Sinusitis Anhang

Kali-bi.: ?Sommermittel?

Luffa.: ?Wintermittel?

[Subrata K. Banerjea]

Hekla.: Sinus after mastoid operation. 30C

Hep.: Nose blocked and > if secretion commence. Offensive discharge, like old cheese. < from dry cold wind; > in damp weather; < heat and extremely irritable

Kali-i.: Frontal sinuses. Fullness in nose. Great relief from walking. < heat and extremely irritable

Kali-s.: Maxillary sinuses. Kali sulph is like a Pulsatilla patient, weepy, irritable, upset by hot room and hot. < stooping. >> in open air. Discharges thick, yellowish.

[Nomthandazo Dlamini]

The purpose of this double blind placebo controlled study was to evaluate the efficacy of the main miasmatic nosodes in the treatment of chronic sinusitis in terms of the patients perception of the treatment. 30 participants were selected for this double blind placebo controlled study, with 15 being randomly assigned to the treatment group and 15 to the placebo group. Treatment consisted

of powders that were administered 3x daily over a period of five days, with follow-up after three weeks.

The patients perception of the treatment was assessed using the General Well-Being Questionnaire (McDowell and Newell, 1996) (Appendix C1) and Sinus Symptom Visual Analogue Scale (Walker and White, 2000)

All data obtained from questionnaires was statistically analysed using a one-sample t-test, and Mann-Whitney U test.

The General Well-Being Questionnaire results showed that there were elements of improvement within the treatment group before and after treatment, but there was no significant difference between the treatment group and the placebo group.

The Sinus Symptom Visual Analogue Scale results showed that in both groups, the scores before and after treatment showed a significant difference, but there was no significant difference between the treatment and the placebo group.

Thus it was concluded that that the main miasmatic nosodes are not effective in the treatment of chronic sinusitis.

Used terms:

Rhinitis: is an inflammation of the mucous membrane of the nose (Solomon et al., 1990: 826).

Kartageners syndrome: An autosomal recessive disorder, is frequently associated with abnormalities of the cilia that impair mucociliary clearance in the airways, leading to persistent infections (Kumar, 1997: 403).

Ostiomeatus: the outflow tract from the sinuses, incl. the ostium (a tubular organ, or between distinct cavities within the body of each sinus) (Tichenor, 2003) as well as the meati (a canal entering

a structure) (Moore, 1992: 13).

Aspergillosis: opportunistic infections caused by Aspergillus species and inhaled as mould conidia, leading to hyphal growth and invasion of blood vessels, hemorrhagic necrosis, infarction, and potential dissemination to other sites in susceptible patients (Berkow and Beers, 1999:668).

Conchae: are uneven scroll-shaped elevations that form the lateral wall of the nasal cavity (Moore, 1992: 758).

Anosmia: loss of the sense of smell (Solomon et al., 1990: 1153).

Oedema: is the swelling that occurs as a result of an increase in the interstitial fluid (Solomon et al., 1990: 794).

Transillumination: the passage of light through body tissues for the purpose of examination (Bates, 1995: 192).

Halitosis: offensive breath (Edwards, 1995: 415).

Somnoplasty: Radiofrequency tissue ablation of the inferior turbinates using a thermocouple feedback electrode procedure to relieve chronic nasal obstruction (Doctors Guide, 2003).

Sinusitis defined as a condition manifested by inflamed mucous membranes (incl. neuroepithelium) of the nasal cavity and paranasal sinuses, fluids within these cavities +/o. underlying bone

(Lanza and Kennedy, 1997).

Approximately 30% of the population is affected by sinusitis at some point in their lifetime. Sinusitis is one of the most commonly increasing health problems worldwide. (Tichenor, 2000.)

Often, people with chronic sinusitis complain of fatigue, lack of concentration, poor productivity, and general discomfort (Ullman, 2002: 11-23).

Sinusitis is a condition manifested by inflammation of the mucous membranes (incl. neuroepithelium) of the nasal cavity and paranasal sinuses, fluids within these cavities, +/o. underlying bone (Lanza and Kennedy, 1997).

Chronic sinusitis is diagnosed if the sinus condition occurs for more than 4 weeks in duration (Carr, 2002).

Sinusitis was the 5th leading cause for antibiotic prescriptions between 1985 and 1992. (Kaliner et al., 1997: S1-20).

Antibiotics do not always bring medium to long-term relief, and are often followed by persistence of symptoms leading to a chronic state of sinusitis that is very difficult to treat successfully (National Allergy and Infectious Diseases, 2001).

