency regulation, mostly in ascending potencies and repetition
allopathic treatment or any other was used. Subjects who were already on conventional
79
therapy, were asked to discontinue the same. Placebo administration was done in some
cases.
Follow – ups:
Same potencies were repeated in some cases, and in some, it was raised to the
next higher potencies. Each case was followed up to a minimum period of two to six
months from the commencement of the treatment. A follow-up criterion was adapted for
Assessment of Effectiveness:
After following up the cases, assessment of the effectiveness of the treatment was
heaviness of head and associated symptoms like alteration of taste, fatigue etc.
findings were graded in every patient based on their presentation observed during
case taking. After completion of the study, the post treatment disease scores were
Data will be analysed by using descriptive statistics and the results will be
presented by using frequency table, percentage, diagram and graphs. The significance of
treatment effect based on drug source with optimum repetition was assessed from the
clinical status before and after treatment and was analysed by using ‘t’ test.
80
RESULTS…
RESULT
A total number of thirty cases were included in the study after screening as per the
inclusion criteria. They were followed for a period of minimum two to six months. These
cases were subjected to statistical study. The statistical analysis is given below:
In these thirty cases the maximum prevalence of sinusitis was noted in the age
group ranging between 15- 25 yrs, i.e. 13 cases (43.33%). The next higher group was in
0-15 yrs, 7 cases (23.33%). The following group consists of 25-35 yrs, had 5 cases
(16.66%). Other incidence age groups were 3 cases (10 %) in the age group of 35-45yrs,
and least incidence was seen in 45-55 age group, i.e. 2 cases (6.66%).
In these thirty cases, 13 cases (43.33%) were from Hindu religion, of which 3
to the Muslim religion, of which 4 cases(13.33%) were men and 7 cases(23.33%) were
women. 6 cases (20%) were of Christian religion, of which 1 case (3.33%) was male and
81
Distribution of cases according to Age & Sex
15
13 13
No. Of Cases
10
7
5 4 5 4
3 3
2 2
1 1 1 1
0 0
0-15 15-25 25-35 35-45 45-55
Age Group
Figure No. 6
10 10
7
No. of
5
c as es
5 4
3
1
0
Hindu Mus lim chris tian
R elig ion
Male F emale
Figure No.7
82
Table No 7: Distribution of cases according to Occupation:
labour ( including beedi rollers, welders), and 1 (3.33%) patient was unemployed.
In these thirty cases, the 16 cases (53.33%) belonged to the rural area, while the
83
Distribution of cases according to Occupation
20 16
No. of Cases 5 5 3 1
0
Housewife
Professionally
Manual labour
Unemployed
Student
employed
Occupation
Figure No.8
D is tribution of c as es ac c ording to
R es idential Area
14 16
Urban R ural
Figure No.9
84
In these thirty cases the maximum prevalence was noted as chronic sinusitis type,
which accounted for 25 of the total number of cases (83.33%). Acute sinusitis stood next
with 5 cases (16.66%). Among the cases 2 (6.66%) maxillary sinusitis, 1 (3.33%) frontal
observed.
In chronic sinusitis, frontal sinusitis was more prevalent with 10 cases (33.33 %),
followed by chronic maxillary sinusitis with 8 cases (26.66%). The prevalence of other
types of sinusitis were noted as follows: Fronto-maxillary sinusitis with 5 cases (16.66%)
and the least prevalent type of sinusitis was noted as ethmoidal sinusitis with 1 case
In all thirty cases the fundamental miasm were derived. All the cases were
classified under various miasmatic presentations. The fundamental miasm was Psora in 9
cases (30%), Sycotic miasm in 16 cases (53.33%), Syphilis in 2 cases (6.66%) and
Tubercular miasm in 3 cases (10%). The dominant miasm was Psora in 13 cases
85
D is tribution of c as es ac c ording to C linic al D iag nos is
Ac ute C hronic
10 10
8 8
No. Of C as es 6 5
4
2 1 2 1 1 1 1
0
Maxillary
F rontal
F rontal
E thmoidal
F ronto –
Maxillary
E thmoidal
T ypes Of S inus itis
Figure No.10
20
16 17
15 13
9
N o. Of
10
C as es
5 2 3
0
P s ora S ycos is S yphilis Tubercular
Mias m
86
Table No 11: Distribution of cases according to acute remedies used in the study:
A total number of 30 cases were studied, in which acute remedies were employed
in 15 cases (50%). Among these 4 cases (13.33%) required Kali-bich, 3 cases (10%)
required Bryonia and 2 cases (6.66%) cases required Pulsatilla. The remaining 6 cases
respectively.
