Clinical Cases

A Case of Tinnitus

Written by Petr Zacharias

Homeopath Petr Zacharias presents a case of tinnitus and explains throughtout, his analysis of the case.

1st visit: July 2, 2013

A woman (30y.o.) started having problems with rustling in the ears last year. She was dealing with some personal problems at that time and she took remedies that caused her out-of-body experiences. Three months ago, she developed strong sleep problems (3). She tried to get rid of them with herbal therapy, but without any effect. For the past two weeks she has taken Hypericum tablets (herbal medicine), which provide slight amelioration. Both, the humming in the ears and sleeplessness are much worse from alcohol (3). The noises in the ears are the worst when she lies down (3). She cannot sleep in a warm room. She suffers from distension of the abdomen after meat and bakery products (2). As a consequence of cervical spine problems she used to have strong migraines in the past, but they disappeared when she developed the rustling in the ears.

Investigation of the information and analysis of the case:

In every case where the patient is able to date the beginning of the development of the complaints exactly, we have to investigate if we are able to identify the causative factor more precisely. We should do this in all cases without an exception, although the etiology is, of course, not present or clear in every case. However, if the person states that some particular complaints date back to a specific moment in her life, then we have etiology present in the case and examining it more thoroughly is crucial. It will help us to clarify the origin of the complaints and to understand what is really going on with the person. We should endeavor to gain this kind of understanding of a case every time, because if a homeopath ignores it, the analysis of the case loses its meaning and there is only random gathering of symptoms and entering them into the repertorising software going on. This kind of approach neither leads to success nor has it much to do with homeopathy both theoretically and practically.

My first question was directed towards clarification of the causative factor. Three years ago, she discovered an infidelity of her husband and she also fell in love with a married man. However, later on the man started behaving differently from what she was expecting and it caused her tremendous disenchantment and disappointment. She had never been in love with someone so intensively before. One or two months after this event (October 2012), she developed the rustling in the ears. In April 2013 she got promoted and her sleep worsened at that time. She cannot stop the flow of ideas and she is constantly thinking about her work (2). She says she has lost illusions about men, but she cannot forget him. She is thinking about him all the time and it is sometimes accompanied by a feeling of anxiety in the chest (3) or stomach (2).

At this moment we have at our disposal a very important piece of information regarding the stress which the young woman had gone through before her complaints appeared. According to her description, the issue was a very strong love disappointment that developed because her idea about the particular man was different from the reality. She had a feeling that she had lost everything at that moment. Her feelings for the man were so strong that she put all her emotions into this relationship. The disenchantment caused by behavior that she was not expecting was therefore a strong disappointment for her and she still perceives it not only as a constant need to think about the man, but she has also felt some physical symptoms like the anxiety in the chest and stomach since then.

The homeopathic remedy, whose symptoms often develop on the basis of a disappointment as a consequence of a conflict between romantic ideas and reality, is called Ignatia. So I tried to find out whether there were some other keynotes of this remedy present in the case. My first question was: “What is your reaction to coffee?” The client replied that coffee makes her feel very bad, as well as alcohol does. My next question was: “How do you tolerate cigarette smoke?” (Ignatia is often very sensitive to cigarette smoke). The answer: “Since my ear problems started, I am much more sensitive to cigarette smoke than ever before.” She also spontaneously says that she is very sensitive to moods and emotions of other people, but she has had this longer, roughly since puberty. This sentence engaged my attention because it is a keynote of Natrum carbonicum that also covers the distension of the abdomen after bakery products, which she suffers from. Symptoms belonging to the most important keynotes of Natrum carbonicum are aggravation from heat and milk and also a strong aversion to milk. From my experience I can say that these two symptoms are present in almost all the cases needing Natrum carbonicum. Therefore, I asked about her tolerance to heat or cold and I found out that she does not tolerate heat at all, especially during sleep (3) and she has flushes of heat at night, which she has never had before (this makes the symptom more important because it appeared recently). The flushes are present almost every night. She does not drink milk as such and she would not drink it. It also causes her diarrhea.

