Integrating - International Academy of Homotoxicology

d 2.00 • US $ 2.00 • CAN $ 3.00 

Journal of 

Biomedical 

Therapy 

Volume 4, Number 2 ) 201o 

Integrating Homeopathy 

and Conventional Medicine 

Diseases of the Ear, 

Nose, and Throat 

• ENT Disorders: A Clinical Update 

• Vertigo: A Common Problem in Clinical Practice

) 

© iStockphoto.com/ryasick 

Contents 

In Focus 

Common Disorders of the Ear, Nose, and Throat: 

A Clinical Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 

Around the Globe 

Second European Congress for Integrative Medicine . . . . . . . 11 

What Else Is New? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 

Fr o m t h e P ra c t i c e 

Recurrent Otitis Media: A Clinical Case Report . . . . . . . . . . . . 14 

© iStockphoto.com/Milena Lachowicz © H. P. Hoff/artbotanica 

Re f re s h Yo u r H o m o t ox i c o l o g y 

Vertigo: A Common Problem in Clinical Practice . . . . . . . . . . 17 

© iStockphoto.com/Rosemarie © iStockphoto.com/Rebecca Gearhart Ellis 

© iStockphoto.com/TommL 

Practical Protocols 

Viral Laryngeal Polyps: 

Treatment with Bioregulatory Medications . . . . . . . . . . . . . . 22 

Hoarseness: Treatment with Bioregulatory Medications . . . 24 

E x p a n d Yo u r Re s e a rch K n o wl e d ge 

Medical Study Formats: An Overview . . . . . . . . . . . . . . . . . . . 26 

Research Highlights 

Symptomatic Treatment of Rhinitis and Sinusitis: 

Ultra–low-dose Nasal Spray 

Effectively Reduces Severity of Symptoms . . . . . . . . . . . . . . . 2 8 

Meet the Expert 

Dr. Klaus Küstermann . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 

Cover © Bio-MD S.A. 

) 2 

Published by/Verlegt durch: International Academy for Homotoxicology GmbH, Bahnackerstraße 16, 

76532 Baden-Baden, Germany, www.iah-online.com, e-mail: journal@iah-online.com 

Editor in charge/verantwortlicher Redakteur: Dr. Alta A. Smit 

Subeditor: Dr. David W. Lescheid 

Managing Editor: Silvia Bartsch 

Print/Druck: Dinner Druck GmbH, Schlehenweg 6, 77963 Schwanau, Germany 

© 2010 International Academy for Homotoxicology GmbH, Baden-Baden, Germany

) 

Stress and the Immune System 

Dr. Alta A. Smit 

Otorhinolaryngology is an old 

science. Indications are that 

the ancient physicians, such as the 

Greek, Hindu, and Byzantine doctors, 

treated diseases of the larynx, 

nose, and ears. 1 

This science has undergone rapid 

development. Today, we see the end 

result of an evolution through eras 

of anti-infective agents and steroids, 

invasive surgical procedures, and innovative 

treatments in the form of 

endoscopy, microsurgery, and information 

technology. 

The primary care physician is still 

the first contact for patients with 

diseases of the ear, nose, and throat, 

especially diseases with an infective 

or atopic origin. In conventional 

medicine, antimicrobial agents are 

still seen as the desirable intervention, 

despite warnings from experts 

stating that the injudicious use of 

these compounds is creating a critical 

health situation because of the 

resistance of more virulent pathogens. 2 

Recurrent infections pose a special 

problem because there is often a 

vicious circle of infection, chronic 

inflammation, secretion, and again 

infection. The importance of mucosal 

integrity was discussed in a previous 

issue of this journal. 3 However, recent 

evidence suggests that local 

events in the ear, nose, and throat 

are not alone in playing a role in the 

etiology of disease in this region. In 

addition, for example, gastric reflux 

can play a role in serous otitis 

media. 4,5 This opens the field for 

new adjuvant treatments in bioregulatory 

medicine. 

Thus, the medical need is high for 

more holistic, biological treatment 

options. In a study by Witt et al, 6 it 

was shown that especially patients 

with atopic diseases (also in otorhinolaryngology) 

migrate toward 

holistic practices using biological 

interventions. 

The occurrence of dizziness and 

vertigo is frequent and is associated 

with a considerable personal and 

health care burden. Vestibular vertigo 

accounts for a considerable percentage 

of this burden, suggesting 

that the diagnosis and treatment of 

frequent vestibular conditions are 

important issues in primary care. 7 

In this issue of the Journal of Biomedical 

Therapy, we concentrate on 

the practical solutions to many problems 

in otorhinolaryngology. In the 

focus article, Dr. Joan Lewis provides 

a review of the current concepts and 

treatments, especially in infective 

otorhinolaryngology; Dr. Markus 

Mundhenke explores the etiology 

and treatment of vertigo; Dr. Jacques 

Deneef offers practical solutions for 

hoarseness and laryngeal polyps; 

and Dr. Maria Cherubina Capitelli 

discusses a pediatric case with a successful 

biological intervention for 

recurrent otitis media. 

Dr. Robbert van Haselen delivers 

the first of the announced articles on 

research methodology and reports 

on the successful second European 

Congress for Integrative Medicine. 

In the “Research Highlights” section, 

we present an article by Dr. 

Ghassan Andraos on research with 

Euphorbium compositum nasal 

spray. Finally, we introduce an expert 

who has a long history in biological 

medicine and especially in 

homotoxicology, Dr. Klaus Küstermann. 

Dr. Alta A. Smit 

References 

1. Nogueira JF Jr, Hermann DR, dos Reis 

Américo R, Barauna Filho IS, Cassol Stamm 

AE, Nagata Pignatari SS. A brief history 

of otorhinolaryngolgy: otology, laryngology 

and rhinology. Braz J Otorhinolaryngol. 

2007;73(5):693-703. 

2. Microbial resistance towards antibiotics: still 

a critical issue. Medical News Today Web 

site. http://www.medicalnewstoday.com/ 

articles/104775.php. Published April 21, 

2008. Accessed August 9, 2010. 

3. Mucosal Distress. J Biomed Ther. 2009;3(2). 

4. Tasker A, Dettmar PW, Panetti M, Koufman 

JA, Birchall JP, Pearson JP. Reflux of 

gastric juice and glue ear in children. Lancet. 

2002;359(9305):493. 

5. Al-Saab F, Manoukian JJ, Al-Sabah B, et al. 

Linking laryngopharyngeal reflux to otitis 

media with effusion: pepsinogen study of 

adenoid tissue and middle ear fluid. J Otolaryngol 

Head Neck Surg. 2008;37(4):565-571. 

6. Witt CM, Lüdtke R, Baur R, Willich SN. Homeopathic 

medical practice: long-term results 

of a cohort study with 3981 patients. BMC 

Public Health. 2005;5:115. 

7. Neuhauser HK, Radtke A, von Brevern M, 

Lezius F, Feldmann M, Lempert T. Burden of 

dizziness and vertigo in the community. Arch 

Intern Med. 2008;168(19):2118-2124. 

) 3 

Journal of Biomedical Therapy 2010 ) Vol. 4, No. 2

) In Focus 

Common Disorders of the Ear, 

Nose, and Throat 

A Clinical Update 

By Joan Lewis, MD 

Otorhinolaryngologist 

) 4 

Introduction 

Disorders of the ear, nose, and throat 

(ENT) are the cause of many patient 

visits to a primary care physician. 

Some of the common ENT disorders 

include acute and recurrent otitis 

media (OM); acute, chronic, and 

recurrent tonsillitis; and allergic and 

recurrent rhinitis and chronic rhinosinusitis 

(CRS). However, the 

common cold remains one of the 

most frequent upper respiratory tract 

infections (URIs). Approximately 

half of the cases of colds in children 

can be attributed to a wide variety 

of up to 200 different viruses that 

are seasonally active, such as rhinoviruses 

in the early fall, spring, and 

summer. Other viruses that might 

cause URIs include coronavirus, 

parainfluenza virus, adenovirus, enterovirus, 

and respiratory syncytial 

virus. 1 The subsequent development 

of recurrent sinusitis 2,3 and OM 4 

commonly has been related to viral 

URIs that last longer than a week. A 

child can be expected to have 6 to 

10 colds annually, whereas adolescents 

may have only 2 to 4 colds per 

year. In developing countries, URIs 

tend to be more severe, such as 

pneumonia and influenza, with a 

higher risk of complications. Therefore, 

URIs can be a leading cause of 

death for children younger than 5 

years. 5 

An increased understanding of the 

pharmacoeconomic incidence, relevance 

of antibiotic resistance, physician 

involvement, and anatomical 

and physiological features of each 

of the common ENT disorders will 

improve clinical outcomes. An integrative 

medical approach that uses 

complementary and alternative therapies, 

such as antihomotoxic medications, 

in addition to mainstream 

medical therapies is a therapeutic 

strategy that shows much promise in 

reducing the current disease burden 

and preventing further recurrences. 

Pharmacoeconomic 

Incidence 

The annual cost of time lost from 

school for adolescents and from 

work for adults, because of URIs, is 

substantial and is estimated to be as 

high as $15 billion in direct treatment 

costs by practitioners, with 

more than half of that amount being 

for ambulatory care centers in hospitals. 

The indirect cost wages from 

URIs is estimated at $9 billion. 6 The 

over-the-counter cough and cold 

remedy market was identified as being 

the “most competitive category 

in North America,” with sinusitis 

showing the most potential growth. 

Figures extrapolated from a survey 

of 4000 US residents suggested that 

a total economic burden of $40 billion, 

including income lost from time 

off for these occurrences, was related 

to noninfluenza viral URIs alone. 

Antibiotic Resistance 

In 2007, prudent antibiotic use was 

not correlated with appropriate 

knowledge of microbial resistance 8 ; 

thus, the reduction of unnecessary 

antibiotics as treatment options for 

the virally associated common cold 

was identified in 2008 as a public 

health priority. 9 Recent public opinion 

polls show an increased understanding 

of the relationship between 

the development of resistant bacterial 

strains and inappropriate antibiotic 

use and also report a significantly 

higher level of trust in physicians 

who did not prescribe antibiotics for 

the common cold. 10 However, 45% 

of respondents in the United States 

in 2008 and 41% of a population in 

Belgium in 2001 still did not understand 

the lack of efficacy of antibiotics 

in treating viral illnesses. 11 These 

data suggest that there is still a considerable 

opportunity to better educate 

patients and health care providers. 

Environmental Impact 

In the pediatric population, the close 

proximity of children in day-care 

centers contributes to the transmission 

of respiratory tract disease. 12 

Childhood exposure to common 

environmental pollutants, such as 

firsthand or secondhand smoke, and 

common household allergens, such 

as aerosolized cleaning products, in 

persons with a genetic predisposition 

might be associated with later 


) In Focus 

© Bio-MD S.A. 

development of asthma and allergic 

conditions through inappropriate 

sensitization. 13 Furthermore, asthmatic 

children have URIs more frequently 

than their nonasthmatic classmates. 

The polycyclic aromatic hydrocarbons 

present in diesel exhaust particles 

have recently been shown to 

stimulate the release of interleukin 

(IL) 4, IL-8, and histamine from basophil 

cells, 14 suggesting that other 

common environmental pollutants 

also can play a role in the development 

of asthma and allergic rhinitis. 

Physician Involvement 

Most persons with ENT disorders 

visit their health care practitioners 

early in the disease process because 

the associated signs and symptoms 

are readily apparent to both the patient 

and practitioner and frequently 

affect activities of daily living. The 

high visibility of the nasal and oral 

area and the high risk of symptoms 

interfering with activities of daily 

living may precipitate an early practitioner 

visit. The mechanical and 

physical appearances of structures 

(eg, teeth, palate, gingiva, and tongue) 

indicate a variety of physiological 

states and can be used diagnostically 

with a minimal investment of time. 

For example, fasciculations of the 

tongue might indicate neural disorders; 

glossy tongue is associated 

with nutritional deficiencies, such as 

a deficiency in vitamin B12. Dental 

caries or loss correlates with impaired 

immune systems, smoking or 

tobacco use or exposure, 15 and poor 

nutritional status. Xerostomias are 

linked to poor hygiene, and temporomandibular 

joint disorders can 

be attributed to trauma or articular 

disorders. 16 

Relevant Anatomical 

and Physiological Features 

Lymphatic tissue in the Waldeyer 

ring is designed to protect the body 

from pathogens and toxins encountered 

in this vulnerable area; therefore, 

it is strategically placed to protect 

critical respiratory and digestive functions. 

It is the first protective barrier 

encountered by orally ingested and 

inhaled toxins, viruses, and bacteria. 

An interaction with the body’s lymphatic 

tissues provokes a reaction that 

includes copious nasal discharge, 

sneezing, coughing, and mucosal 

egorgement as a mechanism to remove 

the offending substance. The 

resultant reaction, with its associated 

signs and symptoms, is diagnosed as 

the common cold or rhinitis. Further 

progression to include fever and 

exhaustion, and the presence of 

clusters of similar infections in the 

community and a documented influenza 

virus infection, would lead to a 

diagnosis of the flu. 

Treatment for these uncomfortable 

reactions is largely symptomatic. 

Over-the-counter remedies for these 

conditions are common and constitute 

one of the highest sources of 

pharmaceutical sales for all persons 

seeking symptom relief. 10 According 

to a recent survey in both the United 

States and Belgium, antibiotics are 

still widely prescribed despite evidence 

that challenges their usefulness. 

Therefore, there is still an 

increase in bacterial resistance and a 

subsequent increase in pathology. 11 

Pathological Conditions 

A short review of the relevant pathological 

features of each of the common 

ENT disorders is included to 

provide further insight into potential 

therapeutic strategies. 

Otitis Media 

Acute OM: Acute OM is the most 

frequent ailment encountered by pediatricians. 

17 Persistent middle ear 

effusion from a failure of the mucus 

and microbial and immune system 

debris in the middle ear to drain via 

the Eustachian tube to the pharynx 

is associated with recurrent OM. 18 

Implicated factors include functional 

obstruction of the Eustachian tube, 

anatomical differences in the infant’s 

Eustachian tube, and a more horizontal 

position when bottle feeding 

an infant in a supine position, 

favoring a retrograde flow of milk. 

