Test four (weeks 6 + 7) Flashcards
What is bilateral nasal specific technique?
Procedure in which a balloon is inserted into each nasal passage in 3 different positions; briefly inflated in each position, then removed
Serves to open nasal passages and allow for optimal breathing and drainage of sinuses
Major indications for BLNS
Sinusitis (chronic/recurrent, acute with no sig rhinitis)
Snoring
Headaches
Hx facial trauma w pain/dysfunction
Difficulty breathing through nose
Other conditions that have been treated with BLNS
Seizure disorders
Nasal polyps
Sphenoid malposition (pituitary hypofunction)
TMJ dysfunction
CI BLNS technique
Implanted hardware
Severe epistaxis (blood thinning meds, clotting disorders)
Recent nasal surgery
Status post surgery
Foreign body in nose
Latex allergy
Cautions BLNS technique
Osteoporosis
Elderly patients
Infants and children
Nervous, hesitant, or reticent patients
Nat mur themes
Proper, responsible, closed off, perfectionist, disciplined, dry, never better since grief/being betrayed or forsaken
Nat mur healthy pt
“Buttoned up”
Friendly but reserved
Dependable, responsible, mature, disciplined
Holds old betrayals, wont share unless directly asked
Intolerant to imperfections (small pimples)
General clinical picture nat mur
Very affected by grief, betrayal like a child “little adult”
Well put together, not overly done
Perfectionist
Fingernail biter
Insomnia thinking about past
Sleeps on left side, dreams of robbers
Emotional complaints nat mur
Betrayal
Depression, suicidal thoughts
Easily offended/humiliated
Sad but can’t cry > involuntary crying
Dwells on past
Aversions nat mur
Company, consolation
Fatty/slimy foods like egg whites, chicken, bread, salt, milk
Sensitive to noise/music
Fears nat mur
Robbers, break ins, dark, storms, insects, germs, heights, claustrophobic
Aggravations nat mur
Heat
Sun
Sea (can be better or worse)
10am
Cravings nat mur
Salt, sour, bitter, beer, chocolate, fish, burned food, bread, milk
Ice cold drinks
Onset nat mur
Periodicity, sx recur at intervals (such as fever, malaria)
Clinical uses nat mur
Recurring/periodic fevers
Vertigo worse looking in distance, with nausea and falling to the left
Migraine, hammers beating head, hx head injury/grief, numbness in face beforehand
Facial neuralgia
Egg white coryza/colds with sneezing
Herpetic eruptions
Pharyngitis with stitching pains
Sensation of lump in throat
Hepar sulf themes
Cold, hypersensitive, irritable, anxious, painful, intolerant, impatient, swollen
Hepar sulf pain
stitching, splinter like, sharp debilitating pains
Inc sensitivity to pain, complains intensely
Slow to heal
Painful swelling and induration of glands, abscesses, ulcers
Hepar sulf healthy pt
Deep remedy; sensitive to all stimuli and pain, dont like to leave home, impatient and cranky
General clinic picture Hepar sulf
Oversensitive to all external stimuli, esp pain
Irritable/angry outbursts
Mental anguish at night
Critical, impatient, hurried, anxious
Discouraged, suicidal over suffering
Violent impulses to stab/kill
Fire (dreams, impulses of pyromania)
Offensive odors, sour/old cheese, sour smelling stool
Lots of pus
Fears Hepar sulf
Hearing of violent accidents or movies, injury, dentist
Temps Hepar sulf
Chilly and aggravated from cold
One of coldest remedies
Worse uncovering hands or feet
Intolerant to drafts, esp cold dry winds
Head sensitive to uncovering (ear pain, headache, etc)
Desires Hepar sulf
Pyromania
Violent impulses to stab or kill
Fat, sour (esp vinegar/pickles), spicy, pungent
Hepar sulf clinically used for
