Dr Siddamma
ABSTRACT
Introduction: Meniere’s disease is an inner ear disorder that causes vertigo, fluctuating sensorineural hearing loss, and tinnitus. Affects the quality of life of the patient. Homoeopathic medicines are found to be effective in E.N.T (ear, nose and throat) disorders, hence this case report is an effort to showcase the positive impact of these medicines in the treatment of Meniere’s disease.
Case summary: A 20 years old female patient presented with vertigo, nausea and hearing impairment, after detailed case taking Natrum muriaticum, an individualized homoeopathic remedy was prescribed followed by which steady improvements in the patient were noted. It also shows how broad is the field of utility of homoeopathic medicines
Keywords: Meniere’s disease, Homoeopathy, Individualized, Natrum muriaticum.
INTRODUCTION
Meniere’s disease is a Symptom complex consists of spontaneous episodic vertigo, fluctuating sensorineural hearing loss (SNHL), tinnitus and often a sensation of fluctuating ear fullness1. There is no diagnostic test for this, hence this condition is mainly diagnosed clinically. Meniere disease has a prevalence of approximately 200 cases per 100,000 people in the United States and in other states its less than 0.2% of the population has a case of Meniere disease. Prevalence increases steadily with increasing age, and in especially over 60 years2.
In Meniere’s disease, pressure and volume changes of the labyrinthine endolymph affect inner ear function. The etiology of endolymphatic fluid accumulation is unknown. Risk factors are a family history of Meniere’s disease, preexisting autoimmune disorders, allergies, trauma to the head or ear, and, rarely, syphilis (even several decades previously). Peak incidence is between ages 20 and 50 3. Though its not a fatal condition it affects the quality of life of the patient (QOL) significantly.
According to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), Meniere’s disease can be characterized mainly by 4 symptoms: (1) Vertigo: episodic, sensation of spinning, mild to severe, rotational, with a duration of at least 20 minutes per attack, never more than 24 hours. (2) Hearing decline: low-frequency sensory deafness, impairment, which worsens during an attack, and may become progressively worse over time. (3) Tinnitus: typical low-pitched ringing or roaring noise in the ears (4) Aural fullness: A feeling of fullness in the ear2.
Co-morbidities that can be seen along with Meniere disease are Migraine, Autoimmune diseases like Rheumatoid arthritis (RA), Ankylosing spondylitis and Systemic lupus erythematosus (SLE). Ig E could be a factor that’s causing Meniere. Genetic factors like autosomal recessive or dominant inheritance can be seen4.
Diagnosed mainly by the presence of 2 or more episodes of spontaneous whirling vertigo lasting for 20 minutes or more, sensory hearing loss (HL), Tinnitus or aural fullness – Other causes excluded1.
Conventional treatment options include Symptom relief with antiemetics, antihistamines, or benzodiazepines, Diuretics and low-salt diet, rarely vestibular ablation by drugs or surgery, Intratympanic gentamicin. Surgical intervention like Endolymphatic sac decompression, Vestibular neurectomy and labyrinthectomy3.
Homoeopathy is a system of medicine which when applied rightly according to the principles of master Hahnemann has proven to be effective. Individualising the patient is one of the essential feature of homoeopathy wherein we consider the patient as a complete entity with respect to his mental, physical, social, emotional and spiritual wellbeing. Totality of symptoms is formed with respect to the whole of the patient. And a remedy more suitable in this aspect is chosen and administered.
PATIENT INFORMATION
A 20-years-old female patient had come to the outpatient department (O.P.D.), of the Government Homoeopathic Medical College and Hospital, Bengaluru on 20th December 2022 for the following complaints, with vertigo, nausea and hearing impairment since2 years, which has aggravated since last 3-4 months.
HISTORY OF PRESENTING COMPLAINT:
The patient was apparently healthy 2 years ago, gradual appearance of symptoms vertigo, nausea and hearing impairment was noted since2 years. symptoms aggravated since last 3-4 months. Vertigo aggravates whenever she gets stressed or tensed and after much exertion. < bending downwards, sudden movement. It would occur whenever patient took head bath. It would last for up to 1-2 hours. Weekly 3-4 episodes of vertigo. Nausea occurs along with vertigo. Hearing ability had gradually reduced since the appearance of symptoms especially the left ear. there’s ringing, buzzing noises in the ear. she had sought for treatment from conventional medicines but the relief from symptom was temporary and short lived.
PERSONAL HISTORY
Her appetite was reduced, thirst moderate. Urine and stools were regular and satisfactory. Perspiration was moderate. Sleep-good, no particular desires and aversions. Thermally, she was a chilly patient. Menses-regular.
PHYSICAL EXAMINATION
General physical examination and systemic examination- no abnormality detected.
LIFE SPACE INVESTIGATION
Pt is born& brought up in Bengaluru, Lower middle-class family.