87
D is tribution of c as es ac c ording to Ac ute R emedies
us ed in the s tudy
4 4
3 3
No. Of C as es
2 2
1 1 1 1 1 1 1
B ell
K ali – bic h
K ali – iod
Nat‐s ulph
A mmoniu
L emna –
B ry
P uls
Nux ‐v
minor
m‐phos
R emedies
Figure No.12
D is tribution of c as es ac c ording to
C ons titutional R emedies us ed in the
s tudy
10 9
6
No. Of
C as es
5
3
2 2 2 2
1 1 1 1
0
Nux –v
Nat – mur
S il
A rs – alb
C ac –c arb
K ali – c arb
S ep
S ulph
L yc
P uls
P hos
R emedies
Figure No.13
88
In all the thirty cases, constitutional remedies were prescribed, based on
i.e. 9 (30%) of cases and proved to be effective remedy in the treatment of sinusitis. Puls
was given in 6 (20%) of cases, Lyco was given in 3 (10%) cases. Ars alb , Silicea , Calc-
carb and Kali-carb were given to 2 cases ( 6.66%) each. Nux v, Sepia, Phos, Sulph were
Table No 13: Distribution of cases according to drug source used in the study:
Out of the thirty cases, in 12 cases (40%) minerals alone were used, of which 11
cases (36.66%) showed improvement and 1 case (3.33%) did not show improvement. In 7
cases (23.33%) plant remedies alone were used, and all the seven cases showed
improvement. More than one drug source was used in 11 cases (36.66%), in which, 3
cases acute mineral and constitutional plant remedies were used, and all the 3 cases
(10%) showed improvement. In 7 cases (23.33%), acute plant and constitutional mineral
were used, of which 6 cases (20%) improved, and 1 case (3.33%) did not improve. In 1
case (3.33%), acute mineral and chronic animal remedy were used and that case showed
improvement.
89
D is tribution of c as es ac c ording to D rug S ourc e us ed
in the s tu dy
Mineral
7 P lant
3
Mixed
11
7 A c‐ mineral
cons t‐ plant
12
A c‐ plant, cons t‐
1 mineral
A c‐ mineral,
cons t‐ animal
Figure No.14
22
4
H ig h Moderate L ow
Figure No.15
90
Table No 14: Distribution of cases according to Susceptibility:
Susceptibility No. of cases Percentage
High 4 13.3%
Moderate 22 73.33%
Low 4 13.33%
moderate.4 cases (13.3%) showed high and 4 cases (13.3%) cases showed low
susceptibility.
8 cases (26.6%) presented with high sensitivity and the remaining 2 cases (6.6%) showed
low sensitivity.
In 10 cases (33.33%), 200th potency alone was used and in 3(10%) cases ascending
potency, from 200th-1M was used. In 2 cases (6.66%) ascending potency, 6th-200th was
used, in 1 case (3.33%) 30th potency alone was used. In 1 case (3.33%) ascending
potency, from 30th-1M was used. Potency selection was based on the assessment of
91
D is tribution of c as es ac c ording to S ens itivity
7%
27%
66%
High Moderate L ow
Figure No.16
15 13
10
10
No. Of C as es
5 3
2
1 1
0
6‐200 30 30‐200 30‐1M 200 200‐1M
P otenc ies
Figure No.17
92
Table No 17: Distribution of cases according to repetition schedule employed in
acute remedies:
During the course of the study of the thirty cases, in 15 cases (50%) acute
remedies were given. Among the 15 cases, in 13 cases (43.33%) remedies were repeated
frequently, and all 13 cases improved. In 2 cases (6.66%) remedies were repeated
infrequently, and in these 2 cases, 1 case (3.33%) showed improvement and 1 case
(3.33%) did not improve. All these 15 cases were followed by contitutional remedies.
constitutional remedies:
During the course of the study, in all the 30 cases constitutional remedies was
cases did not improve. Employment of remedies was based on the assessment of
93
D is tribution of c as es ac c ording to R epetition
s c hedule employed in Ac ute R emedies
15 13 13
10
No. of
C as es
5 2 1 1
0
F requent In frequent
R epetition
Figure No.18
40
28 26
No. of
C as es
20
2 2 2
0
In frequent F requent
R epetition
Figure No.19
94
Table No 19: Distribution of cases according to duration of treatment:
In this study, 21 cases (70%) were followed for 2-5 months. Among these 15
(50%) were females and 6 (20%) were males. 6 cases (20%) were followed for 5-8
months. In this group 4 (13.33%) were females and 2 (6.66%) were males. 2 (6.66%)
female patients were followed for 8-11 months and 1 (3.33%) female patient was
Improved 28 93.33%
showed no improvement.