V painful otitis media (pt shrieking, can’t be comforted)
Otorrhea
Ears v sensitive to wind
Iritis, corneal ulcers
Conjunctivitis
Eruptions on eyelids
Sinusitis with thick dc, post nasal dc
Dental abscesses, toothache, gum abscesses
Swollen tonsils
Croup
Mercurius themes
Closed, suspicious, emotionally intense, impulses, putrid, dripply, smelly, sweaty, ulcerated
Mercurius healthy pt
Too pathological to truly have a healthy pt; may put on a facade of normalcy, thnk others out to get them
General clinical picture mercurius
Introverted, closed, emotionally intense and suspicious
Hurried, irritable, anxious, restless
Violent destructive impulses (stabbing, screaming, punching nose of strangers, sex, kill/get rid of enemy)
Slow to answer, stammering
Withdrawn, depressed, suicidal
Offensive dc, stool, breath
Sick often
Abscesses, v painful
Ulcerations
Bone pain
Metallic taste in mouth, drooling
Imprint of teeth on tongue
Wake up with weakness, SOB on exertion
Pale, marble blotchy and translucent face
Fears mercurius
Death, disease, insanity, darkness, heights, ghosts, people, agoraphobia, poverty (stingy)
Aggregation/aversion mercurius
Suppressed dc
Perspiring, night sweats
Aversion to sweets, salts, artichokes
Cravings mercurius
Bread and butter, sweets, salty
Mercurius clinical uses
Rhinitis, chorionic, green dc
Althea in mouth/tongue
Ulceration in mouth/pharynx
Otitis media (acute + chronic)
Gingivitis, toothache
Conjunctivitis, iritis
Acute or chronic pharyngitis with coated tongue and salivation
Tonsillitis
Sinusitis, URIs
Pulsatilla themes
Changeable (weather vane remedy), weepy, need consolation/affection, emotional, clingy, warm, thick/greenish yellow dc
Healthy pt pulsatilla
Soft, sensitive, prone to shyness
Attached, wants affection
Clingy/anxious
Changeability w softness (have a hard time explaining patterns bc of Changeability)
Dogmatic about beliefs/religion but otherwise easily influenced and dependent on others
General clinical picture pulsatilla
Changes (no two stools the same, no two menses the same)
Sensitive, attached
Weeps easily
Changeable moods, forsaken, desires consolation, worse stress
Irritable/manipulative to get affection
Sleeps with arms raised over heads
Hormone problems, allergies, acute infection
Congestion in circulation
Sensation of cold water on back
Thirstless (but mouth may be dry)
Pulsatilla aggrevations
Worse warm room, before menses, evening, sun ,exertion, fatty foods, lying on left or painless side
amelioration pulsatilla
Better open air, cold, pressure
CBC results allergic rhinitis
MAY show eosinophilia
Nasal smear results allergic rhinitis, cholinergic rhinitis, NARES
Allergic - eosinophils
Cholinergic - negative
NARES - eosinophils
Scratch test results allergic rhinitis, cholinergic rhinitis, NARES
Allergic - wheals/flares, IgE reaction
Cholinergic - negative
NARES - negative
Pathophys of allergic rhinitis
Th2 > IL-4, IL-13 > IgE > mast cells > histamine, LT, kinins, TNFa >
contraction of smooth muscle, cap dilation (inc permeability), glandular hyper-secretion
What supplements help stabilize cell membranes?
Antioxidants
EFAs
What supplement stabilizes mast cell membranes?
Quercetin stabilizes mast cell membranes, inhibits degranulation and reduces IgE production
Which bioflavonoid inhibits histidine decarboxylase and is also a potent antioxidant?
Catechin
Which class of EFAs do atopic patients have trouble converting?
Atopic pts have problems converting linoleum acid > PGE1
Linoleum acid > GLA > DgGLA > PGE1
What foods should allergic patients avoid?
