RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA, BANGALORE.

ANNEXURE-II

APPLICATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE AND ADDRESS (IN BLOCK LETTERS)

DR.(MISS) THAIBEMA YENDREMBAMBHARATESH HOMOEOPATHIC MEDICAL COLLEGE & HOSPITALS AND P.G. RESEARCH CENTRE,BELGAUM-590016.KARNATAKA.

PERMANENT ADDRESSKWAKEITHEL, THOKCHOM , LEIKAI, IMPHAL- MANIPUR 795001

2. NAME OF INSTITUTION

BHARATESH HOMOEOPATHIC MEDICAL COLLEGE & HOSPITALS AND P. G. RESEARCH CENTRE, BELGAUM-590016.KARNATAKA.

3. COURSE OF STUDY & SUBJECT

M.D. (HOMOEOPATHY)ORGANON OF MEDICINE & HOMOEOPATHIC PHILOSOPHY

4. DATE OF ADMISSION TO COURSE

16-06-2010

5. TITLE OF THE TOPIC

“MIASMATIC INTERPRETATION OF SINUSITIS WITH ITS HOMOEOPATHIC MANAGEMENT ”

6. BRIEF RESUME OF INTENDED WORK:

6.1 NEED FOR STUDY

1. Sinusitis is the most common health complaints encountered by

physician. There are 24-31 million cases occurring per year all over the

world.

2. It usually occurred in age between 16 to 35 years. And most frequently

diagnosed as having sinusitis.

3. Sinusitis often associated with mixed infections i.e. viral, bacterial etc.

4. All types of sinusitis i.e. acute, chronic and sub acute having similar

presentations so very difficult to distinguish.

5. Affects the socio-economic status by hampering the work ability.

6. Comparing to the other systems of medicine, Homoeopathy has a wide

scope and particular approach in the treatment of sinusitis.

7. Homoeopathy is the holistic therapy and Homoeopathic management

can certainly ascertain positive results in cases of sinusitis.

8. The efficacies of various Homoeopathic remedies in sinusitis have

been proven by our masters and hence a miasmatic interpretation as

well as reportorial approach will definitely help in finding the right

similimum.

HYPOTHESIS:

Null Hypothesis: Homoeopathic management of Sinusitis with emphasis on

miasmatic interpretation is not effective.

6.2 REVIEW OF LITERATURE

Sinusitis is a common problem caused by acute or chronic inflammation

of the paranasal sinuses. The paranasal sinuses are aerated cavities in the bones

of the face that develop from the nasal cavity and maintain communication

with it. The main sinuses are the maxillary, the frontal, the ethmoid, and the

sphenoid sinuses. Maxillary sinusitis is the most common type of sinusitis. The

ethmoid, frontal and sphenoid sinuses are affected less frequently. 1

Classification: By Duration

Sinusitis can be acute (going on less than four weeks), subacute (4–8

weeks) or chronic (going on for 8 weeks or more). All three types of sinusitis

have similar symptoms, and are thus often difficult to distinguish. Acute

sinusitis is very common. Roughly ninety percent of adults have had sinusitis at

some point in their life.2

Acute sinusitis

Acute sinusitis is usually precipitated by an earlier upper respiratory tract

infection, generally of viral origin. If the infection is of bacterial origin, the

most common three causative agents are Streptococcus pneumoniae,

Haemophilus influenzae, and Moraxella catarrhalis. Until recently,

Haemophilus influenzae was the most common bacterial agent to cause sinus

infections. However, introduction of the H. influenza type B (Hib) vaccine has

dramatically decreased H. influenza type B infections and now non-typable H.

influenza (NTHI) are predominantly seen in clinics. Other sinusitis causing

bacterial pathogens include Staphylococcus aureus and other streptococci

species, anaerobic bacteria and, less commonly, gram negative bacteria. Viral

sinusitis typically lasts for 7 to 10 days, whereas bacterial sinusitis is more

persistent. Approximately 0.5% to 2% of viral sinusitis results in subsequent

bacterial sinusitis. It is thought that nasal irritation from nose blowing leads to

the secondary bacterial infection.

Acute episodes of sinusitis can also result from fungal invasion. These

infections are typically seen in patients with diabetes or other immune

deficiencies (such as AIDS or transplant patients on immunosuppressive anti-

rejection medications) and can be life threatening. With type I diabetes,

ketoacidosis causes sinusitis by Mucormycosis.