Furthermore, passive smoke environments 

impairing normal ciliary 

movement that sweeps away debris 

and immune system disorders associated 

with increased mucus produc- 

) 5 


) In Focus 


) 6 

tion are thought to be predisposing 

factors. 19 An allergic etiology, such 

as to cow’s milk and other food allergens, 

has been implicated 20 but is 

controversial. 21,22 Other associated 

factors include frequent attendance 

at day-care centers and low socioeconomic 

status. 22 

Recurrent OM: Preexisting antibiotic 

treatment is associated with an increased 

rate of recurrent OM in 

young children, 23 inferring support 

for the hygiene hypothesis (in which 

the interruption of a normal inflammatory 

response to infections [Thelper 

{Th} 1] during childhood 

leads to an imbalance in Th1/Th2 

cell regulation, predisposing a child 

toward allergy). Novel otopathogens 

can be cultured in those with recurrent 

OM after a month-long course 

of antibiotics for acute OM. This 

evidence would seem to support the 

occurrence of microbial-resistant 

pathogens yet fails to exclude the hygiene 

hypothesis 24 as a contributing 

factor. This evidence also might suggest 

that there may be unique infectious 

causes between the 2 diseases. 

Long-term morbidity, with recurrent 

OM occurring before the age of 3 

years, might affect the child’s subsequent 

decreased comprehension 

when reading. 25 

Bioregulatory treatment: For acute 

OM, use the basic/symptomatic approach 

as follows: Prescribe Belladonna-Homaccord 

(8-10 drops 2 

times per day) and Traumeel (8-10 

drops or 1 ampoule warmed up and 

poured into the appropriate ear 2 

times per day). If resolution does not 

occur within a reasonable time, individualize 

the therapy as follows: 

• With a confirmed bacterial etiology 

and a marked inflammatory 

reaction and serious infection, 

prescribe Echinacea compositum. 

For acute conditions, prescribe 1 

tablet every 30 to 60 minutes to 

a maximum of 12 tablets per day. 

For chronic conditions, prescribe 

1 tablet dissolved in the mouth 3 

times per day. If injection therapies 

are within the practitioner’s 

regulatory framework, prescribe 

1 ampoule intramuscularly (IM), 

subcutaneously (SC), intradermally 

(ID), or intravenously (IV) 

1 to 3 times per week. N.B. Avoid 

the use of Echinacea compositum 

in patients with a known 

hypersensitivity reaction to botanicals 

in the Compositae family. 

• With a confirmed viral etiology, 

prescribe Engystol (in general, 1 

tablet 3 times per day or 1 ampoule 

per day). If the situation is 

acute, prescribe 1 ampoule per 

day IM, SC, ID, or IV. 

• With marked restlessness, possible 

fever, and agitation, prescribe 

Viburcol suppositories. For acute 

disorders in adults, insert 1 suppository 

into the anus 2 to 3 

times per day. Use only half of 1 

suppository in infants and children 

up to the age of 6 months, up 

to a total of 1 suppository per day. 

If there are still signs and symptoms 

after a reasonable time using the 

basic/symptomatic approach (even 

with appropriate individualized 

therapies), the patient may not have 

the ability to self-regulate and the 

correct etiology may not have been 

identified and addressed. Furthermore, 

if the condition is recurrent, it 

can also be assumed that the patient 

has lost the ability to self-regulate. 

In both these situations, the 

regulation/3-pillar approach (detoxification 

and drainage, immunomodulation, 

and cell and organ support) 

would be most appropriate. 26 

During periods of flare-ups, the 

basic/symptomatic approach should 

be used, as previously described. 

During latent phases, Mucosa compositum 

(and, if necessary, Coenzyme 

compositum and Ubichinon 

compositum) should be used as cellular 

and organ support, Traumeel 

as an immunomodulator, and the 

Detox-Kit* for basic detoxification 

and drainage. 

Persistent middle ear effusion can 

lead to hearing deficits and speech 

delay; therefore, for unresolving 

cases, it might be necessary to refer 

patients to the appropriate health 

care professional for a myringotomy. 

* The Detox-Kit consists of Lymphomyosot, Nux vomica-Homaccord, and Berberis-Homaccord. 


) In Focus 

Tonsillitis 

Acute tonsillitis: Tonsils, part of the 

Waldeyer ring of lymphatic tissue in 

the oropharynx and nasopharynx, 

are considered to be the site of antigen 

presentation, resulting in the 

mounting of an appropriate B-cell 

response. Acute tonsillitis commonly 

presents as erythematous and 

swollen tonsils accompanied by 

stertorous breathing in children. 

Hypertrophied tonsils are a common 

cause of sleep disorders in children 

and can be associated with 

resultant daytime inattentiveness 

during classes. 27 In cases in which 

the diagnosis is unclear, a microbiological 

evaluation is needed and 

positive throat culture or rapid antigen 

detection tests are required to 

exclude the diagnosis of streptococcal 

pharyngitis, which requires 

appropriate antibiotic treatment to 

avoid cardiovascular and/or renal 

complications. 28 The presence of 

tonsils is considered to play a significant 

role in the maturation of 

natural killer lymphocytes, one of 

the first lines of the body’s defense 

against foreign substances, 29 

suggesting that a tonsillectomy should 

be considered as a therapy of last resort. 

Chronic tonsillitis: Acute tonsillitis 

can have either a viral or a bacterial 

etiology. However, chronic tonsillitis 

is generally restricted to bacteria 

and is considered to be more prevalent 

in adults than in children. 

Chronic tonsillitis can be associated 

with crypts containing pus that form 

in the tonsils. Surgical excision of 

tonsillar tissue is controversial for 

chronic tonsillitis, in part because of 

the subsequent impact on pharyngitis 

postoperatively, despite the lack 

of a visible recurrent tonsillar infection. 

30 Changes in oral flora noted 

after tonsillectomy indicate that the 

chronically infected tonsil may serve 

as a nidus, harboring anaerobic 

bacteria, and that surgical removal 

may help restore normal oral flora 

colonization. 31 The presence and ratio 

of matrix metalloproteinases to 

inhibitors of metalloproteinase activity 

suggest that these substances 

may be a factor in the progression of 

tonsillar disease states. 32 Common 

emergent complications of chronic 

tonsillitis include a peritonsillar abscess 

(also termed quinsy) when the 

crypts fail to drain appropriately. 

This is identified by drooling, a 

distinctive “thrust forward” head 

position, a “hot potato” voice, and a 

visible asymmetrical mass in the area 

of the affected pharyngeal tonsil. 

Treatment for this condition requires 

the oral extraction of purulent bacterial 

material and is associated with 

an immediate decrease in symptoms. 

Recurrent tonsillitis: In children, recurrent 

tonsillitis is considered a 

more accurate term than chronic 

tonsillitis. A difference from the 

chronic tonsillitis of adulthood is a 

higher percentage of antigen in the 

acute stages compared with a higher 

percentage of antigen in the chronic 

stages of tonsillitis in adults. 34 If a 

peritonsillar abscess is associated 

with chronic tonsillitis, tonsillectomy 

may be the first-line treatment. 35 

Antigen presentation and B-cell 

activity and response are preserved 

in children with recurrent disease, 36 

indicating the maintenance of normal 

physiological function of the 

lymphoid tissue despite an infectious 

appearance. These data provide 

support for a decision to leave the 

tonsils surgically intact. If possible, 

it is important to avoid a tonsillectomy 

because, as previously mentioned, 

the natural killer lymphocytes 

undergo normal maturation within 

tonsils, contributing to the ultimate 

development of a normal immune 

response. 29 


tonsillitis, use the basic/symptomatic 

approach as follows: Prescribe 

Angin-Heel † (in acute situations, 

prescribe an initial massive dose of 1 

tablet every 15 minutes for a maximum 

of 2 hours or, in general, 1 

tablet 3 times per day), Vinceel 

(spray once 1-3 times per day), and 

Mercurius-Heel (1 tablet 3 times per 

day). If resolution does not occur 

within a reasonable time, individualize 

the therapy as follows: 


and a marked inflammatory 

reaction, prescribe Echinacea 

compositum. For acute conditions, 

prescribe 1 tablet every 30 

to 60 minutes to a maximum of 

12 tablets per day. For chronic 

conditions, prescribe 1 tablet to 

be dissolved in the mouth 3 

times per day. If injection therapies 

are within the regulatory 

framework, prescribe 1 ampoule 

IM, SC, ID, or IV 1 to 3 times 

per week. N.B. Avoid the use of 

Echinacea compositum in patients 

with a known hypersensitivity 

reaction to botanicals in the 

Compositae family. 







• For chronic dysregulation of the 

lymphatic system, prescribe Barijodeel 

(1 tablet to be dissolved in 

the mouth 3 times per day). 







) 7 

† Marketed as Belladonna compositum in the United States. 


) In Focus 

) 8 



if the condition is chronic or 

recurrent, it can also be assumed 

that the patient has lost the ability to 

self-regulate. In both these situations, 

the regulation/3-pillar approach 

(detoxification and drainage, 

immunomodulation, and cell and 

organ support) would be most 

appropriate. 26 During periods of 

acute flare-ups, the basic/symptomatic 

approach should be used, as 

previously described. During latent 

phases and for chronic tonsillitis, 

the Detox-Kit should be used for 

basic detoxification and drainage, 

with prolonged use of Lymphomyosot 

if resolution of symptoms does 

not occur within a reasonable time. 

Traumeel or Tonsilla compositum 

can be used for immunomodulation, 

and Mucosa compositum (and Coenzyme 

compositum and Ubichinon 

compositum) can be used for cellular 

and organ support. 

The tonsils form an important part of 

the innate immune system; therefore, 

a tonsillectomy should only be considered 

as a treatment of last resort. 

Rhinitis 

Allergic rhinitis: The diagnosis of 

allergic rhinitis is based on the presence 

of copious clear rhinorrhea 

associated with exposure to a known 

allergen, usually in the spring and 

summer. Symptoms are more likely 

to be associated with bronchial hyperresponsiveness, 

wheezing, and 

conjunctivitis in children with 

exposure to furry pets in addition to 

pollen rather than pollen alone. 37 

Resultant nasal stuffiness and sleep 

deprivation have been treated successfully 

with leukotriene receptor 

antagonists, such as montelukast and 

topical nasal steroids; adverse effects 

were not enumerated in this study. 38 

The decreased frequency of allergic 

rhinitis in children who are exposed 

to the childhood diseases of their 

siblings before they are aged 2 years 

(ie, before their immune systems 

have fully developed) and an observed 

increased frequency of allergic 

rhinitis after tonsillectomies 

support the hygiene hypothesis. 39 

A persistent imbalance between 

T-regulatory and Th2 cells may be 

associated with the development 

and expression of allergic asthma, 

providing a promising option for 

using natural health products or 

pharmaceutical agents that target 

T cells for treatment other than the 

mainstay of inhaled steroids. 40 

Allergic rhinitis is a costly disease 

because of the many physician visits, 

the high cost of prescription 

medications, related comorbidities, 

and lost productivity because of absenteeism 

and presenteeism (ie, poor 

performance on the job when ill). 

The conventional symptomatic treatment 

protocols include antihistamines 

and steroids. 

Recurrent rhinitis: The diagnosis of 

recurrent rhinitis is based on the 

frequency of rhinitis experienced 


annually, generally referring to more 

than 12 weeks of symptoms with 

incomplete resolution. An imbalance 

in subsets of lymphocytes (Th2 and 

T-regulatory cells) has been implicated 

in the development of CRS. 41,42 

When present with nasal polyps, eosinophilic 

aggregations indicate an 

association with a predominant 

Th2-allergic etiology. In pediatric 

CRS, the nasal mucosa shows a predominance 

of macrophages and 

neutrophils, 43 indicating a Th1 predominance. 

Allergic upper respiratory 

tract disorders may present with 

laryngeal dysphonia and may be 

misdiagnosed as reflux disease. 44 

T-cell imbalances have been implicated 

as contributing etiological 

factors for CRS in children with an 

increased production of Th17 cells, 45 

and the receptors that bind nucleotides 

found in the nasal mucosa of 

patients with allergic rhinitis are 

down-regulated. 46 In CRS with 

nasal polyps, the IL-6 level is significantly 

increased, 47 whereas the 

IL-17 level is decreased, indicating a 

pathophysiological response. The 

conventional first-line treatment for 

this disorder may include the topical 


) In Focus 

application of steroids to the mucosa 

for prophylaxis. 48,49 Some of the 

newer steroids for allergic rhinitis 

show a mechanism of action of 

binding to the glucocorticoid receptor, 

resulting in the inhibition of 

IL-4 and IL-5 levels; these steroids 

are associated with suppressed overnight 

cortisol levels and hypothalamic-pituitary-adrenal 

axis suppression. 

50 Associated adverse effects 

include mucosal atrophy, perioral 

dryness, and rebound 51 ; the use of 

long-term steroids can be associated 

with decreased growth rates. However, 

these therapies fail to address 

the significant disturbance of normal 

immune support physiological 

mechanisms 52 and often have poor patient 

compliance because of their perceived 

lack of efficacy and the adverse 

effects encountered. 53 


rhinitis with a suspected microbial 

cause, use the basic/symptomatic 

approach as follows: Prescribe Euphorbium 

compositum (1-2 sprays 

per nostril 3-5 times per day and 

10 drops every 15 minutes for a 

maximum of 2 hours and then 

reduce to 10 drops 6 times per day 

or 1 ampoule per day). In cases of 

marked rhinitis, add Naso-Heel 

(8-10 drops 3 times per day). If the 

etiology has a documented allergic 

component (especially seasonal allergy), 

use Luffeel (1-2 sprays into 

each nostril 3-5 times per day and 1 

tablet every 15 minutes for a maximum 

of 2 hours and then decrease 

to 1 tablet 3 times per day) instead 

of Euphorbium compositum. If resolution 

does not occur within a 

reasonable time, individualize the 

therapy as follows: 


and serious inflammation 

and septic conditions, prescribe 

Echinacea compositum. For acute 

conditions, prescribe 1 tablet 

every 30 to 60 minutes to a 

maximum of 12 tablets per day. 

For chronic conditions, prescribe 

1 tablet to be dissolved in the 

mouth 3 times per day. If injection 

therapies are within the regulatory 

framework, prescribe 1 

ampoule IM, SC, ID, or IV 1 to 3 

times per week. N.B. Avoid the 

use of Echinacea compositum in 

patients with a known hypersensitivity 

reaction to botanicals in 

the Compositae family. 