Dairy, citrus (cooling, mucus)
Foods that trigger arachidonic acid pathways (trans fatty acids)
Ways to support the adrenals
Vit C
B vitamins
DHEA if indicated
Ginseng
Drenatrophin, antronex
herbal Ed’s formula for hay fever
Hydrastis, achillea, euphrasia, armoracia
Echinacea and Vit C effectiveness in cold prevention/tx
Not beneficial in prevention, helpful in treatment when sx appear
Types of inflammatory rhinitis
Eosinophil-predominant
Neutrophil-predominant
Complex infiltrates
Eosinophil predominant inflammatory rhinitis ex
Allergic rhinitis
NARES
Nasal polyps (Sampters triad) Fungal sinusitis (allergic and non-allergic)
Churg Strauss
Eosinophilic granuloma
Neutrophil predominant inflammatory rhinitis ex
Acute bacterial rhinosinusitis
Foreign body with infection
Corrosive occupational rhinitis
Acute infection
Nasal polyps in cystic fibrosis
HIV/AID rhinosinusitis
Immunodeficiency
Hypogammglobulinemia
Kartageners
Complex infiltrates inflammatory rhinitis ex
Common colds
TB
Leprosy
Syphilis
Autoimmune
Atrophic rhinitis
Basophilic/metachromatic non allergic
Granulomatous and vasculitis disease
Ex of structural abnormalities leading to non-inflammatory rhinitis
Deviated septum
Hypertrophic turbinates
Strictures
Tumors
Foreign body
Hormonal causes of non-inflammatory rhinitis
Pregnancy
Hypothyroid
Acromegaly
Adrenergic dysfunction
Drugs that can contribute to non-inflammatory rhinitis
Anti hypertensives (beta blockers, reserpine)
Chronic topical a-adrenergic agonist abuse (Afrin)
Cocaine abuse
Eye drops/glaucoma meds
Chlorpromazine (neuroleptic)
Neural dysfunction causes of non-inflammatory rhinitis
Absent sympathetic function (horners, stellate ganglion resection/block)
Hyperactive cholinergic parasympathetic function (inc mucus)
Nociceptive/irritant rhinitis
Cold, dry air induced
Food induced
Supplements used for inner ear disorders
Zinc
Magnesium
Glutathione
B6/pyridoxine
Vit A, D, B12, iron if def
Folic acid
Zinc usage in inner ear disorders
Presbycusis, other SN hearing loss
Magnesium use inner ear disorders
Ototoxicity from aminoglycoside antibiotics
Noise and age induced SN hearing loss
Glutathione use inner ear disorders
Gentamicin toxicity
Vit A use inner ear disorders
Vit A def associated with SN hearing loss
Vit D inner ear disorders
Vit D def associated with SN hearing loss, BPPV, otosclerosis
Vit B12 inner ear disorders
Vit B12 def associated with tinnitus and noise induced hearing loss, presbycusis
Iron inner ear disorders
Iron def associated with SN hearing loss
Clinical / sub clinical endocrine disorders associated with inner ear disorders
Hypothyroid, diabetes, dysglycemia
Inner ear highly vascular, organ of orti and vestibular apparatus have high metabolic rate > ATP dependent (glucose) > highly sensitive to anoxia and nutrient deprivation
Naturopathic recs for reactive hypoglycemia
Inc Whole Foods, water soluble fiber
Avoid sugar
Chromium in the form of brewers yeast
GTF, glycyrrhiza, adrenal protomophogen
Reg, balanced meals; lean protein esp at bfast
Rule out electrolyte problems
Metabolic associated with menieres
Associated with allergy to dust, pollen, mold, and/or food sensitivity (gluten)
Hyperlipidemia association inner ear disorders
Combination of atheroslerotic diet and HTN in addition to even moderate noise is devastating to hearing
High lipids have also been associated with tinnitus and vertigo
Ototoxins
Alcohol
Caffeine
MSG
AA
Smoking
Quinine
Loop and thiazide diuretics
Aminoglycoside
Vanco-/erythro-mycin
Heavy metals
Street drugs
Platinum chemos
What is protective after platinum based chemotherapeutics?
