A Case of Laryngeal Keratosis

Abstract:
Laryngeal keratosis is a precancerous condition which has an incidence of 3.33% – 4.31% in development of laryngeal carcinoma. Thus, early detection and treatment is necessary. The usual practice in surgery is excision biopsy and subsequent follow up of the case. Homoeopathy has a significant role in treating these cases. This case of a 28 year old male, adds significant evidence in the efficacy of homoeopathy in treating laryngeal keratosis (Homeopathy Treatment for Keratosis Pilaris). Lachesis was prescribed in fifty millesimal potency, on the basis of totality of symptoms.

Keywords: Homoeopathy, laryngeal keratosis, totality of symptoms

Introduction:
Laryngeal keratosis is a precancerous condition. This is clinically a white keratotic plaque in the larynx. Laryngeal cancer precursors causally associated are tobacco smoking and alcohol drinking. The scope of homoeopathy in treating such cases will establish its place in medical science for prevention of cancers.

Case:

Chief complaints:
• Pricking sensation in throat since 2 years.
• Inability to open mouth since 1year.
• Altered voice since 6 months.

History of presenting illness:
A male patient aged 28 years presented with pricking sensation in throat since 2 years. It is continuous since 2 yrs and doesn’t increase or decrease with swallowing of solid food and water. There are no aggravating or relieving factors. There is no history of painful swallowing. The pricking sensation is localised in the right upper neck and is non- radiating. He also complains of inability to open his mouth since one year. It is progressively increasing with recurrent ulceration and vessications. There is inability to take spicy food and whitish discoloration of the oral cavity.
His voice has altered since 6 months. It has become rough and this is progressively increasing, but not continuous. Not associated with respiratory embarrassments or dyspnoea.

Past history:
• History of chicken pox at the age of 8 years
• History of dog bite at 15 years of age

Family history:
• Paternal uncle – died of CA lung
• Paternal grandfather – died – Pulmonary tuberculosis
• Paternal grandmother – alive – Asthma

Personal history:
• Diet – regular, vegetarian
• Habit of smoking – smokes bidis, 2 bundles per day for 7-8 years
• Tobacco chewing – 10-20 packets a day for 10 years
• Bowel habits – regular
• Marital status – married
• No. of children – 2

General Physical examination:
• Mental state and consciousness- Conscious and well oriented with time, place and persons.
• Build and Nutrition: Well built, well nourished
• Gait- Normal
• Decubitus: Of choice
• Face- Normal
• Pallor- Absent
• Icterus- Absent
• Cyanosis- Absent
• Oedema- Absent
• Clubbing- Absent
• Pulse- 80/min
• Respiration- 15/min
• Temperature- Normal
• B.P.- 130/80 mm of Hg

Local examination:
On inspection of the oral cavity, anterior open bite was one finger, with extensive submucous fibrosis. Indirect laryngoscopy was not possible due to submucous fibrosis.

Systemic examination:
• Nervous system – Cranial nerves – normal
Motor functions – normal
Sensory system – normal
Cerebellar function – normal
• G.I. System – normal
• Cardiovascular system – S1 and S2 normal, no added sound
• Respiratory system – normal breath sounds, no added sound.
• Locomotor system – normal

Special investigation: Fibre optic laryngoscopy (FOL) revealed Right-sided raised white keratotic patch, measuring about 2mm diameter on the posterior end of the right false vocal cord. (Image 1)

Diagnosis: Laryngeal Keratosis with oral submucous fibrosis.

Physical generals:
• Appetite-good
• Desire- salty food, Paneer, curd
• Thirst- 5-6 glasses per day for cold water
• Tongue- clean, moist, trembling
• Stool- regular but hard
• Urine-clear, offensive
• Sweat- profuse, offensive, more on forehead
• Sleep-sound, lies on left side

Mental symptoms:

Irritable wants to beat someone if angry.

On observation the patient wore a kurta and dhoti. The kurta was not buttoned till his chest. (Desires loose clothing around neck)

Totality of symptoms:
• Pricking pain in throat
• Inability to open mouth
• Altered voice
• Desires salty food
• Tongue trembling
• Desire loose clothing around neck

Repertorization by Kent repertory:

Throat – Pain – Sticking

Mouth, Open-difficult to

Voice Changed

Desires salt things

Tongue trembling when protruding it

Throat, clothing aggr.

Mouth and throat – Tongue tremulous

Throat right

Throat and gullet, pricking

Mouth – Open- difficult to

Speech difficult

Desires salty things

Constriction, neck, band feels to tight

Prescription:

Lachesis in 0/1 was given thrice daily in succussed doses, followed by 0/2, 0/3, 0/4 & 0/5. He was advised to stop chewing tobacco and quit smoking.

Follow-up:
The patient felt relief in his symptoms following medication. The pricking pain subsided and his voice was normal. Trismus was better. He could open his mouth to 2 fingers. His appetite was good. The stools were normal. He slept well.
The follow-up FOL report was normal on 29.09.10. (Image 2)

Medicine was continued to 0/7 once daily till Nov’10 when he was free of all symptoms. The patient was under follow-up with placebo.

The patient started smoking and chewing betel leaf with tobacco again. His pricking pain reappeared in throat and FOL on 12.1.11 (image 3) suggested a small white keratotic patch with inflammation on the previous site.

Since the complaints were the same as before, he was prescribed Lachesis again in 0/7 followed by 0/8 and 0/9 until 10.2.11. He was relieved of all symptoms. Placebo was given 17.3.11 onwards and he was kept under supervision. A repeat FOL was done on 12.5.11 which revealed a normal study. (Image 4)

Discussion and conclusion :
The case showed relief in symptoms and pathology with homoeopathic medicine prescribed on totality of symptoms. The patient quit smoking and tobacco chewing. This case was repertorized by Kent and Boenninghausen’s method for a comparison.

Acknowledgement:
The author expresses gratitude to Dr. Sameer Rana, E.N.T. Surgeon, who performed the FOLs and constantly supported this work.

References:

• Eduardo L. Franco, Thomas E. Rohan, Cancer precursors: epidemiology, detection, and prevention
• Scott-Brown’s Otorhinolaryngology, Head and Neck surgery
• P.L.Dhingra, Diseases of Ear, Nose and Throat
• Hompath Classic M.D. software
• H.C. Allen, Keynotes and Characteristics – comparisons of some of the leading remedies of the materia medica – with nosodes.