95
D is tribution of duration of T reatment ac c ording to S ex
25
21
20
15
No. Of C as es
15
10
6 6
5 4
2 2 2 1 1
0
2 to 5 5 to 8 8 to 11 11 to 13
Ag e G roup
Figure No.20
93%
7%
Improved Not‐improved
Figure No.21
96
Table No 21: Distribution of the scores before and after treatment:
97
Distribution of Disease intensity scores Before &
After the treatment
25
20
Treatment score
15
10
0
1 2 3 4 5 6 7 8 9 101112131415161718192021222324252627282930
No. of cases
Before After
Figure No.22
98
Question to be answered. Is there any difference between the scores taken before the
A. Null hypothesis: There is no difference between the scores before and after the
Homeopathic treatment?
Z = Mean difference
Σ Z = 356
Ż = Σ Z/n
= 356/30
= 11.8
Σ (Z – ż)2 = 265.3
SD = √Σ ( Z – ż)
2
/ n-1
= √265.3/ 30-1
= √265.3/ 29
99
= √9.14
= 3.02
= 3.02/ √30
= 3.02/5.47
= 0.55
D. Critical ratio
‘t’ = ż / S /√n
D
= 11.86/0.55
t = 21.56
This critical ratio, t follows a distribution with n-1(29) degrees to freedom. The
5% level is 2.045 and 1% level is 2.756 for 29 degrees of freedom. Since the calculated
value 21.56 is greater than tabled value at 5% and 1% level, we reject the null hypothesis.
Inference:
This study provides to say that, there is a significant reduction in the disease
100
DISCUSSION…
DISCUSSION
encountered in the common medical practice and patients seem to suffer more in spite of
prolonged treatment procedures in the modern medicine. These patients keep visiting
with the help of proper repetition and knowledge of drug source in management of
sinusitis.
The subjects were taken from the out patient department and the peripheral
Centers of Father Muller Homoeopathic Medical College and Hospital, as per the
A total number of thirty cases were selected randomly for the study and after
careful analysis, homoeopathic medicines were prescribed and the patients of all age
groups and of either sex were included in the study and were followed for a minimum
period of two to six months. The diagnosis was made on the basis of strong clinical
presentation. The statistical analysis made here is based on the data obtained from the 30
cases.
head, post nasal dripping, nose block, and coryza. There was a significant difference in
the incidence of sinusitis in both the sex. Out of 30 patients 22(73.33%) were females and
101
Maximum prevalence was noticed in the age groups of 15-25 years in which 13
cases (43.33%) were seen, and in the age group 0-15 years, 7 (23.33%) cases were seen.
Next prevalence was in the age group of 25-35 years with 5 (16.66%) cases, and other
incidence age group of 35-45 years with 3 (10%) cases. The least prevalence was noted in
cases and acute sinusitis in 5 cases (25%). Among the chronic sinusitis type, maximum
maxillary sinusitis seen in 8 cases (26.66%) and fronto maxillary sinusitis seen in 5 cases.
The least prevalent was ethmoid & pan sinusitis with 1 case (3.33%) each. Among the
acute types acute maxillary sinusitis was found to be maximum with 2 cases (6.67%). In
relation to the residence, 16 cases (53.33%) were found to be from rural area.
When the miasmatic analysis was done the sycotic miasm dominated the study in
17 cases (56.66%), and the next being psoric miasm which covered 13 (43.33%) cases.
cases received kali-bich and the next 3 cases (10%) received Bryonia. The maximum
number of remedies prescribed on the basis of constitutional approach were Nat-Mur for
9 cases(30%) and the next being Pulsatilla 6 (20%) cases. Here majority of the remedies
both in acute and constitutional aspects were minerals- Kali-Bich and Nat-Mur in 13
cases (43.33%), next highest in acute and constitutional aspects were plants- Bryonia and
sensitivity was moderate. If one looks at which potency was indicated then, 21 cases
102
constituting 70% of total cases were managed with 200th potency of which 10 cases
constituting 33.33% of total cases were managed with 200th potency alone, and 11 cases
(36.66%) were managed with 30th - 200th potency. Thus majority of the cases presented
with moderate susceptibility and sensitivity were given medium potency. This
observation may help in concluding that susceptibility and sensitivity play major role in
potency selection. But Susceptibility can be modified by many factors like age,
Susceptibility can also vary from time to time in the same person.
