Rajiv Gandhi University of Health Science, Karnataka, Bangalore Annexure Ii

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCE, KARNATAKA, BANGALORE ANNEXURE II

APPLICATION FOR THE REGISTRATION OF SUBJECT FOR DISSERTATION

1 / NAME OF THE CANDIDATE ADDRESS / DR. SAVITA D. KORI
PRESENT ADDRESS
DR. SAVITA D. KORI
H. NO. 1792/1, JED GALLI,
SHAHAPUR, BELGAUM.
PERMANENT ADRESS / DR. SAVITA D. KORI
D/O SHRI D. M. KORI
H.NO. 1792/1, JED GALLI, SHAHAPUR, BELGAUM.
2 / NAME OF THE INSTITUTION / BHARTESH HOMOEOPATHIC MEDICALCOLLEGE AND HOSPITAL, BELGAUM – 16.
3 / COURSE OF STUDY AND SUBJECT / DOCTOR OF MEDICINE (HOMOEOPATHY)
ORGANON OF MEDICINE AND HOMOEOPATHIC PHILOSOPHY
4 / DATE OF ADMISSION TO COURSE / 01-06-2008
5 / TITLE OF TOPIC / “THE CONSTITUTIONAL APPROACH IN THE MANAGEMENT OF ADENOIDS”.
BRIEF RESUME OF INTENDED WORK
6.1NEED FOR THE STUDY :
Adenoids are glands situated at the junction of the roof and posterior wall of the nasopharynx and also act as defense organs. But if they become enlarged, they can cause severe obstruction to breathing, so much so that the person is forced to breathe through the mouth. Keeping the mouth open, slowly causes the lower jaw to protrude.
Enlarged adenoids are a concern in young children as they can be major source of recurrent infections like sore throat, middle ear infections and sinusitis and form a bulk of padietric cases in day to day practice.
The conventional system of medicine recommends surgery as a solution for enlarged adenoids, but it is not a definite solution to the problem as it prevents the Upper Respiratory Tract Infections but paves way for recurrent lower respiratory tract infections.
In such a commonly occurring condition, “the constitutional approach in the management of adenoids”, plays a significant role, wherein not only the adenoids, but the overall growth of the child is taken care of.The constitutional approach in management of any disease has a totalistic approach, where in not only the local affection but also the individual as a whole is treated. Such a holistic, totalistic approach, especially in a growing child will furnish his overall growth and is a permanent, gentle cure for this recurrent infection. Moreover the adenoids are an integral part of the immune mechanism, which enhance the body’s resistance to fight recurrent infections. Thus the constitutional approach offers a coveted solution to treat the enlarged adenoids and thus save the little one’s from the surgeons knife.
The present study, “The constitutional approach in the management of adenoids” is an earnest attempt to study the role of Homoeopathy in such a common condition.
Null Hypothesis: The constitutional approach in the management of adenoids may have unfavourable result.
6.2REVIEW OF LITERATURE:
Definition :When hypertrophied nasopharyngeal tonsils start producing symptoms the condition is called as adenoids.The normal involution of the nasopharyngeal tonsils starts from the onset of puberty but sometimes it can persist for a longer period.1
Anatomy and physiology of adenoids: The nasopharyngeal tonsils, commonly called “adenoids” is situated at the junction of the roof and posterior wall of the nasopharynx. It is composed of vertical ridges of lymphoid tissue separated by deep clefts and covered by ciliated columnar epithelium. Adenoids have no crypts and no capsule. Adenoid tissue is present at birth, shows physiological enlargement up to the age of six years, and then tends to atrophy at puberty and almost completely disappears by the age of twenty years.2
Aetiology: adenoids occurs usually between the age of 3 years and 10 years they may be present earlier also. The hypertrophy of the nasopharyngeal tonsil is physiological but it is considered to be unhealthy if it produces symptoms. Predisposing factors are:-

Endogenous :-Pre-existing upper respiratory tract infection, Pre-existing chronic tonsillitis, Post nasal discharge due to sinusitis, Residual tonsillar tissue after tonsillectomy, General lowering of the resistance and Exanthemata.
Exogenous:-Ingestion of cold drinks or cold foods may directly cause infection or lower the resistance by vaso constriction, Pollution and crowded ill ventilated environment and Imbedded foreign body. The infection may be contacted from other individuals having infection.1

Symptoms of adenoids are as follows –

Obstructed nasal breathing, snoring, drooling of saliva from the mouth and restlessness at night.
When mouth breathing has existed for a long period the so called adenoid facies is observed.This is characterized by the partially open mouth, short upper lip, prominent eye balls, broad face and a flat expression.
Other symptoms observed are impairment of the intellect, interference with speech, chronic cough with nocturnal aggravation and nasal discharge of mucopus.