Corticosteroids amongst the potent drugs used for chronic sinusitis in conventional medicine often leading to conditions such as growth retardation and poor immune systems as a result of long term treatment (McDonogh, 1999).

Even surgery gives only temporary relief and does not guarantee a permanent recovery from sinusitis, many patients experience more congestion and swelling of the nasal passages following this procedure (Adler, M. 1999).

Homoeopathic medicines may produce additional symptoms during the course of treatment, but these are rarely serious or harmful, and disappear quickly (the so called „Homoeopathic aggravation“) (Hahnemann, 1997: 220).

Homoeopathy attempts to bring each individual to the highest level of health possible on the physical, mental, and emotional levels. In acute and chronic disease, whether the symptoms are physical, mental, or emotional, homoeopathy produces subtle, yet often dramatic, healing and elimination of the underlying susceptibility to developing a disease state. (Ullman, 1995:11-23.)

Samuel Hahnemann: „the ideal cure is rapid, gentle and permanent restoration of health in the shortest, most reliable, and most harmless way“ (Hahnemann, 1997: 92).

Implicit in this approach is the idea formulated by Hahnemann that it is impossible to fundamentally and permanently cure a chronic disease state unless treatment is directed towards the underlying miasm/s (Watson, 1991: 41).

Therefore the main aim of this double blind placebo controlled study was to determine the efficacy of the main miasmatic nosodes in improving the symptoms of chronic sinusitis in terms of the patients perception of the treatment.

The precise aetiology and phathophysiology for sinusitis is not perfectly clear as it is commonplace to have a clinical setting in which sinusitis coexists with other conditions such as allergic rhinitis, cystic fibrosis +/o. asthma (Lanza and Kennedy, 1997).

Inhalation of airborne allergens such as dust, pollen, mould, often sets off allergic reactions such as allergic rhinitis that in turn, may contribute towards chronic sinusitis. Certain weather conditions such as humidity (N. hemisphere) can affect people with chronic sinusitis. (National allergy and infectious diseases, 2000.)

The development of sinusitis depends on a variety of inciting factors that lead to either anatomical or functional sinus outflow obstruction (Lanza and Kennedy, 1997).

Multifactorial causes of sinusitis (Lanza and Kennedy, 1997:S2)

Host factors:

- Genetic/ congenital conditions:

Cystic fibrosis

Immotile cilia syndrome

- Allergic/ immune conditions

- Anatomic abnormalities

- Systemic diseases:

Endocrine

Metabolic

- Neoplasm

Environmental factors:

- Infectious/viral agents

- Trauma

- Noxious chemicals

- Iatrogenic

Medications

Surgery

PHYSIOLOGY AND PATHOPHYSIOLOGY

The sinuses are pneumatic = air-filled extensions of the respiratory part of the nasal cavity into the following cranial bones: frontal, ethmoid, sphenoid, and maxilla (Moore, 1992:758). They are named according to the bones that they lie in, namely the ethmoidal, frontal, maxillary, and sphenoidal sinuses (Giles, 1995:39).

Genetic disorders:

1. cystic fibrosis (CF)

2. immotile cilia syndrome (Kartageners syndrome) associated with a chronic sinus disease state where the CF transmembrane conductance regulator (cAMP dependent chloride channels) are defective as a result of genetic mutation (Kaliner et al., 1997).

This resulting in impaired clearance of secretions and abnormal viscidity of airway secretions that may result in colonisation and secondary infections caused by two common pathogens:

1. Staphylococcus aureus

2. Pseudomonas aeruginosa (Kumar, 1997:208).

A role for allergies in the development of sinusitis has been suggested but not proven (Benninger, 1997).

It has been suggested that in allergic fungal sinusitis, the progressive epithelial damage resulting from eosinophil influx associated with the presence of fungi and apparent allergic responses may initiate a self perpetuating, cyclical inflammatory/immunologic response (Kaliner et al., 1997).

Histamine is the most prominent mediator of inflammation released as a result of inhalation of airborne allergens such as dust, pollen and mould that cause antigen-antibody reactions, followed

by increased vascular permeability, destabilised lysosomal membranes, and other reactions that produce inflammation and mucosal swelling (Benninger, 1997).

This leads to obstruction of the sinus ostia, preventing mucus outflow, reduction in oxygen tension, changes in mucociliary transport, and a transudation of fluid into the sinuses, creating a suitable environment for bacterial overgrowth (Benninger, 1997).