Chemical irritation can also trigger sinusitis, commonly from cigarettes

and chlorine fumes. Rarely, it may be caused by a tooth infection.1,3

Chronic sinusitis

Chronic, by definition, lasts longer than three months and can be caused

by many different diseases that share chronic inflammation of the sinuses as a

common symptom. Symptoms of chronic sinusitis may include any

combination of the following: nasal congestion, facial pain, headache, night-

time coughing, an increase in previously minor or controlled asthma symptoms,

general malaise, thick green or yellow discharge, feeling of facial 'fullness' or

'tightness' that may worsen when bending over, dizziness, aching teeth, and/or

halitosis. Each of these symptoms has multiple other causes. Unless

complications occur, fever is not a feature of chronic sinusitis.[citation needed]

Often chronic sinusitis can lead to anosmia, a reduced sense of smell. In a small

number of cases, acute or chronic maxillary sinusitis is associated with a dental

infection. Vertigo, lightheadedness, and blurred vision are not typical in

chronic sinusitis and other causes should be investigated.

Chronic sinusitis cases are subdivided into cases with polyps and cases

without polyps. When polyps are present, the condition is called chronic

hyperplastic sinusitis; however, the causes are poorly understood and may

include allergy, environmental factors such as dust or pollution, bacterial

infection, or fungus (either allergic, infective, or reactive). Non-allergic factors,

such as vasomotor rhinitis, can also cause chronic sinus problems.[citation

needed] Abnormally narrow sinus passages, such as having a deviated septum,

can impede drainage from the sinus cavities and be a contributing factor. A

combination of anaerobic and aerobic bacteria are detected in conjunction with

chronic sinusitis, including Staphylococcus aureus and coagulase-negative

Staphylococci. Typically antibiotic treatment provides only a temporary

reduction in inflammation, although hyperresponsiveness of the immune

system to bacteria has been proposed as a possible cause of sinusitis with

polyps (chronic hyperplastic sinusitis).

Attempts have been made to provide a more consistent nomenclature for

subtypes of chronic sinusitis. The presence of eosinophils in the mucous lining

of the nose and paranasal sinuses has been demonstrated for many patients, and

this has been termed Eosinophilic Mucin RhinoSinusitis (EMRS). Cases of

EMRS may be related to an allergic response, but allergy is not often

documented, resulting in further subcategorization into allergic and non-

allergic EMRS.

A more recent, and still debated, development in chronic sinusitis is the

role that fungus plays in this disease. Fungus can be found in the nasal cavities

and sinuses of most patients with sinusitis, but can also be found in healthy

people as well. It remains unclear if fungus is a definite factor in the

development of chronic sinusitis and if it is, what the difference may be

between those who develop the disease and those who remain symptom free.

Trials of antifungal treatments have had mixed results.1

Classification: By location

There are several paired paranasal sinuses, including the frontal,

ethmoid,maxillary and sphenoid sinuses. The ethmoid sinuses is further

subdivided into anterior and posterior ethmoid sinuses, the division of which is

defined as the basal lamella of the middle turbinate. In addition to the severity

of disease, discussed below, sinusitis can be classified by the sinus cavity

which it affects:

Maxillary sinusitis - can cause pain or pressure in the maxillary (cheek)

area (e.g., toothache, headache)

Frontal sinusitis - can cause pain or pressure in the frontal sinus cavity

(located behind/above eyes), headache

Ethmoid sinusitis - can cause pain or pressure pain between/behind the

eyes and headaches

Sphenoid sinusitis - can cause pain or pressure behind the eyes, but

often refers to the vertex, or top of the head

Recent theories of sinusitis indicate that it often occurs as part of a spectrum of

diseases that affect the respiratory tract (i.e., the "one airway" theory) and is

often linked to asthma. All forms of sinusitis may either result in, or be a part

of, a generalized inflammation of the airway, so other airway symptoms, such

as cough, may be associated with it.2

Signs and symptoms

Headache/facial pain or pressure of a dull, constant, or aching sort over

the affected sinuses is common with both acute and chronic stages of sinusitis.

This pain is typically localized to the involved sinus and may worsen when the

affected person bends over or when lying down. Pain often starts on one side of

the head and progresses to both sides.

Acute and chronic sinusitis may be accompanied by thick nasal discharge

that is usually green in colour and may contain pus (purulent) and/or blood.

