From:

Dr.JAY VIJAY SINGH

Post Graduate Student,

Post Graduate Dept.of Homoeopathic Materia Medica,

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 forRegistration 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 HomoeopathicMateria Medica,.

Title of Dissertation:

“STUDY OF CONSTITUTIONALMANAGEMENT OF CHRONIC TONSILLITIS IN HOMOEOPATHY”

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

Thanking you,

Yours faithfully,

Place: Dharwad.

Date: (Dr.JAY VIJAY SINGH.)

“STUDY OF CONSTITUTIONALMANAGEMENT OF CHRONIC TONSILLITIS IN HOMOEOPATHY”

SYNOPSIS

Submitted to

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE.

BY

Dr.JAY VIJAY SINGH

Through

DBHPS’S

DR. B.D. JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL & P.G. RESEARCH CENTRE, D.C. COMPOUND, DHARWAD – 580001(KARNATAKA).

In partial fulfillment of requirement for the

DOCTOR OF MEDICINE (HOMOEOPATHY) in

HOMOEOPATHIC MATERIA MEDICA

Under the guidance of

Dr.S. K. TAMPI M.D. (Hom.)

Professor

Dept.of Homoeopathic Materia Medica.

DR. B.D. JATTI HOMOEOPATHIC MEDICAL COLLEGE, HOSPITAL & P.G. RESEARCH CENTRE, D.C. COMPOUND, DHARWAD – 580001(KARNATAKA).

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

BANGALORE.

Annexure-II

REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF CANDIDATE & ADDRESS / Dr.JAY VIJAY SINGH Post Graduate Student,
Post. Graduate Dept of Homoeopathic Materia Medica.
DR. B. D. Jatti Homoeopathic Medical College, Hospital& P.G. Research Centre,
Dharwad– 580001.
PERMANENT ADDRESS / Dr.JAY VIJAY SINGH S/o Kailash Nath Singh,
Vill/post. Kardhana
Via- mirzamurad
Varanasi (U.P)
2. / NAME OF THE
INSTITUTION. / D.B.H.P.Sabha’s
DR. B. D. Jatti Homoeopathic Medical College, Hospital & P.G. Research Centre,
D.C. Compound,
Dharwad– 580001.
3. / COURSE OF STUDY AND SUBJECT. / M.D. (Homoeopathy) in Homoeopathic Materia Medica.
4. / DATE OF ADMISSION TO COURSE. / 27-04-2010.
5. / TITLE OF THE TOPIC. / “STUDY OF CONSTITUTIONALMANAGEMENT OF CHRONIC TONSILLITIS IN HOMOEOPATHY”
6. / BRIEF RESUME OF THE INTENDED WORK
6.1 / NEED FOR STUDY:
  1. Tonsillitis is one of the most common infection of children between the age group of 6-15 yrs in day to day clinical practice.
  1. Poor oral hygiene is the important predisposing factor for tonsillitis.
  1. The most common symptom is a sore throat. There may be a desire to swallow because of excessive secretions, swallowing tends to exacerbate the pain and patients tend to be anorexic.
  1. 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.
  1. 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.
  1. To prevent rheumatic fever and glomerular nephritis, sore throat, pharyngitis and tonsillitis orthodox(modern) physician use Penicillin and other antibiotics. Long term use of penicillin may causes S.L.E and immune-suppression so there is a debate when to use antibiotics and how much to use ,as described in the paper.
“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.
  1. Complications of tonsillectomy are haemorrhage, and pulmonary complications etc.
  1. Homoeopathy has been said to be having 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 chronic tonsillitis this study has been under taken.
6.2 / REVIEW OF LITERATURE:
1)Inflammation of the tonsils is one of the commonest diseases of the throat, not only in child-life but among adults as well1.
2)Pharyngitis and tonsillitis account for 10% of all office visit to primary care clinicians and 50% of outpatient antibiotic use2.
3)PEAK INCIDENCE: Late winter/ early spring ( group A streptococcal infections)3.
4) 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.Poor orodental hygiene,poor nutrition and congested surroundings are important predisposing factors for the disease4.
5) 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 infection5.
6) 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 fibrosed6.
7) The symptoms vary with severity of infection. The predominant symptoms are:
Sore throat.
Difficulty in swallowing.The child may refuse to eat anything due to local pain.
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.There may be abdominal pain due to mesenteric lymphadenitis simulating a clinical picture of acute appendicitis7.
8) SIGNS
The Tonsils become congested and swollen.
Secretions increase and become tenacious.
Movements of the Palate become impeded due to pain.
Halitosis:Foul breath may be present8.
9) Chronic tonsillitis usually results from repeated attacks of acute tonsillitis in which the tonsils become progressively damaged and provides a reservoir for infective organisms9.
10) 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 glomerulonephritis10.
11) A throat swab for culture and sensitivity is a useful test11.
HOMOEOPATHIC APPROACH:
12) 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 cycle12.
13) 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 organ13.
14 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 cold14.
15) W.A.Dewyrecommends 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 15.
16) Samuel Lilienthal recommends the following remedies Ammonium carb, Amygdale persica, Apis mel, Baryta carb, Baryta mur, Belladonna, Bromium, Calc carb, Conium, Capsicum, Graphitis, Guiacum, Lac caninum, Lachesis, Lycopodium, Mercurius, Phosphorus, Psorinum, Sulphur16.
6.3 / AIMS AND OBJECTIVES OF THE STUDY:
  1. To study of clinical presentation of chronic tonsillitis.
  2. To study the constitutional approach of homoeopathy in the management of chronic tonsillitis
  3. To study the role of constitutional remedies in treatment of tonsillitis