If we witness a situation where we recognize pictures of more than one homeopathic remedy among the symptoms, it means that the state of the patient is quite serious from a homeopathic point of view and the level of health of the person is lower. This can be caused either by strong hereditary load and therefore inborn constitutional weakness of the given organism, or by stress, which is so intense that the organism has to create more layers corresponding with more homeopathic remedies. In such a situation, it is our task to investigate which of the remedies that we recognize in the case covers the uppermost symptomatic layer.

At this moment, it can cross the reader’s mind that it might be better to try to find a remedy which covers the symptoms of Ignatia and Natrum carbonicum together. If such a remedy existed and was present in all relevant rubrics in the repertory, it would mean nothing unless these symptoms were also keynotes of the given remedy. Without keynotes, the remedy would actually only cover the totality which has the least value when selecting the remedy. If at least some of the symptoms which comprise the totality are not keynotes of the remedy at the same time, the remedy will have no effect or only a partial effect in the overwhelming majority of cases.

One of the most complicated questions in homeopathic practice is how to recognize which symptoms create the uppermost layer in each case and the complete answer to this question is beyond the scope of this article. However, we have several rules that can help us in such a situation. The first rule is, which symptoms are the most bothering and the most prominent, as far as their intensity is concerned. A time sequence of the appearance of the symptoms and a development of their intensity during life can be the second aid. In such a way the most recent symptoms often, but not always, have precedence over the older ones. If we are choosing between several remedies which have clear indications in the case with the aim of finding the first one to give, it is very important to determine which areas of the case it covers. For instance, if we find out that one of them covers the keynotes and the totality and the second covers the essence and the causative factor or the essence and the keynotes, the second remedy has a priority. If we discover that the first one covers the keynotes and the totality and the second covers the etiology and the keynotes, we prefer the second one. A combination of pieces of information (essence, keynotes, etiology and totality) which individualizes the case more is preferred over a combination which individualizes it less.

Depth of the disturbance:

Conventional medicine describes several different causes of tinnitus ( Homeopathy for Tinnitus ). It can be a sign of arteriosclerosis, fluctuations of blood pressure, nerve compression as a consequence of cervical spine problems or psychological stress. In this case, we find a direct connection with stress caused by troubles in personal life. Most symptoms, e.g., anxiety, manifest themselves on the physical plane, rather than on the psychological level. However, the psychological stress seems to be the most probable cause of the complaints. Another possible explanation for the noises in the ears may be the cervical spine problems that we can find in the patient’s medical history.

In homeopathy, it is very important where and how the complaints manifest after a particular stress. A person at a higher level of health will have a tendency to manifest an imbalance caused by psychological stress mostly on the physical plane, in a form of local complaints which do not limit the functioning of the organism as a whole as much as in people at lower levels of health, where we can see systemic disorders and these people often tend to develop psychological disorders like anxieties or depressions more easily (even after physical stress). Of course, such complaints limit the life of a person in a much more complex way than local physical complaints with which a relatively high level of freedom still remains because the organism at a higher level of health is able to protect other functions like concentration, joy of life, creativity, memory, etc.

Prognosis and level of health:

As already stated above, the fact that the complaints manifested mainly on a physical plane after strong psychological stress and that we know the probable etiology (in this case stress and not any serious pathology) makes the prognosis very good. The patient, however, does not remember when she had the last high fever over 38.5°C and we can therefore conclude that she has not had fevers at least for the past few years. This fact, on the contrary, makes the prognosis worse and the probable level of health of this patient is C7. The fact that we can see more remedy pictures in the case and the symptoms do not point clearly to one remedy is also indicative of a lower level of health.