• For chronic discharge from the 

nasal mucosa, Natrium-Homaccord 

(in general, 10 drops 3 

times per day) should be used. 

N.B. Long-term use of this medication 

(ie, over periods of longer 

than a few months) should be 

supervised by the appropriate 

health care professional. 









if the condition is recurrent, 

it can also be assumed that the patient 

cannot self-regulate or that 

there is a persistent etiological 

factor that has not been adequately 

addressed. In both these situations, 

the regulation/3-pillar approach 

(detoxification and drainage, immunomodulation, 

and cell and organ 

support) would be most appropriate. 

26 During periods of acute 

flare-ups, the basic/symptomatic approach 

should be used, as previously 

described. During the latent phases, 

the regulation/3-pillar approach is 

indicated. The Detox-Kit should be 

used for basic detoxification and 

drainage, Traumeel or Tonsilla compositum 

for immunomodulation, and 

Mucosa compositum (and Coenzyme 

compositum and Ubichinon compositum) 

for cellular and organ support. 

There are many different potential 

etiologies for rhinitis; therefore, it is 

important to identify and try to remove 

or reduce the effects of the 

initiating causes. 

Conclusions 

The mainstream medical treatment 

options include surgical removal of 

tonsils, steroid ablative treatment for 

symptoms that reflect a normal 

physiological response to pathogens, 

antibiotic intervention in cases in 

which no true disease state can be 

identified, and a failure to allow the 

normal homeostatic immune system 

defense processes to proceed unimpeded. 

These options do not appear 

to result in better health outcomes. 

Recent research seems to support 

the more restrained approach of 

watchful waiting through the discomforts 

of the usual childhood 

disease states and the use of supportive 

medical therapies that allow 

the body to “learn” to selectively 

neutralize threats to health.| 

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4. Winther B, Alper CM, Mandel EM, Doyle WJ, 

Hendley JO. Temporal relationships between 

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5. Denny FW Jr. The clinical impact of human 

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Care Med. 1995;152(4, pt 2):S4-S12. 

) 9 


) In Focus 

) 10 

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P, Davey P. Don’t wear me out: the 

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dkl558 

9. Earnshaw S, Monnet DL, Duncan B, O’Toole 

J, Ekdahl K, Goossens H. European Antibiotic 

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in participating countries. Euro Surveill. 

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10. Andre M, Vernby A, Berg J, Lundborg CS. 

A survey of public knowledge and awareness 

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dkq104 

11. Edgar T, Boyd SD, Palame MJ. Sustainability 

for behaviour change in the fight 

against antibiotic resistance: a social marketing 

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Broome CV. Childhood upper respiratory 

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affected by day-care attendance? Pediatrics. 

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exert proallergic effects in birch pollen 

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Web site. http://emedicine.medscape.com/ 

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otitis media during infancy and linguistic 

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26. Smit A, O’Byrne A, Van Brandt B, Bianchi 

I, Küstermann K. The three pillars of antihomotoxic 

treatment. In: Smit A, O’Byrne A, 

Van Brandt B, Bianchi I, Küstermann K. Introduction 

to Bioregulatory Medicine. Stuttgart, 

Germany: Thieme; 2009:49-143. 

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The infections of the upper respiratory tract 

in children. Int J Immunopathol Pharmacol. 

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29. Freud AG, Caligiuri MA. Purification of human 

NK cell developmental intermediates 

from lymph nodes and tonsils. In: Campbell 

KS, ed. Natural Killer Cell Protocols. 2 nd ed. 

New York, NY: Humana; 2010. Methods in 

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30. Burton MJ, Glasziou PP. Tonsillectomy or adeno-tonsillectomy 

versus non-surgical treatment 

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doi:10.1002/14651858.CD001802.pub2. 

31. Karaman E, Enver O, Alimoglu Y, et al. 

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otohns.2009.07.010. 

32. Acioglu E, Yigit O, Alkan Z, Server EA, Uzun 

H, Gelisgen R. The role of matrix metalloproteinases 

in recurrent tonsillitis. Int J Pediatr 


33. Schechter GL, Sly DE, Roper AL, Jackson 

RT. Changing face of treatment of peritonsillar 

abscess. Laryngoscope. 1982;92(6, pt 

1):657-659. 

34. Bussi M, Carlevato MT, Panizzut B, Omede 

P, Cortesina G. Are recurrent and chronic 

tonsillitis different entities? An immunological 

study with specific markers of inflammatory 

stages. Acta Otolaryngol Suppl. 

1996;523:112-114. 

35. Page C, Chassery G, Boute P, Obongo R, 

Strunski V. Immediate tonsillectomy: indications 

for use as first-line surgical management 

of peritonsillar abscess (quinsy) and 

parapharyngeal abscess [published online 

ahead of print April 20, 2010]. J Laryngol 

Otol. April 2010:1-6. doi:10.1017/ 

S0022215110000903 

36. Jesic S, Stojiljkovic L, Stosic S, Nesic V, Milovanovic 

J, Jotic A. Enzymatic study of tonsil 

tissue alkaline and acid phosphatase in 

children with recurrent tonsillitis and tonsil 

hypertrophy. Int J Pediatr Otorhinolaryngol. 

2010;74(1):82-86. 

37. Bertelsen RJ, Lødrup Carlsen KC, Carlsen 

KH. Rhinitis in children: co-morbidities and 

phenotypes [published online ahead of print 

April 27, 2010]. Pediatr Allergy Immunol. 

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j.1399-3038.2010.01066.x 

38. Craig TJ, Sherkat A, Safaee S. Congestion 

and sleep impairment in allergic rhinitis. Curr 

Allergy Asthma Rep. 2010;10(2):113-121. 

39. Matheson MC, Walters EH, Simpson JA, et 

al. Relevance of the hygiene hypothesis to 

early vs late onset allergic rhinitis. Clin Exp 

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40. Heijink IH, Van Oosterhout AJM. Strategies 

for targeting T-cells in allergic diseases 

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pharmthera.2006.05.005 

41. Schleimer RP, Lane AP, Kim J. Innate and acquired 

immunity and epithelial cell function 

in chronic rhinosinusitis. Clin Allergy Immunol. 

2007;20:51-78. 

42. Schleimer RP, Kato A, Peters A, et al. Epithelium, 

inflammation, and immunity in 

the upper airways of humans: studies in 

chronic rhinosinusitis. Proc Am Thorac Soc. 

2009;6(3):288-294. 

43. Duplantier JE. Immunopathology of chronic 

rhinosinusitis in young children. Pediatrics. 

2009;124(suppl 2):S135. 

44. Roth D, Ferguson BJ. Vocal allergy: recent 

advances in understanding the role of allergy 

in dysphonia. Curr Opin Otolaryngol Head 

Neck Surg. 2010;18(3):176-181. 

45. Ciprandi G, Castellazzi AM, Fenoglio D, 

Battaglia F, Marseglia G. Peripheral TH-17 

cells in children with allergic rhinitis: preliminary 

report. Int J Immunopathol Pharmacol. 

2010;23(1):379-382. 

46. Bogefors J, Rydberg C, Uddman R, et al. 

Nod1, Nod2 and Nalp3 receptors, new 

potential targets in treatment of allergic 

rhinitis [published online ahead of print 

April 7, 2010]? Allergy. 10.1111/j.1398- 

9995.2009.02315.x 

47. Peters AT, Kato A, Zhang N, et al. Evidence 

for altered activity of the IL-6 pathway in 

chronic rhinosinusitis with nasal polyps. J Allergy 

Clin Immunol. 2010;125(2):397-403. 

48. Okano M. Mechanisms and clinical implications 

of glucocorticosteroids in the treatment 

of allergic rhinitis. Clin Exp Immunol. 

2009;158(2):164-173. 

49. Baldwin CM, Scott LJ. Mometasone furoate: 

a review of its intranasal use in allergic rhinitis. 

Drugs. 2008;68(12):1723-1739. 

50. Lumry WR. A review of the preclinical and 

clinical data of newer intranasal steroids used 

in the treatment of allergic rhinitis. J Allergy 

Clin Immunol. 1999;104(4):S150-S158. 

51. Tamaki A. Side effects of topical steroids. Skin 

Res. 1999;41(suppl 21):26-30. 

52. Immune system. Anabolic Bible Web site. 

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6, 2010. 

53. Naclerio RM, Hadley JA, Stoloff S, Nelson 

HS. Patient and physician perspectives on the 

attributes of nasal allergy medications. Allergy 

Asthma Proc. 2007;28(suppl 1):S11-S17. 


) Around the Globe 

Second European Congress 

for Integrative Medicine 

Berlin, Germany, November 20 to 21, 2009 

By Robbert van Haselen, MSc 

The Second European Congress for Integrative Medicine 

took place in Berlin from November 20 to 21, 2009. 

Compared with the first conference, which took place 

in 2008, both the venue and the number of attendants 

(approximately 500 persons) were larger. 

After the cessation of the annual 

conference series on complementary 

medicine, organized by 

Professor Edzard Ernst (since the 

1990s), this conference seems to 

have filled a real gap in terms of the 

need of the European complementary 

and alternative medicine (CAM) 

community to meet on an annual 

basis. The overall vision is that this 

conference should evolve to a truly 

European (rather than German) platform 

for the CAM community. To 

properly establish this conference, it 

will take place one more time in 

Berlin (December 3-4, 2010). However, 

after this year, a rotation of 

hosting countries within Europe is 

foreseen: Sweden is scheduled for 

2011 and England or Italy is scheduled 

for 2012. 

A variety of topics was presented at 

this congress. For example, there 

were interesting presentations on 

educational initiatives involving the 

inclusion of integrative medicine 

within conventional medical schools; 

on methodological aspects (eg, how 

to approach the clinical research on 

“complex interventions”); and on 

more basic topics, such as the possible 

biological mechanisms of action 

of integrative medical approaches. 

Antihomotoxic medicine was strongly 

represented at this conference. 

There was a lunch symposium on 

the following subject, “Vertigo – 

Benefits of a CAM-Orientated 

Approach.” Approximately 75 participants 

attended this symposium. 

In the presentation, the benefits of 

Vertigoheel were highlighted, including 

its multitargeted action on 

microcirculation. These benefits 

were supported by an extensive 

basic research program directed by 

Professor Axel R. Pries from the 

Center for Cardiovascular Research 

of the Charité University Hospital 

in Berlin. In addition, 3 research 

posters on the following topics were 

presented: (1) the long-term effectiveness 

of Vertigoheel in treating 

vertigo 1 ; (2) basic in vitro research, 

suggesting possible joint-protective 

effects of Traumeel 2 ; and (3) a postmarketing 

surveillance study on the 

use of Lymphomyosot N injection 

therapy in treating edema and swelling 

due to any postthrombotic or 

inflammatory etiology and allergic 

disease in clinical practice. 3 Abstracts 

of all presentations can be found in 

the European Journal of Integrative 

Medicine (volume 1, issue 4).| 

References 

1. Seeger-Schellerhoff E, Corgiolu V. Effectiveness 

and tolerability of the homeopathic 

treatment Vertigoheel for the treatment of 

vertigo in hypertensive subjects in general 

clinical practice [abstract PO-014]. Eur J Integr 

Med. 2009;1(4):231. 

2. Seilheimer B, Wierzchacz C, Gebhardt R. 

Influence of Traumeel on cultured chondrocytes 

and recombinant human matrix metalloproteinases: 

implications for chronic joint 

diseases [abstract PO-054]. Eur J Integr Med. 

2009;1(4):252-253. 

3. Moyseyenko V, Corgiolu V. Effectiveness and 

tolerability of Lymphomyosot N solution for 

injection in treating oedemas and swellings 

of thrombotic or inflammatory aetiology in 

general clinical practice [abstract PO-051]. 

Eur J Integr Med. 2009;1(4):251. 

) 11 


) What Else Is New? 

© Image Source/CD Senior Sports 

Physical activity increases 

life expectancy, even if initiated 

at an advanced age. 

Extensive television exposure 

can have negative effects on 

children’s emotions and behavior. 

It’s Never too Late 

Reduced Gray Matter in 

Sleep Apnea 

Internet Brain Gym for 

Older Adults 

for Fitness 

) 12 

Anyone who is physically active is 

likely to live significantly longer 

than a couch potato. At least, that’s 

the conclusion of a new long-term 

study from Jerusalem. The study examined 

the effects of physical activity 

on mortality rates in a group of 

1,861 men and women aged 70 to 

88. For purposes of the study, being 

“physically active” was defined as 

participation in athletic activities for 

more than four hours per week. 

Only 15.2% of the active group died 

during eight years of follow-up 

compared to 27.2% of inactive 

70-year-olds. Among 78-year-olds, 

the eight-year mortality rate was 

26.1% for the active group and 

40.8% for the sedentary group, and 

at age 85, the three-year mortality 

rate was 6.8% for “athletes” in comparison 

to 24.4% percent for “couch 

potatoes.” Physical activity not only 

reduces mortality but also increases 

the likelihood of remaining independent. 

The authors concluded 

that physical training significantly 

increases survival rates even if it is 

initiated at an advanced age. 

Arch Intern Med. 2009; 

169(16):1476-1483. 

Korean scientists have discovered 

that there are reduced gray matter 

concentrations in patients suffering 

from obstructive sleep apnea (OSA). 

Conventional imaging techniques 

cannot detect these changes; therefore, 

the researchers used optimized 

voxel-based morphometry to characterize 

structural differences in gray 

matter in 36 male patients with 

newly diagnosed severe obstructive 

sleep apnea compared to 31 healthy 

male volunteers. This automated 

MRI processing technique demonstrated 

significant reductions in gray 

matter in specific parts of the brain, 

including the limbic system, the prefrontal 

cortex, and the cerebellum. 

The authors of the study suggest 

that these observed deficits in specific 

regions of brain gray matter may 

account for the memory impairment 

and cognitive and emotional dysfunctions 

frequently seen in OSA patients. 

Sleep. 2010;33(2):235-241. 

