A case of recurrent nasal polyp with coryza and sneezing

Kishan Kumar Brij, MEGHA, Haobam Vidyalaxmi Devi

ABSTRACT:
Nasal polyps are benign growths that form in the nasal passages or sinuses, typically due to chronic inflammation known as chronic rhinosinusitis with nasal polyps. These soft, teardrop-shaped clusters can cause persistent nasal congestion, leading to symptoms like reduced sense of smell, facial pain, and postnasal drip. The blockage disrupts mucus flow, contributing to chronic coughing and frequent sneezing.

Coughing is a common symptom of nasal polyps, often aggravated by postnasal drip, which worsens at night or upon waking. Sneezing is triggered by polyp-induced nasal irritation, especially in response to allergens like dust or pollen. The causes of nasal polyps are linked to nasal mucosa inflammation from conditions such as allergies, sinusitis, asthma, or genetic predisposition.

KEYWORDS: Homoeopathy, Nasal polyp, Coryza

INTRODUCTON:

Nasal polyps are benign, soft growths that develop in the mucous membranes lining the nasal passages or sinuses. They are often associated with chronic inflammation of the nasal lining, a condition known as chronic rhinosinusitis with nasal polyps. These polyps can vary in size and number and are typically teardrop-shaped or grape-like clusters.

Coughing is a common symptom associated with nasal polyps. The continuous presence of polyps in the nasal passages can irritate the airways, triggering a persistent cough. This cough may worsen at night or upon waking in the morning due to postnasal drip—when excess mucus drips down the back of the throat. The cough may be dry or accompanied by mucus production, depending on the extent of inflammation and mucus accumulation.

Sneezing is another prevalent symptom of nasal polyps. The presence of polyps can irritate the nasal lining, triggering frequent bouts of sneezing. Sneezing is the body’s natural reflex to expel irritants or allergens from the nasal passages. In individuals with nasal polyps, the constant irritation caused by the polyps can lead to persistent sneezing, especially in response to environmental triggers such as dust, pollen, or strong odors.

Managing nasal polyps often involves ongoing care and monitoring, as they have a tendency to recur even after successful treatment. Patients with nasal polyps are advised to work closely with their ENT specialist to develop a comprehensive treatment plan aimed at reducing inflammation, improving nasal function, and minimizing symptoms to enhance quality of life.

CASE REPORT

The patient, previously healthy, began experiencing symptoms four days ago, initially with a nasal discharge. Over the course of these four days, the patient developed excessive sneezing, which caused irritation, along with itching following the sneezing episodes.

Additional symptoms emerged, including nasal stuffiness due to obstruction, partial or complete loss of smell, headaches likely related to associated sinusitis, and watery nasal discharge indicative of an allergic response. Notably, a visible mass protruding from one nostril was observed.

The patient also reported nose blockage, making breathing difficult, along with pain and a burning sensation in the outer and inner parts of the nose.

Based on these symptoms, nasal polyps are suspected. Nasal polyps are soft, benign growths that can cause nasal obstruction, altered sense of smell, and associated symptoms like sneezing and itching. The presence of a visible mass and associated symptoms such as nasal stuffiness, headache, and discomfort further support this diagnosis.

Further evaluation by an otolaryngologist (ENT specialist) is recommended to confirm the diagnosis and discuss appropriate management options. Treatment may include medications like nasal corticosteroids to reduce inflammation and shrink the polyps, or in more severe cases, surgical removal of the polyps to alleviate symptoms and improve nasal function. Regular follow-up and monitoring will be essential to ensure effective management and optimize the patient’s quality of life.

CHIEF COMPLAINTS:

• Recurrent episode of nasal polyp since 2015
• Coryza for 4-5 days
• Sneezing in morning after awaking from sleep
• Soreness in throat.
• Nasal stuffiness due to nasal obstruction,
• partial or total loss of smell,
• headache due to associated sinusitis,
• sneezing and watery discharge of nose due to associated allergy and mass protruding out of nostril are the presenting symptoms in nasal polyp
• Voice may become dull due to hypo nasality

HISTORY OF PRESENTING COMPLAINTS:
Patient was apparently well 4 days back; he started complaining of discharge from nose for 4 days. Sneezing comes to much, patient got irritated from sneezing. Itching also started after sneezing. Nasal stuffiness due to nasal obstruction, partial or total loss of smell, headache due to associated sinusitis, sneezing and watery discharge of nose due to associated allergy and mass protruding out of nostril are the presenting symptoms in nasal polyp. Voice may become dull due to hypo nasality. Nose blockage and difficulty in breathing. Pain in the outer of nose and burning in the nose too started.

DISCHARGE: CHARACTER – yellow greenish colour

• Consistency- thick
•  Smell- offensive
• Amount- scanty Intermittent
• Aggravating factor- rainy weather, during cold and cough, sour things, weather changes
• Ameliorating factor- medicine and warm things

Intermittent sinusitis- present.