  1. Disappointment in love

Intense symptoms:

  1. Noises in ears worse from lying
  2. Anxiety in the chest around heart region
  3. Anxiety in stomach
  4. Sensitivity to cigarette smoke
  5. Aggravation from alcohol
  6. Flushes of heat at night
  7. Thoughts about the past
  8. Aggravation from milk
  9. Aversion to milk
  10. Distension of abdomen (aggravation) after bakery products
  11. Aggravation from heat (sun)

Peculiar symptoms:

  1. Aggravation from coffee
  2. Sensitivity to emotions of other people


Repertorisation in RADAR software with Synthesis 9.1 repertory

The repertorisation is done using a technique of summary of symptoms with regard to the intensity of symptoms (For Radar users: Sum of symptoms and degrees – intensity is considered)

1 1234 3 MIND – AILMENTS FROM – love; disappointed 41
2 1234 2 EAR – NOISES in – lying, while 19
3 1234 3 CHEST – ANXIETY in – Heart, region of 138
4 1234 2 STOMACH – ANXIETY 99
5 1234 2 GENERALS – TOBACCO – aversion to – smell of tobacco; sensitive to 18
6 1234 2 GENERALS – FOOD and DRINKS – alcoholic drinks – agg. 179
7 1234 2 GENERALS – ORGASM of BLOOD – night 20
8 1234 3 MIND – DWELLS – past disagreeable occurrences, on 53
9 1234 2 GENERALS – FOOD and DRINKS – milk – agg. 131
10 1234 3 GENERALS – FOOD and DRINKS – milk – aversion 82
11 1234 2 GENERALS – FOOD and DRINKS – farinaceous – agg. 29
12 1234 3 GENERALS – SUN – exposure to the sun 69
13 1234 3 GENERALS – FOOD and DRINKS – coffee – agg. 117
14 1234 3 MIND – SENSITIVE – certain persons, to 8


nat-m. ign. puls. sulph. nux-v. nat-c. calc. carb-v. phos. bell.
93 90 84 76 69 68 65 62 59 57
1 4 4 1 1 1 2
2 1 1 2 1 1
3 1 3 2 1 2 2 3 3 3
4 1 3 2 1 2 2 2 1
5 2 2 2 1 2
6 2 2 2 3 3 2 2 2 2 2
7 1 1 2 2 2 2 2 2
8 4 3 1 2 1 1
9 2 1 2 3 2 4 3 2 2 1
10 2 2 2 2 1 3 2 2 2 1
11 3 3 1 1 2 2
12 3 1 3 1 2 3 1 2 3
13 1 3 2 1 3 1 1 1
14 3 1


Differential diagnostics:

Natrum muriaticum is one of the main remedies we think of when strong grief often originating from very dramatic life circumstances, e.g., loss of parents or children, is the main causative factor for the development of the complaints. Although Natrum muriaticum comes out the first among the remedies covering the totality of symptoms, it does not cover any of the peculiar symptoms of the case, not even the strong aggravation from coffee or the sensitivity to the emotions of others. Natrum muriaticum can be confirmed by strong aggravation from sun despite the fact that the patient is mainly bothered by heat of the sun, whereas patients needing Natrum muriaticum are rather aggravated from light, especially in connection with eyes, head and skin. Dwelling on past disagreeable experiences is another typical characteristic of this remedy. Intense anxieties in the chest and stomach are not keynotes of Natrum muriaticum, however, in our case they are very pronounced.

Ignatia covers not only the etiology of grief, but also the essence of the patient’s state, i.e. the disappointment of ideals which has as a result a conflict between expectations and reality. This is the exact type of disappointment of Ignatia. The anxieties in chest, heart region and stomach and the strong aggravation from coffee are keynotes of Ignatia. The remedy does not cover the sensitivity to moods of others, which is an intense and peculiar symptom of the case, however, its importance is reduced by the fact that she has had it for a long time, namely since the time before she developed the current complaints. We can therefore confirm Ignatia on the basis of the essence, the etiology, the keynotes and the totality of symptoms.

Pulsatilla covers the strong aggravation from sun, but none of the other symptoms of the case is a keynote of this remedy. Apart from the aggravation from sun we cannot confirm this remedy otherwise.

