A clinical study on the utility of homoeopathic constitutional medicines in the treatment of chronic suppurative otitis media in age group 5-50 years
Dr Sreenath B MD (Hom) Organon from GHMC Calicut
Medical Officer, Department of Homoeopathy, Govt of Kerala
siglisreenath@gmail.com
Abstract
Background and objectives: Chronic suppurative otitis media (CSOM) is the chronic inflammation of part or whole of middle ear cleft characterized by ear discharge and permanent perforation. Global burden of illness from CSOM involves 65–330 million individuals with draining ears, 60% of whom suffer from significant hearing impairment. Surgical procedures like mastoidectomy with or without tympanaoplasty are costly and do not always lead to satisfactory hearing improvement.
The risk of ototoxicity is one stumbling block in the widespread use of topical antibiotics. Antibiotic sensitivity has changed overtime and a continuous and periodic surveillance is necessary and studies show most of the CSOM cases are poly microbial. Homeopathic approach is to treat the patient, evaluating health in multiple levels of each individual. This study is conducted to understand the effectiveness of constitutional medicines in the management of CSOM. This study is to assess the effectiveness of Homoeopathic constitutional medicines in the treatment of chronic suppurative otitis media and also to compare the wellbeing levels and symptomatic changes of the patients before and after treatment.
Materials and method: The study comprised of 30 patients randomly selected from the inpatient and outpatient department of Government Homeopathic Medical College, Kozhikode, in the year 2016-2017, in the age group of 5-50, presenting with ear discharge continuous or intermittent with tympanic membrane perforation according to the diagnostic criteria. Study period was 1 year with minimum 6 months follow up in each case.
Result: After 6 months, found amelioration of ear discharge in 73% cases, aggravation in 10%, and no change of ear discharge in 16.66%. Recurrence of ear discharge was decreased 66.66% patients; in 33.33 patients recurrence was same as before and in no case recurrence was increased. Calcarea Carb was indicated in 16.66% cases. Otoendoscopic finding of tympanic membrane was not changed after treatment. 88.88% patients with hearing improvement had no change in hearing after treatment, 11.11% patients had improvement in conductive deafness and no improvement was found in cases with mixed hearing loss.
Conclusion: Results shows there is significant improvement in ear discharges of patients. Character, volume and recurrence have improved after Homoeopathic constitutional medicines. Hearing impairments were not found to be improved in most of the cases. Homoeopathic constitutional medicines are effective in management of chronic suppurative otitis media.
Key words : chronic suppurative otitis media; middle ear; Homoepathy; otoendoscopy; ear discharge; tympanic membrane; recurrence; pure tone audiogram; conductive deafness; mixed deafness;
This study concluded Homoepathic constitutional medicines are effective in management of chronic suppurative otitis media. The cases with long duration of pathology, responded well to the treatment. Character, volume and recurrence of discharge improved after medicines. Conductive deafness responded but mixed deafness did not change after treatment.
REFERENCES
1.Acuin, Jose; WHO, Dept. of Child and Adolescent Health and Development; WHO Programme for the Prevention of Blindness and Deafness. Chronic suppurative otitis media : burden of illness and management options. Geneve: World Health Organization. ISBN 92-4-159158-7
2.Dhingra PL, Dhingra shruthi, Dhingra deeksha. Diseases of ear, nose and throat and head and neck surgery. 6th edition: Elsevier; 2014.
3.Mohammad Maqbool, Suhail Maqbool.Textbook of ear, nose and throat diseases.11th edition .New Delhi: Jaypee brothers medical publishes (P) LTD; 2007.
4.Noam Yehudai, Tova Most, Michal Luntz. Risk factors for sensorineural hearing loss in pediatric chronic otitis media.international journal of paediatric otolaryngiology.2015;79(1):26–30.DOI: http://dx.doi.org/10.1016/j.ijporl.2014.10.025.
5.Shikhar Saxena, Anuja Bhargava, Shitanshu Srivastava, Mrinal Ranjan Srivastava. Malnutrition among children having otitis media: A hospital-based cross-sectional study in Lucknow district.Indian journal of otology. 2016 ; 22 (3) :188-192
6.Monique Verhoeff a, Erwin L. van der Veen a, Maroeska M. Rovers a, b, c, Elisabeth A.M. Sanders c, Anne G.M. Schilder. Chronic suppurative otitis media: A review.international Journal of Pediatric Otorhinolaryngology (2006) 70, 1-12-elsevier.