A gram-negative rod or anaerobic microorganism may cause exacerbations of chronic sinusitis (Berkow and Beers, 1999: 688).

SINUSITIS IN METABOLICALLY OR IMMUNOLOGICALLY COMPROMISED PATIENTS

In patients with poorly controlled diabetes or with immunodeficiency, aggressive and even fatal fungal or bacterial sinusitis can occur (Berkow and Beers, 1999:688).

Mucormycosis (phycomycosis) is a mycosis caused by fungi of the order mucorales that may develop in patients with poorly controlled diabetes that is characterized by black, devitalised tissue in the nasal cavity (Berkow and Beers, 1999:688).

Aspergillosis and candidiasis of the paranasal sinuses may occur in a patient who is immunologically compromised as a result of therapy with cytotoxic drugs or the underlying disease process in leukemia, lymphoma, multiple myeloma, AIDS, or other immunosuppressive diseases. Aspergillosis is characterized by polypoid tissue in the nose and paranasal sinuses (Brekow and Beers, 1999:688).

Anatomic abnormalities such as nasal septal spurs or deviations, hypertrophic or paradoxic middle turbinates, and concha bullosa can affect sinus ostia outflow so that minimal mucosal swelling or inflammation from an upper respiratory tract infection or an allergy intermittently obstructs the sinus causing sinusitis (Benninger, 1997).

Sinusitis is often a sequela of an upper respiratory tract infection followed by mucosal swelling that obstructs sinus outflow resulting in infection (Benninger, 1997). The oxygen in the sinus is absorbed into the blood vessels of the mucous membrane resulting in relative negative pressure (vacuum) that can be painful (Berkow and Beers, 1999: 687).

Chronic sinusitis with or without polyposis is characterised by inflammatory thickening and polypoid changes in the sinus mucosa.

Epithelial cells produce cytokines, such as interleukins that recruit neutrophils and other T-lymphocytes, and GM-CSF (granulocyte macrophage colony stimulating factor) that primes the eosinophils for enhanced responses to activating stimuli by altering epithelial ion transport processes and inducing ciliostasis. (Kaliner et al., 1997.)

This can result in bacterial colonisation by microorganisms that enter directly through the nasal passages, spreading cellulitis or thrombophlebitis in the lamina propria of the mucous membrane lining the nasal passages being influenced by production of nitric oxide, which is generated by the nasal epithelium (Berkow and Beers, 1999: 687).

Furthermore, bacterial products can affect both epithelial function and cytokine production resulting in long term epithelial thickening and goblet cell hyperplasia (Kaliner et al., 1997).

Headache located either frontally, interorbitally, temporally or on the vertex.

Nasal obstruction, purulent nasal discharge, and anosmia, alteration in the sense of smell.

Facial pain, upper dental pain, pain in and behind the eyes.

Postnasal discharge in the pharynx which looks like a thick strand or a solid band of discoloured mucous causing continual throat clearing or hawking, and is an important cause of secondary respiratory and gastric disorders such as pharyngitis, earache, deafness, nausea and vomiting of clear mucous and cough. There can also be breath odour, and fatigue present (McDonogh, 1999).

Diagnosis is based on a careful medical history and thorough physical examination of the head and neck. All sinuses must be palpated for tenderness (Bates, 1995:182-184).

The nasal mucosa and septum are examined using an otoscope; a nasal speculum; or a nasal endoscope to find signs such as hyperemia, oedema, crusts, purulence, concha bullosa, polypoid mucosa,

or cysts protruding into the meatus ( Carr, 2002). Anatomic anomalies such as deviated septum, concha bullosa, and middle meatal polyps that cause narrowing of the osteomeatal units should also

be noted (McDonogh, 1999).

Transillumination may be a handy diagnostic tool for diagnosis, but is not a reliable examination (McDonogh, 1999).

X-rays of the apices of the teeth are required in chronic maxillary sinusitis to exclude a periapical abscess (Berkow and Beers, 1999: 688).

Normal radiographs of the sinuses only show gross abnormalities within the sinuses and do not give any idea of the extent of the disease (McDonogh, 1999).

CT scanning (coronal computed tomography) of the paranasal sinuses is superior to radiography, and is very helpful in diagnosing difficult or recalcitrant cases of sinusitis (Lanza andKennedy, 1997). One cut through the frontal sinus, two cuts in the anterior ethmoid and maxillary sinuses and one cut each in the posterior ethmoids and sphenoid sinuses will give a fairly comprehensive picture of the extent of the disease (McDonogh, 1999).

