A Case of Meniere's Disease
NATIONAL JOURNAL OF HOMOEOPATHY 2004 Jul / Aug VOL VI NO 4.
Dr Anand Kapse
Dr Jinu Elizabeth
'Tub-b / Calc-c / Puls / All-cepa

History Submitted by patient
Preliminary Information
Mrs S B, Graduate, housewife, Hindu- Bengali Brahmin, born on 8th Jan 1963,
She is a Non-Vegetarian, takes tea regularly.

Family Set-up

1. Lives with Husband, 11 yr-old son, sister-in-law and mother-in-law.
2. All household chores, including cooking all meals and studies of son.

Daily Work

1. Wakes up at 5.30 am; prepares tiffin for son, bathes and readies him for school.
2. Prepares breakfast for family
3. 10.00 am bath and Pooja
4. 10.30 am Takes breakfast
5. Cooks lunch
6. 1.30 pm takes lunch
7. Short nap for one hour, then takes studies and homework of son.
8. 6.00 pm Cooks Dinner for all
9. 7.30 pm Studies of son
10. 9.00 pm Takes Dinner
11. 10.15 pm Goes to Bed

Dietary Schedule
Breakfast - 1 cup Tea + One Chapatti + Bhaji.
Lunch - 2 cup rice + 1 cup Dal + 1 cup Bhaji + Fish.
Snacks (6.00 pm) - 2 cup Rice + 1 cup Dal + 1 cup Bhaji.
Dinner - 3 Chapattis + 1 cup Bhaji + Green Salad.

Chief Complaints

1. As per ENT: Vertigo + heaviness in left ear + severe hearing loss - due to fluid secreted in the rear portion of ear drum (Tympanic cavity + Eustachian tube and mastoiditis) ie Otitis Media associated with Mastoiditis.
2. Diagnosis Meniere's Disease.
3. Vertigo problem is not continuous only on changing position of head suddenly the Vertigo increases. Also < cold Air/ fan > after sleep.
4. With severe vertigo gets Nausea or vomiting.

Other Complaints/Previous Illness

1. Since childhood pain in left ear particularly while having cold and cough.
2. Two years back one small perforation in the Lt ear drum. Ear was cleared through ENT Surgeon and after taking Hom- Silicea 200 + Calc-phos 200 + Conium-maculatum, the problem was over.
3. Now for last four months taking  Merc-dulcis 1M thrice a week.
   Natrum-salicilicum 6 BD.
   Chininum-salicilicum 6 BD.

Personal Data
Short, Well Built but Slightly stocky. Relationship with family members besides husband and son is not so good. Worried of future, particularly husband and son and feels very insecure.

Reaction to surroundings:

1. Pain in abdomen < Egg.
2. < Rainy season, cold temperature and bath
3. While sleeping-left leg sometime moves - No particular dream.
4. Normal sex with husband.

Family History
Not contributory except Mother - high blood pressure. Father: Piles,due to constipation.

Enclosures

1. Previous Doctor's prescriptions.
2. Report of MRI Scan of Brain .
3. ABR findings report.
4. Audiogram report.

SCR
Mrs S B came on 21/10/03 to Palghar Hospital.
She was 40 yrs old, a Hindu-Bengali brahmin, Educated till BA(Eng), is now a housewife, Husband is 45 yrs and is in Construction Business
Father: Died 1 year back. Mother: Died 10 yrs back, in 1993.
Children: Son: 11 yrs.
Brother: 50 yrs- elder, Sister: 46- elder
Address: Boisar.

Chief Complaints

Associated Complaints

Patient as a Person (Attributes and Functions)
Physical Characteristics
Appearance: Short, well built, Whitish complexion
Skin: Cracks < + winter, Wounds: N. Tongue: White coated
Coldness: Palms
Perspiration: Neck ++ palms ++ axilla +.
Digestion: Hunger: No <
Cravings: Egg³, Ice cream², Milk², Potatoes², Sweets²
Aversions: Sour³
Aggravations: Pungent (spicy)² < acidity, Eggs² < Pain abdomen
Eliminations
Stool: H/O hard ++. Urine: Pain Occ. burning after micturation if  intake of Water

Menstrual Function
LMP 19/10/03. Duration: 4 days. flow: 
Stains: Colour: Blackish (+)
Before Menses: Abdomen pain, thigh pain and heaviness in breast² (since menarche)

Sexual Function
Desire N. Freq: Once/week. No complaints.

Patient's Obstetric History
MTP: 1 1/2 month; Morning sickness: up to 9 months
Oedema: ++ pedal.