7.Hassan O, Adeyemi RE, ET. A study of bacterial isolates in cases of otitis media in patients attending OAUTHC Ile-Ife. African journal of clinical and experimental microbiology 2007; 8(3):130-136.
8.Hahnemann.S.Organon of Medicine. 5th and 6th edition (Dudgeon).New Delhi.B Jain; 2002.
9.Rahul Mittal,Christopher V. Lisi,Robert Gerring,Jeenu Mittal, Kalai Mathee,Giri Narasimhan,3 Rajeev K. Azad,4 Qi Yao,M’hamed Grati, Denise Yan, Adrien A.Eshraghi, Simon.Angeli, Yeo SG, Park DC, Hong SM, Cha CI, Kim MG. Bacteriology of chronic suppurative otitis media- a multicenter study.pubmed.2007; 127(10):1062-7.
10. “Anatomy of the Ear – Fairview Health Services”. Fairview.org. N.p., 2017. Web. 5 May 2017.
11.Ricardo Insausti ,David G. Amaral.science direct.the human nervous system.3rd edition.chapter 24- hippocampal formation :2012;896-942
12.”Ear Bone – Anatomy”. Encyclopedia Britannica. N.p., 2017. Web. 5 May 2017.
13.Alma maniu, Iuliu v. catana,Oana harabagiu, Maria petri, Marcel cosgarea. Anatomical variants of tympanic compartments and their aeration pathways involved in the pathogenesis of middle ear inflammatory disease. Clujul Med. 2013; 86(4): 352–356.
14.Kent James Tyler. Homoopathic philosophy. New Delhi: B Jain publishers; 2003
15.”Ptolentinobioresearch – >> Outline the Role of the Eustachian Tube”. Ptolentinobioresearch.wikispaces.com. N.p., 2017. Web. 5 May 2017.
16.Marchisio P, Chonmaitree T, Leibovitz E, Lieberthal A, Lous J, Mandel E, McCormick D, Morris P, Ruohola A. Panel 7: Treatment and comparative effectiveness research. Otolaryngol Head Neck Surg. 2013;148(4 Suppl):E102-21. DOI: 10.1177/0194599812465397
17.Gates GA, Klein JO, Lim DJ, Mogi G, Ogra PL, Pararella MM, Paradise JL, Tos M. Recent advances in otitis media. Definitions, terminology, and classification of otitis media. Ann Otol Rhinol Laryngol Suppl. 2002; 188:8- 18.
18.Levi J, Robert C O’Reilly. Chronic suppurative otitis media (CSOM): Pathogenesis, clinical manifestations, and diagnosis. http://www.uptodate.com/contents/chronic-suppurative-otitis-media- csompathogenesis-clinical-manifestationsand-diagnosis
19.Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, et. al. (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study.Lancet; 2010:380:2197–223. doi: 10.1016/S0140-6736(12)61689-4. pmid:23245608
20. Monasta L, Ronfani L, Marchetti F, Montico M, Vecchi Brumatti L, Bavcar A, Grasso D, Barbiero C, Tamburlini G. Burden of disease caused by otitis media: systematic review and global estimates. PLoS ONE. 2012;
7(4):e36226. DOI: 10.1371/journal.pone.0036226
21.Telian SA, Schmalbach CE. Chronic Otitis Media. In: Snow JB Jr, Ballenger JJ, eds. Ballenger’s Otorhinolaryngology Head and Neck Surgery. Hamilton: BC Decker; 2003: 261-93.
22.Nelson, John D.chronic suppurative otitis media.Pediatric Infectious Disease
Journal: 1988 ;7(6) : 446-448
23.Elemraid MA, Brabin BJ, Fraser WD, Harper G, Faragher B, et al. Characteristics of hearing impairment in Yemeni children with chronic suppurative otitis media: a case-control study. Int J of Ped Otorhinolaryngology.2010; 74: 283–286. doi: 10.1016/j.ijporl.2009.12.004. pmid:20042241
24.Hanushek E, Peterson PE (2014) Higher Grades, Higher GDP. Hoover Digest (pub med). 2014; 3:75–78.