Microscopy, culture and sensitivity (MCS) of the postnasal drip, the sputum, and any pus from the middle meatus is another useful investigation (McDonogh, 1999).

If necessary, other local and systemic causes should be excluded by means of a full blood count, immunoglobulin evaluation and skin tests for allergies.

Assessment of the ESR (erythrocyte sedimentation rate), can indicate whether the symptoms are caused by an infection or not, especially in complicated cases involving surrounding bone inflammation. (McDonogh, 1999.)

According to Lanza and Kennedy (1997), and Carr (2002), the basis for diagnosis of chronic sinusitis is as follows:

The patient must have more than 2 major factors or 1 major and 2 minor factors occurring for more than 4 weeks in duration.

Major Factors

- Facial pain/ pressure

- Facial congestion/ fullness

- Nasal obstruction

- Nasal discharge: purulent, or discoloured postnasal drainage

- Hyposmia/Anosmia

- Purulent discharge in the nose

Minor Factors

- Ear pressure/fullness

- Headache

- Halitosis

- Fatigue

- Dental pin

- Cough

Swelling of the upper eyelid, proptosis, loss of visual acuity, loss of eye movement, swelling over the frontal sinus, signs of meningeal irritation and secondary chest problems (McDonogh, 1999).

Sinusitis frequently complicates asthma, and medical +/o. surgical therapy for underlying sinusitis can improve asthma (Kaliner et al., 1997).

Infection from the nasal passages can spread into the surrounding bones of the face if left untreated, resulting in osteomyelitis (Giles et al., 1995:40), and intracranial abscesses (Edwards, 1995: 1098).

DD.:

- Rhinitis

- Common cold

- Barre syndrome

- Upper dental Sepsis.x

- Temporomandibular joint disease

- Cervical muscular disease

- Old neck injuries (McDonough, 1999).

Treatment is aimed at restoring the health of the mucous membrane of the osteomeatal unit, and combating infection of the sinuses and the complications or secondary effects of these infections.

It must decrease oedema of the mucosa, thereby opening airspaces of the infendibulum and stimulating the movement of secretion from the sinuses, and must have bactericidal components. (McDonogh, 1999.)

Local decongestants such as oxymetazoline or xylometazoline are advisable for a limited period only (McDonogh, 1999).

Methylxanthines are said to stimulate ciliary activity and relieve the associated cough. Pseudoephedrine sulphate is a sympathomimetic that helps to shrink the mucous membrane and has no effect on the viscocity of the mucous produced. (McDonogh, 1999.)

Among antibiotics, penicillin is the drug of first choice (amoxycillin clavulanic acid preparations). They are broad-spectrum bactericidal agents and should be used for a minimum of 10 days initially, but for up to 4 weeks if necessary. After the initial course, a further three weeks of antibiotic therapy is permissible or a sulphonamide-based product can be prescribed for one month. (McDonogh, 1999.)

Prolonged antibiotic courses are usually prescribed in unresolved cases and for patients with complications. Tetracyclines, macrolides, antifungal agents and metronidazole are prescribed only if indicated by the MCS (= microscopy, culture and sensitivity) results, or if the patient is allergic to penicillin. (McDonogh, 1999.)

If there is an allergic component, patients are advised to avoid allergens, they are given antihistamines, systemic steroids and immunotherapy (Carr, 2002). Anti-inflammatory agents such as corticosteroids decrease oedema of the mucous membrane, inflammatory infiltrate of the membranes and also stimulate ciliary activity (McDonogh, 1999).

Prednisone should be used as a single morning dose for five days and then on alternate days for further five doses. Such drugs are not prescribed in immunocompromised patients, since they lower then immunity and can cause growth retardation in children if used continuously for longer than seven days. (McDonogh, 1999.)

Patients with a nasal obstruction are advised to inhale steam from a vaporiser or a hot cup of water to lessen the discomfort and soothe inflamed sinuses. Hot wet compresses are applied over the inflamed area to alleviate symptoms of congestion (National allergy and infectious diseases, 2000).

Physiotherapy usually entails up to 8 treatments sessions with nasal douches, or nebulisation with normal saline and in a non-asthmatic patient, sodium 2-mercaptoethane-sulphonate solution to help remove and break down thick mucous plugs in the nasal cavity and middle meatus. Ultrasound and laser treatment of the sinus cavities promotes movement of viscid mucous in the sinus cavities and promotes blood flow through the mucous membrane thereby aiding action of medication. (McDonogh, 1999.)