Rosemarius inhibits apoptosis of primary organ of corti and auditory cells
Curcumin, Vit E
What botanicals are good for increased blood flow?
Ginkgo biloba
Vaccinum (bilberry)
Capsicum
Ginger
Vinca minor
Vincopocetine
Pycnogenol
Patients most likely to benefit from ginkgo will have _____
Cerebral insufficiency
Ginkgo is useful in what conditions
Tinnitus, vertigo, SN hearing loss
Vinca minor inc cerebral blood flow and is indicated in which conditions
Tinnitus
SN hearing loss of old age
Secondary to arteriosclerosis and vertigo of Menieres
Vincopocetine action inner ear disorers
Vasodilators; improves micro circulation of stria vascularis in the inner ear
Tinnitus, vertigo
Pycnogenol inner ear disorders
Improves tinnitus sx by improving cochlear blood flow in pts with altered perfusion
Antiviral botanicals for vestibular neuritis
Lomatium
Ligusticum
Echinacea
Larix
Astragalus
Curcumin use inner ears
Anti-inflammatory; resolve hearing loss associated with otitis media
Nervines role in inner ear disorders
Supports neural tissue and dec stress/insomnia associated with inner ear sx
Avena saliva
Scutellaria
Melissa
Pasiflora
Hummulus
Acupuncture role in inner ear disorders
Tinnitus
Vertigo
Phys med role in inner ear disorders
Cervical manipulation; hearing loss and tinnitus, aural sx of TMJ
Epley for BBPV
What are vestibular rehab exercises and what are they used for?
Vertigo
Train the brain to use alternative proprioceptive and visual cues to maintain balance; brain adjusts to new baseline of vestibular function
Tx otosclerosis
Vit D
Calcium citrate or gluconate
Osteoprime Gaby/Wright formation for osteoporosis
Tea of nettles, raspberry leaf, alfalfa, avena
Calc Phos
Meniere diet
Low sodium diet
Allergy elimination diet
Meniere botanicals
Diuretics - taraxacum leaf
Meniere pts should avoid
Allergenic foods
Sodium
Vasoconstrictors (alcohol, caffeine, chocolate)
Meds/supplements/therapies meniere
Pyridoxine
Migraine meds (comorbid)
Diuretics
Betahistine, antihistamines, steroids (weak evidence)
Vestibular rehab / hearing aids
Constitutional hydro
Tx acute vestibular syndrome (Labyrinthitis and vestibular neuronitis)
Treat underlying infection; E tube massage
Anti inflammatory tx, adrenal support
Steroids
Acupuncture
Homeopathy, anticholinergics, histamine antagonists, benzos
Vestibular rehab exercises
Presbycusis tx
Ginkgo
Antioxidants (via diet is best), NAC
Low sat/trans fat
Diet, exercise
B12, folate, zinc, marine oils
Assess thyroid and aldosterone
Tinnitus management
Noise protection
Correct def (esp B Vit and mg)
Homeopathy, acupuncture
If cerebral vascular insufficiency: ginkgo, vinpocetine, centella, pychnogennol
Cognitive therapy, biofeedback
Insomnia
Depression
Hearing aids
Acoustic therapy
Transcranial magnetic stim
SSNHL tx
Start tx early
Steroids
Ginkgo
Antioxidants: Vit E, alpha lipoic acid
High dose IV Vit C
Mag oral or IV meyers cocktail
Oral zinc
B Vit
CoQ10
Fasting, inc water, Mediterranean diet
Hyperbaric O2 therapy
BPPV management
Epley
Modify diet to lower serum uric acid
Sup Vit D helps prevent recurrences
Acoustic neuroma (Schwannoma) management
Gamma knife radiosurgery