To download this issue, 

visit our web site at 

www.iah-online.com 

A small pilot study at the University 

of California, Los Angeles suggests 

that even a few hours of web searching 

offers significant benefits to the 

aging brain of seniors. This pilot 

study measured brain activity, using 

fMRI, in 24 neurologically healthy 

older subjects as they performed Internet 

searches. Half of the participants 

were complete novices, whereas 

the others were already daily 

Internet users. After the initial baseline 

brain activity was determined, 

the subjects continued to perform 

Internet searches at home for an 

hour a day seven days over a twoweek 

period and then repeated the 

fMRI scans as they surfed the Internet. 

It was determined that the two 

weeks of practice produced additional 

brain activity, especially in the 

middle frontal gyrus and inferior 

frontal gyrus; areas of the brain associated 

with working memory and 

decision-making. The scan after two 

weeks no longer showed any differences 

in brain activity between beginners 

and routine web users, suggesting 

that it takes a relatively short 

amount of regular Internet use to 

produce positive changes in the 

brain of older adults. 

Poster [Poster Session 382.3/GG2] 

presented at: Neuroscience 2009; October 

17-21, 2009; Chicago, USA. 


) What Else Is New? 

© iStockphoto.com/ryasick 

Daily consumption of wild blueberry 

juice improves memory performance. 

© iStockphoto.com/Olga Lyubkina 

Aggression and TV Exposure 

Excessive TV viewing has been 

shown to be harmful to young children. 

A US study examined the connection 

between TV viewing time 

and increased aggression among 

three-year-olds. Over 3,000 mothers 

in 20 US cities were surveyed 

about how much time their children 

spend in front of the TV, including 

indirect exposure through general 

household TV use. Direct child TV 

exposure and household TV use 

correlated significantly with childhood 

aggression even after controlling 

for other potentially confounding 

factors, including being spanked, 

living in a disorderly neighborhood, 

and having a mother who reported 

depression or parenting stress. 

Arch Pediatr Adolesc Med. 2009; 

163(11):1037-1045. 

Exercise Reduces Anxiety 

Anxiety symptoms often accompany 

chronic illness and frequently remain 

untreated. In a systematic 

review of current relevant Englishlanguage 

scientific journal articles, 

US researchers investigated whether 

exercise training can reduce anxiety 

symptoms among sedentary adults 

with a chronic illness. It was confirmed 

that exercise can significantly 

reduce anxiety symptoms (mean 

effect Δ of 0.29). The most effective 

were programs lasting no more than 

12 weeks with individual training 

sessions of at least 30 minutes. 

The effects were reduced in programs 

lasting longer than 12 weeks, 

a finding the authors attribute to 

reduced compliance with longerterm 

commitments. 

Arch Intern Med. 2010;170(4):321-331. 

Blueberry Juice Improves 

Memory 

Blueberries are reputed to improve 

human brain functioning, a claim 

now supported by the results of a 

recent North American study. Nine 

seniors with signs of mild dementia 

drank 2 to 2.5 cups of wild blueberry 

juice per day for 12 weeks. It 

was determined that the participants 

performed significantly better on 

learning and memory tests than a 

demographically comparable control 

group that had consumed a fruit 

juice mixture with no blueberry 

component. The authors attribute 

this positive effect primarily to the 

high anthocyanin content of blueberries 

and its associated antioxidant 

and anti-inflammatory properties. 

J Agric Food Chem. 2010; 

58(7):3996-4000. 

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Some of the products referred to in articles may not be available in all countries in which the journal is made available, with the formulation described in any article or 

available for sale with the conditions of use and/or claims indicated in the articles. It is the practitioner’s responsibility to use this information as applicable 

and in a manner that is permitted in his or her respective jurisdiction based on the applicable regulatory environment. We encourage our readers to share 

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Written permission is required to reproduce any of the enclosed material. The articles contained herein are not independently verified for accuracy or truth. They have 

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) 13 


) From the Practice 

Recurrent Otitis Media 

A Clinical Case Report 

By Maria Cherubina Capitelli, MD 

This case report describes a boy, aged four years, who 

presented to an otorhinolaryngologist in the autumn of 

2009 with recurrent acute otitis media. This report provides 

a brief description of the patient’s medical history. 

The boy was born at term by 

spontaneous vaginal delivery 

and breastfed; his early development 

was unremarkable. At the age of 4 

years, the boy was thin and pale; he 

had shadows under his eyes. He also 

was timid, introverted, insecure, 

quiet, and lazy. The pertinent family 

history included a father with allergies 

to the Gramineae plant family. 

During the previous year, the boy 

was diagnosed as having chickenpox. 

Six months ago, he developed 

persistent nasal dyspnea and acute 

purulent otitis media that often 

resulted in a perforated tympanum; 

these symptoms occurred every 

month. Antibiotics were given as the 

treatment for each episode. 

First Visit 

The first visit occurred on October 

10, 2009. Findings on clinical examination 

were as follows: Otoscopy 

indicated chronic bilateral catarrhal 

otitis media, whereas findings 

on anterior rhinoscopy were normal. 

Nasal fibrendoscopy indicated a 

grade 4 adenoid hypertrophy (Figure 

1). No tonsillar hypertrophy was 

indicated on pharyngoscopy. On palpation, 

there was diffuse enlargement 

of the lateral cervical lymph nodes. 

Two different instruments were used 

for examination: impedance and puretone 

audiometers. Impedance audiometry 

indicated a flat tympanogram 

and the absence of stapedius 

reflexes bilaterally (Figure 2). Bilateral 

mild conductive hearing loss 

was determined by pure-tone audiometry 

(Figure 3). The boy received 

Figure 1. Nasal Endoscopy Image 

of First Visit 

Figure 2. Impedance Audiometry 

Findings of First Visit 

Figure 3. Pure-tone Audiometry 

Findings of First Visit 

) 14 



Figure 4. Nasal Endoscopy Image of 

Second Visit 


Findings of Second Visit 


Findings of Second Visit 

the following treatments: Silicea 

200CH, 1 dose per month; Lymphomyosot 

and Euphorbium compositum, 

10 drops of each in water in 

the morning and evening for 2 

months; Echinacea compositum forte, 

1 ampoule orally on Tuesday and 

Friday evenings; and Tonsilla compositum, 

1 ampoule orally, on Sunday 

evenings. A follow-up visit was 

scheduled in 2 months. 

Second Visit 

The patient’s second visit to the otorhinolaryngologist 

was on December 

3, 2009. His mother reported 

an improvement in the boy’s nasal 

breathing and in hearing loss, with 

no further sleep apnea. He had 1 

episode of acute catarrhal otitis media 

10 days after the first visit that 

was treated with Viburcol pediatric 

suppositories (1 in the morning and 

1 in the evening) and Traumeel tablets 

(1 tablet 3 times a day). This 

condition resolved in a few days, 

with no further episodes of acute 

upper airway inflammation. 

The patient’s physical examination 

findings were as follows: There was 

an improvement in otoscopy results; 

a return of translucency and bilateral 

retraction of the tympanic membrane 

were observed. On nasal 

endoscopy, it was determined that 

the adenoids were reduced from 

grade 4 to grade 3 (Figure 4). 

Impedance audiometry indicated a 

tympanographic peak and progression 

to negative pressures bilaterally. 

Stapedius reflexes remained absent 

(Figure 5). Pure-tone audiometry 

still indicated bilateral mild conductive 

hearing loss on low tones 

(Figure 6). 

The previously described treatment 

(Silicea 200CH, Lymphomyosot, 

Euphorbium compositum, Echinacea 

compositum forte, and Tonsilla 

compositum) was continued for 2 

additional months. 

Third Visit 

This patient’s third visit to the otorhinolaryngologist 

was on February 

4, 2010. During this visit, the boy’s 

nasal breathing was normal. His 

mother also reported that a case of 

acute afebrile catarrhal adenoiditis 

that he had experienced 10 days 

previously had resolved spontaneously. 

The patient’s physical examination 

findings were as follows: 

Otoscopy revealed a normal tympanic 

membrane, and the result of 

pharyngoscopy was normal. The nasal 

fibrendoscopy findings showed 

grade 2 hypertrophy of the adenoids 

(Figure 7). On palpation, there was a 

reduction in the size of the lateral 

cervical lymph nodes. 

Impedance audiometry indicated 

normal tympanographic and stapedius 

reflexes (Figure 8), and puretone 

audiometry indicated normal 

hearing (Figure 9). The following 

medications were given as a form of 

) 15 



Figure 7. Nasal Endoscopy Image of 

Third Visit 


Findings of Third Visit 


Findings of Third Visit 

) 16 

preventive therapy: Echinacea compositum, 

1 ampoule orally on Monday 

and Friday evenings; and 

Omeogriphi, 1 tube on Sunday evenings, 

up to the end of May. 

Fourth Visit 

In June 2010, the patient visited the 

otorhinolaryngologist again for a 

follow-up examination. The physical 

findings on ears, nose, and throat 

examination and instrumentation 

remained unchanged, with no further 

indications of acute infections 

of the upper airways. 

Discussion 

The mainstream medical therapy 

that is commonly used to treat hypertrophy 

of the adenoids and 

chronic catarrhal otitis media is oral 

cortisone therapy (for a few days) or 

nasal spray (used long-term). This 

treatment has acceptable results in 

some young patients, but relapses 

frequently occur after discontinuation 

of these drugs, and there are 

known adverse effects. In many patients, 

including the one in this report, 

common relapses are frequent 

ear infections that are treated with 

several courses of antibiotics. The 

child is finally referred to the care of 

a specialist and diagnosed as having 

a chronic ears, nose, and throat pathology. 

A reduced appetite, fatigue, 

symptoms of intestinal dysbiosis, 

and increased susceptibility to infection 

are often associated factors. 

Homotoxicological therapy, especially 

in cases of recent onset (as described 

in this case report), is often 

effective and free of adverse effects. 

In pediatric patients, it is commonly 

observed that there is general symptomatic 

improvement in addition to 

resolution of the chronic ears, nose, 

and throat pathology. Additional 

episodes of acute otitis media and 

adenoiditis can be prevented by using 

homotoxicological medicines to 

support a balanced immune system 

response, especially during the winter 

months. 

Furthermore, these medications can 

be used to reduce the size of the adenoids 

and, therefore, resolve chronic 

catarrhal otitis media and completely 

remove or limit the number 

of exacerbations. 

When exacerbations occur during 

the use of homotoxicological therapy 

(as in this case report), this may 

be indicative of health evolution. 

These exacerbations, if treated properly 

with antihomotoxic medications 

(especially in the acute catarrhal 

phase), often rapidly resolve, 

promote self-regulatory processes, 

and, therefore, help avoid the use of 

antibiotics.| 


) Re f r e s h Yo u r H o m o t ox i c o l o g y 

Vertigo: A Common Problem 

in Clinical Practice 

By Markus Mundhenke, MD 

“Doctor, I feel dizzy.” Often heard and not welcomed, this 

statement poses quite a challenge to the general practitioner 

(GP). Dizziness is defined as a general term for disorientation. 

Vertigo is a subtype of dizziness that is characterized by 

an illusion of movement. 1 However, dizziness and vertigo are 

often used interchangeably by the patient. Vertigo/dizziness 

is a multisensory syndrome and not a disease entity. 2 Diagnostic 

and therapeutic strategies to treat vertigo/dizziness 

need to be customized to the individual patient’s needs. 

Vertigo/dizziness accounts for 

more than 2% of all consultations 

in general practice 3,4 and 

emergency departments. 5 Vertigo is 

1 of the 10 most common symptoms 

for which patients seek medical 

advice. Most of these patients 

are elderly people, with an increased 

prevalence up to the age of 50 years; 

approximately 30% of 65-year-old 

people experience recurrent episodes 

of vertigo. 6,7 Disturbances in 

balance increase the risk of falling 

considerably and, therefore, the 

rapid and appropriate treatment of 

dizziness/vertigo is necessary to 

prevent any associated increase in 

morbidity or mortality. 

Classification of Vertigo 

Different classifications of vertigo 

exist, sometimes making a common 

communication platform within the 

medical community difficult. From 

a practical point of view, vertigo can 

be divided into specific (true) vertigo, 

originating in the vestibular 

system; and nonspecific and nonvestibular 

vertigo/dizziness, formerly 

subdivided into disequilibrium, 

presyncope, or light-headedness. 

Vertigo is a multisensory syndrome 

(Figure 1); when originating in the 

vestibular system, it is often subclassified 

into peripheral or central vertigo 

and termed neurotological 

vertigo. The most prevalent diseases 

classified under vestibular vertigo 

are benign paroxysmal positional 

vertigo (BPPV), Meniere disease, 

vestibular neuritis, and migraine-associated 

vertigo. 1,8,9 Nonvestibular 

vertigo or dizziness is not well-defined 

in the literature because of the 

many diseases associated with this 

symptom. Generally, dizziness is described 

as unsteadiness, imbalance, 

disequilibrium (tendency to fall), 

and presyncope (light-headedness). 

The main causes are multisensory or 

balance disorders (due to sensory 

deprivation, muscle weakness as the 

result of minimal muscular activity, 

degenerative processes of sensory 

organs and pathways, drugs, alcohol 

abuse, or vitamin deficiencies). Additional 

causes are neurological or 

mental disorders (ie, dementia of 

various origins, anxiety, panic, agoraphobia, 

and stress), cardiovascular 

disorders (ie, cerebrovascular disease, 

cardiac arrhythmia, stroke, 

transient ischemic attack, hypertension, 

and orthostatic hypotension), 

adverse effects of therapeutic drugs 

(including antihypertensive and sedative 

agents), and cervical vertigo. 