25.Orji FT. A Survey of the Burden of Management of Chronic Suppurative Otitis Media in a Developing Country. Ann Med Health Sciences Res.2013; 3: 598–601. doi: 10.4103/2141-9248.122126. pmid:24380016
26.Srikanth S, Isaac R, Rebekah G, Rupa V (2009) Knowledge, attitudes and practices with respect to risk factors for otitis media in a rural South Indian community. Int J Pediatr Otorhinolaryngol.2009; 73: 1394–1398. doi: 10.1016/j.ijporl.2009.06.024. pmid:19640593
27.Sophia A, Isaac R, Rebekah G, Brahmadathan K, Rupa V. Risk factors for otitis media among preschool, rural Indian children. Int J Pediatr Otorhinolaryngol 2010; 74: 677–683. doi: 10.1016/j.ijporl.2010.03.023. pmid: 20416956
28.Atef A, A yad EE. Ciliary count in chronic suppurative otitis media: comparative quantitative study between mucosal and squamous types using scanning electron microscopy and image analysis. J Laryngol Otol. 2004 May; 118(5):343-7. DOI: 10.1258/002221504323086516
29.M A Elemraid, I J Mackenzie, W D Fraser, G Harper, B Faragher, Z Atef, N Al-Aghbari and B J Brabin. A case–control study of nutritional factors associated with chronic suppurative otitis media in Yemeni children.European journal clinical nutrition. (2011) 65, 895–902; doi:10.1038/ejcn.2011.58; published online 4 May 2011.
30.Neelaveni.D, .Sankar.P . Detection and Genomic Characterization of Carbapenemase producing Pseudomonas aeruginosaisolates in Chronic SuppurativeOtitis Media (CSOM).global journal for research analysis. Medical science.2016; 5(9). ISSN no; 2277-8160.u
31.Sellappampatty Veerappapillai Dhanasekharan, Jiji Sanjeevan Nir, Kombathi Raja, Govind Krishnan Gopalakrishna Pillai, Abhilash Kuniyath Chandran, Shankar Radhakrishnan. A clinical study on the influence of sinusitis in Chronic suppurative otits media.Bengal Journal of otolaryngology and head and neck surgery.2016; 24 (2).
32.Bluestone CD. Pathogenesis of otitis media: role of eustachian tube. Pediatr Infect Dis J. 1996; 15(4):281-91. DOI: 10.1097/00006454-199604000-00002
33.Arzu Tatar,Sener Tasdemir,Ibrahim Sahin,Ceyda Bozoglu,Haktan Bagis Erde m, Ozgur Yoruk, Abdulgani Tatar. Mitochondrial DNA deletions in patients with chronic suppurative otitis media. European Archives of Oto-Rhino- Laryngology. 2016; 273(9): 2473–2479.
34.Lannigan FJ, O’Higgins P, Mcphie P. The cellular mechanism of ossicular erosion in chronic suppurative otitis media. J Laryngol Otol. 1993; 107:12.
35.Allen, E. K., Manichaikul, A, Sale, M. M. Genetic contributors to otitis media: agnostic discovery approaches. Curr Allergy Asthma Rep.2014; 14: 411
36.Elmorsy, S., Shabana, Y. K., Raouf, A. A., Naggar, M. E., Bedir, T., Taher, S. & Fath-Aallah, M. The role of IL-8 in different types of otitis media and
bacteriological correlation. J Int Adv Otol.2010; 6: 269–273.
37.Rahul Mittal,Christopher V. Lisi, Robert Gerring, Jeenu Mittal, Kalai Mathee, Giri Narasimhan, Rajeev K. Azad, Qi Yao, M’hamed Grati, Denise Yan, Adrien A. Eshraghi, Simon I. Angeli, Fred F. Telischi and Xue-Zhong Liu. Current concepts in the pathogenesis and treatment of chronic suppurative
otitis media. Journal of Medical Microbiology. 2015; 64: 1103–1116.
38.Rye, M. S., Blackwell, J. M. & Jamieson, S. E. Genetic susceptibility to otitis
media in childhood. Laryngoscope.2012; 122: 665–675.
39.Li, J. D., Hermansson, A., Ryan, A. F., Bakaletz, L. O., Brown, S. D.,Cheeseman, M. T., Juhn, S. K., Jung, T. T., Lim, D. J. & other authors . Panel 4: Recent advances in otitis media in molecular biology, biochemistry, genetics, and animal models.Otolaryngol Head Neck Surg.2013; 148.E52– E63.
