From:



From:

Dr.BISHWANATH SHARMA

Post Graduate Student,

Post Graduate Dept.of Homoeopathic Organon of Medicine,

DBHP Sabha’s. DR. B. D. Jatti Homoeopathic Medical College,

Hospital & P.G. Research Centre,

D.C. Compound, Dharwad – 580001.

To:

The Registrar

Rajiv Gandhi University of Health Sciences, Karnataka,

Bangalore.

Through: [The Principal, DBHP Sabha’s. DR. B.D.Jatti Homoeopathic Medical College, Hospital & P.G. Research Centre, Dharwad]

Respected Sir,

Subject: Submission of Completed Proforma of synopsis for Registration of

Subject for Dissertation.

I request you to kindly register the below mentioned subject against my name for the submission of dissertation to the Rajiv Gandhi University of Health Sciences, Karnataka. Bangalore, in partial fulfillment for the award of the degree of M.D.(Homoeopathy) in Organon of Medicine & Homoeopathic Philosophy.

Title of Dissertation:

“A CLINICAL APPROACH IN THE MANAGEMENT OF ACUTE AND RECURRENT TONSILLITIS IN CHILDREN”

I am herewith enclosing completed Performa of synopsis for registration of subject for dissertation.

Thanking you,

Yours faithfully,

Place: Dharwad.

Date: (Dr BISHWANATH SHARMA.)

“A CLINICAL APPROACH IN THE MANAGEMENT OF ACUTE AND RECURRENT TONSILLITIS IN CHILDREN”

SYNOPSIS

Submitted to

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE.

BY

Dr. BISHWANATH SHARMA

Through

DBHPS’S

DR. B.D. JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL & P.G. RESEARCH CENTRE, D.C. COMPOUND, DHARWAD – 580 001 (KARNATAKA).

In partial fulfillment of requirement for the

DOCTOR OF MEDICINE (HOMOEOPATHY) in

HOMOEOPATHIC ORGANON OF MEDICINE

Under the guidance of

Dr.(Mrs) A.S. MIRAJKAR M.D. (Hom.)

PROFESSOR

Dept. of Homoeopathic Organon of Medicine.

DR. B.D. JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL & P.G. RESEARCH CENTRE, D.C. COMPOUND, DHARWAD – 580 001 (KARNATAKA).

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

BANGALORE.

Annexure-II

REGISTRATION OF SUBJECT FOR DISSERTATION

| | | |

|1. |NAME OF CANDIDATE & ADDRESS |Dr.Bishwanath Sharma |

| | |Post Graduate Student, |

| | |Post. Graduate Dept of Homoeopathic Organon of Medicine. |

| | |DR. B. D. Jatti Homoeopathic Medical College, Hospital & P.G. Research Centre, |

| | |Dharwad – 580 001. |

| | | |

| |PERMANENT ADDRESS |Dr. Bishwanath Sharma |

| | |S/o S.Lokendra Sharma |

| | |Heingang Makha Leikai |

| | |P.O. Mantripukhri, |

| | |Imphal(E) |

| | |Manipur - 795002 |

| | | |

| | | |

|2. |NAME OF THE |D.B.H.P.Sabha’s |

| |INSTITUTION. |DR. B. D. Jatti Homoeopathic Medical College, Hospital & P.G. Research Centre, |

| | |D.C. Compound, |

| | |Dharwad – 580 001. |

| | | |

|3. |COURSE OF STUDY AND SUBJECT. |M.D. (Homoeopathy) in Homoeopathic Organon of Medicine |

| | | |

|4. |DATE OF ADMISSION TO COURSE. |23-03-2011. |

| | |“A CLINICAL APPROACH IN THE MANAGEMENT OF ACUTE AND RECURRENT TONSILLITIS IN |

|5. |TITLE OF THE TOPIC. |CHILDREN” |

| | | |

|6. | |BRIEF RESUME OF THE INTENDED WORK |

| | | |

| |6.1 |NEED FOR STUDY: |

| | |Tonsils are sub-epithelial lymphoid collections situated in between the faucial pillers which helps the respiratory |

| | |and alimentary tracts from microbial infection.inflamation of these tonsils are known as tonsillitis. |

| | | |

| | |Tonsillitis affects mostly school going children. But also affects adults and rarely in infants and after the age of |

| | |50 years. |

| | | |

| | |Poor oradental hygiene,poor nutrition and congested surroundings are the important predisposing factor for |

| | |tonsillitis. |

| | | |

| | |Prominent symptom is a discomfort in the throat. There may be a difficulty in swallowing,earache and generalised body|

