Biomedical Therapy

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Biomedical
Therapy
J o urnal o f
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
Contents
iStockphoto.com/ryasick
I n Fo c u s
Common Disorders of the Ear, Nose, and Throat:

A Clinical Update . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Around the Globe
Second European Congress for Integrative Medicine . . . . . . . 11
W h a t E l s e I s N e w ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
From the Practice
Recurrent Otitis Media: A Clinical Case Report . . . . . . . . . . . . 14
Re f r e s h Yo u r H o m o t ox i c o l o g y
iStockphoto.com/TommL
iStockphoto.com/Rosemarie
Gearhart
iStockphoto.com/Rebecca
Ellis
Vertigo: A Common Problem in Clinical Practice . . . . . . . . . . 17
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 r c h K n o wl e d g e
Medical Study Formats: An Overview . . . . . . . . . . . . . . . . . . . 26
Re s e a r c h H i g h l i g h t s
Symptomatic Treatment of Rhinitis and Sinusitis:

Ultralow-dose Nasal Spray
Effectively Reduces Severity of Symptoms . . . . . . . . . . . . . . . 28
Meet the Expert
Dr. Klaus Kstermann . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Cover Bio-MD S.A.
)2
Published by/Verlegt durch: International Academy for Homotoxicology GmbH, Bahnackerstrae 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
H. P. Hoff/artbotanica
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Stress and the Immune System

Dr. Alta A. Smit
torhinolaryngology 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 oto
rhinolaryngology) 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.
Journal of Biomedical Therapy 2010 ) Vol. 4, No. 2
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 Kstermann.
Dr. Alta A. Smit
References
1. Nogueira JF Jr, Hermann DR, dos Reis
Amrico 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, Ldtke 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
) I n Fo c u s
Common Disorders of the Ear,

Nose, and Throat

)4
A Clinical Update
By Joan Lewis, MD
Otorhinolaryngologist
Introduction
cian 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.
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 sinusitis2,3 and OM4
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, physi-
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 resistance8;
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
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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 im-
paired 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
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
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 bodys 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
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 infants
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
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tion are thought to be predisposing

factors.19 An allergic etiology, such
as to cows milk and other food allergens, has been implicated20 but is
controversial.21,22 Other associated
factors include frequent attendance
at day-care centers and low socio
economic 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 hypothesis24 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 childs subsequent decreased comprehension
when reading.25
)6
Bioregulatory treatment: For acute

OM, use the basic/symptomatic ap-
proach 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 practitioners
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 sup-
* The Detox-Kit consists of Lymphomyosot, Nux vomica-Homaccord, and Berberis-Homaccord.
pository 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.
) I n Fo c u s
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 bodys 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
Marketed as Belladonna compositum in the United States.
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:
With a confirmed bacterial etiology 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

identified and addressed. Furthermore, 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
)8
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
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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
) I n Fo c u s
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 rebound51; 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
mechanisms52 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:
With a confirmed bacterial etiology 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.
identified and addressed. Furthermore, 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.|
References
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3. Alho OP. Viral infections and susceptibility
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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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)9
) I n Fo c u s
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6. Dixon RE. Economic costs of respiratory

tract infections in the United States. Am J
Med. 1985;78(6B):45-51.
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doi:10.1093/jac/
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9. Earnshaw S, Monnet DL, Duncan B, OToole
J, Ekdahl K, Goossens H. European Antibiotic
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10. Andre M, Vernby A, Berg J, Lundborg CS.
A survey of public knowledge and awareness related to antibiotic use and resistance
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11. Edgar T, Boyd SD, Palame MJ. Sustainability for behaviour change in the fight
against antibiotic resistance: a social marketing framework. J Antimicrob Chemother.
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Broome CV. Childhood upper respiratory
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14. Lubitz S, Schober W, Pusch G, et al. Polycyclic aromatic hydrocarbons from diesel emissions exert proallergic effects in birch pollen
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Maternal and Child Health Study. Ann Epidemiol. 2005;15(5):358-364.
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Web site. http://emedicine.medscape.com/
article/764006-overview. Updated February
26, 2010. Accessed August 3, 2010.
18. Emerick KS, Cunningham MJ. Tubal tonsil
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19. Kerschner JE, Lindstrom DR, Pomeranz A,
Rohloff R. Comparison of caregiver otitis
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Otorhinolaryngol. 2005;69(1):49-56.
20. Juntti H, Tikkanen S, Kokkonen J, Alho OP,
Niinimaki A. Cows milk allergy is associated
with recurrent otitis media during childhood.