Often a localized headache or toothache is present, and it is these symptoms

that distinguish a sinus-related headache from other types of headaches, such as

tension and migraine headaches. Infection of the eye socket is possible, which

may result in the loss of sight and is accompanied by fever and severe illness.

Another possible complication is the infection of the bones (osteomyelitis) of

the forehead and other facial bones - Pott's puffy tumor.

Recent studies suggest that up to 90% of "sinus headaches" are actually

migraines. The confusion occurs in part because migraine involves activation

of the trigeminal nerves, which innervate both the sinus region and the

meninges surrounding the brain. As a result, it is difficult to accurately

determine the site from which the pain originates. Additionally, nasal

congestion can be a common result of migraine headaches, due to the

autonomic nerve stimulation that can also cause in tearing (lachrymation) and a

runny nose (rhinorrhoea). A study found that patients with "sinus headaches"

responded to triptan migraine medications, but stated dissatisfaction with their

treatment when they are treated with decongestants or antibiotics.1,2

Complications

The close proximity of the brain to the sinuses makes the most

dangerous complication of sinusitis, particularly involving the frontal and

sphenoid sinuses, infection of the brain by the invasion of anaerobic bacteria

through the bones or blood vessels. Abscesses, meningitis, and other life-

threatening conditions may result. In extreme cases the patient may experience

mild personality changes, headache, altered consciousness, visual problems,

and, finally, seizures, coma, and possibly death.1,2

Causes

Factors which may predispose someone to developing sinusitis include:

allergies; structural abnormalities, such as a deviated septum, small sinus ostia

or a concha bullosa; nasal polyps; carrying the cystic fibrosis gene, though

research is still tentative; and prior bouts of sinusitis, because each instance

may result in increased inflammation of the nasal or sinus mucosa and

potentially further narrow the nasal passageways.

Second hand smoke is the cause of about 40% of chronic rhinosinusitis3.

Pathophysiology

It has been hypothesized that biofilm bacterial infections may account

for many cases of antibiotic-refractory chronic sinusitis. Biofilms are complex

aggregates of extracellular matrix and inter-dependent microorganisms from

multiple species, many of which may be difficult or impossible to isolate using

standard clinical laboratory techniques. Bacteria found in biofilms have their

antibiotic resistance increased up to 1000 times when compared to free-living

bacteria of the same species. A recent study found that biofilms were present

on the mucosa of 75% of patients undergoing surgery for chronic sinusitis.3

Diagnosis

Acute sinusitis

Bacterial and viral acute sinusitis are difficult to distinguish. However, if

symptoms last less than 7 days, it is generally considered viral sinusitis. When

symptoms last more than 7 days, it is considered bacterial sinusitis (usually

30% to 50% are bacterial sinusitis). Hospital acquired acute sinusitis can be

confirmed by performing a CT scan of the sinuses.4

Chronic sinusitis

For sinusitis lasting more than eight weeks, diagnostic criteria are

lacking. A CT scan is recommended, but this alone is insufficient to confirm

the diagnosis. Nasal endoscopy, a CT scan, and clinical symptoms are all used

to make a positive diagnosis. A tissue sample for histology and cultures can

also be collected and tested. Allergic fungal sinusitis is often seen in people

with asthma and nasal polyps. Examining multiple biopsy samples can be

helpful to confirm the diagnosis.

Nasal endoscopy involves inserting a flexible fiber-optic tube with a light

and camera at its tip into the nose to examine the nasal passages and sinuses.

This is generally a completely painless (although uncomfortable) procedure

which takes between five to ten minutes to complete.4

Sinusitis homeopathic understanding:

Miasmatic consideration:

Here we will have an overview of the manifestations of all the miasms in

sinusitis.

Psora:

Psora manifests the symptoms of functional disorders only. No structural

change can be seen in uncomplicated psora. All the ‘sensation as if’ and

characteristic symptoms especially concomitants belongs to psora.

Psora presents with morning constantly returning, persistent, usually frontal

headaches. These headaches grow worse as the sun ascends and decrease as it

descends. The headaches are sharp, severe paroxysmal. Usually frontal,

temporal, or temporo-parietal, sometimes on vertex. Headaches, which are

better by being quiet, rest or sleep. Headaches better by hot applications.

Headache from hunger.