| | |symptoms like malaise,anorexia,bodyache and fever. |

| | | |

| | |Tonsillitis is important to recognize and treat early, because of its potential to develop peritonsillar abscess or |

| | |result in post streptococcal glomerulonephritis and acute rheumatic fever as its complications. |

| | | |

| | |In conventional system of medicine, sometimes has side effects and causes intolerance to sensitive individuals and |

| | |there is more chances of recurrence. And the surgical method i.e. tonsillectomy is not only the solution to this |

| | |problem because as the tonsils are protective organ for the invasion of micro organisms to the respiratory and |

| | |alimentary tract. |

| | | |

| | |“The most appropriate management continues to be debated because some of the issue are deceptively complex, but |

| | |consensus has increased in recent year the main concern is determining who is likely to have a group A beta-hemolytic|

| | |streptococcal infection (GABHS), as this can lead to subsequent complication such as rheumatic fever and glomerular |

| | |nephritis. A second pubic health policy concern is reducing the extraordinary cost (both in dollars and in the |

| | |development antibiotics –resistant S pneumonia ) in the United State associated with unnecessary antibiotics use. |

| | |Questions now being asked : Is there still role of culturing a sore throat , or have rapid antigen tests supplanted |

| | |this procedure under most circumstances? Are clinical criteria alone a sufficient basis for decisions about which |

| | |patient should be given antibiotics ? Should any receive any antibiotics othere than penicillin(or erythromycin if |

| | |penicillin-allergic)? For how long should treatment be contnuid? Numerous well-done studies in the past few years as |

| | |well as increasing experience with rapid laboratory tests for detection of streptococci ( eliminating the delay |

| | |caused by culturing ) appear to make a consensus approach more possible. So Homoeopathic treatment not only reduces |

| | |acute phase of tonsillitis but also prevent further sequel of tonsillitis” 2. |

| | | |

| | |Complications of tonsillectomy are haemorrhage, and pulmonary complications etc. |

| | | |

| | |Differential diagnosis |

| | |Membranous tonsillitis |

| | |Diptheria |

| | |Vincent’s angina |

| | |Infectious mononucleosis |

| | |Agranulocytosis |

| | |Leukaemia |

| | |Apthous ulcers |

| | |Malignant tonsil |

| | |Traumatic ulcer |

| | | |

| | |Homoeopathy has much efficacy in treating tonsillitis because of its holistic approach and concept of |

| | |individualization. And it also reduces the complications of tonsillitis. |

| | |Hence to know the efficacy of homoeopathic treatment in the management of acute and recurrent tonsillitis, this study|

| | |has been under Taken. |

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| |6.2 |REVIEW OF LITERATURE: |

| | | |

| | |Acute tonsillitis is one of the most common infections encountered in everyday life.1 |

| | | |

| | |Inflammation of the tonsils may affect any age group but is one of the commonest diseases of the throat, not only in |

| | |child-life but among adults as well. 2 |

| | | |

| | |PEAK INCIDENCE: Late winter/ early spring ( group A streptococcal infections) 3. |

| | | |

| | | |

| | |Poor orodental hygiene, poor nutrition and congested surroundings are important predisposing factors for the disease |

| | |. It may occur as a primary infection of the tonsil itself or may secondarily occur as a result of the upper |

| | |respiratory tract usually following viral infection. Common causative bacteria include haemolytic streptococcus, |

| | |staphylococcus, haemophilus influenza and pneumococcus. |

| | |Causative organisms: usually gram positive cocci like streptococcus(mainly haemolytic),staphyllococcus,pneumococcus |

| | |and diptheroid organisms. 1,3,4 |

| | | |

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| | | |

| | |There are 3 main types of tonsillitis: acute, sub acute and chronic. Acute tonsillitis can either be bacterial or |

| | |viral in origin. Sub acute tonsillitis is caused by the bacterium Actinomycin. Chronic tonsillitis, which can last |

| | |for long periods if not treated, is mostly caused by bacterial infection 5. |

| | |Acute tonsillitis is characterised by enlargement, redness and inflammation. Acute tonsillitis may progress to acute |

| | |follicular tonsillitis in which crypts are filled with debris and pus giving it follicular appearance. Chronic |

| | |tonsillitis is caused by repeated attack of acute tonsillitis in which case the tonsils are small and fibrosed .Acute|

| | |tonsillitis may pass on to tissues adjacent to tonsils to form quinsy6. |

| | | |

| | |Symptoms: |

| | |Raw sensation ,pain,refusal to eat due to pain,thick and muffled voice,enlarged and painful jugulodigastric nodes may|