40.Sierra, A., Lopez, P ., Zapata, M. A., V anegas, B., Castrejon, M. M., Deantonio, R., Hausdorff, W. P. & Colindres, R. E. (2011). Nontypeable Haemophilus influenzae and Streptococcus pneumoniae as primary causes of acute otitis media in Colombian children a prospective study. BMC Infect Dis 11, 4.
41.Qureishi, A., Lee, Y., Belfield, K., Birchall, J. P. & Daniel, M. Update on otitis media – prevention and treatment. Infect Drug Resist.2014; 7:15–24.
42.Stewart, P. S. & Costerton, J. W. Antibiotic resistance of bacteria in biofilms. Lancet.2009; 358:135–138
43.Hall-Stoodley, L. & Stoodley, P. Evolving concepts in biofilm infections. Cell Microbiol.2009; 11:1034–1043.
44.Donelli, G. & Vuotto, C. Biofilm-based infections in long-term care facilities. Future Microbiol.2014; 9:175–188.
45.Meher D. Well, L. Michaels. Mode of growth of acquired cholesteatoma. The journal of laryngology and otology.1991; 105(4): 261-267.
46.Marileen Roos, Tashneem Harris, Riaz Seedat. Fatal Lemierre’s syndrome as a complication of chronic otitis media with cholesteatoma. The South African journal of child health.2016; 10 (4).
47.Yorgancilar.E, Yildirim.M, Gun.R, Bakir.S, Tekin.R, Gocmez.C, Meric.F, Topcu.I. Complications of chronic suppurative otitis media: a retrospective review. European Archives of Oto-Rhino-Laryngology.January 2013; 270(1): 69–76.
48.Brobby GW. The discharging ear in the tropics: a guide to diagnosis and management in the district hospital. Tropical Doctor. 1992; 22 (1): 10-13.
49.Elango S, Purohit GN, Hashim M, Hilmi R. Hearing loss and ear disorders in Malaysian school children. Int J Pediatr Otorhinolaryngol.1991; 22: 75-80
50.Halama AR, Voogt GR, Musgrave GM. Prevalence of otitis media in children in a blackrural community in Venda (South Africa). Int J Pediatr Otorhinolaryngol., 1986; 1(1):73-77.
51.Balasubramanian T.Otoendoscopy.otolaryngology online journal.2012; 2(1)
52.”Endoscopes | Gem Surg Equipments”. Gemsurgindia.com. N.p., 2017. Web. 5 May 2017.
53.”Cite A Website – Cite This For Me” Slideplayer.com. N.p., 2017. Web. 5 May 2017
54. “OTO-RINO-LARINGO”. Pinterest. N.p., 2017. Web. 5 May 2017. 55.”OSHA Technical Manual (OTM) | Section III: Chapter 5 – Noise | Occupational Safety And Health Administration”. Osha.gov. N.p., 2017. Web. 5 May 2017.
56.”Tympanogram Classification”. S0utdlab.com. N.p., 2017. Web. 5 May 2017.
57.”Home”. Drmkotb.com. N.p., 2017. Web. 5 May 2017.
58.Anoop Attakkil, Vandana Thorawade, Mohan Jagade, Rajesh Kar, Kartik Parelkar, Poonam Khairnar, Reshma Hanowate, Devkumar Rangaraja. Squamous Cell Carcinoma of the Middle Ear Mimicking CSOM with Intracranial Complications: A Diagnostic Dilemma. International Journal of Otolaryngology and Head & Neck Surgery, 2014, 3, 376-381. http://www.scirp.org/journal/ijohns http://dx.doi.org/10.4236/ijohns.2014.36067.
59.Rejee Ebenezer Renjit, Sajilal Manonmony, Jeeva Thankom Philip, Dora Jerina Jose.internation journal of biochemical research. Spectrum of ENT diseases among urban school children in south Kerala, India. 2014; 5(5).
60.Leach AJ, Morris PS, Matthews JD, Chronic Otitis Media Intervention Trial— One (COMIT1) group Compared to placebo, long-term antibiotics resolve otitis media with effusion (OME) and prevent acute otitis media with perforation (AOMwiP) in a high risk population: a randomized controlled trial. BMC Pediatr; 2008;8:23. doi: 10.1186/1471-2431-8-23. pmid:18513453-
61.Rotimi V, Olabiyi D, Banjo T, Okeowo P. Randomised comparative efficacy of clindamycin, metronidazole, and lincomycin, plus gentamicin in chronic suppurative otitis media.West African Journal of Medicine. 1990; 9:89-97.