Acta Otolaryngol. 1999;119(8):867-873.
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rate of late recurrence of acute otitis media in
young children. J Pediatr. 2010;156(1):163.
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Dis J. 1996;15(10):854-858.
26. Smit A, OByrne A, Van Brandt B, Bianchi
I, Kstermann K. The three pillars of antihomotoxic treatment. In: Smit A, OByrne A,
Van Brandt B, Bianchi I, Kstermann K. Introduction to Bioregulatory Medicine. Stuttgart,
Germany: Thieme; 2009:49-143.
27. Hoban TF. Sleep disorders in children. Ann N
Y Acad Sci. 2010;1184:1-14.
28. Bonsignori F, Chiappini E, De Martino M.
The infections of the upper respiratory tract
in children. Int J Immunopathol Pharmacol.
2010;23(suppl 1):16-19.
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. 2nd ed.
New York, NY: Humana; 2010. Methods in
Molecular Biology; vol 612.
30. Burton MJ, Glasziou PP. Tonsillectomy or adeno-tonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev. 2009;(1):CD001802.
doi:10.1002/14651858.CD001802.pub2.
31. Karaman E, Enver O, Alimoglu Y, et al.
Oropharyngeal flora changes after tonsillectomy [published online ahead of print
October 1, 2009]. Otolaryngol Head Neck
Surg. 2009;141(5):609-613. doi:10.1016/j.
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 Otorhinolaryngol. 2010;74(5):535-539.
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, Ldrup Carlsen KC, Carlsen

KH. Rhinitis in children: co-morbidities and
phenotypes [published online ahead of print
April 27, 2010]. Pediatr Allergy Immunol.
2010;21(4, pt 1):612-622. doi:10.1111/
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
Allergy. 2009;39(3):370-378.
40. Heijink IH, Van Oosterhout AJM. Strategies for targeting T-cells in allergic diseases and asthma [published online ahead
of print July 11, 2006]. Pharmacol Ther.
2006;112(2):489-500.
doi:10.1016/j.
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.13989995.2009.02315.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.
http://www.anabolic-bible.org/ShowPage.
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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.
fter 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 Charit University Hospital
in Berlin. In addition, 3 research
posters on the following topics were
presented: (1) the long-term effectiveness of Vertigoheel in treating
vertigo1; (2) basic in vitro research,
suggesting possible joint-protective
effects of Traumeel2; and (3) a postmarketing surveillance study on the
use of Lymphomyosot N injection
therapy in treating edema and swellJournal of Biomedical Therapy 2010 ) Vol. 4, No. 2
ing 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
Its Never too Late

for Fitness
Anyone who is physically active is
likely to live significantly longer
than a couch potato. At least, thats
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.
) 12
life expectancy, even if initiated

at an advanced age.
Extensive television exposure

can have negative effects on
childrens emotions and behavior.
Reduced Gray Matter in

Sleep Apnea
Internet Brain Gym for

Older Adults
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.
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.
Sleep. 2010;33(2):235-241.
To download this issue,

visit our web site at
www.iah-online.com
Poster [Poster Session 382.3/GG2]

presented at: Neuroscience 2009; October 17-21, 2009; Chicago, USA.
iStockphoto.com/Olga Lyubkina
iStockphoto.com/ryasick
) What Else Is New?
Daily consumption of wild blueberry
juice improves memory performance.
Aggression and TV Exposure
Exercise Reduces Anxiety
Blueberry Juice Improves

Memory
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.
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 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.
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.
Arch Pediatr Adolesc Med. 2009;

163(11):1037-1045.
J Agric Food Chem. 2010;

58(7):3996-4000.
Arch Intern Med. 2010;170(4):321-331.
F O R P RO F E S S I ONA L U S E ON LY
The information contained in this journal is meant for professional use only, is meant to convey general and/or specific worldwide scientific information relating to the
products or ingredients referred to for informational purposes only, is not intended to be a recommendation with respect to the use of or benefits derived from the
products and/or ingredients (which may be different depending on the regulatory environment in your country), and is not intended to diagnose any illness, nor is it
intended to replace competent medical advice and practice. IAH or anyone connected to, or participating in this publication does not accept nor will it be liable
for any medical or legal responsibility for the reliance upon or the misinterpretation or misuse of the scientific, informational and educational content of the
articles in this journal.
The purpose of the Journal of Biomedical Therapy is to share worldwide scientific information about successful protocols from orthodox and complementary practitioners. The intent of the scientific information contained in this journal is not to dispense recipes but to provide practitioners with practice information for a better
understanding of the possibilities and limits of complementary and integrative therapies.
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 practitioners 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
their complementary therapies, as the purpose of the Journal of Biomedical Therapy is to join together like-minded practitioners from around the globe.
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
been provided to the Journal of Biomedical Therapy by the author and represent the thoughts, views and opinions of the articles author.
) 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 patients medical history.
he 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.
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
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
) From the Practice
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 patients second visit to the otorhinolaryngologist was on December 3, 2009. His mother reported
an improvement in the boys 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 patients 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 con
ductive 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 patients third visit to the otorhinolaryngologist was on February
4, 2010. During this visit, the boys
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 patients 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
) From the Practice
Figure 7. Nasal Endoscopy Image of

