A randomised control trial of chronic tonsillitis with LM and Centesimal potency

Dr Nahida M Mulla MD. (Hom), Mach

ABSTRACT: Tonsillitis is one of the most common infections in children between 5-15 years. About 30 million children develop tonsillitis with frequent exposure to bacterial and viral infection. In Homoeopathy we are considering susceptibility as a basic tendency of living organism which is going to decide the well-being of a person. Susceptibility and immunity are interdependent; when tonsils are removed it may affect susceptibility of that person.

Conclusion drawn from various studies show almost all the cases responded well to Homoeopathic medicines and the patient not only got rid of the main complaint of tonsillitis but also got rid of associated complaint.  Also the surgical intervention was avoided. Thus, they concluded Homoeopathic medicine used with holistic approach are very effective in treating the cases of tonsillitis.

The objectives of this study are:
1.To study clinical manifestations and etiological factors of tonsillitis in paediatric age group.
2. To study homoeopathic drugs effective in the treatment of tonsillitis in children.
3. To study the effect of LM potency over the use of centesimal potency in children for treatment of tonsillitis.

The following methodology is adopted;

• Type of research: A Prospective case study
• Sampling design: Simple random sampling.
• Selection criteria: Based on the inclusion and exclusion criteria, history and clinical symptoms.

The treatment is based on interpretation of clinical signs and symptoms

CONCLUSION: After the results were statistically analysed it showed that medicines of 50 millesimal potency have a significant role in the management of tonsillitis over the usage of centesimal potency.

KEYWORDS:Tonsillitis,Homoeopathy, LM potency, centesimal potency.

INTRODUCTION:
The tonsils are masses of lymphoid tissue located in the pharyngeal cavity. There are two pairs of tonsils mainly pharyngeal tonsil (adenoids), tubal tonsil, palatine tonsil, lingual tonsil. There function is to filter and protect the respiratory and alimentary tract from invasion by pathogenic organisms and in antibody formation.

The immunological role of Tonsils is to induce secretary immunity and production of immunoglobulin. As Tonsils are situated at opening of Pharynx it may get infected frequently and may leads to chronic tonsillitis.

It is very common condition, most frequent in children aged 5-10years and young adults between 15 and 25years. A general practitioner with a list of 2000 can expect to see around 120 cases of tonsillitis a year with considerable seasonal variations. About one out of ten children visit doctor for tonsillitis in each year.

Previous cross sectional studies in Belgaum was done in urban community, where there was increase in prevalence. Out of 300 subjects of 5-15 years of age, 45.7% were male, 54.3% were females and most of the children belong to Nuclear families, residing in Pucca house.

The commonest cause of tonsillitis is infection of the tonsils by micro-organisms. Certain bacteria (most common being the streptococcal group of bacteria), viruses, and allergens are known to produce tonsillitis. Allergens are usually in the form of certain food particles.

Signs and symptoms of tonsillitis include,

• Pain in the throat is sometimes severe and may last more than 48 hours, along with pain on swallowing.
• Pain may be referred to the ears.
• Small children may complain of abdominal pain.
• Headache.
• Loss of voice or changes in the voice.
• The throat is reddened, the tonsils are swollen and may be coated or have white flecks of pus on them.
• Swollen regional lymph glands.
• Classical streptococcal tonsillitis has an acute onset, headache, abdominal pain and dysphasia.
• Examination shows intense erythema of tonsils and pharynx, yellow exudates and tender, enlarged anterior cervical glands.
• Possibly a high temperature.

Homoeopathic medicines are highly effective in management of such cases and with the flexibility in potencies the child gets the best suited medicine which treats him internally securing from the recurrence of the same condition again. However there is limited data and researches exploring the full potential of homoeopathy, especially LM potency drugs in prescription for tonsillitis. Prescription of LM potency in practice is still not has come into limelight and not been explored for its fullest capacities regarding present scenarios especially in children.

This prospective study has focused towards fulfilling the purpose of a comprehensive review and the exploration of Dr. Hahnemann’s discovery of LM potency or 50 millesimal scale potency in the clinical condition of tonsillitis along with clinical features and listing the common etiological factors making this age group vulnerable to this infection.

Also by prescribing the 50 millesimal potency drugs we will be aiming towards the rapid and gentle healing of the patients devoiding them of their discomfort at the earliest possible hour.

MATERIALS AND METHODS:

Type of research:A Prospective case study

Sampling design: Probability method of simple random sampling procedure for subjects who presented with clinical signs of Tonsillitis.