The psoric cold begins with sneezing, redness, heat, and sensitiveness to

touch when blown for some time, discharge thin, watery and acrid. Epistaxis

more or less profuse or less frequent. Sensation of dryness in the nose,

troublesome even when the air passes freely. Senses of smell weak, loss.

Stoppage of one nose causes mouth breathing.5

Sycosis:

Sycotic manifestations are characterized by slowness of recovery. Sycosis

develops the catarrhal discharge. Pain in frontal or vertex at or after midnight.

Headaches of sycotic children are more common and are worse at night,

producing feverishness, restlessness, crying, fretting and worrying. Better by

motion. Headaches worse lying down and at night, especially after midnight.

The patient is restless and wants to be kept in motion, which ameliorates.

Headache worse riding, exertion either mental or physical. Headache usually

accompanied by sadness and prostration.

There is loss of smell. Nose clear one hour, the next he cannot get a

particle of air through his nasal passages. A red nose with enlarged capillaries.

Snuffles in children. This is usually moist and tere is no ulceration and no

crusts, or if purulent, is very scanty and has the odor of fish brine or stale fish.

The stoppage is due to local congestion and thickening of the membrane or

enlargement of the turbinate due to congestion. The discharge is yellowish

green, scanty or copious, thin mucous. Children from sycotic parents

complicated with gout, take cold easily at slightest exposure and frequently

suffer from acute coryza. Discharge from nose becomes copious, watery and

often excoriating. The slightest amount of discharge ameliorates.5

Syphilis:

The chief pathology of the syphilitic miasm will be destruction,

deformation, suppuration and ulceration. Degenerative changes are considered

as syphilitic. Headaches worse at night. They improve in the morning and

remain better all day until evening when they grow worse as the night

advances. Dull, heavy or lancinating, constant, persistent headaches. Usually

basilar or linear or one-sided. Headaches worse warmth, rest or while

attempting to sleep. Headache worse on lying down. Loss of smell. Snuffles in

children, ulceration, thick crusts often filling whole nasal cavity. The crusts are

dark, greenish black or brown, thick and not always offensive. Bones of nose

destroyed. Deposition of crusts in nose with offensive breath.5

Tubercular:

Headache occurring every Sunday or on rest days, worse riding in

carriages or are due to the least unusual ordeal, as preparing for examinations;

meeting with strangers and entertaining them. Headache with deathly coldness

of hands and feet, with prostration, sadness and general despondency.

Headache with red face and rush of blood to head, or at certain hours of the

day. Usually in the forenoon; headaches better by rest, quiet, sleep, eating, nose

bleed.

Dr. Phyllis Speight says that, “a tubercular or syphilitic headache will

often last for days and is very severe, often unendurable, sometimes with

sensation of bands about the head, cannot hold it up, and sometimes they

produce unconsciousness, rolling or boring of the head into the pillow, ocular

paralysis, with feverishness and restlessness or patient is stupid, dull or listless,

even semiconscious. Sometimes headaches are worse by heat. Amelioration by

cold is found in the syphilitic miasm. In the syphilitic or tubercular headache of

children, they strike, knock or pound their heads with their hands or against

some object. Great hunger before headache.

Headache better by nosebleed. Catarrhal discharge is thick, usually yellow

and of odor of old cheese or sulphate of hydrogen and in constantly dropping

down the throat.5

2. Dr. J. T. Kent in his Repertory of Homoeopathic Materia Medica has

quote following rubrics in relation to sinusitis: Nose, ozaena, in general; Nose,

pain, root; Nose, blow, constant inclination to; Nose, discharge, copious. Etc6

3. Dr. Ramanlal P. Patel in his Chronic miasms in homoeopathy and their

cure has quoted following in relation to sinusitis: Nose, pain, bones; Nose,

discharge, offensive, foetid; Nose, discharge, crusts, bloody; Nose, discharge,

purulent; etc7

4. Dr. Samuel Lilienthal in his therapeutic has explained various remedies

under the title of Catarrh of the nose, and Catarrh chronic naso-pharyngeal.8

6.3 OBJECTIVES

1. To study the Clinical Presentation of Sinusitis.

2. To study the miasmatic interpretation Sinusitis.

3. Efficacy of Homoeopathic Medicines in the treatment of Sinusitis.

7. MATERIAL AND METHODS:

7.1 Source of Data:

The subjects for the study will be taken from O.P.D./I.P.D. patients and

peripheral clinics of Bharatesh Homoeopathic Medical college and Hospital,

Belgaum.