Surgical treatment simply allows the sinuses, which previously did not drain, to drain through the ostia (Tichenor, 2003) as in cases of failed medical treatment of the primary disease and its complications, and for lesions of the osteomeatal unit that cause persistent disease. Functional endoscopic sinus surgery (FESS) is the only surgery that can be used with accuracy in this region and which does not destroy normal ventilatory and drainage tracts. (McDonogh, 1999.) Some patients will develop new areas of sinusitis post-surgically which may or may not be able to be visualized

on endoscopy and sometimes require repeat CT scans. In those cases, oral antibiotics are more likely to be necessary and in some cases surgical revision may be necessary. In some patients, scar tissue may form after surgery. (Tichenor, 2003.)

In some cases, nasal obstruction is typically caused by enlargement of the inferior nasal turbinates. Normally, turbinates swell and humidify air as it is inhaled. Chronic turbinate enlargement blocks the air passage leading to chronic sinusitis. (Doctors guide, 2003.)

The somnoplasty technique was developed as a means of reducing some of the obstruction caused by the turbinates. This technique gently heats the turbinates. As a result the turbinate will shrink down in size over the course of 6-8 weeks. There may be minimal crusting and bleeding as a result. (Tichenor, 2003.)

Homoeopathy is based on the fundamental principle of „Like cures like“, meaning that,“ any substance which can produce a totality of symptoms in a healthy human being, can cure the totality of symptoms in a sick human being“ (Vithoulkas, 1998:92).

According to homoeopathic principles, disease is not considered as something local, or an affection of the parts, but is the state of being of the whole person at the time, the way he/she feels, thinks and behaves. This is the state that needs to be treated and reversed for the local body parts to function normally. (Sankaran, 1991:10.)

A miasm is a predisposition toward chronic disease underlying the acute manifestation of illness, which is transmissible from generation to generation, and which may respond beneficially to the corresponding nosode (Vithoulkas, 1998: 133).

A nosode is a substance that is prepared from either pathological tissue or from the appropriate drug or vaccine (Vithoulkas, 1998:133).

The pathological tissues are collected and mixed with equal parts of spirits of wine. The next step in preparation of nosodes involves dilution and potentisation. (Vithoulkas, 1998:160-61.)

This procedure involves a serial dilution wherein one part by volume of a medicinal substance is diluted with 99 parts of distilled water or ethyl alcohol, which then is shaken vigorously.

One part of this solution is diluted further with 99 parts of diluted water or ethyl alcohol and then shaken forcefully for a definite number of successions. (Ullman, 1991:12.)

The true natural chronic diseases are those that arise from a chronic miasm, which when left unchecked by the employment of those homoeopathic medicines that are specific for them, always go on growing worse (Hahnemann, 1997:166).

Miasmatic treatment is a method of prescription that is based on the assumption that there exists in virtually everyone an inherited or an acquired energy blockage that produces a predisposition towards a particular and recognisable pattern of illness (Watson, 1991:41).

Eizayaga states that if a patient has „never been well since a specific disease”, the acquired miasmatic layer should be treated with the corresponding disease nosode in the same way as an active miasm would be treated (Watson, 1991:35).

From clinical experience of other Homoeopaths, it is evident that the nosodes are in fact amongst the most frequently indicated homoeopathic medicines (Watson, 1991:41).

There are different situations in which a major nosode ought to be considered when prescribing such as:

When the nosode is the indicated medicine (i.e. the simillimum medicine);

When all well selected and indicated medicine fail to work;

When a patients ailments relapse;

When acute diseases fail to resolve;

When the miasm obscures the symptom picture (Watson, 1991:41).

There are five major miasmatic nosodes indicated for the homoeopathic treatment of chronic sinusitis namely;

Psorinum.

Medorhinum

Syphilinum

Tuberculinum

Carcinosinum

Paceboeffect:

The word placebo means, „I will please“ (Newman, 1994:1298). It is made up of a medicinal inactive substance such as a starch or sugar used in controlled studies for comparison with presumed active drugs or prescribed with the intent to relieve symptoms or meet a patients demands, i.e. it is a „make-believe medicine“, and it is allegedly inert and harmless (Berkow and Beers, 1999:2585).

There is a placebo element in every therapeutic manoeuvre (surgical and psychological techniques/medication in any form). Thus the effects of any drug will vary from patient to patient and doctor to doctor, depending on the placebo reactivity studies to determine whether or not certain personality characteristics correlate with responses to placebos have disagreed extravagantly with one another (Berkow and Beers, 1999:2586).