• no history of dizziness.
• no history of swelling around the ear.
• Sometimes nausea, vomiting, headache.
• no history of facial weakness.
• no history of irritability or neck rigidity.
• no history of visual defects or double vision.

PAST HISTORY

1. NASAL POLYP Right nostril – 2015 Operated 2016 (Jan)
2. NASAL POLYP Right nostril – Operated 2017 (march) Chandigarh
3. NASAL POLYP right nostril- Operated 2017 (sept) Bareilly
4. NASAL POLYP right nostril- Operated 2021 (sept)

AIIMS

5. Recently got injury 5 month ago to nose from fall from cycle.

FAMILY HISTORY

MOTHER- HEALTHY

FATHER – DEAD IN 2020, after an accident

SIBLINGS – Healthy

PERSONAL HISTORY

• DEVELOPMENTAL LANDMARK- ON TIME
• DIET- VEGETARIAN
• HABBIT/ADDICTION – N/S
• ANY ALLERGY- N/S

PHYSICAL GENERALS

• THIRST- NORMAL, 6-7 GLASSES/DAY
• APPETITE- DECREASED, 2 MEALS/DAY
• DESIRE – SPICY, SEASONAL FOOD
• STOOL – NORMAL ,1 TIMES/DAY
• URINE – NORMAL, CLEAR
• PERSPIRATION – NORMAL, NON-STAINING, NON-OFFENSIVE
• TONGUE- MAPPED TONGUE
• THERMAL – CHILLY
• DREAMS – NOT SPECIFIC
• SLEEP- 6-7 HRS, REFRESHING

MENTAL GENERALS:

He is very mild and timid. He weeps over trifles. He does not express himself very much, whatever anybody is saying he will be agree to that point. Does not like to talk to anyone. Fear of strangers and opposite gender.

DIFFERENTIAL DIAGNOSIS

• Sinusitis
• Nasal polyp
• DNS to LEFT
• Cough and coryza

PROBABLE DIAGNOSIS

• Sinusitis in left nostril and Nasal polyp present in right nose.

EVALUATION OF SYMPTOMS

MENTAL GENERALS

• MIND Weeping trifles at  +2
• MIND timidity   +3

PHYSICAL GENERALS

• GENERALS Food and Drinks    spices desire   +2
• MOUTH Discolouration   Tongue white patches +2

PARTICULAR GENERALS

NASAL POLYP	+3
NOSE Discharges yellowish green MIASMATIC ANALYSIS Mind Weeping Trifles at PSORA Mind Timidity PSORA GENERALS Food and drinks spices desire PSORA Mouth Discoloration Tongue White patches                        SYPHILITIC HEARING Impaired                                                             SYPHILITIC	+2

TOTALITY OF SYMPTOMS

• WEEPING TENDENCY
• TIMIDITY
• WHITISH PATCHES ON TONGUE
• DESIRE SPICY FOOD
• YELLOWISH GREEN DISCHARGE FROM RIGHT EAR HEARING IMPAIRED IN BOTH EARS

REPERTORIAL TOTALITY

• MIND -Weeping- Trifles at
• MIND -Timidity
• GENERALS- Food and drinks -spices -desire
• MOUTH- Discoloration- Tongue -White -patches
• HEARING -Impaired
• NOSE -Discharges- Yellowish Green

REPERTORY	CHAPTER AND/OR RUBRIC	SUB-RUBRIC	INDICATED MEDICINES
Kent	NOSE – polypus (34 medicine are given)	Right	Kali-n.
		Left	Alumn,Apis, Calc,Merc – i -r
		Bleeds easily	Calc, calc-p , Phos, Thuj.
		Posterior nares	Teucr.[5]
BBCR	NOSE- Polypi, hypretrophies(21 medicine are given)		Aur, aur-mur, bell, Calc-c, cad-s, con,grap. ,Kali-bi, kali-n, mar. ,merc., merc-aur.,nit-ac., pho., pul.,sang., sep.,sil.,stap.,sul.,thu.[6]
Boericke’s Repertory	NOSE-ERUPTIONS,growths	Polypi	Cadm. s., Calc. c., Calc. iod., Calc. p., Caust., Cepa, Con., Formica, Kali bich., Kali n., Lemna m., Merc. i. r., Nit. ac., Phos., Psor., Sang., Sang. n., Staph., Teucr., Thuya, Wyeth.[7]
Clarke in ‘The Prescriber’	Polypus	Of NOSE	Thuj.,Formica.,Calc c., Kali nit., Kali bichr., Nit ac., Teucr.[8]
Nash in “Leaders In Homoeopathic Therapeutics”	Polypus		Calc., Thuj., Mar-v. [9]
Knerr Repertory of Hering Guiding Symptoms	NOSE- Polypus	Antrum Highmorii, 1st in, deforming face, forcing eyeball upward, everting lid, obstructing nostrils into mouth, so that breathing and mastication were impeded	Hecla.
		Bleeding easily	Phos.
		Bone, extended to ethmoid, into choanæ and into antrum of Highmore	Teucr.
		Fossæ, in	Sang.
		Large, after a severe, badly-treated cold	Teucr.
		Left side, in	Alumn.
		Mucous, of pale red color, on left side, and of large size, mostly in anterior nares, and in plain sight	Teucr.
		Mucous, greenish white, attached to upper turbinated bone, and completely filling nasal cavity and causing occlusion, after repeated attacks of coryza	Teucr.
		Mucous, large, of right side, distending nose	Kali-n.
		Nose, with stoppage of, on side he lies	Teucr.
		Pedunculated, large	CALC-P.
		Recent, or of long standing	Kali-bi.
		Removed every 2 or 3 years by operative means, for 30 years	Teucr.
		Right nostril, in, growing more rapidly after each attack of headache, which was better by camphor	Kali-n.
		Right nostril, occupying entire, projecting slightly	Teucr.
		Smell, with loss of	CALC.
		Water, much discharge of mucus and	Teucr.
		Weather, enlarges in wet	Teucr.
		Women, especially among old and middle-aged	Teucr.
		Year’s, of 1, duration	Teucr. [10]