10-15 

Epidemiology 

In epidemiological studies, patients 

experiencing nonvestibular vertigo/ 

dizziness within the group of all 

vertigo cases range from approximately 

20% to 80%. Research in 

primary care settings usually reports 

a higher percentage of nonvestibular 

vertigo: 88% of the cases tend to be 

chronic, and 44% of those patients 

visit the GP more than once (≤15 

times). Referral rates to specialists 

(otorhinolaryngologists and neurologists) 

are low. 16-19 In an investigation 

of 7609 patients diagnosed as 

having vertigo in 138 German GP 

practices over 18 months, only 

) 17 



Vestibular function Spatial orientation Vestibulo-ocular Posture 

Motion perception reflex 

Physiological vertigo Vestibular Optokinetic Somatokinetic 

Pathological vertigo 

• Peripheral labyrinthine lesion 

• Peripheral eighth nerve lesion 

• Central vestibular lesion 

• Central vestibular 

pathways dysfunction 

Affected central Parietotemporal Brainstem Spinal Medullary vomiting center 

nervous regions cortex Limbic system 

Vertigo syndrome Vertigo Nystagmus Ataxia Nausea 

Figure 1. Vertigo, a Multisensory Syndrome 

) 18 

19.8% were classified as having vestibular 

vertigo (4.3%, BPPV; 2.0%, 

Meniere disease; 0.6%, vestibular 

neuritis; and 12.9%, other vertigo); 

80.2% of the patients were diagnosed 

as having nonvestibular 

vertigo/dizziness. The referral rate 

of these patients to specialists was 

only 3.9%. Also, only 13.7% of 

patients received medical treatment, 

either with conventional drugs (eg, 

betahistine, dimenhydrinate and 

cinnarizine combinations, sulpiride, 

and flunarizine) or bioregulatory 

medications (eg, Vertigoheel). 20 

However, in a report from a specialty 

clinic, this ratio is inverted, with 

two-thirds of the patients diagnosed 

as having specific vertigo and onethird 

diagnosed as having other 

kinds of vertigo. 21 Therefore, nonspecific 

and nonvestibular vertigo 

seems to be the most challenging 

form of vertigo/dizziness for the 

primary care physician. Because of 

an unfavorable risk to benefit ratio 

of long-term conventional drug 

treatment in nonspecific vertigo, 

GPs often seek complementary and 

alternative medicine–orientated approaches 

to care for these patients. 

Diagnostic Approach 

Acute vertigo/dizziness is often selflimiting. 

However, the severity of 

the illness can substantially decrease 

the quality of life. In acute care 

settings, the most relevant decision 

to be made by the health care 

practitioner is if vertigo/dizziness is 

accompanied by so-called red flag 

symptoms. A selection of these 

symptoms includes the following: 

• new/severe headache 

or neck pain 

• blurred vision 

• hearing loss 

• difficulties speaking 

• unconsciousness 

• falling or problems walking 

• ataxia 

• paraesthesia 

• bradycardia/tachycardia 

• angina pectoris 

These symptoms should be taken 

seriously. Further emergency measures, 

including prompt referral to a 

specialist or an emergency department, 

have to be taken. Careful 

medical history taking and a clinical 

evaluation are usually sufficient to 

guide diagnosis and initiate treatment 

in patients without red flag 

symptoms (Figure 2). Also, there is 

spontaneous resolution potential for 

vertigo/dizziness. Nevertheless, after 

the initial 3-month compensation 

period, acute cases can become 

chronic. The most relevant questions 

for assessing a patient with dizziness/vertigo 

are as follows: 

• Can you describe the sensation you 

are feeling during the attack? (Avoid 

giving influencing examples.) 

Rotational vertigo with the sign 

of nystagmus at rest is usually 

vestibular vertigo. 



• How long do your vertigo attacks 

last? 

Benign paroxysmal postural vertigo 

usually lasts only for seconds 

after head motion, whereas 

Meniere disease is usually episodic 

(from 20 minutes to a few 

hours). Long-lasting and disabling 

vertigo is often a sign of 

acute loss of vestibular function, 

as is seen in vestibular neuritis or 

other forms of loss in vestibular 

function. 

• Do you have associated symptoms? 

If vertigo is accompanied by a 

headache, be aware of migraineassociated 

vertigo. Tinnitus and 

reduced hearing capacity of low 

frequencies are characteristic of 

Meniere disease. Anxiety symptoms 

are seen in patients with 

phobic vertigo. Fainting is characteristic 

in individuals with orthostatic 

hypotension, cardiac 

arrhythmias, or reactive hypoglycemia. 

• What triggers the attack? 

Head motion can trigger BPPV, 

and special situations (eg, taking 

an elevator) can trigger phobic 

vertigo. 

In elderly patients with chronic 

symptoms, further diagnosis is often 

not helpful. A watchful waiting 

strategy can be considered, but 

symptoms tend to persist. 10,11 A 

thorough medical history regarding 

therapeutic drug use is necessary because 

many drugs (eg, antihypertensive 

agents, psychotropic agents, and 

others) can cause dizziness in elderly 

patients. Therefore, a careful decision 

has to be made regarding the 

risks and benefits of drugs in this 

population group. In addition to 

discontinuing the medication, detoxification 

measures might be helpful 

in this situation. Vestibular rehabilitation 

22 and complementary and 

alternative medicine–orientated approaches 

can be beneficial to this 

group. 

Bioregulatory 

Medical Approach 

Because vertigo is a multisensory 

syndrome of various origins and of 

different pathological features, the 

attempt to treat vertigo with a conventional, 

single-target, single-molecule 

approach is limited. Different 

parts of the peripheral and central 

nervous systems are involved in vertigo/dizziness, 

and no specific approach 

from conventional medicine 

has been absolutely effective. Furthermore, 

conventional medications 

have adverse effects that prohibit the 

long-term use of these drugs in patients 

with chronic vertigo. A multitargeted 

and multicomponent approach, 

as delivered by bioregulatory 

therapy with low-dose/ultra–lowdose 

medications, might be an efficient 

therapeutic option. Treatment 

goals are symptomatic, specific, or 

rehabilitative. The basic medication 

for patients with any kind of symptomatic 

vertigo is a combination 

preparation, Vertigoheel. This prep- 

Figure 2. Algorithm for Diagnosing Vertigo for the General Practitioner 

(adapted from Labuguen 9 ) 

Yes 

Prompt referral to specialist/ 

emergency department 

Yes 

Consider discontinuing 

the medication 

Patient complains of dizziness 

“Red flag” symptoms 

Does the patient have true vertigo? 

Yes 

Is the patient taking 

a drug that 

can cause vertigo? 

No 

No 

No 

Obtain a medical history, 

especially of timing and duration, 

provoking and aggravating factors, 

associated symptoms, 

and risk factors for 

cerebrovascular disease 

Perform a physical 

examination with special 

attention to the head, eyes, 

and neurological system; add 

provocative diagnostic tests 

as necessary 

Refine the differential diagnosis: 

Which conditions are 

consistent with the physical 

examination findings? 

Adapt further diagnosis 

and treatment to your 

specific findings 

Continue 

diagnostic workup 

as appropriate for 

light-headedness, 

presyncope, 

or dysequilibrium 

) 19 



aration contains Anamirta cocculus, 

Conium maculatum, Ambra grisea, and 

Petroleum rectificatum. Vertigoheel is 

indicated for various types of vertigo 

and has been investigated thoroughly 

in experimental settings on microcirculation 

and in clinical studies. 

23-26 In acute care settings, 

Vertigoheel might be administered 

parenterally. Under supervision by a 

treating physician, Vertigo heel is 

usually given for 6 to 8 weeks and 

can be easily switched from the parenteral 

to the oral form. If vertigo 

can be linked to a specific vestibular 

disease, the pathogenesis of this disease 

should be considered in the 

treatment plan. The focus is on the 

3-pillar approach in bioregulatory 

medicine. For example, BPPV is 

thought to be caused by otoliths in 

one of the semicircular canals of the 

vestibular system and is routinely 

treated by positioning maneuvers as 

standard treatment. Otoliths are a 

manifestation of the deposition 

phase and, therefore, a course of 

basic detoxification and drainage 

might be worth considering from a 

bioregulatory medicine point of 

view to prevent relapses. Vestibular 

neuritis, a further example of a specific 

disease in vestibular vertigo, is 

linked to viral infections in some 

cases. This means that patients with 

vestibular neuritis might be treated 

with Engystol or Traumeel for immunoregulatory 

purposes. Meniere 

disease, a type of episodic vertigo 

with endolymphatic hydrops within 

the vestibular system, might benefit 

from basic and advanced detoxification/drainage 

measures. Because accompanying 

symptoms are often 

troublesome to patients with acute 

vertigo, patients can be treated optionally 

with Vomitusheel for nausea, 

often found in those with peripheral 

vertigo; and with Gelsemium-Homaccord 

or Spigelon for headache. 

Vertigo can be a stress-related symptom, 

and relaxation methods and 

low-dose medications (eg, Nervoheel 

or Neurexan) might help. An 

example of a bioregulatory therapy 

protocol for vertigo is shown in the 

Table (Meniere disease). 

Nonspecific vertigo, characterized 

by a feeling of dizziness, is a problem 

especially to elderly patients 

and was formerly termed presbyvertigo. 

With increasing age, the functioning 

of all stability systems involved 

in orientation of the body 

declines to an individual extent. 

This decline in proprioception might 

cause disequilibrium of sensory input 

and, together with a decline in 

central compensation mechanisms, 

Table: Bioregulatory Treatment Protocol for Meniere Disease 

DET-Phase 

Basic and/or 

Symptomatic 

Regulation Therapy a 

Optional 

Neurodermal 

Impregnation 

• Vertigoheel D&D • Basic b and advanced c 

detoxification and drainage 

where appropriate (see text) 

IM 

• Engystol 

(only in cases in which virus 

infection contributes to 

Meniere disease) 

• Vomitusheel 

(in the presence of nausea) 

• Nervoheel/Neurexan 

(if stress related) 

• Cerebrum compositum 

(in the presence of cognitive decline) 

COS 

• Coenzyme compositum 

• Ubichinon compositum 

(see text) 

Notes: Vestibular rehabilitation, including habituation exercise or balance (mind/body) therapy, is helpful. 

Dosages: Please refer to the general dosage recommendation of the specific country. 

Abbreviations: COS, cell and organ support; D&D, detoxification and drainage; DET, Disease Evolution Table; IM, immunomodulation. 

a 

Antihomotoxic regulation therapy consists of a 3-pillar approach: D&D, IM, and COS. 

) 20 

b 

For basic detoxification and drainage, the Detox-Kit consists of Lymphomyosot, Nux vomica-Homaccord, and Berberis-Homaccord. 

c 

For advanced supportive detoxification and drainage, therapy consists of Hepar compositum (liver), Solidago compositum (kidney), 

and Thyreoidea compositum (connective tissue). 



can lead to dizziness. 27-29 Sclerosis 

of cerebral blood vessels also might 

be involved. However, it is not clear 

to what extent structural changes of 

the macrocirculation and microcirculation 

are the cause of dizziness in 

elderly patients. It would be interesting 

to investigate if drugs from 

the catalyst medication group (eg, 

Coenzyme compositum or Ubichinon 

compositum) or Composita 

medications (eg, Cerebrum compositum) 

would have additional 

functional effects on the sensory 

system in elderly patients. Given the 

potency of these drugs, this approach 

is not recommended routinely 

but might be considered on an 

individual basis. 

Additional Measures 

Postural maneuvers are helpful because 

they generally trigger the 

compensation and adaptation processes 

of the central nervous system 

to the pathological conditions. They 

should be performed as soon as 

possible; as a rule of thumb, they are 

feasible under appropriate precautions 

and supervision and only with 

patients that will not vomit when 

their head is moved. During the 

acute phases of vertigo, the patient 

should be advised to avoid circumstances 

in which a vertigo/dizziness 

attack can cause harm (eg, when 

driving, handling machines, swimming, 

or diving). If vertigo/dizziness 

persists for longer than 3 

months, a long-term course is likely 

and vestibular rehabilitation 31 is 

always an option. This includes repositioning 

treatments and balance 

therapy. Head movement exercises 

while sitting or standing are the option 

of choice because they decrease 

vertigo/dizziness, improve standing 

balance, and increase independence 

in activities of daily living. 30 

Conclusions 

Dizziness/vertigo is a common 

problem in clinical care. Individualized 

therapy is mandatory in acute 

and chronic cases. Bioregulatory 

medical therapy is exceptionally 

promising for this multisensory syndrome 

because it is a multitargeted 

therapy and does not suppress the 

compensation mechanisms needed 

for symptomatic recovery.| 

References: 

1. Baloh RW. Vertigo. Lancet 1998;352(9143): 

1841-1846. 

2. Dieterich M. Dizziness. Neurologist. 2004; 

10(3):154-164. 

3. Sloan PD. Dizziness in primary care: results 

from the National Ambulatory Medical Care 

Survey. J Fam Pract. 1989;29(1):33-38. 

4. Colledge NR, Wilson JA, Macintyre CC, 

MacLennan WJ. The prevalence and characteristics 

of dizziness in an elderly community. 

Age Ageing. 1994;23(2):117-120. 

5. Kerber KA, Meurer WJ, West BT, Fendrick 

AM. Dizziness presentations in US emergency 

departments, 1995-2004. Acad Emerg 

Med. 2008;15(8):744-750. 

6. Jonsson R, Sixt E, Landahl S, Rosenhall 

U. Prevalence of dizziness and vertigo in 

an urban elderly population. J Vestib Res. 

2004;14(1):47-52. 

7. Neuhauser HK, von Brevern M, Radtke A, et 

al. Epidemiology of vestibular vertigo: a neurotologic 

survey of the general population. 

Neurology. 2005;65(6):898-904. 

8. Neuhauser HK. Epidemiology of vertigo. 

Curr Opin Neurol. 2007;20(1):40-46. 

9. Labuguen RH. Initial evaluation of vertigo. 

Am Fam Physician. 2006;73(2):244-251. 

10. Kroenke K, Lucas CA. Causes of persistent 

dizziness: a prospective study of 100 patients 

in ambulatory care. Ann Intern Med. 

1992;117(11):898-904. 

11. Colledge NR, Barr-Hamilton RM, Lewis SJ, 

Sellar RJ, Wilson JA. Evaluation of investigations 

to diagnose the cause of dizziness in elderly 

people: a community based controlled 

study. BMJ. 1996;313(7060):788-792. 

12. O’Mahony D, Foote C. Prospective evaluation 

of unexplained syncope, dizziness, 

and falls among community-dwelling 

elderly adults. J Gerontol A Biol Sci Med Sci. 

1998;53(6):M435-M440. 

13. Michels T, Lehman N, Moebus S. Cervical 

vertigo–cervical pain: an alternative and 

efficient treatment. J Altern Complement Med. 

2007;13(5):513-518. 

14. Heinrichs N, Edler C, Eskens S, Mielczarek 

MM, Moschner C. Predicting continued dizziness 

after an acute peripheral vestibular disorder. 

Psychosom Med. 2007;69(7):700-707. 