Sulphur comes out among the first five remedies in most repertorisations. It is therefore necessary to confirm this remedy very precisely by keynotes. But in this case we cannot confirm it either on the basis of etiology, or by keynotes.

Nux vomica has the aggravation from alcohol and coffee as keynotes. However, the fact that our patient is strongly aggravated from heat is a contraindication for Nux vomica, because this remedy is generally better from heat. Nux vomica does not cover the emotional state (the sensitivity to moods of others) at all. The leading symptom for Nux vomica on the emotional plane is strong irritability, which we cannot find in the case.

Natrum carbonicum is an important remedy for after effects of grief and at the same time, it covers a lot of keynotes in the case, like the aversion to milk, the aggravation from sun and heat and the intolerance to farinaceous food. However, the most important thing is that it covers the sensitivity to moods of other people, which is the most important emotional keynote of Natrum carbonicum.

Calcarea carbonica, Carbo vegetabilis and Phosphorus are ameliorated by heat, which is a contraindication in this case.

Belladonna covers neither the causative factor nor the essence of the case and it can only be confirmed by the aggravation from sun which is a keynote of this remedy.


Selection of the remedy, potency and dosage:

It is obvious from the differential diagnostics that we are going to choose between two remedies – Ignatia and Natrum carbonicum. The most limiting symptoms for the patient at this moment are the strong physical anxieties, the thoughts about the past and the tinnitus. Ignatia does not cover the tinnitus modality, the aggravation from lying down, however, it is a common symptom of tinnitus and it will be present in most people with this diagnosis, so it has no priority for us at this moment. Ignatia, however, covers the essence and the etiology and we can also confirm it by several keynotes which are currently the most bothering for the woman at the same time and they represent the uppermost layer of symptoms. Natrum carbonicum does not cover the essence of the case and its keynotes (the aggravation from farinaceous food, milk and heat) are not bothering the patient at the moment, except the sensitivity to moods of others. Natrum carbonicum can be confirmed on the basis of the totality of symptoms and keynotes, whereas Ignatia fits the totality, the essence, the etiology and keynotes. It is very probable that Natrum carbonicum will be indicated in the future, provided its keynotes do not disappear. Ignatia appears to be a better option for the similimum covering the uppermost layer because it fits more aspects of the case and it covers the symptoms that are currently the most bothering for the patient.

Because Ignatia can be confirmed by all aspects of the case and its picture is therefore expressed in a very complex and clear way and considering that the woman is not taking any allopathic drugs, nor does she suffer from any serious health problem, it is possible to recommend a homeopathic remedy in a very high potency.


Prescription: Ignatia 1M single split dose


Follow-up 1: October 15, 2013

Shortly after taking Ignatia, the patient felt very sleepy and the next day she developed a mild coryza, which lasted for 4 days. Her sleep improved a lot. She has not had the episodes of late falling asleep everyday like before, although once or twice a week she happens to be falling asleep for two or three hours. The humming in the ears was better and she felt better in general. This improvement lasted for three weeks.

She was very busy at her work and she experienced working stress. At that time her state started getting worse again. She also drank coffee five times then. The thoughts about the man with whom she was in love are much less frequent and when they come they are not so intense and they are not accompanied by the anxiety around the heart and stomach. The oversensitivity to cigarette smoke and the flushes of heat at night have disappeared as well.

She suffers from two types of sleeplessness: Either she cannot fall asleep because of the activity of her thoughts until 3-4 a.m. or she falls asleep very early in the evening because she is very tired and she tends wake regardless of the time. Her thoughts are influenced by the situation at work a lot. She is anxious to do everything on time. She thinks about a lot of things, like what else she has to do and about her work (3). She had to reduce farinaceous food (3) because of the distension after wheat bread. She does not drink milk as such and she would not drink it (3). It also causes her diarrhea. There has been no change in this. She does not tolerate heat and seeks shadow, but does not have any strong reaction to the sun itself.

Again, she says spontaneously that she is very sensitive to moods of others and she describes a situation when for instance her boss comes to work and she senses that he is tired and sad. She has this problem with strangers as well and it has always bothered her because she cannot do anything about it.