Third Visit

Findings of Third Visit

Findings of Third Visit
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
) 16
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 patients needs.
ertigo/dizziness accounts for

more than 2% of all consultations in general practice3,4 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
Motion perception
Vestibulo-ocular
reflex
Posture
Physiological vertigo
Vestibular
Optokinetic
Somatokinetic
Pathological vertigo

Peripheral labyrinthine lesion

Peripheral eighth nerve lesion
Central vestibular lesion
Central vestibular
pathways dysfunction
Affected central
nervous regions
Parietotemporal
cortex
Brainstem

Spinal

Medullary vomiting center

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 medicineorientated 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 rehabilitation22 and complementary and
alternative medicineorientated approaches can be beneficial to this
group.
Bioregulatory
Medical Approach
thermore, 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/ultralowdose 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-
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. Fur-
Figure 2. Algorithm for Diagnosing Vertigo for the General Practitioner

(adapted from Labuguen9)
Patient complains of dizziness
Red flag symptoms

Yes
Prompt referral to specialist/

emergency department
No
Does the patient have true vertigo?

Yes
No
Is the patient taking

a drug that
can cause vertigo?
Yes
Consider discontinuing
the medication
No
Continue
diagnostic workup
as appropriate for
light-headedness,
presyncope,
or dysequilibrium
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
) 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, Vertigoheel 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 op-
tionally with Vomitusheel for nausea,

often found in those with peripheral
vertigo; and with Gelsemium-Hom
accord 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
Neurodermal
Vertigoheel
D&D
Impregnation
Regulation Therapya
Optional
Basicb and advancedc

detoxification and drainage
where appropriate (see text)
Vomitusheel
(in the presence of nausea)
IM
COS
Coenzyme compositum
Engystol
(only in cases in which virus
infection contributes to
Meniere disease)
Nervoheel/Neurexan
(if stress related)
Cerebrum compositum
(in the presence of cognitive decline)
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
) 20
Antihomotoxic regulation therapy consists of a 3-pillar approach: D&D, IM, and COS.
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 rehabilitation31 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. OMahony 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 vertigocervical 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, Mnsson NO, Hkansson
A. Benign paroxysmal positional vertigo
among elderly patients in primary health
care. Gerontology. 2005;51(6):386-389.
17. Hanley K, ODowd 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, Jggi 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. Ganana MM, Caovilla HH, Munhoz MS,
et al. Optimizing the pharmacological component of integrated balance therapy. Braz J
Otorhinolaryngol. 2007;73(1):12-18.
28. OMahony 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

) 22
Treatment with Bioregulatory Medications
By Jacques Deneef, MD
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 childs immune system, and
local trauma3,5 (possibly from recurrent extraesophageal acid reflux8).
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
ocal 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 persons
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 medicines 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
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
Endodermal,
mucodermal
Phosphor Homaccord
Regulation Therapya
D&D
Impregnation
Advanced supportive
detoxification and drainageb
with Galium-Heel
followed by
Basic detoxification and

drainage: Detox-Kitc
Degeneration
IM
Engystol
COS
Coenzyme compositum
Optional
Vomitusheel
(in the presence of nausea)
Nervoheel/Neurexan
(if stress related)
Cerebrum compositum
(in the presence of cognitive decline)
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.
Advanced supportive detoxification and drainage consists of Hepar compositum (liver), Solidago compositum (kidney), and Thyreoidea
compositum (connective tissue).
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. Prog
nostic 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,

Czegldy 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):147151.
) 23
Hoarseness

) 24
Treatment with Bioregulatory Medications
By Jacques Deneef, MD
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 12 290 adults (9920 men
and 2370 women) diagnosed in
oarseness 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
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
Table. Treatment for Hoarsenessa

Basic and/or Symptomatic
Optional
Phosphor-Homaccord
Tartephedreel
(if postnasal drip)
Arnica-Heel
(if severe concomitant infection)
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.