In total 30 cases, 15 cases were managed with acute medicines in acute phase.
Among these 15 (50%) cases, in 13 (43.33%) cases acute medicines were used in
frequent repetition and all the 13 (43.33%) cases showed improvement. In 2 (6.66%)
cases infrequent repetition was used, in which 1 (3.33%) case did not improve. In general
in acute conditions we have to repeat the similimum more frequently because the action
of a remedy is known to exhaust early as stated by many authors like, Stuart Close, M.L
remedies in acute phase; all these remedies repeated frequently and gained well
Mandal it is noted that “Medicines obtained from elements, compounds (inorganic and
organic ), minerals, and nosodes have longer duration of action and, hence , repeated
less frequently.” But in this study 100% of minerals were repeated frequently in acute
phase and obtained good results so it is in support of Elizabeth Wright’s view , “The only
103
true guide to the duration of action of any remedy in a given potency on any patient is the
All the 30 cases were managed with constitutional medicines. Among these
cases, 28 (93.33%) cases were managed with infrequent repetition in which 17 (56.66%)
cases with minerals, with plants 10 (33.33%), with animal source 1 (3.33%). 2 (6.66%)
cases were managed with frequent repetition both with mineral remedies. The duration of
action varies according to the potencies. It also depends on susceptibility, sensitivity, seat
of the disease, nature and intensity of the disease, the stage and duration of the disease
In one of the 30 cases Pulsatilla 200th potency, 1 dose was prescribed for
susceptibility and sensitivity. In further 3 months follow ups no medicine was given
except placebo. Patient showed 80% improvement. But according to available literature,
“Medicines obtained from vegetable and animal sources have shorter duration of action
and, hence, their repetition is to be more frequent”. Now it is clear and supports Dr.
Griesselich words “It is impossible to give fixed rules for the repetition of the dose for all
cases, we can only speak properly of the duration of the action of a dose but not to speak
duration of action of a medicine.” Also Stuart Close states “To allow a dose, or a remedy
attempt to fix arbitrary limits to the action of medicine, as some have done is contrary to
experience”.
Of the total 30 cases, minerals were used in 12 (40%) cases alone, among those
104
The curative result after the study, 28 cases (93.33%) showed improvement and 2
condition and presenting complaints was seen in majority of the patients. A disease
intensity scoring was done to evaluate improvement, taking the symptom as parameters
before and after treatment. Most of the symptoms were relieved completely. From this
study with the above results, it clearly indicates that Homoeopathic remedies are very
effective in the treatment of sinusitis, and minerals are more effective in sinusitis cases.
105
LIMITATIONS
1. The number of cases taken for the study was limited (30 cases), hence conclusions
3. Selections of cases were difficult since many cases were irregular in reporting and
4. There was no control group since the sample size was small.
5. In some cases necessary information was lacking and the study was conducted
6. Investigations like PNS and rhinoscopy were not done in all the cases. The
7. The assessment scales may not be foolproof, human errors are possible.
RECOMMENDATIONS
1. Bigger sample size, with extended time of study would provide better result.
3. Improved scales can be used, so that evaluation of outcome of the study would
106
CONCLUSION…
CONCLUSION
A total number of thirty cases were taken up randomly for the study which
included statistical analysis. Conclusion was arrived after a statistical analysis and
interpretation of patients suffering with sinusitis. The following conclusions are drawn
1) The prevalence of sinusitis is more among females 22 cases (73.33%) than males.
2) Majority of the patients belonged to the age group of 15-25 years 13 (43.33%).
3) Among clinical condition, chronic frontal sinusitis, ranked high i.e 10 cases
4) Incidence of sinusitis was more prevalent in rural residential area with 16 cases
(53.33%)
5) Sycosis was found to be the dominant miasm in the majority of cases of sinusitis
17 cases(56.66%).