She tolerates weather changes very badly. Especially when it is getting warmer, she is restless, she feels generally worse and she has a feeling that something is going on. Noises in the ears have improved, but they are still 80% there. They are still better when she lies down.

Analysis of the first follow-up:

There was an aggravation followed by an amelioration of her psyche after Ignatia. The improvement remained for about 3 weeks and then it got worse after stress at work and having drunk coffee, but the original keynotes of Ignatia have not returned (the thoughts about the past, sensitivity to tobacco smoke, anxiety in the chest) and neither have returned the flushes of heat at night. However, her sleep got worse again back to the previous state, but without other Ignatia symptoms. The initial aggravation after the remedy followed by amelioration shows that the recommended remedy was correct. The aggravation which came after the 3-week improvement was caused by repeated drinking of coffee together with very strong stress at work. In these cases, it is a crucial question whether to repeat the original remedy, to wait, or recommend another remedy.

Let’s now repeat a few rules, by which we have to be guided in such situations. The first important thing is to determine whether we can pronounce the relapse full. If it is a full relapse, it is necessary to repeat the remedy in the same potency, because in a full relapse the action of the remedy has been interrupted, the organism has returned to the original state and the full potential of the remedy (potency) has not been utilized. This rule comes from another rule which says that we can give a higher potency of the remedy only when we are sure that the previous (lower) potency has done everything it could.

A full relapse is defined as a return of the original keynotes, which led us to the original remedy. It is not necessary to have all the symptoms back, but particularly those which are determining for the given remedy, the keynotes. In our case, however, we witness that the keynotes of Ignatia are either completely gone or their intensity is minimal.

So in this case we cannot talk about a full relapse. The second important question is how long the relapse has lasted because if it lasted for example only a few days or a week, it would be better to wait at least two more weeks and see if the organism overcomes the aggravation on its own. However, in this case we can see that the aggravation had lasted for about a month and a half, so the chances that the organism finds the balance using its own powers are very low and the stressful situation at work also contributes to it.

The last question to solve is whether the remaining symptoms together with the ones that have returned comprise a picture of another homeopathic remedy. If that is the case, it is necessary to give this new remedy because it covers the current symptoms. If this is not so, we have to repeat the original remedy, even if its original symptoms have not come back.

So the current symptoms are as follows:

Intense symptoms:

  1. Noises in ears worse when lying
  2. Aggravation after alcohol
  3. Diarrhea after milk
  4. Aversion to milk
  5. Distension of abdomen (aggravation) after bakery products
  6. Aggravation from heat (sun)

Peculiar symptoms:

  1. Sensitivity to emotions of others

Repertorisation in RADAR software with Synthesis 9.1 repertory

The repertorisation is done using a technique of summary of symptoms with regard to the intensity of symptoms (For Radar users: Sum of symptoms and degrees – intensity is considered)


1 1234 2 EAR – NOISES in – lying, while 19
2 1234 3 GENERALS – FOOD and DRINKS – alcoholic drinks – agg. 179
3 1234 2 RECTUM – DIARRHEA – milk – after 25
4 1234 2 GENERALS – FOOD and DRINKS – milk – aversion 82
5 1234 2 GENERALS – FOOD and DRINKS – farinaceous – agg. 29
6 1234 3 GENERALS – SUN – exposure to the sun 69
7 1234 3 MIND – SENSITIVE – certain persons, to 8


nat-c. sulph. calc. nat-m. puls. bry. stann. carb-v. ars. nux-v.
17/42 14/26 13/22 12/27 12/27 12/19 11/11 10/20 10/19 10/19
1 1 2 1 1
2 2 3 2 2 2 1 1 2 3 3
3 3 2 3 1 1
4 3 2 2 2 2 2 1 2 1 1
5 2 1 3 3 2 2 1
6 3 1 1 3 3 2 1 2 2 2
7 3 1 1


Selection of the remedy, potency and differential diagnostics:

The first thing we have to notice is that there is a very clear picture of Natrum carbonicum now, because Ignatia has removed the uppermost layer of symptoms. In all multilayer cases we observe a rule which says that after an administration of each correct remedy the picture becomes more and more clear. Our case is not very complicated, because after the first remedy, the picture has become very clear and comprehensive. However, there are also cases where we have to choose among a lot more than two remedies in the beginning and although the picture becomes clearer after the administration of the first one, it still remains very complicated. This is mainly valid for people with strong inherited genetic predispositions.