7.2 Methods of Collection of Data (including sampling procedure, if any)

1. Patients will be selected on the basis of Inclusion and Exclusion

Criteria.

2. Patient will be seen at every fifteen days for first three months and

every month for a period of nine months basing on a particular case.

3. Sample size will be minimum 30 in number.

4. Cases will be followed for a period of 09 months duration.

5. Reference to Materia Medica and its collaboration to the reportorial /

remedial diagnosis will be done.

6. Therapeutic plan of management will be done for each individual case

following the Hahnemannian Principles.

7. All patients registered between the periods of june 15 th 2010 to 15th

Nov 2010, will be selected for study.

8. The case will be studied from Nov 2011 to Nov 2012.

Inclusion Criteria:

1. Patients of all age group, both sexes, and of all economic status are

taken for study.

2. Only the known cases of Sinusitis are taken for study.

3. Cases will be considered on the basis of severity of the symptoms of

Sinusitis.

Exclusion Criteria:

1. Cases associated with gross pathological changes.

2. Cases associated with Allergies like Asthma, Urticaria, Allergic

Rhinitis etc.

3. Age groups below 16 and above 45 years will not be included in the

study.

Result Criteria:

Recovered

Improved

Not improved

7.3 Does the study require any investigation or intervention to be

conducted on

Patients or other humans or animals? If so, please describe briefly.

The diagnosis of the case will be done on the basis of the case history

and clinical findings, and also the specific investigations will be done as per the

demand of the case. Following investigations will be done.

1. Haematological – CBC, ESR.

2. Radiograph – X – ray.

3. C.T. Scan.

4. Bacteriological – blood culture, smear of nasal secretions.

5. Nasal Endoscopy.

7.4 Has ethical clearance been obtained from your institution in case of

7.3?

YES, ethical clearance has been obtained from the institution.

LIST OF REFERENCES:

1. Bhargava K.B., Bhargava S.K., Shah T.M., “A Short Text Book Of

E.N.T”. 8th edition, may 2009, Usha publications, Gopal Bhuvan,

Mumbai, 194 pp.

2. Dhingra P.L., “Diseases of Ear, Nose, and Throat” third edition,

Elsevier, a division of Reed Elsevier India Pvt. Ltd, 234 pp.

3. http://en.wikipedia.org/wiki/Sinusitis

4. http://www.webhealthcentre.com/DiseaseConditions/

sinusiti.aspx#introduction#introduction

5. http://homeoresearch.blogspot.com/2010/01/sinusitis-homeopathic-

understanding.html

6. Kent J.T. “Repertory of Homoeopathic Materia Medica and a Word

Index”. Reprint edition, 2001, New Delhi, B.Jain Publisher, Pvt. Ltd,

324, 330, 343, 344 pp.

7. Patel Ramanlal P., “Chronic Miasms in Homoeopathy and Their Cure

with Classification of Their Rubrics/Symptoms in Dr Kent Repertory”.

310, 311, 321 pp.

8. Lilienthal Samuel, “Homoeopathic Therapeutics”. Reprint Edition,

2000, New Delhi, B.Jain Publisher, Pvt. Ltd, 131, 139 pp.

9. SIGNATURE OF CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME & DESIGNATION OF (IN BLOCK LETTERS)11.1 GUIDE

DR. RAMADAS AMBUGAPROF. & GUIDE, DEPT. OF ORGANON OF MEDICINE & HOMOEOPATHIC PHILOSOPHY,BHARATESH HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL, P.G. RESEARCH CENTRE, BELGAUM-590016

11.2 SIGNATURE

11.3 CO-GUIDE

11.4 SIGNATURE

11.5 HEAD OF DEPARTMENT

DR. RAVINDRA NADANPROF. & GUIDE, DEPT. OF ORGANON OF MEDICINE & HOMOEOPATHIC PHILOSOPHY, BHARATESH HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL, P. G. RESEARCH CENTRE, BELGAUM-590016.

11.6 SIGNATURE

12. 12.1 REMARKS OF CHAIRMAN & PRINCIPAL

DR. S. B. KONKANIPRINCIPAL,BHARATESH HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITALS, P. G. RESEARCH CENTRE, BELGAUM-590016.

12.2 SIGNATURE