| | |be seen.. |

| | |Fever. It may vary from 380c to 400c and may be associated with chills and rigors. Sometimes a child presents with |

| | |an unexplained fever and it is only on examination that an acute tonsillitis is discovered. |

| | |Earache. It is either referred pain from the tonsil or the result of acute otitis media which may occur as a |

| | |complication. |

| | |Constitutional symptoms. They are usually more marked than seen in simple pharyngitis and may include headache, |

| | |general bodyaches, malaise and constipation 1,7. |

| | | |

| | |SIGNS |

| | |Congested and swollen tonsils. |

| | |Tenacious and increased secretions. |

| | |Movements of the Palate become impeded due to pain. |

| | |Halitosis |

| | |Jugulodigastric nodes gets enlarged and tender.1,8 |

| | | |

| | |Chronic tonsillitis usually results from repeated attacks of acute tonsillitis in which the tonsils become |

| | |progressively damaged and provides a reservoir for infective organisms. 9 |

| | | |

| | |Peritonsillar abscess or quinsy is the most common complication of acute tonsillitis; retropharyngeal abscess may |

| | |also occur. Infection with beta haemolytic streptococcus may result in the sequelae of scarlet fever, rheumatic fever|

| | |or glomerulonephritis. 10 |

| | |Complications –Chronic tonsillitis,Peritonsillar abscess,Paraphyryngeal abscess,Cervical absceee,Acute otitis |

| | |media,Rheumatic fever,Subacute bacterial endocarditis etc… |

| | |A throat swab for culture and sensitivity is a useful test. 11 |

| | | |

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| | | |

| | |HOMOEOPATHIC APPROACH: |

| | | |

| | |Murphy repertory : |

| | |Throat - TONSILLITIS, infection, tonsils Acon. aesc. Ail. ALUMN. aml-ns. anan. ant-t. anthraci. Apis Ars. bad. Bapt. |

| | |BAR-C. Bar-m. BELL. benz-ac. berb. bufo Canth. Caps. cedr. Cham. chel. Chen-a. Colch. Crot-h. Cupr. cur. Dulc. |

| | |ferr-p. Fl-ac. Gels. GUAJ. ham. HEP. Ign. Iod. Kali-bi. Kali-chl. kali-p. LAC-C. LACH. Lyc. MERC. Merc-cy. MERC-D. |

| | |Merc-i-f. Merc-i-r. naja Nat-s. NIT-AC. Phyt. Plb. Psor. puls. Sabad. Sang. sep. SIL. Staph. still. Sulph. tarent. |

| | |ust. verat. vesp. zinc.12 |

| | |Mills W.S Exciting causes of tonsillitis- chief among them is cold or exposure. Many young people seem to have a |

| | |diathetic tendency to tonsillitis i.e., very slight causes will develop the disease and they will have repeated |

| | |attacks. This tendency I believe I have seen eraducated by homoeopathic medicines. We cannot have a crop until the |

| | |seed is planted in proper soil.homoeopathic medicines changes the soil.13 |

| | |William Burt says in simple tonsillitis, when the tonsils are swollen and present a bright red appearance, with pain |

| | |ful and difficuld deglutition,at first dryness of the fauces and then moderate secretion of a ropyy mucous os |

| | |saliva,with the characteristic pulse andface,Belladona suffices to effect a cure in a few hours.14 |

| | | |

| | |Burnett puts forth- In the medicinal treatment of enlarged tonsils there are two main lines of procedure, and the |

| | |first is to cure the cause of the enlargement which is commonly not only not attempted, but it is not even thought |

| | |of. For it must be manifest that to get rid of the cause of the enlargements usually disappear – this is the best |

| | |way. When you cut off a tonsil you certainly get rid of it, so you do if you shrivel it with gland tissue destroyers,|

| | |but the perfect cure is where the enlargement disappears under the influence of dynamic remedies, the normal tonsils |

| | |remain to do the work allotted to them within nature’s cycle 15. |

| | |E.A.Farrington says in tonsillitis Belladonna stands at the head of list of remedies. Here it far exceeds Apis in |

| | |therapeutic value because it attacks the parenchyma of the organ 16. |

| | |E.B. Nash says Besides the strong action of Baryta upon the glandular system generally, it seems to have a peculiarly|

| | |strong affinity for the throat, especially the tonsils, which become greatly inflamed, swollen and suppurate as a |

| | |consequence of the least exposure to cold 17. |

| | | |

| | |W.A.Dewy recommends the following remedies for tonsillitis Baryta carb, Calcarea phosphoricum, Calcarea iodata, |