Natrum carbonicum is the only remedy which has the main emotional symptom of the case as a keynote, as well as most of the symptoms this woman states (the aggravation from farinaceous food and milk, the diarrhea after milk and the aggravation from sun and heat).

Prescription: Natrum carbonicum 200C single split dose

Follow-up 2: December 18, 2013 – e-mail

“I am reporting one month after taking Natrum carbonicum. I took the remedy on 16th April. The next day, I had post-nasal coryza which went away on its own the day after, but reappeared one week later and also lasted for 2 days. My sleep has become better. I fall asleep without problems. Only about twice a week, it takes me more than 30 minutes to fall asleep. Sometimes I tend to wake up earlier, but it is not often. The sensitivity to people has improved significantly. In situations where I used to have cramps in the abdomen, I am now calm, which is superb. This changed 2-3 days after taking the remedy. The tinnitus still remains. However, it is true that I tolerate it better, because I sleep better. Thank you in advance for your reply.”

Analysis of the second follow-up:

There was an immediate aggravation after the remedy in a form of coryza followed by amelioration of the main psychological complaint and sleep. The tinnitus has remained unchanged. This is a situation where a lot of homeopaths (especially beginners) make a mistake and they focus on the information about the unchanged tinnitus while ignoring the strong general amelioration. Every time we witness indisputable psychological and general amelioration, it is imperative to wait. After a correct homeopathic remedy, the defence mechanism has a tendency to shift the pathology from within outwards in compliance with Hering’s laws. The vital force of people at the highest levels of health have enough strength to ameliorate both inner and local problems at once after the correct remedy. At lower levels, however, the reaction takes place in phases, i.e. inner complaints ameliorate first and the local ones remain without change or they get worse and after some time, they will start getting better as well, either spontaneously or after taking another remedy based on the actual set of symptoms. Because the reaction to Natrum carbonicum corresponds with Hering’s laws and the patient feels better, it is necessary to wait without any further interventions.

Prescription: wait

Follow-up 3: January 1, 2014 – e-mail

“Good afternoon, I would like to confirm the impressions I wrote in the last e-mail. My sleep is still much better (the same level as I wrote the last time). The sensitivity to outer environment is significantly better. The humming in the ears is milder, it bothers me less and I only perceive it when falling asleep.”

Analysis of the third follow-up:

The amelioration from the last follow-up still remains with the difference that the woman now describes the humming in the ears to be milder. The keynotes of Natrum carbonicum do not tend to return and her physical level is very slowly recuperating. Therefore, it is necessary to wait.

Prescription: wait


Follow-up 4: March 5, 2014 – e-mail

“I am sending you another report. The rustling in the ears has not disappeared completely, but it is much less than before and I notice it only in some situations (when I am exhausted or when my cervical spine hurts). The sleep is all right, with only a few exceptions. Thank you very much for your help.”

Analysis of the fourth follow-up:

It is obvious from this follow-up that most of the complaints are either completely gone, or they are only mild. The patient confirms in her e-mail that she feels better in general and she notices the noises in ear only when she is exhausted or when she has pain of her neck. There are no sleep problems, with only a few exceptions. For these reasons, it is necessary to wait further.

Prescription: wait

About the author

Petr Zacharias

Petr Zacharias is the founder and main teacher at the Prague College of Classical Homeopathy. He studied with George Vithoulkas at the IACH and has conducted seminars with Dr. A. U. Ramakrishnan, Dr. S. K. Banerjea, Dr. Jorgos Kavouras and Erik van Woensel.


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