15. Karatas M. Central vertigo and dizziness: epidemiology, 

differential diagnosis, and common 

causes. Neurologist. 2008;14(6):355-364. 

16. Ekvall Hansson E, Månsson NO, Håkansson 

A. Benign paroxysmal positional vertigo 

among elderly patients in primary health 

care. Gerontology. 2005;51(6):386-389. 

17. Hanley K, O’Dowd T. Symptoms of vertigo in 

general practice: a prospective study of diagnosis. 

Br J Gen Pract. 2002;52(483):809-812. 

18. Kuo CH, Pang L, Chang R. Vertigo, part 

1: assessment in general practice. Aust Fam 

Physician. 2008;37(5):341-347. 

19. Lawson J, Johnson I, Bamiou DE, Newton 

JL. Benign paroxysmal positional vertigo: 

clinical characteristics of dizzy patients 

referred to a falls and syncope unit. Q J Med. 

2005;98(5):357-364. 

20. Kruschinski C, Kersting M, Breull A, Kochen 

MM, Koschack J, Hummers-Pradier E. Frequency 

of dizziness-related diagnoses and 

prescriptions in a general practice database 

[in German]. Z Evid Fortbild Qual Gesundhwes. 

2008;102(5):313-319. 

21. Strupp M, Brandt T. Diagnosis and treatment 

of vertigo and dizziness. Dtsch Arztebl Int. 

2008;105(10):173-180. 

22. Yardley L, Beech S, Zander L, Evans T, 

Weinman J. A randomized controlled trial 

of exercise therapy for dizziness and 

vertigo in primary care. Br J Gen Pract. 

1998;48(429):1136-1140. 

23. Klopp R, Niemer W, Weiser M. Microcirculatory 

effects of a homeopathic preparation 

in patients with mild vertigo: an intravital 

microscopic study. Microvasc Res. 2005;69 

(1-2):10-16. 

24. Heinle H, Tober C, Zhang D, Jäggi R, Kuebler 

WM. The low-dose combination preparation 

Vertigoheel activates cyclic nucleotide 

pathways and stimulates vasorelaxation. Clin 

Hemorheol Microcirc. 2010;46(1):23-35. 

25. Schneider B, Klein P, Weiser M. Treatment 

of vertigo with a homeopathic complex remedy 

compared with usual treatments: a metaanalysis 

of clinical trials. Arzneim Forsch/Drug 

Res. 2005;55(1):23-29. 

26. Karkos PD, Leong SC, Arya AK, Papouliakos 

SM, Apostolidou MT, Issing WJ. “Complementary 

ENT”: a systematic review of commonly 

used supplements. J Laryngol Otol. 

2007;121(8):779-782. 

27. Ganança MM, Caovilla HH, Munhoz MS, 

et al. Optimizing the pharmacological component 

of integrated balance therapy. Braz J 


28. O’Mahony D, Foote C. Prospective evaluation 

of unexplained syncope, dizziness, 

and falls among community-dwelling elderly 

adults. J Gerontol A Biol Sci Med Sci. 

1998;53(6):M435-M440. 

29. Tinetti ME, Williams CS, Gill TM. Dizziness 

among older adults: a possible geriatric syndrome. 

Ann Intern Med. 2000;132(5):337-344. 

30. Cohen HS. Disability and rehabilitation 

in the dizzy patient. Curr Opin Neurol. 

2006;19(1):49-54. 

) 21 


) Practical Protocols 

Viral Laryngeal Polyps 

Treatment with Bioregulatory Medications 

By Jacques Deneef, MD 

) 22 

Vocal polyps are superficial benign 

growths on the vocal 

folds. They are generally unilateral 

and range widely in appearance, 

from the true pedunculated polyp to 

a hemorrhagic growth. There are a 

number of different recognized etiologies 

for vocal polyps, including 

phonotrauma (misuse of the voice, 

generally from a speaking or singing 

profession), a local hemorrhage, or a 

viral origin. 1 A papilloma is a type 

of polyp that is defined as a small 

benign epithelial tumor. In the 

respiratory tract, they commonly 

present as small wartlike nodules in 

the larynx or trachea. 2,3 

Papillomas are traditionally categorized 

into four major groups based 

on their morphology but not necessarily 

on clinical relevance. These 4 

groups are as follows: multiple juvenile 

papillomas, solitary juvenile 

papillomas, multiple adult papillomas, 

and solitary adult papillomas. 4 

The lesions can be markedly recurrent, 

with some reports of up to 150 

surgical procedures during a person’s 

lifetime. 3,5 Papillomas are not reactionary 

lesions; they have a definitive 

and persistent etiological agent, 

such as a virus. Current evidence 

suggests a correlation between persistent 

infection by human papillomavirus 

(HPV), especially types 6 

and 11, and the development of laryngeal 

papillomas, 6,7 lending support 

to mainstream medicine’s campaign 

to vaccinate all young children 

with the HPV vaccine. However, 

only 20% of persons with laryngeal 

papillomas have measurable levels of 

HPV DNA present. 3,6 

Vocal polyps and recurrent respiratory 

papillomatosis are still considered 

relatively rare disorders with an 

estimated incidence of only 1.8 and 

4.3 cases per 100 000 adults and 

children, respectively, per year in the 

United States. 3 Laryngeal papillomatosis 

primarily affects infants and 

young children, with 60% to 80% 

of cases occurring before the age of 

3 years. Risk factors for children include 

exposure to the cervix and vagina 

of a mother with genital HPV 

infections during delivery, the status 

of the child’s immune system, and 

local trauma 3,5 (possibly from recurrent 

extraesophageal acid reflux 8 ). 

Adult risk factors include compromised 

immune systems and orogenital 

or oroanal transmission between 

persons with active HPV infections. 

2,3 

Because the tumors grow quickly, 

young children with the disease may 

find it difficult to breathe when 

sleeping or they may experience difficulty 

swallowing (dysphagia) and/ 

or hoarseness and an abnormal cry. 

Adults with laryngeal papillomatosis 

may experience hoarseness, a 

change in voice quality and/or increased 

effort in vocalizing, chronic 

coughing, or breathing problems. 

Signs of airway obstruction, including 

tachypnea, stridor, use of accessory 

muscles of breathing, and flaring 

of nasal ala, also might be 

present. 1,3 Any acute onset of a 

marked change in vocal quality or 

dysphonia should alert the clinician 

to exclude any possible medical 

emergencies, such as an airway obstruction 

from a foreign body or 

epiglottitis (possibly from a Haemophilus 

influenzae B infection). If the 

change in voice quality has been 

long-term, the most likely diagnosis 

is a laryngeal polyp or a flare-up of 

recurrent laryngeal papillomatosis. 

This diagnosis is confirmed by measurements 

in a voice laboratory and 

imaging studies, such as videostrobolaryngoscopy. 

2,3 

The course of the disease is unpredictable 

with a possibility of pulmonary 

spread and malignancy. For 

example, there is a correlation 

between the development of viral 

laryngeal polyps, head and neck 

carcinomas, and a chronic persistent 

HPV infection, 9 although there are 

some significant controversies. 10 

Current evidence suggests that an 

accumulation of additional cellular 

changes is necessary, such as from 

alcohol and tobacco use, before neoplastic 

transformation can occur. 11 

The long-term consumption of mycotoxins 

(eg, aflatoxin and fumonisin) 

also has recently been linked to 

the development of esophageal 

carcinomas. 12 

The therapy of choice is complete surgical 

excision of the polyp with laser 

vaporization or excision using the 

cold steel or carbon dioxide laser. 13 

Depending on the size and type of 

vocal polyps, antihomotoxic medications 

can be useful in reducing the 

signs and symptoms, preventing recurrence, 

and supporting mainstream 

medical therapies. A bioregulatory 

protocol for the supportive treatment 

of vocal polyps is shown in the Table.| 



Table. Supportive Treatment for Viral Laryngeal Polyps 

DET-Phase 

Basic and/or 

Symptomatic 

Regulation Therapy a 

Optional 

Endodermal, 

mucodermal 

Impregnation 

Degeneration 

• Phosphor- 

Homaccord 

D&D 

• Advanced supportive 

detoxification and drainage b 

with Galium-Heel 

followed by 

• Basic detoxification and 

drainage: Detox-Kit c 

• Vomitusheel 

(in the presence of nausea) 

• Nervoheel/Neurexan 

(if stress related) 

• Cerebrum compositum 

(in the presence of cognitive decline) 

IM 

COS 

• Engystol 

• Coenzyme compositum 

• Ubichinon compositum 

• Mucosa compositum 

Note: It is important to obtain a complete medical history and perform a thorough clinical workup to ensure that there is minimal risk of 

severe complications. 

Dosages: Phosphor-Homaccord, 10 drops 3 times per day. Regulation therapy: tablets, 1 tablet 3 times per day; ampoules, 1 ampoule of 

each medication, 1 to 3 times per week; Detox-Kit, 30 drops of each medication in 1.5 L of water (drink throughout the day). Optional 

therapy: ampoules, 1 ampoule 1 to 3 times per week; drops, 10 drops 3 times per day; tablets, 1 tablet 3 times per day. 

Abbreviations: COS, cell and organ support; D&D, detoxification and drainage; DET, Disease Evolution Table; IM, immunomodulation. 

a 

Antihomotoxic regulation therapy consists of a 3-pillar approach: D&D, IM, and COS. 

b 

Advanced supportive detoxification and drainage consists of Hepar compositum (liver), Solidago compositum (kidney), and Thyreoidea 

compositum (connective tissue). 

c 

The Detox-Kit consists of Lymphomyosot, Nux vomica-Homaccord, and Berberis-Homaccord. 

References 

1. Buckmire RA. Vocal polyps and nodules. 

eMedicine Web site. http://emedicine.medscape.com/article/864565-overview. 

Updated 

September 8, 2008. Accessed June 24, 2010. 

2. Derkay CS, Wiatrak B. Recurrent respiratory 

papillomatosis: a review. Laryngoscope. 

2008;118(7):1236-1247. 

3. McClay JE. Recurrent respiratory papillomatosis. 

eMedicine Web site. http://emedicine. 

medscape.com/article/865758-overview. 

Updated October 29, 2008. Accessed June 

24, 2010. 

4. Aaltonen LM, Peltomaa J, Rihkanen H. Prognostic 

value of clinical findings in histologically 

verified adult-onset laryngeal papillomas. 

Eur Arch Otorhinolaryngol. 1997;254(5): 

219-222. 

5. Stamataki S, Nikolopoulos TP, Korres S, Felekis 

D, Tzangaroulakis A, Ferekidis E. Juvenile 

recurrent respiratory papillomatosis: still a 

mystery disease with difficult management. 

Head Neck. 2007;29(2):155-162. 

6. Major T, Szarka K, Sziklai I, Gergely L, 

Czeglédy J. The characteristics of human papillomavirus 

DNA in head and neck cancers 

and papillomas. J Clin Pathol. 2005;58(1):51-55. 

7. Bonnez W, Reichman RC. Papillomaviruses. 

In: Mandell GL, Bennett JE, Dolin R, eds. 

Principles and Practice of Infectious Diseases. 

6th ed. New York, NY: Churchill Livingstone; 

2005:1841-1856. 

8. McKenna M, Brodsky L. Extraesophageal 

acid reflux and recurrent respiratory papilloma 

in children. Int J Pediatr Otorhinolaryngol. 

2005;69(5):597-605. 

9. Mannarini L, Kratochvil V, Calabrese L, et al. 

Human papilloma virus (HPV) in head and 

neck region: review of literature. Acta Otorhinolaryngol 

Ital. 2009;29(3):119-126. 

10. Campisi G, Giovannelli L. Controversies surrounding 

human papilloma virus infection, 

head & neck vs oral cancer, implications for 

prophylaxis and treatment. Head Neck Oncol. 

2009;1(1):8. 

11. Smith EM, Rubenstein LM, Haugen TH, 

Hamsikova E, Turek LP. Tobacco and alcohol 

use increases the risk of both HPV-associated 

and HPV-independent head and neck cancers 

[published online ahead of print April 17, 

2010]. Cancer Causes Control. doi:10.1007/ 

s10552-010-9564-z. 

12. Williams JH, Grubb JA, Davis JW, et al. 

HIV and hepatocellular and esophageal 

carcinomas related to consumption of mycotoxin-prone 

foods in sub-Saharan Africa 

[published online ahead of print May 19, 

2010]. Am J Clin Nutr. 2010;92(1):154-160. 

doi:10.3945/ajcn.2009.28761 

13. Goon P, Sonnex C, Jani P, Stanley M, Sudhoff 

H. Recurrent respiratory papillomatosis: an 

overview of current thinking and treatment. 

Eur Arch Otorhinolaryngol. 2008;265(2):147- 

151. 

) 23 



Hoarseness 

Treatment with Bioregulatory Medications 

By Jacques Deneef, MD 

) 24 

Hoarseness refers to the symptom 

of changed quality or volume 

of sound produced when trying 

to speak. A diagnosis of hoarseness 

is termed dysphonia. 1,2 The pitch or 

quality of sound when someone has 

hoarseness has been characterized in 

a number of different ways, including 

“raspy,” “scratchy,” “husky,” 

“weak,” and “breathy”. 3 

Hoarseness is a common symptom 

affecting up to approximately 20 

million people in the U.S. at any given 

time, and about one in three individuals 

becoming hoarse at some 

point in their life. 1 Furthermore, 

there is a widespread impact from 

hoarseness, leading to frequent 

healthcare visits and several billion 

dollars in lost productivity annually 

from work absenteeism. 1 

Although hoarseness might develop 

in all ages and in both sexes, there is 

a much higher occurrence in women; 

in children between the ages of 8 

and 14 years; and in those with certain 

occupations, including teachers 

and singers, who frequently use their 

voice. 3 Other risk factors for the 

development of hoarseness are tobacco 

smoke (primary or secondary 

exposure), misuse of alcohol, longterm 

exposure to dusts and vapors, 

humidity (excess or deficient), and 

previous or concurrent upper respiratory 

tract infection (eg, with a rhinovirus 

or an influenza virus). 