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):363370.
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):719730.
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/383230overview. 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, Bairo 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
Heel annually honors outstanding scientific research in
the field of a unique homeotherapeutic system (homotoxicology) with the Hans-Heinrich Reckeweg Award.
The main award ( 10,000)
is presented for scientific work of fundamental theoretical and/or practical significance in antihomotoxic
medicine in the fields of human and veterinary medicine.
The incentive award ( 5,000)
is presented for promising results arising from clinical,
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.
Both prizes are awarded for research carried out in a

laboratory or registered practice. All results must be
new, convincing and previously unpublished, and research should not have involved animal testing.
The deadline for submissions is May 31, 2011.
For more information contact:
Biologische Heilmittel Heel GmbH,
Department of Research,
76532 Baden-Baden, Germany
Phone +49 7221 501-227,
Fax +49 7221 501-660, info@heel.de,
www.heel.com
) 25
) E x p a n d Yo u r Re s e a r c h K n o w l e d g e
Medical Study Formats:

An Overview

By Robbert van Haselen, MSc
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.
) 26
ithin 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 over-
looked 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-
) E x p a n d Yo u r Re s e a r c h K n o w l e d g e
Figure: Evidence Mosaic
ing homeopathic products). This is

reflected by the arrow in the Figure.
Clinical trials
Reviews
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
studys objectives. As in any enterprise in life, the latter should always
come first.|
) 27
) Re s e a r c h H i g h l i g h t s
Symptomatic Treatment of
Rhinitis and Sinusitis
Ultralow-dose Nasal Spray Effectively Reduces Severity of Symptoms
Abstract
) 28
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 meanSD of 26.713.4 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
By Ghassan Andraos, MD
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 ultralow-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
Photograph by Valrie & Agns; 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
Euphorbium, the name-giving
ingredient of Euphorbium comp.-Nasal
Spray SN, is prepared from the hardened

sap of Euphorbia resinifera, a native of
Morocco.
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 meanSD
age of the patients was 30.420.2
years (range, 1-82 years). The
meanSD weight of the patients
was 53.019.4 kg, and the

meanSD height of the patients was
152.621.5 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 meanSD duration of treatment was 26.713.4 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 manufacturers recommendations, is 1 to 2 sprays into each nostril 3 to 5 times daily for adults and
) 29
1 spray into each nostril 3 to 4 times
daily for children younger than 6
years. The dosages applied met the
manufacturers 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).
) 30
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
ultralow-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 manufacturers
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 Kstermann

By Catherine E. Creeger
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 fr Biologische Medizin (International Society of Biological Medicine) and
managing director of the Internationale Gesellschaft fr Homopathie
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 masters 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. Kstermanns 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-
r. Klaus Kstermann 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 Klsch. Fortified by such experiences, he returned
to work in his fathers private surgical clinic after completing his internship in Cologne. After his fathers
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-
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

) 32
www.iah-online.com
Free of charge

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Volume 4, Number 2 ) 201o

Diseases of the Ear,

Common Disorders of the Ear, Nose, and Throat:

Around the Globe

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

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

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

Viral Laryngeal Polyps:

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

Symptomatic Treatment of Rhinitis and Sinusitis:

Meet the Expert

Dr. Klaus Kstermann . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Cover Bio-MD S.A.

Stress and the Immune System

new adjuvant treatments in bioregulatory medicine.

In the Research Highlights section, we present an article by Dr.

Dr. Alta A. Smit

Common Disorders of the Ear,

cian involvement, and anatomical

Disorders of the ear, nose, and throat

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

development of asthma and allergic

paired immune systems, smoking or

pharmaceutical sales for all persons

Lymphatic tissue in the Waldeyer

tion are thought to be predisposing

Bioregulatory treatment: For acute

proach as follows: Prescribe Belladonna-Homaccord (8-10 drops 2

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

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

pository into the anus 2 to 3

chronically infected tonsil may serve

Marketed as Belladonna compositum in the United States.

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

development of a normal immune

correct etiology may not have been

Allergic rhinitis: The diagnosis of

rhinitis in children who are exposed

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

annually, generally referring to more

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

indicated. The Detox-Kit should be

6. Dixon RE. Economic costs of respiratory

with recurrent otitis media during childhood.

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

37. Bertelsen RJ, Ldrup Carlsen KC, Carlsen

) Around the Globe

Second European Congress

Berlin, Germany, November 20 to 21, 2009

By Robbert van Haselen, MSc

The Second European Congress for Integrative Medicine

fter the cessation of the annual

ing due to any postthrombotic or

) What Else Is New?

Image Source/CD Senior Sports

Physical activity increases

Its Never too Late

life expectancy, even if initiated

Extensive television exposure

childrens emotions and behavior.

Reduced Gray Matter in

Internet Brain Gym for

Korean scientists have discovered