The subjective and objective, desirable and undesirable effects of placebos appear to be related to two components of the placebo reaction. The first is anticipation (usually optimistic) of results because drugs are expected to work; it can be called "suggestibility," "faith," or "hope." The second is spontaneous change, which is at times even more important. A placebo may be credited for spontaneous improvement or blamed for spontaneous deterioration or an entirely new problem (eg, headache, rash) (Berkow and Beers, 1999:2586.) In studies, effects of placebo must be subtracted from those of the active drug. The active drug must perform significantly better than the placebo to demonstrate efficacy. (Berkow and Beers, 1999:2586.)

Related homeopathic research:

Sengpiehl (1994) evaluated the reaction of homoeopathic Luffa Operculata 4X and a combination of Kalium Bichromium 5CH and Cinnabaris 5CH.

40 patients were randomly selected and divided into 2 experimental groups. The study was carried over a period of four months. One group received Luffa 4X and the other group a combination

of Kalium Bichromium 5CH and Cinnabaris 5CH. The statistical results form questionnaires were analysed using Mann-Whitney U test and Wilcoxon Signed Rank test. The Mann-Whitney U test results showed values of p = 0.033 and p = 0.31 within each group. The conclusion was that Luffa Operculata was a more effective mode of treatment for chronic sinusitis than a combination

of Kalium Bichromium and Cinnabaris. (Sengpiehl, 1994.)

However, it is difficult to assess the validity of these results, because, there was no placebo control group in this study. Smit (2002) conducted a study to determine the efficacy of a homoeopathic simillimum in the symptomatic treatment of chronic sinusitis over a period of 8 weeks. 15 patients were selected, diagnosed with chronic sinusitis by a medical doctor via case history taking and

an endoscopic examination. Data collected from evaluation forms completed by participants and objective medical assessment was statistically analysed using Wilcoxon Signed Rank test.

The results indicated a highly significant improvement in all the determinants measured (primary, associated ,and secondary symptoms of sinusitis, mood, vitality, and medical improvement).

The validity of these results is difficult to assess, because there was no placebo control group in this study and the sample size was very small.

Fleming (2001) investigated the efficacy of Hydrastis Canadensis Ø and 3X potency in the treatment of sinusitis. This double blind placebo controlled study was carried over a 3 week period.

45 patients between the ages of 13 and 50 years with pre-diagnosed sinusitis were randomly selected into three groups . The control group received placebo. One experimental group received Hydrastis canadensis Ø and the one experimental group received Hydrastis canadensis 3X.

The data from questionnaires was analysed using Wilcoxon-Rank-Sum test, Kruskal-Wallis test, Mann-Whitney U test and goodness-of-fit tests.

There was a generally observed reduction in symptom severity for all 3 groups between days 1 and 11 of the study.

Hydrastis Canadensis 3X group showed a symptom severity reduction between days 11 and 21. There was however no significant difference between the three groups. It was concluded that neither Hydrastis Canadensis Ø nor Hydrastis Canadensis 3X was effective in the treatment of sinusitis.

Two other studies on homoeopathic treatment of sinusitis were conducted at the same time as this study, using the same protocol and methodology.

Ismail (2003) investigated the efficacy of homoeopathic simillimum in the treatment of chronic sinusitis. This double blind placebo controlled study was conducted over a three-week period.

30 participants were selected for this study and were divided into two experimental groups „“ simillimum and placebo group. The data collected from questionnaires was statistically analysed using

a one-sample t-test and Mann-Whitney U test.

The one-sample t-test results showed that both treatment groups showed a statistically significant improvement , however the Mann-Whitney U test results showed that there was no statistically significant difference between the two groups. Therefore the simillimum treatment was found to be as significant as the placebo group. It was concluded that simillimum treatment was not effective in the treatment of chronic sinusitis.

Ebrahim (2003) investigated the efficacy of a homoeopathic complex (Hydrastis Canadensis 9CH, Kalium Bichromium 9CH and Sambucus nigra 9CH) in the treatment of chronic sinusitis over a period of three weeks.

This was a double blind placebo controlled study. Thirty participants were selected for this study and were divided into two groups, one receiving complex treatment and the other receiving placebo. Data collected from questionnaires was statistically analysed using one-sample t-test and Mann-Whitney U test.

The one-sample t-test results showed that both treatment groups showed a statistically significant improvement. Mann-Whitney U test results showed that there was no significant difference between the two groups.

Therefore the complex treatment was found to be as significant as the placebo group. It was concluded that homoeopathic complex treatment was not effective in the treatment of chronic sinusitis.