Pts relationship with parents is good, pt is the first child of her parents she has a younger brother. She lost her father when she was 4-5 years old. She is pursuing bachelors in commerce degree now, and does part time job as well. She wants to support her family financially hence she is working. She is introverted, reserved doesn’t speak much. Very sensitive, weeps easily but doesn’t like anybody consoling her. Likes to be alone, doesn’t like to socialize much. Average in studies, wants to complete the degree so that she can get a decent job. Has 1 friend. Has good relationship with classmates and lecturers. No behavioural issues. When she gets angry if its family members she will express, if its others she’ll not express. She gets easily worried if her routine is disturbed, but she can take up the new responsibility and manage it well even under stress. Sometimes feels slightly jealous at how her friends are enjoying in life whereas she is working hard. Able to forgive and forget those who offended her. Contented with her life but worried about how her health is upset off late. Memory- feels very forgetful and absentminded about her routine also. She startles easily when someone speaks to her or approaches her suddenly, at loud noise etc.
DIAGNOSIS
According to Barany diagnostic criteria this case falls under the diagnosis- Meniere’s disease.
ANALYSIS OF SYMPTOMS
After analysing the case thoroughly symptoms considered were: vertigo aggravated from mental exertion, absentmindedness, startling easily, weeping aggravated by consolation, noises in ear and impaired hearing. Her physical generals like appetite reduced. Totality of case was formed and Repertorisation done, Materia medica was also referred at last for the confirmation of the remedy. Synthesis repertory was used.
Repertorisation
Mind – Absent-minded
Mind – Starting easily
Mind – weeping consolation
Vertigo – mental exertion
Ear – Noises in
Hearing – impaired
Nat-m : 6/17
Silici a- 6/14
Nux – 6/13
PRESCRIPTION
Individualized Homoeopathic medicine Natrum muriaticum 200 was prescribed. And repeated as and when required.
FOLLOW UP
The patient was followed-up and assessed for 4 months. Follow ups are given in Table 1.
Table1: Follow Up
| DATE | SYMPTOMS | PRESCRIPTION |
| 10/1/2023 | Patient reported of slight improvement in ringing noises. Vertigo still persists. Sleep-good
Appetite- improved. |
PL 15 days
|
| 21/1/2023
|
Nausea and vertigo 3-4 episodes. And hearing impairment persists. Sleep, appetite- good | Natrum mur 200
1 dose PL 15 days |
| 17/2/2023 | Vertigo from mental exertion has reduced by 50%
Nausea-not present. Ringing sounds can still be perceived. Hearing slightly better. |
PL 15 days |
| 3/3/2023 | Vertigo, nausea, ringing better by 80%
Hearing-improved |
PL 15 days |
| 2/4/2023 | Vertigo, nausea, ringing almost nil
Hearing-improved considerably. patient feeling better. |
PL 1 month |
DISCUSSION
The case was treated according the principles laid by master Hahnemann. Patient mainly presented with vertigo, nausea and hearing impairment. The individualizing method that’s followed during the case taking helped to arrive at the indicated remedy after repertorisation. The indicated remedy was Natrum muriaticum the characteristic symptoms of the patient like absentmindedness, startling easily, weeping aggravated by consolation and vertigo aggravated by mental exertion were present in the drug picture of the remedy, apart from these common symptoms of the disease like ringing noises, hearing impairment were covered and patient’s introverted, reserved nature, likes to be alone, ability to handle responsibility were also covered when Materia medica was referred. Potency throughout the course of treatment was 200C. and the patient gradually improved within a period of 4 months.
CONCLUSION
The individualised homoeopathic medicine had favourably acted upon the patient and she has considerably improved. This case proves the efficacy of individualized homoeopathic medicines in the management of such conditions. Single and simple medicine with reasonable repetition of doses had proved to be very useful. These are the findings of a single case report further studies and evaluation can be made to better generalize the findings.
ACKNOWLEDGEMENT
Thankful to my PG Guide and professor Dr Vijayalaksmi M Angadi ma’am. Department of organon of medicine with homoeopathic philosophy. Also thankful to the patient for the co-operation.
DECLARATION OF PATIENT CONSENT
Due written informed consent was taken from the patient assuring anonymity for using her clinical information while publishing this article.
CONFLICT OF INTEREST
None declared.
REFERENCES
1.Sansal M. Diseases of ear, nose & throat: With head & neck surgery. 2nd ed. New Delhi, India: Jaypee Brothers Medical; 2018.
2. Rahmarini E, Hidayati HB. Meniere Disease: A Case Report. International Journal Of Scientific Advances [Internet]. 2021;2(5). Available from: http://dx.doi.org/10.51542/ijscia.v2i5.34
3.Merck. The Merck manual of diagnosis and therapy. 19th ed. London, England: Merck; 2011.
4.Koenen L, Andaloro C. Meniere Disease. StatPearls Publishing; 2023.
Dr Siddamma
PG Scholar, Dept of organon of medicine
Govt, homoeopathic medical college & hospital, Bengaluru-79
UGO: Dr Vijayalakshmi M Angadi
Professor, Dept of organon of medicine
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