62.Morrison R .Desktop companion for physiological pathology. Hahnamann clinic publishers;1998
63.Hanson LA. Human milk and host defence: immediate and long-term effects. acta paediatrica. 1999; 88 (430): 42–46
64.Nakatani M. Treatment of chronic suppurative otitis media with Broncasma Berna. Ear Nose & Throat Journal (pubmed).2001; 80: 529.
65.Mackenzie GA, Carapetis JR, Leach AJ, Morris PS. Pneumococcal vaccination and otitis media in Australian Aboriginal infants: comparison of two birth cohorts before and after introduction of vaccination. BMC Pediatr .2009; 9:14. doi: 10.1186/1471-2431-9-14. pmid:19228431
66.Kakehata, Seiji; Futai, Kazunori; Sasaki, Akira; Shinkawa, Hideichi. Endoscopic Transtympanic Tympanoplasty in the Treatment of Conductive Hearing Loss: Early Results.otology and neurotology. 2006; 27(1).
67. Eero Vartiainen, MD, Jukka Vartiainen, MSc. Tympanoplasty in Young Patients: The Role of Adenoidectomy.american academy of otolaryngology- head and neck surgery.1997; 117(6).
68.Hardman John, Muzaffar Jameel, Nankivell Paul, Coulson Chris. Tympanoplasty for Chronic Tympanic Membrane Perforation in Children: Systematic Review and Meta-analysis.otology and neurotology. 2015; 36(5): 796–804. doi:10.1097/MAO.0000000000000767
69. “India Has Highest Number Of People Living Below Poverty Line: World Bank”. Businesstoday.in. N.p., 2017. Web. 5 May 2017.
70.Nemer Al-Khtoum, Mohammad Ali Hiari. Myringoplasty in children: retrospective analysis of 35 cases. Brazilian journal of otorhinolaryngol. 2009; 75(3). .doi.org/10.1590/S1808-86942009000300011
71.Close Stuart.Genius of Homoeopathy.Second edition.New Delhi: B Jain publishers; 2005
72.Hahnemann Samuel. Essay on new principles for ascertaining the curative power of drugs. The Lessor writings of Samuel Hahnemann (collected and translated by Dudgen). Reprint edition.New Delhi: B Jain publishers; 2004
73.Allen J.H. Chronic miasms-psora and pseudo psora.student edition.New Delhi.B Jain publishers ; 2002
74.Roberts H A.The Principles and Art of cure By Homoeopathy. 3rd edition.B Jain; 2005.
75.Hahnamann Samuel. Chronic disease, their peculiar nature and their cure.Second edition.New Delhi:Bjain publishers; 2005
76. Banarjee S. Miasmatic prescribing.2nd extended edition.B.Jain publishers; 2007.
77.Baehr B. science of therapeutics according to the principles of Homoeopathy.Reprint edition.New Delhi: B Jain publishers; 1996
78. Clark J H. The presciber. New Delhi: B. Jain publishers; 1998
79.Kent J.T. Lessor writings-clinical cases, new remedies, aphorisms and
precepts. reprint edition.New Delhi: B Jain Publishers; 2004
80.Speight Phyllis. A comparison of chronic miasm. New Delhi: B Jain publishers;1994
81.Choudhury H. Indications of miasm.NewDelhi:B Jain publishers;1995
82.Shore Jonathen, (seminar series Scotland 1989). Collected seminars from modern classical masters.New Delhi: B Jain publishers; 1999
83.Kent J.T. Repertoty of Homoeopathic materia medaica.New Delhi: B Jain publishers; 2007:285-320
84.Allen T F. Boenninghaussen.therapeutic pocket book.13th edition.New Delhi;2003
85.Boericke Oscar.Pocket Manuel of Homoepathic materia medica and repertory. 3rdrevised and augmented edition based on 9th edition. New Delhi: B Jain publishers; 2012
86.Shroyens Frederik. Augmented Clinical Synthesis. Edition 9.1. New Delhi: B Jain Publishers; 2014.
87.Murphy Robin. Homoeopathic medical repertory. Third revised edition. New Delhi: B. Jain publishers;2014
88.Boger C M. Boenninghausen’s characteristics Materia Medica and Repertory with word index. New Delhi:IBPP;2007
89.Boericke William.Pocket Manuel of Homoeopathic Materia Medica and Repertory. 3rd revised and augmented edition, based on 9th edition: New Delhi. B.Jain Publishers; 2012.