There is chronic rhinitis and pharyngitis is associated and evidenced by the mucopurulent discharge and frequent clearing of the throat.
Children affected with enlarged adenoids may also present early fatigue, irritability, fitful appetite, epistaxis and gritting of the teeth in sleep.
Ear symptoms are commonly caused by adenoids due to low grade secretory catarrh of the eustachian tube and middle ear. Recurrent attacks of otitis media are common.3

The signs of examination revealsas mucoid or mucopurulent discharge in the nose, throat examination reveals post nasal discharge and in a co-operative child, posterior rhinoscopy will show enlarged mass of adenoids on the postero superior wall of nasopharynx.Palpation of nasopharynx though trouble some may sometimes be needed to come to diagnosis, Adenoids have a feel like bag of worms. In long standing cases there may occur “Adenoid Facies” the child presents with a dull look, pinched nostrils, open mouth, narrow maxillary arch. Retracted upper lip and protruding teeth. X-ray lateral view of nasopharynx may sometimes be done to show an adenoid mass.4
Subrata Kumar Banerjea explains the miasmatic cleavage of adenoids as –
In psoric maism, respiratory infections are generally in the upper respiratory tract. There is recurrent catching of colds and the nose and throat are sensitive. All psoric respiratory complaints are aggravated during the winter and from cold and are ameliorated by warmth in general and the appearance of natural discharges.
In sycosis there is an oedematous appearance of the nose, uvula and tonsils with hypertrophy of nasal turbinate. Sycosis has nasal blockages and the patient generally unable to breath through the nose.
In syphilis, there may be flat depressed appearance of the nose. Ulcerative sore throat. The syphilitic patient feels worse at night and during morning. Dyspnoea before going to bed or while lying down is indicative of syphilitic miasm. The tubercular patients catches cold easily. There is always swelling of the tonsils and of the glands around the neck.5
Phyllis speight quotes that, adenoids covers sycosis miasm as there is the stoppage which is due to local congestion and thickening of the membrane or enlargement of the turbinated bodies due to congestion.The discharge is yellowish green, scanty except in fresh winds, when it is copious thin mucus. New babies of sycotic parents often get snuffles, nose dry stuffed up frequently. Child will scream with anger in its attempt to breath with its mouth closed which may last for few days or weeks but is usually displaced by something more serious especially if local measures are applied to relieve it.6
Borland Douglas says of calcarea phosphorica that, if instead of presenting this typical picture the child is beginning to lose some fat, does not flush up so easily, shows hypertrophy of adenoid tissue rather than enlargement of tonsils and cervical glands, has a more adenoid facies.7
Clarke explains about adenoids in his prescriber – In pale, fat children, cold clammy feet, head perspiring at night, Calc.c 30, 8h. In children with comsumptive family history, Bac.100, gl.v. once a week. Much clear mucus discharge, Agraph .n. 3x, 8h. Children who are always hungry, irritable skins, averse to be washed, Sul. 30, 8h. Mentally weak, Baryta .iod. 3x-30, 8h. Dark-eyed, dark-hair children, Iod. 3x-30, 8h.8
Richard Huges quotes Dr. Copper, who says that in certain cases there is a history of repeated attacks of inflammation, while in others – perhaps more numerous – the enlargement seems to be a primary hypertrophy: and I go further with him in believing calcarea phosphorica to be a valuable remedy for the latter form, capable of removing also the adenoid growths which often accompany it.9
Kent given examples of“Adenoids cured with tuberculinum” in his lesser writings wherein he discusses a case of a child with adenoids. She was irritable, extremely stupid, unable to breath through the nose day or night, except through the mouth. He gave the tuberculinum and after 4 weeks, the child was breathing through her nose. The child’s head was all stopped up with adenoids. This child was also stupid, it was sickly, having night sweats and many symptoms suggestive of tuberculinum. He has given tuberculinum. After a short time the child was breathing through the nose and was gaining school.10
Lilienthal suggests the following remedies for adenoids- Ammonium carb., Apis mell., Arsenicum iod., Aurum met., Badiaga, Bar c., Bar. m., Belladona, Calcarea carb., Calcarea fluor., Causticum, Chamomilla, Conium mac., Dulcamara, Graphites, Silicea, Sulphur, Syphilinum.11
Boricke mentions the following constitutional remedies for adenoids:- Agraph.; Bar.c,: calc.c.; calc. fl;. calc. iod; calc.p; chrom.ac; Iod; kali .s.; Lob, syph; Mez; Psor; Sang. n.; Sul; thuja.12
6.3OBJECTIVES OF STUDY

Tostudy the clinical presentation of adenoids.
To study the miasmatic cleavage of adenoids.
To study the role of constitutional approach in the management of adenoids and their recurrences.