Some of the well-characterized etiologies 

include laryngitis (viral, bacterial, 

or allergic), 4 gastroesophageal 

reflux (eg, in professional singers because 

of the strong intra-abdominal 

pressure and anxiety of singing), 5 

drugs (eg, steroid inhalers used for 

asthma), 6 and malignancy. For example, 

laryngeal cancer is one of the 

most common head and neck cancers 

in the United States, with an estimated 

12290 adults (9920 men 

and 2370 women) diagnosed in 

Table. Treatment for Hoarseness a 

Basic and/or Symptomatic 

• Phosphor-Homaccord 

• Arnica-Heel 

(if severe concomitant infection) 

2009 and potentially up to 3660 

deaths (2900 men and 760 women) 

annually. 7,8 Hypopharyngeal cancer 

is another type of malignant cause of 

hoarseness, with an estimated 2400 

adults (1900 men and 500 women) 

diagnosed every year in the United 

States and an etiology linked to misuse 

of alcohol and tobacco and iron 

and vitamin C deficiency. 9 

Optional 

• Tartephedreel 

(if postnasal drip) 

• Gripp-Heel 

(if caused by influenza) 

• Drosera-Homaccord 

(if spasmodic cough or croup) 

• Vinceel 

(for viral pharyngitis) 

• Spascupreel 

(if laryngospasms occur) 

• Aconitum-Homaccord 

(for a crouplike cough) 

• Bronchalis-Heel 

(for chronic smokers) 

• Husteel 

(for irritating and tickling cough 

with spasms) 

• Echinacea compositum 

(for any bacterial infection) 

Dosages: Phosphor-Homaccord and Arnica-Heel, 8 to 10 drops 3 times per day. Optional 

therapy: ampoules, 1 ampoule 1 to 3 times per week; drops, 10 drops 3 times per day; 

tablets, 1 tablet 3 times per day; throat spray, 1 spray 3 times per day. 

Abbreviation: DET, Disease Evolution Table. 

a 

There is no regulation therapy/3-pillar approach for hoarseness because treatment is based 

on the symptoms of the patient and the specific etiological factors. 



Hypertrophic chronic laryngitis refers 

to a type of hoarseness that 

develops after persistent irritation to 

the larynx from misuse of alcohol, 

tobacco smoking, toxic vapors, and 

chronic rhinosinusitus. 10 The larynx 

is erythematous, with simple thickening 

of vocal cords and chronic 

hypersecretion of mucous due to the 

secondary infection. The voice has a 

modified timbre and weakens substantially 

with changes in temperature 

and during various times of the 

day, such as the evening. 11 Another 

cause of hoarseness that is more frequent 

in adults than children is vocal 

polyps or nodes. The vocal node develops 

because of an inherent dysfunction 

of the vocal cords, overuse 

and abuse of the vocal cords, localized 

bleeds, and/or inflammatory 

factors. It presents as an intermittent 

type of dysphonia with progressive 

symptoms. 12 

Hoarseness is only a symptom and, 

therefore, the best management is to 

determine and treat the underlying 

cause. Depending on the etiology, 

natural health products, such as antihomotoxic 

medications, can be used 

as safe and effective stand-alone 

therapies or in conjunction with 

mainstream medical therapies. A bioregulatory 

protocol for the symptomatic 

treatment of hoarseness is shown 

in the Table.| 

References 

1. Barclay L. Guideline issued for evaluation 

and management of hoarseness. Medscape 

Web site. http://www.medscape.com/viewarticle/708360. 

Published September 3, 

2009. Accessed June 24, 2010. 

2. Feierabend RH, Shahram MN. Hoarseness in 

adults. Am Fam Physician. 2009;80(4):363- 

370. 

3. Hoarseness. MedlinePlus Web site. http:// 

www.nlm.nih.gov/medlineplus/ency/article/003054.htm. 

Updated October 10, 

2008. Accessed June 24, 2010. 

4. Simpson CB, Fleming DJ. Medical and vocal 

history in the evaluation of dysphonia. 

Otolaryngol Clin North Am. 2000;33(4):719- 

730. 

5. Modlin IM, Moss SF, Kidd M, Lye KD. Gastroesophageal 

reflux disease: then and now. J 

Clin Gastroenterol. 2004;38(5):390-402. 

6. DelGaudio JM. Steroid inhaler laryngitis: 

dysphonia caused by inhaled fluticasone 

therapy. Arch Otolaryngol Head Neck Surg. 

2002;128(6):677-681. 

7. American Cancer Society. Cancer Facts and 

Figures 2009. American Cancer Society Web 

site. http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancerfacts-figures-2009. 

Accessed June 24, 2010. 

8. Iqbal N, Lo S, Frazier AJ, et al. Laryngeal 

carcinoma. eMedicine Web site. http:// 

emedicine.medscape.com/article/383230- 

overview. Updated March 3, 2010. Accessed 

June 24, 2010. 

9. Quon H, Goldenberg D. Hypopharyngeal 

cancer. eMedicine Web site. http://emedicine.medscape.com/article/1375268-overview. 

Updated July 8, 2008. Accessed June 

24, 2010. 

10. Silva L, Damrose E, Bairão F, Della Nina 

ML, Junior JC, Olival Costa H. Infectious 

granulomatous laryngitis: a retrospective 

study of 24 cases. Eur Arch Otorhinolaryngol. 

2008;265(6):675-680. 

11. Eisenbeis JF, Fuller DP. Voice disorders: 

abuse, misuse and functional problems. Mo 

Med. 2008;105(3):240-243. 

12. Buckmire RA. Vocal polyps and nodules. 

eMedicine Web site. http://emedicine.medscape.com/article/864565-overview. 

Updated 

September 8, 2008. Accessed June 24, 

2010. 

Hans-Heinrich Reckeweg Award 2011 

Join in – have your experience rewarded 

Both prizes are awarded for research carried out in a 

Heel annually honors outstanding scientific research in laboratory or registered practice. All results must be 

the field of a unique homeotherapeutic system (homotoxicology) 

with the Hans-Heinrich Reckeweg Award. search should not have involved animal testing. 

new, convincing and previously unpublished, and re- 

The deadline for submissions is May 31, 2011. 

The main award (€ 10,000) 

is presented for scientific work of fundamental theoretical 

and/or practical significance in antihomotoxic Biologische Heilmittel Heel GmbH, 

For more information contact: 

medicine in the fields of human and veterinary medicine. 

76532 Baden-Baden, Germany 

Department of Research, 

Phone +49 7221 501-227, 

The incentive award (€ 5,000) 

Fax +49 7221 501-660, info@heel.de, 

is presented for promising results arising from clinical, www.heel.com 

case-based or fundamental research in antihomotoxic 

medicine in the fields of human and veterinary medicine. 

The prize money is intended to fund further research. 

) 25 


) Expand Your Research Knowledge 

Medical Study Formats: 

An Overview 

By Robbert van Haselen, MSc 

) 26 

In a world dedicated to evidence-based medicine, clinicians 

and researchers alike are experiencing a rapid and dramatic 

increase in the availability of medical scientific information. 

For clinicians, it is relatively easy to go into a state of information 

overload. In addition, it is not always easy to make 

sense of the information; therefore, it is important that 

clinicians are suitably armed to separate the “chaff from 

the wheat” in terms of the reliability of the information. 

This article provides an overview of the types of medical 

studies available and their placement in a broader context. 

Within the world of evidencebased 

medicine, a “hierarchy 

of evidence” is often mentioned. 

One of the commonly used hierarchies 

is as follows: I, the existence of 

meta-analysis and/or systematic 

positive reviews of the literature; IIa, 

several randomized controlled trials 

(RCTs) with positive results; IIb, 1 

RCT with positive results; IIIa, multiple 

cohort studies with positive results; 

IIIb, a single cohort study with 

positive results; and IV, expert opinion 

(clinical cases and daily practice). 

As can be seen, and as most clinicians 

have been taught in medical 

school, systematic reviews of 

clinical trials are at the top and case 

reports are at the bottom of this 

hierarchy. However, an often overlooked 

problem is that this hierarchy 

is dependent on different individual 

perspectives. If the main 

aim is to make statements about the 

likelihood of cause-and-effect relationships 

in medicine, the hierarchy 

described clearly makes sense. However, 

if the aim is to make qualitative 

and representative statements about 

the day-to-day reality of treating individual 

patients in clinical practice, 

case reports should probably be at 

the top and RCTs should probably 

be at the bottom of this hierarchy. 

Therefore, the previously described 

hierarchy is not necessarily wrong; 

rather, the problem is that the hierarchy 

tends to be overly generalized 

as universally valid for all objectives. 

Because of the dependency of this 

hierarchy on the specific context in 

which it is used, we prefer to use the 

concept of an “evidence mosaic.” 

The advantage of this concept is that 

it does not imply a hierarchy; moreover, 

it underlines the more comprehensive 

concept that evidence will 

almost always consist of multiple 

pieces in a mosaic. Therefore, depending 

on the objectives, different 

pieces in the mosaic will be more 

(or less) important. One way of approaching 

such an evidence mosaic 

from a “helicopter view” is the distinction 

of 4 “pieces”: basic research, 

observational studies, clinical trials, 

and reviews (Figure). 

Basic Research 

Basic (preclinical) research is often a 

starting point in the development of 

new products and in furthering our 

understanding of bioregulatory 

medicine and its principles. Many 

homeopathic medicinal products 

have been used for years and have 

efficacy and safety data; however, 

further information is needed on 

their possible mecha-nism(s) of action. 

Basic research aims to investigate all 

of the previous questions by using 

appropriate in vitro and/or animal 

models. In conclusion, basic research 

can be both a starting point (product 

development) and a finishing 

point (mechanism of action of exist- 


) Expand Your Research Knowledge 

Figure: Evidence Mosaic 

Clinical trials 

Reviews 

ing homeopathic products). This is 

reflected by the arrow in the Figure. 

Observational 

studies 

Basic 

research 

Observational Studies 

A problem with the population of 

patients treated in many clinical 

trials is that they usually are not representative 

of the patients seen in 

routine practice conditions. Consequently, 

effectiveness in a practice 

setting should be demonstrated (ie, 

the pragmatic benefit of the patient 

from the bioregulatory approach to 

treatment in daily medical practice). 

Therefore, it is important to investigate 

the safety and effectiveness of 

treatments in observational studies. 

A study of effectiveness addresses the 

following question: “Does it work in 

routine practice?” Therefore, such 

studies are more representative of 

“real-world clinical practice” or, in 

more technical terms, such studies 

have a high external validity. A principal 

strength of observational studies 

is that statements of safety and 

tolerability can be further substantiated. 

These statements require many 

patients to substantiate them, and 

this is usually not possible in clinical 

trials. 

Clinical Trials 

Randomized controlled trials are required 

to demonstrate the efficacy of 

a treatment. Randomized controlled 

trials usually include highly selec- 

tive patient populations to facilitate 

an unbiased comparison to placebo 

or another treatment. In technical 

terms, this means that RCTs have 

high internal validity, which is one 

of their main strengths. In more 

practical terms, an investigation of 

efficacy in RCTs addresses the following 

question: “Can it work?” 

However, clinical trials can also include 

more representative patient 

populations and clinical settings. 

Such trials have a high external validity 

and are often called pragmatic 

trials. 

Reviews 

A systematic review is a literature 

review focused on a single question 

that tries to identify, appraise, select, 

and synthesize all high-quality 

research evidence relevant to that 

question. Systematic reviews are 

generally regarded as the highest 

level of medical evidence. 

Although many systematic reviews 

are based on an explicit quantitative 

meta-analysis of available data, there 

are also qualitative reviews that adhere 

to the standards for gathering, 

analyzing, and reporting evidence. 

The latter type of review is particularly 

important in the evidence 

mosaic approach because it can 

incorporate data not only from clinical 

trials but also from observational 

studies and basic research. 

Each of the described pieces in the 

mosaic has certain possibilities; 

however, each piece also has certain 

limitations. Of course, each piece 

consists of a number of more 

detailed and specific research designs; 

a further elaboration on this is 

outside of the scope of this introduction. 

In conclusion, I would like to reiterate 

that a starting point for “good 

science” is always a clearly formulated 

research question. Once there 

is a clear question, the most appropriate 

research method can be selected. 

Therefore, a research method 

is always a means to an end and can 

never be an end in itself. It is easy to 

squabble about methods; it is often 

harder to think clearly about a 

study’s objectives. As in any enterprise 

in life, the latter should always 

come first.| 

) 27 


) Research Highlights 

Symptomatic Treatment of 

Rhinitis and Sinusitis 

Ultra–low-dose Nasal Spray Effectively Reduces Severity of Symptoms 

By Ghassan Andraos, MD 

) 28 

Abstract 

Objective: To obtain additional information 

about the effectiveness and 

safety of a homeopathic medication 

(Euphorbium comp.-Nasal Spray SN) 

in the primary treatment of rhinitis 

and sinusitus in 91 patients. 

Methods: The present study is an observational, 

open, prospective, multicenter, 

noninterventional cohort study. 

Results: A total of 91 patients (aged 

1-82 years), diagnosed as having 

rhinitis (n=77) and/or sinusitis 

(n=35), were treated with Euphorbium 

comp.-Nasal Spray SN. The 

applied dosage was predominantly 

1 or 2 sprays in each nostril 3 times 

per day. The duration of treatment 

was a mean±SD of 26.7±13.4 days. 

The outcome measure was the severity 

of disease-specific symptoms 

(eg, headache, secretion, itching, 

and fatigue). The main findings were 

a significant decrease in the severity 

of the symptoms and global improvement 

of symptom scores within 

the first 2 days for 30 patients 

(33%). The tolerability of the treatment 

was assessed as “good” or “very 

good” in 84 (92%) of the patients by 

physicians; 77 (85%) of the patients 

self-assessed tolerability as good or 

very good. Finally, there were no 

concerns regarding patient compliance, 

which was rated as very good 

or good in 82 (90%) of the patients. 

Conclusions: This observational study 

was performed to obtain data on the 

therapeutic potential and tolerability 

of the homeopathic preparation Euphorbium 

comp.-Nasal Spray SN. 

Data suggest that Euphorbium 

comp.-Nasal Spray SN effectively 

manages the symptoms of rhinitis 

and/or sinusitis and is very well tolerated 

and accepted by patients. 

Introduction 

The use of homeopathic medicines 

is well established in Europe, especially 

France, the United Kingdom, 

and Germany. Euphorbium comp.- 

Nasal Spray SN is an ultra–low-dose 

combination medication produced 

according to the rules of the German 

Homeopathic Pharmacopoeia. 