| | |Bromine, Lycopodium, Ferrum phosphoricum, Belladonna, Gelsemium, Phytolacca, Ignatia, Hepar Sulphur, Guaiacum, |

| | |Silicea, and Mercurious 18. |

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| | |Ruddok.E.H. The predisposing factors are- tubercular constitution,abuse of mercury and a previous attack of quinsy. |

| | |The exciting cause is one of the germs of suppuration but sudden atmospheric changes, or a chill from getting wet |

| | |though seems occasionally to be the final factor.19 |

| | |Dr. C.Sigmund Raue recommends |

| | |Bell – in early stages when there is dryness and redness of throat, with pain on swallowing,throbbinh headache,high |

| | |fever and flushed face |

| | |Apis –oedematous swelling of the mucous membrane,sharp sticking pains on swallowing |

| | |Ign – in folliculous tonsillitis when there are sharp,lancinating pains extending to the ears |

| | |Merc iod rubr –in full developped stage when exudation is absent |

| | |Hepar sulph is needed in many cases to hasten suppuration |

| | |Guiacum – recurring attacks due to rheumatic diathesis |

| | |Sil –protracted cases,suppuration continues after the evacuation of pus.20 |

| | | |

| |6.3 |AIMS AND OBJECTIVES OF THE STUDY: |

| | | |

| | |To study of clinical presentation of acute and acute recurrent tonsillitis. |

| | |To study the miasmatic approach of homoeopathy in the management of recurrent tonsillitis |

| | |To study the role of constitutional remedies in treatment of tonsillitis |

|7. | |MATERIALS AND METHODS: |

| | | |

| |7.1 |PRIMARY SOURCE: |

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| | |The subject for this study will be collected from OPD/IPD/Peripheral camp of DR. B.D. Jatti Homoeopathic Medical |

| | |College, Hospital and Post Graduate Research Centre, Dharwad. |

| | | |

| |7.2 |METHOD OF COLLECTION OF DATA (Including sampling procedures, if any,) |

| | | |

| | |Definition of study subject: |

| | | |

| | |Patients are considered on the basis of clinical presentations .i.e., sore throat, difficulty in swallowing, fever |

| | |and constitutional symptoms like headache, general bodyache etc. |

| | |Following are the inclusion criteria : |

| | |1. Subjects of age group 5 -15 years ,of both sexes, and all ethnic groups. |

| | |2. Subjects clinically diagnosed to be having uncomplicated tonsillitis. |

| | |Following are the exclusion criteria : |

| | |1. Subjects with any complications of tonsillitis. |

| | |2. Subjects with tonsillitis associated with any other chronic and systemic disease on active treatment. |

| | | |

| | |STUDY SAMPLING DESIGN : |

| | |Sampling method : |

| | |Purposive Sampling Method. |

| | | |

| | |Sampling size : |

| | |Prevalence rate of Tonsillitis in our hospital is 2% considering the 95% confidence interval at 5% permissible error,|

| | |sample size works out to be 32 subjects. Since it is a time bound study, subjects admitted to IPD/ attending the OPD,|

| | |and peripheral OPD during the study period will be considered for the study. |

| | |Study design : |

| | |Purposive sampling method of selection of cases. The cases are selected according to inclusion and exclusion |

| | |criterias. |

| | |Follow up : |

| | |Follow up of the cases would depend on severity of the symptom,and as per the need and necessity of the case , |

| | |preferably once in week for One Month and later on once in 15 days. |

| | |Parameters used are : |

| | |Change in clinical findings like the presenting symptoms, signs, change in investigation are parameter for accessing |

| | |cure , improved and not improved criteria |

| | |CURE: |

| | |Regression of tonsil along with relief of inflammation and also sign and symptom for the end of my study period. |

| | | |

| | |IMPROVED: |

| | |Relief of sign and symptom and hypertrophied tonsil but again occurs within end of my study period. |

| | |Relief of sign and symptom and inflammation of tonsil but no regression of hypertrophied tonsil. |

| | |Regression of hypertrophied tonsil but sign and symptom not totally relieved. |

| | |NOT IMPROVED: |

| | |Drop out cases. |

| | |Neither relief of inflammation of tonsil ,along with relief of sign and symptom not regression of hypertrophied |

| | |tonsil. |

| | |Study period : |

| | |From 30th April-2012 to 30th April-2014. |

| | |Statistical tests : |

| | |Appropriate test will be used depending upon the data available at the end of study. |

| | | |

| |7.3 |DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS? IF |

| | |SO DESCRIBE BRIEFLY. |

| | | |

| | |The study requires following investigations to be conducted on patients whenever necessary. |