7 / MATERIALS AND METHODS
7.1SOURCE OF DATA:
The subjects for this study will be collected from OPD, IPD, and rural OPD’s of BharateshHomoeopathicMedicalCollege and Hospital.
7.2METHODS OF COLLECTION OF DATA (INCLUDING SAMPLING PROCEDURE IF ANY).

Patients will be selected on the basis of inclusion and exclusion criteria,history and findings.
Detailed case history by interview will be taken as per the proforma prepared.
All the patients registered between the period of June 2008 to Dec 2010 will be selected for the study. Follow up will be seen as per requirement.
Sample size will be minimum 30 in number. No particular sampling procedure shall be adopted.

Following are the inclusion and exclusion criteria fixed for study:
Inclusion Criteria
1)All patients suffering from adenoids between the age group of 3 to 10 yrs will be selected for the study.
2)Subjects will be selected irrespective of their sexes, socio-economic status.
Exclusion Criteria:

The subjects who have adenoidal complications and surgical cases will be excluded.

7.3DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON THE PATIENTS OR OTHER HUMANS OR ANIMALS ? IF SO, PLEASE DESCRIBE BRIEFLY:
The diagnosis of the cases will be done on eliciting the case history and clinical findings, therefore no specific investigations are required. However rhinoscopy or routine blood examination if needed will be done as per the requirement of the case.
7.4HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
Yes, I have obtained ethical clearance.
8. / LIST OF REFERENCES
1)Bhargava KB, Bhargava SK. Ashort text book of ENT diseases. Mumbai: Usha Publications. 7th ed, 2005. 243, 246 pp.
2)Dhingra PL. Diseases of Ear Nose of Throat.ELSEVIER Adivision of Reed Elsevier India Private limited. 3rd ed, 2004. 296pp.
3)Clay Joseph. Diseases of the nose and throat. New Delhi: B. Jain Publishers Pvt. Ltd. Reprint ed, 1990. 120-121 pp.
4)Maqbool Mohammad. Text book of Ear Nose of Throat diseases.New Delhi:Jaypee Brothers Medical Publishers Pvt. Ltd. 6th ed, July 1993. 365 pp.
5)Banerjea Subrata Kumar.Miasmatic Diagnosis Practical tips with clinical comparisons.New Delhi: Jain Publishers Pvt. Ltd.Revised ed, 2003. 46 – 51 pp.
6)Speight Phyllis. A comparison of the chronic miasms.New Delhi: Jain Publishers Pvt. Ltd.1948. 31pp.
7)Borland Douglas. Children’s Types. New Delhi: B. Jain publishers Pvt. Ltd. 3 pp.
8)Clarke John H. The prescriber. New Delhi: B. Jain Publishers Pvt. Ltd. Reprint ed, 1990. 90pp.
9)Huges Richard. The Principles and Practice of Homoeopathy. New Delhi: B. Jain publishers Pvt. Ltd. Reprint ed, 1999. 470 pp.
10)Kent JT. Kent’s New remedies clinical cases lesser writings. Aphorisms and precepts. New Delhi: B. Jain Publishers Pvt. Ltd. Reprint ed, 1997. 506-507pp.
11)Lilienthal Samuel. Homoeopathic Therapeutics. New Delhi: B. Jain Publishers Pvt. Ltd. Reprint ed, 2001. 462-463pp.
12)Boricke Willium.Pocket manual of homoeopathic Materia Medica and Repertory.New Delhi: Jain Publishers Pvt. Ltd. Reprint ed,1994. 764 pp.
9 / SIGNATURE OF THE CANDIDATE
10 / REMARKS OF THE GUIDE
11 / NAME AND DESIGNATION OF
(IN BLOCK LETTERS)
11.1 GUIDE / DR. RAVEENDRA NADHAN M.D. PROFESSOR, H.O.D. & GUIDE DEPARTMENT OF ORGANON OF MEDICINE & HOMOEOPATHIC PHILOSOPHY,
BHARATESH HOMOEOPATHIC MEDICALCOLLEGE,
BELGAUM – 16.
11.2 SIGNATURE
11.3 CO-GUIDE (IF ANY)
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT / DR. G. M. KHAN M.D.
PROFESSOR, H.O.D. & GUIDE DEPARTMENT OF ORGANON OF MEDICINE & HOMOEOPATHIC PHILOSOPHY,
BHARATESH HOMOEOPATHIC MEDICALCOLLEGE,
BELGAUM – 16.
11.6 SIGNATURE
12 / 12.1REMARK OF THE
CHAIRMANAND PRINCIPAL
12.2 SIGNATURE