INVESTIGATIONS

• Nasal polyps can be easily clinically diagnosed by anterior and posterior rhinoscopy.
• Investigations like PNS-X ray, X-ray lateral view-soft tissue nasopharynx, CT scan and histopathological examination can be done to rule out other pathology.

SELECTION OF MEDICINE : ON THE BASIS OF REPERTORIAL TOTALITY THE MEDICINE SELECTED IS KALI BICHROMIUM 30

SELECTION OF POTENCY : The slow disease progresses and availability of mental, physical and particular characteristic  symptoms with structural reversible pathological changes indicate that the state of susceptibility was moderate to high. Thus, 200C potency were selected and repeated infrequently.

JUSTIFICATION OF REMEDY
After doing the proper case taking and having the totality of symptoms the medicine Kali Bichromium is prescribed by repetorizing. In this case physical generals and characteristic particulars symptoms are prominent. The medicine was prescribed in 30c potency in one dose to avoid  any kind of medical aggravation.

PRESCRIPTION : 10/05/22

Rx-

• KALI BICHROMIUM 30/TDS/2 DAYS – ORALLY
• SL 30 / TDS FOR 7 DAYS- ORALLY

Follow up after 7days

TO TAKE ADEQUATE NUTRITIOUS DIETFIRST FOLLOW UP

17/05/22
NO DISCHARGE FROM RIGHT NOSE

RESULTS AND DISCUSSION
Nasal polyp is a common chronic condition that can lead to recurrent infections and poor quality of life if left untreated. Main conventional treatment for polyp is application of tropical steroids but it has lots of side effects.  The equilibrium of healthy and mucosa might be affected by these chemicals or pharmaceutical agents, causing different manifestations. It was found that kali bichromium remedy as described in various Materia Medica it is well used when are been seen in body, also in Materia Medica by Gaurang Gaikwad, comes up over and over again in cases where nasal polyp is seen.

CONCLUSION:
In various chronic diseases where after years of treatment with conventional medicines no improvement occurs or relapses occurs therapeutically individualised homoeopathic medicines proves themselves to be effective.

ACKNOWLEDGEMENT:
In bringing out the present work, I would like to give my sincere thanks to Prof. (Dr.) Meenakshi Ambwani, Head of the Department of Homoeopathic Pharmacy, Bakson Homoeopathic Medical College and Hospital, Greater Noida, U.P, 201310.

LIMITATIONS OF THE STUDY:
This is only a single case, further studies with a greater number of cases can be done to proof effectiveness of nasal polyp.

PATIENT CONSENT: In this study patients’ consent was taken for publication of case.

REFERENCES:

1. Global report on Nasal polyp, https://www.who.int/publications/i/item/9789241565189;
2. P.L, DHINGRA; Text book of E.N.T for homoeopaths, fourth edition;
3. Jain Publishers (P) Ltd.
4. Hahnemann S. The Chronic Disease, their peculiar nature and their homoeopathic cure. New Delhi: B Jain Publishers P.Ltd. 2017
5. Speight PA. comparison of the chronic miasm. New Delhi, India : B jain publisher (P)Ltd.
6. Banerjea S. Miasmatic Diagnosis. New Delhi: B Jain Publisher P.Ltd; 2004
7. Mandal PP, Mandal BA. Textbook of Homoeopathic Pharmacy.2nd ed. Kolkata: NewCentral Book Agency(P)Ltd;2009

Kishan Kumar Brij¹, MEGHA¹, Haobam Vidyalaxmi Devi^1
1PG Student, Part11nd BATCH – 2021-2024,
(DEPARTMENT OF HOMOEOPATHY PHARMACY) at Bakson Homoeopathic Medical college and Hospital, Greater Noida, UP, 201310