The indications for the use of Euphorbium 

comp.-Nasal Spray SN 

include symptoms of rhinitis of 

various origins. In practice, the medication 

is also sometimes used for 

the auxiliary treatment of atrophic 

rhinitis (ozena) and chronic sinusitis. 

The objective of this observational 

study was to gather information 

regarding the effectiveness and safety 

of Euphorbium comp.-Nasal 

Spray SN. The study collected relevant 

data from 32 office-based practitioners 

(3 general practitioners, 9 

surgeons, 1 licensed practitioner, 

and 19 others, not specified) who 

prescribed/recommended this medication 

to the appropriate patients. 

The study was prepared, performed, 

and analyzed according to the standards 

of the German Federal Institute 

for Drugs and Medical Devices; 

and followed the principles of the 

Declaration of Helsinki. 

Methods 

Design 

This observational study was designed 

as an open, prospective, multicenter, 

noninterventional cohort 

study. The 32 participating practitioners 

treated the patients according to 

their own discretion. There were no 

exclusion criteria: every patient with 

associated symptoms was included 

in the study based solely on the 

judgment of a participating practitioner. 

This kind of study was performed 

to achieve a closer approximation 

of actual clinical treatment 

practices, which can often not be 

achieved in controlled randomized 

studies. This design allowed the 

physicians to include and evaluate a 

broader range of patients. The use of 

concomitant (pharmacological and 

nonpharmacological) therapies was 

permissible. The study was conducted 

between July 2002 and October 

2002. Patients were examined initially 

and at the final visit. Standardized 

questionnaires (ie, case record 

forms) were used for recording the 

medical histories and treatment of 

the patients; demographic data; disease 

or diagnosis (specification, 

cause, severity, and duration); disease-specific 

symptoms (specification 

and severity); dosage of Euphorbium 

comp.-Nasal Spray SN 

used; concomitant drug or nondrug 



Euphorbium, the name-giving 

ingredient of Euphorbium comp.-Nasal 

Spray SN, is prepared from the hardened 

sap of Euphorbia resinifera, a native of 

Morocco. 

Photograph by Valérie & Agnès; licensed under the Creative 

Commons Attribution-ShareAlike 3.0 Unported 

(http://creativecommons.org/licenses/by-sa/3.0/deed. 

en); http://en.wikipedia.org/wiki/File:Euphorbia_resinifera.jpg 

therapy used; onset of improvement; 

occurrence of adverse drug reactions; 

global evaluation of the compliance 

of the patient; and global evaluations 

of the tolerability and overall result 

of treatment. 

Outcome Measures 

The severity of disease-specific symptoms 

was rated by the following 

5-point scale: none, mild, moderate, 

severe, or very severe. The onset of 

efficacy was assessed by using the 

following 8-point scale: immediately 

after the first dose, after 1 day, 

after 2 days, after 3 days, after 4 to 

7 days, after more than 1 week, no 

improvement, and treatment discontinued. 

The global evaluation of the 

overall result of treatment (assessed 

by the physician and the patient) 

was determined using the following 

4-point scale: very good (complete 

absence of symptoms), good (definitive 

improvement in symptoms), satisfactory 

(slight improvement in 

symptoms), and no improvement 

(symptoms remain the same or worsening 

of symptoms). 

Safety Measurements 

The safety measurement included 

recording any adverse drug reactions 

during treatment. The global 

evaluation of tolerability (assessed 

by the practitioner and the patient) 

was measured by the following 

4-point scale: very good (no adverse 

reactions), good (infrequent adverse 

reactions), moderate (frequent adverse 

reactions), and poor (medication 

could not be used because of 

strong adverse reactions). These ratings 

of symptom intolerance were 

collected and recorded after every 

application of Euphorbium comp.- 

Nasal Spray SN. 

Treatment Compliance 

The global evaluation of compliance 

of the patient (assessed by the physician) 

was determined by the following 

4-point scale: very good (patient 

adheres strictly to the scheme of the 

therapy), good (patient adheres 

mostly to the scheme of the therapy), 

moderate (patient adheres minimally 

to the scheme of the therapy), 

and poor (patient does not adhere at 

all to the scheme of the therapy). 

Data Analysis 

No follow-up was performed. All 

case record forms were reviewed for 

completeness and consistency. There 

were no changes to the protocol. 

The statistical analysis was performed 

descriptively. 

Results 

Patients 

A total of 91 patients were included 

in the study. Most patients (48 

[53%]) were male. The mean±SD 

age of the patients was 30.4±20.2 

years (range, 1-82 years). The 

mean±SD weight of the patients 

was 53.0±19.4 kg, and the 

mean±SD height of the patients was 

152.6±21.5 cm. 

Diagnosis 

The most common diagnoses were 

rhinitis (77 patients) and sinusitus 

(35 patients), with the potential for 

more than 1 diagnosis. The causes 

of the disease were primarily allergy 

(35 patients with overall allergy and 

19 with house dust allergy) and the 

common cold (15 patients). The severity 

of the disease was assessed as 

mild in 45 patients (50%), moderate 

in 24 patients (26%), and severe in 

13 patients (14%). There were no 

data collected for 9 patients (10%). 

The following categories were used 

to mark the duration of disease: less 

than 3 days, 4 to 7 days, 1 to 2 

weeks, 2 to 4 weeks, 1 to 3 months, 

3 to 6 months, 6 to 12 months, and 

longer than 1 year. 

The most frequently reported disease-specific 

symptoms were rhinorrhea, 

sneezing, pruritus, and nasal 

obstruction. 

Treatment 

The mean±SD duration of treatment 

was 26.7±13.4 days. The 

minimum observation period was 3 

days; and the maximum, 79 days. 

The proper dosage of Euphorbium 

comp.-Nasal Spray SN, according to 

the manufacturer’s recommendations, 

is 1 to 2 sprays into each nostril 

3 to 5 times daily for adults and 

) 29 



) 30 

1 spray into each nostril 3 to 4 times 

daily for children younger than 6 

years. The dosages applied met the 

manufacturer’s recommendations, 

with the most common dosage being 

1 or 2 sprays into each nostril 3 

times daily (60 patients [66%]). 

Seven patients (8%) used a lower 

than recommended dose. Of the 91 

patients, 46 (51%) received only 

Euphorbium comp.-Nasal Spray SN 

and 45 (49%) received additional 

treatment. The additional treatments 

included drug therapy (n=29), nondrug 

therapy (n=7), and both drug 

and nondrug therapy (n=9). Drug 

therapy included other homeopathic 

medications; antibiotics; antiallergic, 

rhinological, analgesic, antitussive, 

and broncholytic agents; and sympathomimetic 

drugs. Nonpharmacological 

therapy included neural 

therapy, laser therapy, inhalation, and 

moxa. The most frequent concurrent 

medications were homeopathic drugs 

(n=12), antibiotics (n=9), and antiallergy 

drugs (n=7); the most frequent 

concurrent nonpharmacological therapies 

were neural therapy (n=5) and 

laser therapy (n=4). 

Effectiveness 

The scale used to assess the severity 

of disease-specific symptoms was as 

follows: 0, none; 1, mild; 2, moderate; 

3, severe; and 4, very severe. At 

both the initial and final visits, the 

intensity of 3 disease-specific symptoms 

per patient was assessed and a 

mean symptom score was calculated 

using these data to determine the 

general reduction in symptom severity 

by the end of treatment. In the 

total patient population, the rating 

of the disease-specific symptoms decreased 

from a mean of 2.45 at the 

admission visit to 0.65 at the final 

visit. No relevant differences were 

found in the evaluation of single 

most frequent symptoms (ie, rhinorrhea, 

sneezing, pruritus, and nasal 

obstruction). Global improvement 

scores were collected within the first 

2 days for 30 patients (33%). The 

overall assessment of effectiveness 

was rated by physicians (based on 

the 5-point scale) as “very good” or 

“good” in 78 (86%) of the patients; 

70 (77%) of all patients rated the 

efficacy of the therapy as very good 

or good during self-assessment. 

Interestingly, 38 (83%) of the 46 

patients who received monotherapy 

with Euphorbium comp.-Nasal 

Spray SN had very good or good results, 

according to practitioners; 39 

(85%) of the patients self-assessed 

their results as very good or good. 

Global Evaluation of Tolerability 

Both the physicians and the patients 

rated the tolerability of Euphorbium 

comp.-Nasal Spray SN positively. 

Physicians recorded tolerability as 

very good or good in 84 (92%) of 

the patients; 77 (85%) of the patients 

self-assessed tolerability as 

very good or good. 

No adverse drug reactions were 

reported during the observation period. 

Finally, there were no concerns 

regarding patient compliance, which 

was rated as very good or good in 

82 (90%) of the patients. 

Conclusions 

This observational cohort study was 

performed to assess the therapeutic 

potential and tolerability of the homeopathic 

medication Euphorbium 

comp.-Nasal Spray SN. A total of 

91 patients, primarily diagnosed as 

having rhinitis or sinusitis, were 

treated with Euphorbium comp.- 

Nasal Spray SN monotherapy or in 

combination with other medications 

or nondrug therapies. The mean 

treatment duration was 26.7 days. 

Half of the patients received additional 

treatment. Global improvement 

within the first 2 days was 

documented for 30 (33%) of the patients. 

In the total patient population, 

the rating of the disease-specific 

symptoms decreased from a mean of 

2.45 at the baseline examination to 

0.65 at the end of the observation 

period. No relevant differences were 

found in the evaluation of single 

symptoms, such as rhinorrhea, 

sneezing, pruritus, and obstruction. 

The overall outcome of therapy was 

positive in most patients. In the patients 

who were treated with monotherapy, 

the results of treatment were 

comparable to those of the total patient 

cohort, with 83% of the 

patients using monotherapy with 

Euphorbium comp.-Nasal Spray SN 

achieving very good or good results 

compared with 86% of those in the 

total patient cohort. In addition to 

therapeutic effectiveness, this study 

demonstrates excellent tolerability 

of Euphorbium comp.-Nasal Spray 

SN. The health care practitioners 

and patients assessed the tolerability 

of Euphorbium comp.-Nasal Spray 

SN as very good or good in most 

cases. Also, during the total period 

of observation, no adverse drug effects 

were reported. In conclusion, 

this study demonstrates that the 

ultra–low-dose combination medication 

Euphorbium comp.-Nasal 

Spray SN is well established in the 

practice of general medicine in 

which it is prescribed, as either a 

stand-alone therapy or an adjunct to 

mainstream medical therapy. The applied 

dosages met the manufacturer’s 

recommendations. The investigation 

suggests that this medication is both 

effective and well tolerated. Therefore, 

a positive benefit to risk ratio 

can be expected for Euphorbium 

comp.-Nasal Spray SN in the treatment 

of rhinitis and sinusitis.| 

We thank Mary A. Kingzette for providing 

medical writing services based on the 

study report. 


) Meet the Expert 

Dr. Klaus Küstermann 

By Catherine E. Creeger 

Dr. Klaus Küstermann was born 

in 1949 in Bad Bergzabern, 

Germany. Klaus and his two siblings 

grew up in a conventional medical 

family; his father was a surgeon 

whose two favorite and frequent 

expletives were “internist” or (even 

worse!) “homeopath.” 

Klaus first encountered homeopathy 

as a student, soon discovering that 

Nux vomica worked just as well as 

aspirin for the hangover that followed 

overindulging in the tasty 

local beer known as “Kölsch.” Fortified 

by such experiences, he returned 

to work in his father’s private surgical 

clinic after completing his internship 

in Cologne. After his father’s 

early death, he continued to run the 

practice as a naturopathic clinic specializing 

in disorders of the spine 

and joints. In addition, he established 

a rural practice in Family 

Medicine with an emphasis on 

naturopathic treatment and started 

his lecturing and teaching activity, 

giving talks on “Help for Spinal and 

Joint Disorders” to patients all over 

Germany. He enjoys spending what 

little free time he has with his wife 

Christine, with whom he has four 

children. Unfortunately, his many 

responsibilities leave few chances 

for pursuing his passion for hunting, 

but since 1983 his international lecturing 

activity has provided many 

welcome opportunities for travel 

and seeing foreign countries and 

cultures. He has given lectures on all 

continents and in almost all coun- 

tries where homotoxicology has 

fallen on fertile ground. 

For the last seventeen years, he has 

lived and worked in Baden-Baden 

as a physician, medical consultant, 

and lecturer. He is the president of 

the Internationale Gesellschaft für Biologische 

Medizin (“International Society 

of Biological Medicine”) and 

managing director of the Internationale 

Gesellschaft für Homöopathie 

und Homotoxikologie (German chapter 

of the International Society of Homotoxicology 

and Homeopathy). Under 

his leadership, these organizations 

have developed into well-known institutions 

of continuing education 

for German physicians, pharmacists, 

and psychologists. A master’s program 

in Complementary Medicine 

is available to members in collaboration 

with Viadrina European University 

in Frankfurt (Oder). In almost 

thirty years of medical activity, 

Dr. Küstermann’s many encounters 

with patients, colleagues, and pharmacists 

have been a source of rich 

life experiences. At age sixty, many 

are starting to think about retire- 

ment, but for him this is not an option. 

He is eager to continue the 

work he has begun and to help integrative 

therapeutic approaches achieve 

academic recognition that matches 

their time-tested practical value. His 

interest is now focused on the Master 

of Arts in Complementary and 

Alternative Medicine and Cultural 

Studies program. Because he feels it 

is important for academic instructors 

to hold the degrees to which their 

programs lead, he is currently both 

Director of Studies and a student in 

this program. He greatly enjoys getting 

together with his first-year 

classmates every two weeks.| 

) 31 


IAH Abbreviated 

Course 

An e-learning course leading to 

certification in homotoxicology 

from the International Academy for 

Homotoxicology in just 40 hours. 

1 Access the IAH website at www.iah-online.com. 

Select your language. 

2 Click on Login and register. 

3 Go to Education Program. 

4 Click on The IAH abbreviated course. 

5 When you have finished the course, click on Examination. 

After completing it successfully, you will receive your 

certificate by mail. 

For MDs and licensed healthcare practitioners only 

Free of charge 

) 32 

www.iah-online.com

Integrating - International Academy of Homotoxicology

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