7. / MATERIALS AND METHODS:
7.1 / PRIMARY SOURCE:
The subject for this study will be collected from OPD/IPD/Rural 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 anyage group ,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 :
Simple Random 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 :
Simple random 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
IMPROVED:
Regression of tonsil along with relief of inflammation and also sign and symptom for the end of my study period.
NOT IMPROVED:
1)Relief of sign and symptom and hypertrophied tonsil but again occurs within end of my study period.
2)Relief of sign and symptom and inflammation of tonsil but no regression of hypertrophied tonsil.
3)Regression of hypertrophied tonsil but sign and symptom not totally relieved.
DROPPED OUT:
1)Cases who have left the treatment during the study period.
Study period :
From 30th November-2010 to 30thNovember-2012.
Statistical tests :
Appropriate test will be used depending upon the data available at the end of study.
7.3
7.4 / 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. BloodInvestigations like, Differential Count, Total Leucocyte Count andAbsolute Eosinophilic Count as per demands of case.
HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?
Yes, Ethical clearance has been obtained from the institution
8. / LIST OF REFERENCE:
  1. Fisher.Charles.E: A Handbook on the Diseases of Children and their Homoeopathic Treatment, reprint Edition, 1997, B.Jain publishers, New Delhi, p 597.
  1. McPhee .J.Stephen/Papadakis.A.Maxine:2010 Current Medical Diagnosis & Treatment, p204
  1. Ferri. F.Fred.FERRI’S clinical Advisor Instant diagnosis and treatment.2004Edition. p655
  1. MaqboolMohammad:Textbook of Ear, Nose and Throat Diseases, 8thedition, 1998, Jaypee Brothers Medical publishers, New Delhi, p 398.
  1. Tonsillitis from wikipedia.com.
  1. Mohan Harsh: Textbook of Pathology, 5th edition,2005,Jaypee Brothers medical publishers, New Delhi, p528
  1. DhingraPL: Diseases of Ear, Nose And Throat, reprinted 2000, B.I. Churchill Livingstonepublisher’spvt ltd, New Delhi, p 256.
  1. Bhargav K.B and Bhargav S.Ket.al: A Short Textbook of ENT Diseases for students and practitioners, 7th edition 2005, Usha publication, Mumbai, p 244.
  1. Love’s and Bailey: Short Practice of Surgery, 25th edition 2008, Hodder Arnold publishers, p 711.
  1. Colman’sand Hall:Diseases of the Ear, Nose and Throat, 15th edition 2000, Churchill Livingstone publishers, p 179.
  1. Hutchison: Clinical Methods An integrated approach to clinical Practice, 22nd edition 2007, Sunders Elsevier publishers, p 392.
  1. ChitkaraH.L. Best Of Burnett, reprint 2007, B.Jain Publishers Pvt Ltd, New Delhi, p 126,127.
  1. FarringtonE.A: Lectures on Clinical Materia Medica, 4thedition 2006 reprint, revised and enlarged by Harvey Farrington, B.Jain Publishers. p 487.
  1. Nash E.B : Leaders in Homoeopathic Therapeutics with grouping and classification, 5th edition 2006, B.Jain Publishers, New Delhi,p334
  1. DeweyW.A : Practical Homoeopathic Therapeutics,3rd edition 2007 reprint, revised and enlarged, B.Jain Publishers, New Delhi, p 371 to 373.
  1. Lilienthal.Samuel: Homoeopathic Therapeutics, reprint edition 2007, B.Jain publishers, New Delhi, p 1035 to 1038.

9. / Signature of the candidate
10. / Remarks of the guide
11.1 / Name and Designation of (IN BLOCK LETTER)Guide / Dr. S. K. TAMPI M.D.(Hom.)
PROFESSOR
Post Graduate Dept. of Homoeopathic Materia Medica,
DR. B.D. Jatti Homoeopathic Medical College, Hospital & P. G. Research Centre, Dharwad-01
11.2 / Signature
11.3 / Co-guide (if any)
11.4 / Signature
11.5 / Head of the Department. / Dr.R.Y. NADAF 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.
11.6 / Signature
12. / 12.1 / Remarks of Principal
12.2 / Signature.