10) Drugs belonging to mineral kingdom were found to be more effective in the
107
SUMMARY
SUMMARY
A total of 30 cases were selected for the study based on the inclusion and
exclusion criteria. Same group was used as control and intervention group.
Assessment of the susceptibility and sensitivity played major role in the selection of
108
BIBLIOGRAPHIC
REFERENCES…
BIBLIOGRAPHIC REFERENCES
1. Maqbool M. Text book of ear, nose and throat diseases.11th ed. New Delhi:
2. Dhingra PL. Diseases of ear nose, throat. 4th ed. New De Elsever India Private
3. De SK. Fundamentals of ear, nose, & throat diseases and head-neck surgery. 6th
ed. Culcutta: The new book stall; 1996. p.191, 260-64, 266-67,.272-73,277-78
4. Lt col Tuli. BS. Text book of ear, nose, and throat. Jypee brothers(p)ltd.2005.
p.186-193.
5. Likhachev.AG. Diseases of the ear, nose and throat. 2nd ed. Moscow :Mir
publishers.p.163-64,169.
7. Hathiram BT. Grewal DS. Ear, Nose, Throat simplified. Mumbai: Balani book
depot;1999.p.199-202
8. URL:http://www.sinuswars.com/preventions.asp
11. Banerjee DD. Augmented Textbook of homeopathic pharmacy, 2nd ed. B jain
109
12. Patil JD.Group study in homoeopathic materia medica.Reprint ed. New Delhi: B
14. Miller .GR . Relationship of remedies and sides of the bodies. New Delhi: B jain
16. Patel.RP.Cronic miasms in homoeopathy and their cure with classification of their
homoeopathic pharmacy.p.142,305,309,316.
17. Mandal.B. Miasmatic diagnosis in homoeopathy. 1st ed. Kolkata: New central
18. Speight P .A Comparison Of the Chronic Miasms. New Delhi .B. Jain Publishers
19. Banerjea SK. mismatic diagnosis Practical Tips with clinical comparisons.New
20. Allen.JH.The chronic miasms Psora & sycosis. New Delhi: B Jain Publishers ;( p)
ltd. p.189-91.
22. Allen H.C Keynotes and characteristics with comparision . New Delhi: B jain
110
23. Murphy R. Louts materia medica.2nd ed. New Delhi: B Jain Publishers (P)
ltd;2000.
24. Sivaraman P. Ear Nose Throat. New Delhi: B Jain Publishers (P) ltd;1997. p
25. Boericke W.Pocket manual of homoeopathic material medica and repertory. New
26. Clark JH.Dictionary of practical materia medica. New Delhi: B Jain Publishers
27. Clinical research studies series-1 central council for research in homoeopathy new
Delhi:2008. p. 118-120.
31. Kent JT. Repertory of the homoeopathic material medica. New Delhi: B Jain
medical publishers;2003.p.445-46
philosophy. Reprint ed. New Delhi B jain publishers (p) ltd;2004.p.184, 190-206.
111
35. Roberts HA. The principles and art of cure by homoeopathy. Reprint ed. New
publications;2004.p.431
trust;2003.p.103
40. Kent JT. Lectures on homoeopathic philosophy. Reprint ed. New Delhi B jain
41. Wright.E.A brief study course in homoeopathy. Reprint ed. New Delhi: B jain
42. Mandal PP, Mandal B. A text book of homoeopathic pharmacy. Howrah: New
43. Dudgeon RE. Lectures on the theory and practice of homoeopathy. New Delhi: B
44. Gunavante SM. Introduction to homoeopathic prescribing. 4th ed. New Delhi B
112
ANNEXURE…
ANNEXURE-1
Scoring Criteria
No 0
Mild 1
1 HEADACHE
Moderate 2
Severe 3
No 0
2 SNEEZING Occasional 1
Continuous 2
Absent 0
3 NOSE BLOCK Unilateral 1
Bilateral 2
No 0
Occasional white watery 1
4 NASAL DISCHARGE Continuous white watery 2
Occasional yellow thick 3
Continuous yellow thick 4
No 0
POST NASAL DRIPPING
5 Occasional 1
WITH HAWKING
Continuous 2
Absent 0
Each unilateral 1
SINUS INVOLVEMENT
6 Each bilateral (mild) 2
(TENDERNESS )
Each bilateral (moderate) 3
Each bilateral (severe) 4
7 TURBINATES / SEPTUM / Normal 0
POLYP Hypertrophied unilateral 1
Hypertrophied bilateral 2
113
Polyp 3
Deviated nasal septum 4
Absent 0