90.Boericke William and Deway. Twelve tissue remedies of schussler. New Delhi: B Jain publishers; 1998
91.Hering C.Guiding symptoms of our Materia Medica. Reprint edition. New Delhi:B.Jain publishers;1997
92.Herscue P. The Homoeopathic treatment for children, paediatric constitutional types.Berkely, California: North atlantic books; 1991
93.Hughes Richard.Manuel of Pharmacodynamics,Biological and physiological affects of Drugs and their Mechanism of action.New Delhi: B Jain publishers; 2015
94.Lilienthal Samuel. Homoeopathic Therapeutics.New Delhi; B.Jain Publishers; 2009
95.Murphy Robin. Homoeopathic remedy guide Reprint edition.Indian books and periodicals publidation; 2000.
96.Allen T F .Handbook of Materia Medica and Homoeopathic Therapeutics.5th efition. New Delhi: B Jain publishers; 2008
97.Borland Douglas. M .Children’ s types. New Delhi:Indian books ans periodicals publishers;2011
98.Borland Douglas M.Homoeopathy in theory and practice. New Delhi: B Jain publishers; 2003
99.Burt W H Physiological Materia Medica.3rd edition.New Delhi: B Jain Publishers; 2005
100.Clarke J H .Dictionary of Practical Materia Medica.New Delhi: B Jain publishers;1978
101.Degroote F. Physical Examination and Observations in Homoepathy.Gent, Belgium: Homeoden Book service; 1992
102.Deway W.A .Practical Homoeopathic Therapeutics.3rd edition. New Delhi: B Jain publishers;2005
103.Farrington E A. Lesser Writings. Reprint edition. New Delhi: B.Jain publishers; 1999
104. Farrington E.A. Clinical Materia Medica.New Delhi:B Jain publishers;2002 105.Julian O.A.MateriaMedica of New Homoeopathic Remedies. Illustrated, revised edition. Bancosfield publications; 1984
106.Julian O.A. Materia Medica Of Nosodes With Repertory. reprint edition New Delhi: B.Jain publishers; 1996
107.Kent James Tyler. Lectures on Homoeopathic Philosophy. New Delhi: Indian Books and Periodicals Publishers; 2009
108. Master J. Farook. Tubercular Miasm. New Delhi: B Jain publishers; 2013 109.Mathur K.N. Systematic Materia Medica Of Homoeopathic Remedies. New Delhi: B jain Publishers; 2003
110.Paterson F J. Materia Medica and Clinical Therapeutics.Los Olivos CA: Peterson F J;1905
111. Rue R G. Diseases of Children. Second edtion. New Delhi: B Jain publishers; 2000
112.Roberts H.A. Study of Remedies by Comparison.Reprint edition.New Delhi: B Jain publishers; 2002
113.Royal G. Text Book Of Homeopathic Materia Medica.1st Indian edition.Culcutta:Roy publishing house;1962 102
114. Santwani M T. Common Ailments of Children and their Homoeopathic Treatment.Reprint edition.New Delhi: B Jain publishers; 2000
115.Vithoulkas George. Talks on Classical Homoepathy. Reprint edition. New Delhi: B Jain publishers;2006
116. Allen H C. Keynotes rearranged and classified with leading remedies of the materia medica and nosodes. 10th edition. New Delhi: B Jain publishers;2005
117.Lessor O., Textbook of Homoeopathic Materia Medica.reprint edition New Delhi: B.Jain publishers;2001
118.Phatak S R., Materia Medica of Homoeopathic Medicines.1st edition.New Delhi: B Jain publishers; 1999
119.Basu nilanjana. Usefulness of the homeopathic repertory in the management of chronic suppurative otitis media. International Journal of High Dilution Research. 2015; 14(1):12-15.
120.Dhanya MN. A clinical study on the efficacy of Homoeopathic medicines belonging to the mineral kingdom in the management of chronic suppurative otitis media (dissertation). Calicut.Dhanya M N; 2009.
121.Syamalan.K. Statistics in Medicine. Second edition (revised). Trivandrum: Global Education Bureau; 2012
Dr Sreenath B
MD (Hom) Organon from GHMC Calicut
Medical Officer, Department of Homoeopathy, Govt of Kerala
siglisreenath@gmail.com
Download full paper
© Dr Sreenath B All rights reserved
Be the first to comment