Life Space Investigation
Patient is a short female with sharp features. She is 40 yrs old, but appears younger. She had come along with husband and her son.

She was the youngest with 1 elder brother and sister and a native of Calcutta. Father was a businessman, she described him as a thorough gentleman; mother was generous and helpful by nature. She shared a very good relation with family members. She did her BA Eng, used to take part in singing and dancing, liked to play guitar and liked painting. She was shy in childhood.

After marriage she came to Boisar. Relation with MIL and SIL was strained from the beginning. Patient said that her in laws would always sideline her, would never involve her in any of the activities. She would feel of "No importance" "inferior". Patient said that in laws were jealous of her because she was B A (Eng).

Even if she would talk with her son in English they would scorn her. 5 yrs ago, once she prepared tea for MIL, which became cold  leading to argument between SIL and patient  patient got very angry and she too shouted back. She felt very bad that SIL had talked to her so rudely. Since then she has stopped interacting much with them, just talks superficially.

By nature she is sensitive, touchy and weeps when reproached /admonished. Sympathetic. Has fear of thunderstorms, ghosts and dark. Anticipatory anxiety before exams. Palpitation, sweating, coldness of palms and vertigo if Husband or child return home late. She shares good relation with husband but he is very particular about time for eating and taste  shouts if not according to his wish  she feels inferior.

She says now her son supports her. The son shouts back at the husband and corrects him; son even tells mother to be stronger. She is better by company, consolation and narrating. Three years back, husband had started a printing press on patient's name but it failed. There was lot of financial stress during that time and she was very anxious. She likes being in company, but the place she stays is isolated. She mixes with people very easily.

During interview she was fidgety, childish with an appealing behavior.

Sleep Beginning: Jerking of left leg for 5 min since many years.
Dreams: Anxiety  something happening to husband
Description: Visiting places, foreign country, parties, traveling.

Reaction - Physical Factor
Motion and Position: Bus: No < Swing: No <
Meteorological: Sun: < Headache
Seasons: Winter: likes²
Change: weather: Fan: (S) Fast, (W) 2-3
Covering: (S): 0, (W and M) 1 thick up to head.

Physical Examination P: 80/min, B.P.: 130/90, Conjunctiva: N, Weight: 50, Tongue: white coated.

Investigations
MRI: Brain 15/4/03: Evidence of fluid in tympanic cavity, Eustachian tube and mastoid air cells on left is suggestive of otitis media associated with mastoiditis. No significant intracranial abnormality.

Audiogram: 29/4/03 Rt ear Normal hearing Lt ear: moderately severe conductive hearing loss
Tympanogram Rt ear "As" type tympanogram (L) ear: "B" type tympanogram

ABR: 3/6/03
The delay of absolute latency and reduction in amplitude is secondary to otitis media on left side and inter peak latency reduced on left side is due to meniere’s disease on left side.

Discussion
Her husband approached the hospital with a request for dispensing medicines prescribed by his doctor from Kolkata. While the hospital met with the emergency needs, it refused to act as a pharmacy. He then enquired for the address of the "Top Homoeopath in Mumbai", so that he can take his wife there. After a few months the couple approached again with the written history. The history indicated that the patient was simultaneously receiving 3 medicines focusing on the diagnosis of Meniere’s disease. We defined the entire case and came to following plan of Rx.

Constitutional: Calc-carb (D/D Calc-phos and Kali-carb)
Fear of thunderstorms, ghosts and dark
Weeps when reproached / admonished.
Anticipatory anxiety. Dependent. Weak
Suppressed Anger. > Company, Consolation and Narrating
Easy mixing. Sympathetic. Artistic. Dreams traveling
Chilly
Cravings: H/O Egg³, Ice cream², Milk², Potatoes², Sweets²
Aversions: Sour³
Eggs² < Pain abdomen
Before Menses: abdomen pain, thigh pain and heaviness in breast² (since menarche)
Perspiration: Neck ++, palms ++, axilla +.

Intercurrent: Tub-bov
Recurrent colds, CSOM with Meniere's disease
Acutes for respiratory complaints: Pulsatilla, Allium-cepa

Follow Up Summary
Calc-carb was started in 200 weekly doses. After 2 months it was made 3P weekly and later daily bedtime. Response was better with daily doses of Calc-carb. It improved further with infrequent to weekly doses of Tub-bov 1M. Patient is better 70% after 6 months of Rx. She had 2 acute respiratory episodes in this period which required Pulsatilla and Allium-cepa respectively.