Present (mild) 1
8 FACIAL PAIN
Present (moderate) 2
Present (severe) 3
INVESTIGATION : Normal 0
X- RAY –PNS ANY Present – unilateral 1
OPACITY AND FLUID Present - bilateral 2
9
LEVEL ON THE SINUSES
(OR NORMAL / ANY Involvement of all sinuses 3
CHANGES )
Absent 0
Mild 1
10 HEAVINESS OE HEAD
Moderate 2
Severe 3
Absent 0
OTHER ASSOCIATED
Only weakness 1
COMPLAINTS LIKE
11 Weakness and body ache 2
WEAKNESS, BODYACHE,
Weakness, body ache and 3
AND FEVER
fever
Absent 0
12 EYE SYMPTOMS Watering of eyes 1
Pain in eyes 2
Absent 0
13 COUGH
Present 1
Absent 0
14 ALTERATION OF SMELL Present (anosmia) 1
Present (cacosmia) 2
114
ANNEXURE -II
Preliminary data
Religion: Hindu
Occupation: Student
Address: Kasargod
Chief complaints:
15 days, and earache. Headache started gradually at the age of 16 yrs, since then on and
115
off twice in a week. Headache is aggravated by exposure to sun, traveling, and loud
noise. Her menstrual complaint started 6 months back. Earache since one month.
Past history
Nothing Significant
Medication History
Family History
Mother: Migraine
Patient as a Person
Thirst: Less
Aversion: Nil
116
Menstrual function: F.M.P – 15 yrs , L.M.P – 17/2/8 cycle : 2/month, duration : 4 days ,
Dreams: unremembered.
Patient hails from upper middle class family. She has two sisters, elder sister got married
and working in a private sector. Another one sister is a twin sister of her and she
completed B.A and not married yet. Patient completed B.Com. her father is doing
agricultural business.
Childhood : Uneventful. She will be very mild and having more affection towards the
sisters and family. She was more attached to her grand father.
Reaction: she is very short tempered and as fast as she gets she will lose the anger also.
When she gets angry she shouts back and cries afterwards. Sometimes, she used to feel
bad about her mistakes in the past and broods on that. When she is very sad she feels
better by consolation by others. She likes to be with her friends and her family. If any one
contradicts or fight with her she usually gets angry, but maximum she tries not to
contradict back to the person. She doesn’t like quarrel or fight, and she usually avoids
that kind of situation. She is very religious in nature, she used to go temple daily and
Work: she is very anxious in taking any responsibilities, very much shaky in taking any
decisions. She always depends on somebody (parents) to take any decision. Her
117
confidence in taking up responsibilities is very low. She has very much fear of snakes and
darkness.
Memory: Good
Comprehension: Good
Performance: Average
Anger comes fast and goes fast, shouts back and weeps.
Reactions:
> Company3
< contradiction2
Vitals:
Temperature: Afebrile
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Respiratory Rate: 16/mins
Weight: 51 kg.
Systemic Examination:
Local examination:
General Management:
Repertorial result:
Mental generals:
Consolation amelioration
Affectionate
Weeping anger after
Timidity
Physical generals:
Lean, fare complexion
Appetite diminished
Thirstlessness
Desires open air
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Characteristic Particulars:
Pain in forehead stitching type of pain
Headache < sun exposure, noise accompanied by nausea
Heaviness of head < stooping
Analysis of repertorial result:
In reference to the knowledge in Materia Medica, after considering mental generals,
Constitutional remedy.
First prescription:
Dated: 03-03-08
2. No 2 pills 4- 4-4
120
Follow up criteria:
1. Appetite
2. Thirst
3. Menses
4. Nose block
6. Ear pain.
Repertorial Totality:
puls. phos. Nat-m. sulph. bell. nux-v. Caust. alum. bry. lach.