Selection criteria: 60 cases were selected from the OPD, IPD and school camps of A M Shaikh Homoeopathic Medical College and Hospital, Belagavi, on the basis of inclusion and exclusion criteria, history and symptoms.

Inclusion criteria:

1. Subject of age group between 3-18 years
2. Subject of all genders.
3. Subjects who is fulfilling diagnostic criteria.
4. Subjects those who are willing to participate and parents willing to sign written informed consent and assent taken from the subjects.

Exclusion Criteria:

1. Subject associated with other systemic illness or immune compromised children were excluded.
2. Subjects under any other treatment.
3. Diagnosed case of Adenoids, Obstructive sleep apnoea, Quinsy and Acute rheumatic fever.
4. Complicated cases such as Peritonsillar abscess, Otitis media and Para pharyngeal abscess are excluded.

RESULTS
The study was conducted between October 2017 to August 2019 and all the cases were sufficiently given time period to understand and analyse the outcome. At the end of the study following data is observed which is placed in tabular form.

1) Age Incidence: Statistical study was done to identify the age group with highest incidence as shown in Table No.1.

Table No. 1 – Age Incidence

Sl.No.	Age in years	No.of Subjects	Percentage
1.	3 to 6	6	10%
2.	7 to 11	34	56.6%
3.	12 to 14	16	26.6%
4.	15 to 18	4	6.6%
	Total	60	100%

As shown in table, maximum incidence of  tonsillitis was seen in age group 7 -11yrs 56.6% of the subjects (34); 26.6% of subjects were in the age group of 12-14yrs (16); 10% of subjects were in the age groups of 3-6yrs(6);6.6% of subjects were in the age group of 15-18yrs(4).

2)  Sex Incidence: Statistical study was done to identify the sex incidence with highest incidence as shown in Table No.2

Table No. 2 –Sex Incidence

Sl.No.	Sex of subjects	No. of Subjects	Percentage
1.	Male	37	61.6%
2.	Female	23	38.3%
	Total	60	100 %

As shown in table above, 61.6% of the subjects (37) were males and 38.3% of the subjects (23) were females.

3)Incidence of Presenting Complaints: In the statistical study of 60 cases, each subject is presenting with one or more complaints, the presenting complaints are shown in table no.-3.

Table No. 3 – Incidence of Presenting Complaints

Sl.No.	Symptoms	No. of Subjects	Percentage
1.	Pain in throat	55	91.1%
2.	Difficulty in swallowing	48	80%
3.	Redness of pharynx and tonsils	38	63.3%
4.	Pus pockets	33	55%
5.	Swollen regional lymph nodes or tonsils	51	85%
6.	Possible high temperature	20	33.33%
7.	Congestion of the throat and cough	13	21.6%
8.	Loss or change of voice	8	13.3%
9.	Others	6	10%

Table 4: Remedies prescribed

S.no	Remedies	No. of Patients
1.	Phytolacca	08
2.	Merc iod flavum	06
3.	Baryta carb	10
4.	Belladona	23
5.	Aconite	01
6.	Hepar sulph	05
7.	Baryta mur	01
8.	Nitric acid	02
9.	Kali mur	01
10.	Lachesis	01
11.	Merc sol	01
12.	Calcarea carb	01
Total		60

5) POTENCY USED: the following potencies are used in the study

Sl.no	Potency	No. of patients
1.	Centesimal	30
2.	0/1    (LM)	12
3.	0/2 (LM)	18
	Total	60

6) RESULTS:

Result of Treatment: In the statistical study of 60 cases the results of the

Treatment are summarized in Table No.6

Sl.No.	Results	No. of Subjects	Percentage
1.	Recovered	50	83.3%
2.	Improved	7	11.6%
3.	Not Improved	3	5%
	Total	60	100%

DISCUSSION
In this study various observations were made to assess the susceptibility of children in acquiring tonsillitis. Susceptibility is assessed considering age, sex, intensity of symptoms, habit and environment, temperament and constitution. Various factors responsible for tonsillitis like socioeconomic status, locality, vaccination, overcrowding, hygienic measures, nutrition, health awareness and seeking treatment were observed during this study. Study also shows positive treatment response with homoeopathic medicines in early treatment of tonsillitis.

In homoeopathy the patient is treated rather than the disease. In acute illness, the patient changes from the normal are taken into account. Homoeopathic remedies are prescribed holistically rather than one part. The homoeopathic system of Medicine with its unique Similia principle and with its Individualistic approach helps to overcome the acute deviation from health, helps to decrease the duration of acute phenomenon and prevents the hospitalization.