30 volunteering participants were selected according to inclusion and exclusion criteria for this double blind study. 15 participants were randomly assigned to the nosode treatment group and 15 participants were randomly assigned to the placebo group.

Patient number Nosode precribed Dispensed Placebo

1 CARCINOSINUM 200 CH X

2 CARCINOSINUM 30 CH X

3 CARCINOSINUM 30 CH X

4 TUBERCULINUM 30 CH X

5 CARCINOSINUM 1 M X

6 MEDORRHINUM 30 CH X

7 SYPHILLINUM 30 CH X

8 CARCINOSINUM 1M X

9 TUBERCULINUM 200 CH X

10 CARCINOSINUM 30 CH X

11 MEDORRHINUM 30 CH X

12 TUBERCULINUM 200 CH X

13 CARCINOSINUM 200 CH X

14 CARCINOSINUM 200 CH X

15 CARCINOSINUM 30 CH X

16 TUBERCULINUM 30 CH X

17 MEDORRHINUM 30 CH X

18 CARCINOSINUM 200 CH X

19 MEDORRHINUM 30 CH X

20 CARCINOSINUM 30 CH X

21 MEDORRHINUM 30 CH X

22 MEDORRHINUM 30 CH X

23 CARCINOSINUM 200 CH X

24 CARCINOSINUM 30 CH X

25 CARCINOSINUM 200 CH X

26 CARCINOSINUM 30 CH X

27 MEDORRHINUM 30 CH X

28 CARCINOSINUM 30 CH X

29 CARCINOSINUM 200 CH X

30 CARCINOSINUM 30 CH X

The table above shows that there were an equal number of participants in each group that were allocated with either a nosode or a placebo according to the randomisation list. The most common nosode prescribed was Carcinosinum (18 participants). The most common nosode dispensed was also Carcinosinum (10 participants).

Only three nosodes were indicated for participants in this study. 10 participants received the cancer nosode (Carcinosinum), 2 participants received the tubercular nosode (Tuberculinum), and 3 participants received the sycotic nosode (Medorrhinum).

8 participants that received Carcinosinum had complained of a history of headaches during the first consultation before treatment. All these participants reported that they were headache-free during the 3-week treatment Compared to other related research studies, Sengpiehl (1994) and Smit (2002) conducted their studies over a four-month and two-month period respectively. However, both studies were not placebo controlled. Their results showed a significant improvement in sinusitis symptoms. This could have been due to a longer observation treatment period, but it is difficult to assess the validity of these results, because there was no placebo group.

Like this study, Fleming (2001), Ismail (2003) and Ebrahim (2003) conducted double blind placebo controlled studies over a period of three weeks. Their results showed a significant improvement in each mode of treatment investigated. However, there was no statistical significance when compared to the placebo groups.

The outcome of these studies could have been due to the similar weaknesses as the ones mentioned above for the miasmatic nosodes, such as, the short treatment period. There was a placebo effect

in these studies which could have been due??

In addition, the use of subjective outcome measures only may have been insufficient to adequately evaluate the effectiveness of miasmatic nosode treatment of chronic sinusitis. In future, objective clinical evaluation should be included in any similar study.

Based on the results of this study one must conclude that the main miasmatic nosodes are not effective in the treatment of chronic sinusitis.

[Nomthandazo Dlamini]

Department of Homoeopathy, Durban Institute of Technology.

APHENDIKSI A

INCWADI YEMINININGWANE EBALULEKILE

ISIHLOKO SOCWANINGO PHROJEKTHI: Ukubaluleka kwamanosodi

asemqoka ekwelapheni isifo se khronikhi sanusaythisi.

IGAMA LOMPHATHI HLELO: Dokotela Richard Steele

IGAMA LESEKELA LOMPHATHI: Dokotela Corne Hall

IGAMA LOMCWANINGI: Nomthandazo Dlamini

ABANYE ABACWANINGI: Shaida Ismail, Shera Ebrahim

Usuku:

Sawubona

Siyabonga ngokuzinika isikhathi kanye nentshisekelo yakho ekufundeni lencwadi. Ngosizo lwakho, ukubaluleka kwe Homoeopathy ekwelapheni i chronic sinusitis kungacwaningwa.