11/28 10/16 10/15 9/19 9/15 9/16 9/14 8/13 8/14 8/13
1 4 3 2 3 1 2 2 2 3 1
2 1 - 1 - 1 2 1 - - -
3 4 2 - - - - 1 - - -
4 3 2 2 2 3 2 2 1 1 1
5 1 2 1 3 - 2 1 1 1 1
6 3 1 2 3 1 - 1 2 2 2
7 1 1 1 1 1 1 2 3 - 2
8 3 1 1 1 2 1 1 - 1 1
9 3 1 1 2 1 2 - 1 1 -
10 3 1 2 2 3 2 - 1 3 3
11 2 2 2 2 2 2 3 2 2 2
121
Follow ups:
122
DATE SYMPTOM CHANGES PRESCRIPTION
1 2 3 4 5 6 7 8 9 10 RX
19/5/08 G G R >++ >.++ >++ 1. Puls 0 (2P)
Headache no recurrence H.S./weekly
Earache decreased 2. No ii pills
Appetite good 3-3-3 /1 month
O/E: tenderness in left maxillary sinus, enlarged
turbinates size decreased slightly.
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FR. MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL.
A. PROBLEM DEFINITION
Direct case taking was employed. Patient Recorded in the sequence of chief
was very co-operative and was sharing his complaints, emotional state, and reactive
problem active listening method was pattern. Life space investigation physical
employed. generals, past history and family history.
B. CORRELATIONS
124
6. HAHNEMANNIAN MIASMATIC PATHOLOGY: CURRENT
INTERPRETATIONS:
Fundamental miasm: Family History: Grand mother- Bronchial Asthma, Grand father-
T.B - Tubercular
125
D. PROBLEM STRUCTURALISATION:
P
R Mother patient family
Family = Patient
E Sister
D
FM : Tubercular
I Society = patient
Society = Patient DM : Psora - Sycotic
S
P SYPHILIS
Work = Patient O Work = Patient
S
D Does not involve any
I contradictory matter
MILD3
S like fight, likes to keep
Better by consolation P quit. TUBERCLE
M
Likes company O Daily goes to temple,
I RELIGIOUS3
Shy in nature S fear of god punish her
N
Contradiction does not I Very much with family
D
like T AFFECTIONATE friends
I
O WEEPY Cries on anger
N
B FAIR COMPLAXION Headache frontal
Appearance : lean
region
Perspiration : profuse
O Pricking type of pain
Carving : fried items
D SYCOSIS < sun, traveling, noise
Y Accompaniment :
DIATHESIS nausea, occasionally
D vomiting
PSORA I Pricking pain in ears
S
Maxillary sinusitis
E
Metrorrhagiea
A
PHASES S
E
126
E. PROBLEM RESOLUTION.
PROGRAMING:
Chronic maxillary sinusitis with acute exacerbation --- since constitutional medicine
also covering the acute totality, constitutional remedy was given. Medium potency was
PLACEBO ADMINISTRATION:
Placebo administration was done because patient was showing improvement by the
constitutional remedy.
REMEDY RESPONSE:
127
REMEDY REGULATION:
Depending upon the intensity, severity of the disease, remedies regulated according to the
criteria’s put up, spacing between the doses of the remedy increased as improvement
progressed.
PALLIATION: Nil.
SUPRESSION:
20. PROGNOSIS:
128
CASE-CONCEPT EXPOSITION
CLINICAL DIAGNOSIS:
Patient presented with headache forehead region pricking type, frequency twice in
a week, associated with nausea occasionally vomiting and earache. A/ F headbath < sun,
REMEDY DIAGNOSIS:
A. PROBLEM DEFINITION:
respiratory tract of 4year duration, with tenderness over the maxillary sinuses which
preventing the patient from daily activities and is not responding to the modern medicinal
management, she need a constitutional homoeopathic remedy to cure rapid, gentle and
permanently.
1. INTERVIEW TECHNIQUE:
Direct case taking was employed, rapport was good. No difficulty was
129
2. CLINICAL RECORD:
complaints and life space in details so that we will be able to come to a proper clinical
diagnosis and remedial diagnosis. Data was recorded on the basis of Chief complaints,
past history, family history, mental and physical generals and examination results were
B. CORRELATIONS:
CLINICOPATHOLOGICAL:
metaplasia, submucosa is infiltrated with lymphocytes and plasma cells and may show
membrane.
Fundamental Miasm: Family history: Grand mother: Bronchial asthma, grand father:
T.B - Tubercular
130
C. ANALYSIS AND SYNTHESIS: Patient had complaints of recurrent attack of
headache, ear pain, which is brought on headbath. Complaints are getting aggravated by
CHRONIC TOTALITY:
The case presented like mentals like anxious, sensitive, shy, weeping tendency,
RELATED TOTALITY:
TECHNIQUE: REPERTORIAL.
physical generals, and characteristic particulars long with the diagnosis, so that
management of case and constitutional remedy was selected with reference to Materia
medica.