| | | |

| | |1. Blood Investigations like, Differential Count, Total Leucocyte Count and Absolute Eosinophilic Count as per |

| | |demands of case. |

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| | |HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION? |

| | | |

| | |Yes, Ethical clearance has been obtained from the institution |

| |7.4 | |

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|8. | |LIST OF REFERENCE: |

| | |Bhargav K.B and Bhargav S.K et.al: A Short Textbook of ENT Diseases for students and practitioners, 7th edition 2005,|

| | |Usha publication, Mumbai, p 244. |

| | | |

| | |Logan’ Turner’s:disease of the nose,throat and ear,10th edition 2000,printed and bound in India by Gopsons papers |

| | |limited,Noida,p84 |

| | | |

| | |Ferri. F.Fred.FERRI’S clinical Advisor Instant diagnosis and treatment.2004Edition. p655 |

| | | |

| | | |

| | |Dhingra PL: Diseases of Ear, Nose And Throat,2nd edition, reprinted 2000, B.I. Churchill Livingstone publisher’s pvt |

| | |ltd, New Delhi, p 254. |

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| | |tonsillitis |

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| | |Mohan Harsh : Text book of Pathology, 5th edition,2005,Jaypee Brothers medical publishers, New Delhi, p528 |

| | | |

| | |Maqbool Mohammad: Text book of Ear, Nose and Throat Diseases, 8th edition, 1998, Jaypee Brothers Medical publishers, |

| | |New Delhi, p 398. |

| | | |

| | |Disease of E.N.T by B.K.Roychaudhuri 3rd reprint edition 1982, pub by harsh lal bardhan press,p 167. |

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| | |Love’s and Bailey: Short Practice of Surgery, 25th edition 2008, Hodder Arnold publishers, p 711. |

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| | |Colman’s and Hall: Diseases of the Ear, Nose and Throat, 15th edition 1982, Churchill Livingstone publishers, p 179. |

| | | |

| | |Hutchison: Clinical Methods An integrated approach to clinical Practice, 22nd edition 2007, Sunders Elsevier |

| | |publishers, p 392. |

| | | |

| | |Robin Murphy: Homoeopathy medical repertory, 1st indian edition 1994, Indian books and periodicals syndicate,New |

| | |Delhi,p1475 |

| | | |

| | |Mills W.S. Practice of medicine, 1st reprint edition. B. Jain publishers,1994, 15, 16pp |

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| | |William Burt :Physiological materia medica3rd edition 2005,B.Jain publishers,p213 |

| | | |

| | |Chitkara H.L. Best Of Burnett, reprint 2007, B.Jain Publishers Pvt Ltd, New Delhi, p 126,127. |

| | | |

| | |Farrington E.A: Lectures on Clinical Materia Medica, 4th edition 2006 reprint, revised and enlarged by Harvey |

| | |Farrington, B.Jain Publishers. p 487. |

| | | |

| | |Nash E.B : Leaders in Homoeopathic Therapeutics with grouping and classification, 5th edition 2006, B.Jain |

| | |Publishers, New Delhi,p334 |

| | | |

| | |Dewey W.A : Practical Homoeopathic Therapeutics,3rd edition 2007 reprint, revised and enlarged, B.Jain Publishers, |

| | |New Delhi, p 371 to 373. |

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| | |Ruddok.E.H., Homoeopathic Vade Mecum, 4th edition, New Delhi: B.Jain Publishers ltd422 p |

| | | |

| | |Disease of children : Raue .C.G, 2nd edition 1993, B.Jian publishers,p 540-543. |

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| 9. | |Signature of the candidate | |

|10. | |Remarks of the guide | |

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|11. |11.1 |Name and Designation of (IN BLOCK LETTER) |Dr.(Mrs) A.S. MIRAJKAR M.D. (Hom.) |

| | |Guide |PROFESSOR |

| | | |Post Graduate Dept. of Homoeopathic Organon of Medicine, |

| | | |DR. B.D. Jatti Homoeopathic Medical College, Hospital & P. G. |

| | | |Research Centre, Dharwad-01 |

| |11.2 |Signature | |

| |11.3 |Head of the Department. |Dr. G.C.HIREMATH M.D. (Hom.) |

| | | |PROFESSOR & H.O.D |

| | | |Post Graduate Dept. of Homoeopathic Materia Medica, |

| | | |DR. B.D. Jatti Homoeopathic Medical College, Hospital & P. G. |

| | | |Research Centre, Dharwad-01. |

| |11.4 |Signature | |

|12. |12.1 |Remarks of Principal | |

| |12.2 |Signature. | |

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