• From the study it was found that after the use of homoeopathic medicines there was statistical improvement in cases of Tonsillitis. The results of treatment were clearly shown recovery in 50 cases and no improvement in 3 cases. The Chi-Square test was observed to be significant based on the p-value (0.028<0.05) which is less than the standard 0.05 value as assumed for the test.
• The study also showed common disease presentation of Tonsillitis i.e. pain in throat, difficulty in swallowing, redness and swelling of tonsils, pus pockets, temperature etc. But from homoeopathic point of view the clinical presentation in patient has some uncommon peculiar individualizing symptoms which helped in framing the acute totality and selection of medicines.
• The study also showed the role of susceptibility in both acquiring the disease in children and its selection of homoeopathic medicines and potency.
• The study shows that there is maximum age incidence of  tonsillitis in the age group of 7-11years, and 12-14years, than by the age group >3-6years, it shows that that the age group of 7-11years has the highest incidence of tonsillitis in pediatric age group .
• The study shows that the incidence of tonsillitis is more in males than females.
• The study also shows that homoeopathic remedies Belladonna, Phytolacca, Baryta carb, M.I.F., Hepar sulph etc. are helpful in treatment of tonsillitis. It shows that remedies selected on the basis of acute totality comprising both short acting and long acting drugs are effective in the treatment.

CONCLUSION
This study which was conducted on 60 subjects of paediatric age group concentrated mainly on utilization of 50 millesimal scale remedies by comparing them to the regular usage of centesimal scale in the practice of treating tonsillitis.

Pain in throat which was the most common symptom in this study responded well to the medicines of 0/1 potency and also the subjects showed increased general wellness.

The above study revealed the significant effect of individualized homoeopathic medicines in treatment and management of tonsillitis. The rapid and accurate detection, early treatment and management with specific homoeopathic therapy, management of co-morbid conditions, and efforts at primary prevention helps to overcome the acuteness and severity of tonsillitis in children.

Hence, it may be concluded that 50 millesimal drugs are well efficient in the treatment of tonsillitis.

REFERENCES:

1. http;//www.ijims.com-Prevelance of group A streptococcal infection among children of urban community, A cross sectional study –Assessed on 11;08AM on 06/03/2018
2. Parthashastry A ,IAP textbook of pediatrics published by  jaypee brothers  medical publishers (P) ltd,  B-3 EMCA House .23/23B Anssari road , Daryaganj Post box 7193 ,New Delhi 110 002, India. First Edition; Feb1999. Reprint; June 1999
3. Kliegman, Behrman, Jenson and Stanton. Nelson Text book Of Paediatrics.18^th e/. vol 2:1756
4. Little, David, Dosage and potency according to Organon .This article was presented in The American Homoeopath, the Journal of the North American Society of Homoeopaths, 1998, page 128.http://www.simillimum. com/education/little-library/case-management/dpato/article.php accessed on 28/01/2019
5. SchepperDL, LM potencies: one of the hidden treasures of the sixth edition of the Organon Volume 88, Issue 3, June 1999, Pages 128-134 https://www.sciencedirect.com/science/article/pii/S1475491699903090; accessed on 6/02/2019
6. Kent.J. T, Repertory of the Homoeopathic Materia Medica .6/e.B. Jain Publishers (p) Ltd. New Delhi 2012;460-461
7. Murphy Robin. ND. Homoeopathic Medical Repertory 2/e. B.Jain Publishers (P) Ltd. New Delhi 2006 2008; 1837
8. Boericke William.Pocket Manual of Homoeopathic Materia Medica and Repertory. B.JainPublishers (P) Ltd. New Delhi 2012; 514-516.
9. Burt.W.H. Physiological Materia Medica.3/e. B Jain Publishers (p) Ltd. New Delhi 2009;716-720
10. Pathak. S.R.MateriaMedica of Homoeopathic Medicines. 2/e.B.JainPublishers (p) Ltd. New Delhi 1999;558-561
11. ALLEN.H.C, M.D. Keynotes Rearranged and classified .10/e.Indian Books and Periodicals Publishers. New Delhi.2013;308-309

Dr. Nahida M. Mulla Md. (Hom), Mach
Professor & PG Guide
Department Of Paediatrics
A M Shaikh Homoeopathic Medical College,Belgaum -590010
E Mail:drnahida.mulla@gmail.com
Mobile: 9448814660 / 8660646492