D.PROBLEM STRUCTURALISATION:
To define and explain the patient as a whole, essential evolutionary totality was
fundamental miasm and dominant miasm are included. So management of case becomes
easier.
131
E. PROBLEM RESOLUTION:
PROGRAMING:
1. As the disease is a constitutional defect, which can not be brought in to a normal state
2. To arrest her recurrent attacks and try to modify her sensitivity and susceptibility
3. The remedy also covers the dominant miasmatic state. Therefore no separate
PLACEBO ADMINISTRATION:
For the psychological satisfaction as well as to control the remedy regulation placebo
REMEDY RESPONSE:
Gradual improvement of the symptoms and finally complete cure of the disease.
REMEDY REGULATION:
Considering the high sensitivity, susceptibility, sector involved and frequency of the
CURE:
Since in this case its mainly a constitutional defect as well as no structural changes, the
remedy selected is based on sector as well as the constitution cure was expected.
132
PROGNOSIS:
2. Role of detailed case taking to understand the patient as a person in chronic disease.
133
FATHER MULLER HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITAL
STANDARDISED PAPER IN HOMOEOPATHIC PRESCRIBING
MASTER ANSWER BOOK.
PHYSICIAN: DR. S.K.T/DR. R.S CASE REG. NO. 45756.
ACTION. REASONS.
I. CLINICAL A/F. headbath
DIAGNOSIS. Chronic maxillary Headache, heaviness, with nausea
sinusitis and earache, nose block
O/E: tenderness in maxillary
sinuses, hypertrophied turbinates.
II.PERCEIVING THE
TOTALITY.
1. ACUTE.
(a) Fixed general totality.
(b) Sector totality. Headache, heaviness
< sun, traveling,
noise, nose block,
earache, nausea.
2. CHRONIC. Chronic sinusitis, slow
(a) Dominant miasm. Sycotic progression with Enlarged
turbinates bilaterally.
(b) Acute exacerbation. Headache, These are the acute symptoms
heaviness, nose occur while getting exposure to
block, nausea, an allergens.
earache.
(c) Periodic expression.
(d) One sided expression.
(e) Suppression.
(f) Mixed miasm.
(g) Sequence.
(h) Drug affects miasm.
(i) Cause. Grandmother is suffering from
Fundamental. Tubercular bronchial asthma, grandfather
Precipitating. A/F. head bath suffered with T.B.
She is getting attack from
headbath.
(j) Aggravations. Sun, traveling, noise Modalities.
(k) Ameliorations. Nil
(l) Generals. Appearance-lean, General Appearance
Physical. Perspiration-↑sed
sed
Appetite-↓ Attributes
sed
Thirst-↓ , Desires
Open air.
Pathological. Headache with Pathological generals
heaviness, nausea,
134
Mental Mild, timid,
changeable, weepy,
<consolation,
contradiction Attributes.
intolérance,
affectionate.
135
IV. NON REPERTORIAL
APPROACH.
1. Structuralization.
2. Key Notes.
V. PLANNING AND Constitutional
PROGRAMING THERAPY. remedy covers this
1. Acute Remedy. also
Potency.
Repetition.
2. Chronic Remedy. Pulsatilla 200 Covers the Constitution.
Potency. H.S According to the sensitivity,
Repetition. Infrequent. susceptibility, and seat of disease.
3. Intercurrent RX. Constitutional
Potency. remedy covers this
Repetition. also.
4. Placebo. Given during follow For satisfaction of the patient.
up. Thrice per day.
VI. REMEDY RESPONSE. Good response as the The patient has shown a general
(a) Interpretation. patient was better in improvement in all levels and also
both general and at sector level suggesting that the
sector level. selected remedy was similimum
the patient is improved with
constitutional remedy.
(b) Action. Pulsatilla was given Improvement in both general as
as constitutional well as sector.
remedy
5. Purpose: Cure is possible As the disease is in functional
Reasoning. phase.
Expectations.
VII. GENERAL Importance of Homoeopathic Remedies in case of
COMMENTS. chronic sinusitis. So it can be interpreted that if the
remedy is similimum then constitutional problem can be
controlled with Homoeopathic Treatment.
136