Ngingumfundi owenza ihomoeopathy e Durban Institute of Technology. Ukuze ngigogode kulomkhakha, kumele ngenze ucwaningo. Lolu wuhlelo olusemthethweni oluzoletha ulwazi mayelana nokubaluleka kwe

Homoeopathy ekwehliseni izinga lezimpawu ze chonic sinusitis. Ukuze lokhu kufezeke, uyacelwa ukuba uzimbandakanye kuloluhlelo lwamahhala mayelana nokusixoxela ngesifo sakho sechronic sinusitis, nanokuba

sikuphatha kanjani empilweni yakho.

Lolucwaningo phrojekthi luzobe lusingathwe ngu Dokotela oyi homoeopath orejistiwe kuwo lomnyango. Lonke ulwazi ongahle usonike lona kulolucwaningo, luzogcinwa luyimfihlo yakho kanye nomcwaningi kuphela.

Uma uzozimbandakanya kuloluhlelo kumele ube ngumuntu onalokhu okulandelayo:

a) ube neminyaka ephakathi kweyishumi nesishiyagalombili kuya kwiminyaka engamashumini ayisithupha nanhlanu.

b) kumele ube ukade uphethwe yilesifo esikhathini esingamasonto amane elandelana,

c) kumele ube ngumuntu obengathathi muthi wokwelapha isinusitis esikhathini esingangesonto ngaphambi kokuzimbandakanya kulolucwaningo.

d) Kumele ube ngumuntu okwaziyo ukufunda kanye nokubhala.

Labo abanalokhu okulandelayo bazohoxiswa kuloluhlelo:

a) abesifazane abakhulelwe

b) labo abanesifo esiqondene nesifuba njege asma.

c) Kusukela luqala loluhlelo, awuvumelekile ukuthatha olunye uhlobo lomuthi wokwelapha, ngaphandle kwaleyo yezifo ezibucayi ezinjengesofo sikashukela, isifo esiphathelene nenhliziyo kanye nakholesteroli.

d) Labo abangazwani nemikhiqizo yobisi, ilakthozi.

Uma usuyifezile lemigomo ebhaliwe futhi uzimisele ngokubandakanyeka, usungaba kuloluhlelo oluzothatha amasonto amathathu, lapho umcwaningi edinga ukuba akubone ezikhathini ezimbili lapho kudingeke ukuba

ugcwalise ifomu yemibuzo ephathelene nesimo sempilo yakho kanye neye sanusaythisi.

Leli fomu lizobe libhalwe ngolimi lwesiZulu nesi Ngisi . Yonke imininingwane ezobe igcwaliswe kulelifomu izobe iyimfihlo.

Loluhlelo lusingathwa umthetho owenza ukuba umcwaningi, nomphathi hlelo, bangazi ukuba yilowo nalowo muntu welashwa ngaluphi uhlobo lomuthi wokwelapha phecelezi I“double blind placebo control study“.

Abantu abazimbandakanyayo kuloluhlelo, bazocazwa kumaqembu amabili okwelashwa (phecelezi i plasibo noma i thrithmenti) ngendlela engabandlululi.Umuntu ngamunye usethubeni elingamaphesenti angu 25

okuba kwiqembu elibizwa nge plasibo kanye nethuba elingamaphesenti angu 75 lokuba kwiqembu le thrithmenti. Yonke imithi yokwelapha izobe itholakala ngendlela efanayo kulamaqembu womabili ngendlela

yesihomoeopathi.

Amavolontiya angu 15 azofakwa kwiqembu lethrithmenti, kanti amavolovtiya angu 5 azofakwa kwiqembu leplasibo. Labo abazobe bekwiqembu leplasibo bayokwaziswa ekupheleni kohlelo, futhi bayonikwa ithuba

lokwelashwa uma seluphelile lolucwaningo.

Uyaziswa ukuba ukuzimbandakanya kwakho kuloluhlelo lwamahhala kungukuvolontiya, futhi wamukelekile ukuba uhoxe kuloluhlelo noma yinini, nangaphandle kokusinika isizathu. Ukuzimbandakanya kwakho kulolu hlelo

akuzuba nomphumela olimazanayo, kepha ungazizwa ungekho esimweni esejwayelekile ezinsukwini zokuqala esikuthatha njengophawu olujwayelekile uma welashwa ngokwesihomoeopathi.

Uma unemibuzo noma ungacaciselwa ngokweneliskile, ungathintana nalaba abalandelayo kulezinombolo:

Nomthandazo Dlamini - 0825335369

Dokotela Steele- 2042041

Siyabonga ngosizo lwakho.

Umnyango wakwa homoeopathy e Durban Institute of Technology

Vorwort/Suchen. Zeichen/Abkürzungen. Impressum.