MANAGEMENT OF KARNASRAVA WITH STHANIKA GUGGULU DHOOPANA AND RASNADIGUGGULU
A COMPARATIVE STUDY
By
Dr.SATHISH SHANKAR.B, B.A.M.S.
A dissertation submitted to the
Rajiv Gandhi University of Health Science, Bengaluru, for the partial fulfillment of Degree
AYURVEDA VACHASPATHI M.S. (SHALAKYA TANTRA)
Under the guidance of
Dr.SUMITRA.T.GOWDA M.D. (Ayu) Professor Department of Post Graduate Studies in Shalakya Tantra,
Government Ayurvedic Medical College, Bengaluru.
DEPARTMENT OF POST GRADUATE STUDIES IN SHALAKYA TANTRA GOVERNMENT AYURVEDIC MEDICAL COLLEGE
DHANWANTRI ROAD, BENGALURU – 560 009
2010-2011
GOVERNMENT AYURVEDIC MEDICAL COLLEGE DEPARTMENT OF POST GRADUATE STUDIES IN SHALAKYA TANTRA
Dhanwantri Road, Bengaluru – 560 009
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled “Management of karnasrava
with sthanika Guggulu dhoopana and Rasnadiguggulu- A Comparative
study” submitted by Dr. Sathish Shankar. B for the degree of Ayurveda
Vachaspathi – M.S.(Shalakya Tantra) of the Rajiv Gandhi University of
Health Sciences, Bengaluru, is a record of research work done by him under
my guidance and supervision during the period of his study in our department.
This dissertation has not previously formed the basis for the award of any
degree, diploma, associate ship, fellowship or other similar titles.
I am recommending this dissertation for the above degree to the University
Assessment and approval.
Dr. SUMITRA.T.GOWDA. MD (Ayu) Professor Department of Postgraduate Studies in Shalakya Tantra, Government Ayurvedic Medical College, Bengaluru.
Date : Place : Bengaluru
GOVERNMENT AYURVEDIC MEDICAL COLLEGE DEPARTMENT OF POST GRADUATE STUDIES IN SHALAKYA TANTRA
Dhanwantri Road, Bengaluru – 560 009
ENDORSEMENT BY THE HOD & PRINCIPAL
This is to certify that the dissertation entitled “MANAGEMENT OF
KARNASRAVA WITH STHANIKA GUGGULU DHOOPANA AND
RASNADIGUGGULU-A COMPARATIVE STUDY” is a bonafide and
genuine research work done by Dr. Sathish Shankar. B. Under the guidance
of Dr.Sumitra.T.Gowda, M.D.(Ayu), Professor , Department of Post Graduate
Studies in Shalakya Tantra, Government Ayurvedic Medical college
Bengaluru.
Dr. B.N. Ramesh, M.D. (Ayu Shalakya) Professor and HOD, Department of P.G.studies, Shalakya tantra, Government Ayurvedic Medical college, Bengaluru.
Dr. Mangalgi, M.D. (Ayu) Principal Government Ayurvedic Medical College, Bengaluru.
Date : Date : Place : Bengaluru Place : Bengaluru
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE
BENGALURU, KARNATAKA
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled “MANAGEMENT OF
KARNASRAVA WITH STHANIKA GUGGULU DHOOPANA AND
RASNADIGUGGULU-A COMPARATIVE STUDY” is a bonafide and
genuine research work carried out by me under the guidance of
Dr.Sumitra.T.Gowda M.D. (Ayu), Professor, Department of Post Graduate
Studies in Shalakya Tantra, Government Ayurvedic Medical College,
Bengaluru.
Dr. SATHISH SHANKAR.B B.A.M.S. Date :
Place : Bengaluru
COPYRIGHT
DECLARATION BY THE CANDIDATE
I hereby declare that the Rajiv Gandhi University of Health Science,
Bengaluru, Karnataka shall have the rights to preserve, use and disseminate
this dissertation in print or electronic format for academic or research purpose.
Dr. SATHISH SHANKAR.B, B.A.M.S.
Date
Place : Bengaluru
ACKNOWLEDGEMENT
I would like to take this opportunity to express my gratitude to all those who
have rendered help in conducting this clinical study and compiling of this dissertation.
It is with deep sense of gratitude and respect that I express my thanks to my
beloved guide Dr.Sumitra.T.Gowda M.D (Ayu) Professor, Department of Post
Graduate studies in Shalakyatantra, Government Ayurvedic Medical College,
Bengaluru, for her valuable guidance, constant encouragement, motivation and kind
co – operation without which the work would not have been completed.
I express my heartiest gratitude to Dr. B.N. Ramesh. M.D (Ayu Shalakya)
Professor and HOD, Department of PG Studies in Shalakyatantra, G.A.M.C,
Bengaluru for his valuable guidance and deep concern that helped me to pursue my
work with confidence.
I am grateful to our principal Dr. S.G. Mangalagi M.D (Ayu) for his kind help
and cooperation in completing this work.
I am greatful to Dr. Viswambhara M.D (Ayu Shalakya) and Dr. H.T Srinivas
M.D (Ayu) for there cooperation in completing this work.
I also express my sincere gratitude to Dr.Suja K.Sridhar, Dr. Vijayasarathi,
Dr. Shobharani, Dr. Mohankumari and Dr. Syed Munawar Pasha, Dr. Aravind,
Dr. Ashalata for their valuable suggestions and guidance regarding my work.
I express my sincere thanks to Mr. Joshi, Medical Statistician, BMC,
Bengaluru, for helping me in Statistical analysis of my study.
I thank my seniors Dr. Uma, Dr. Apeksha, Dr. Rumana, Dr. Praneeta,
Dr. Manjubhargavi, Dr. Suma and Dr. Rekha for their support and co – operation.
I would like to thank my colleagues with special thanks to my friends
Dr. Lokanath, Dr. Veeresh, Dr. Manasa, Dr. Nishitha, Dr. Suma, Dr. Bharathi,
Dr. Manjunath Joshi, Dr. Jayanth, Dr. Pratibha, Dr. Tejaswini, Dr. Sunita,
Dr. Ravi Kumar Patil, Dr. Sudarshan, Dr. Praveen, Dr. Pooja and Dr. Amol for all
the support they have extended.
I would also wish to extend my thanks to my juniors, Dr. Chiranjeevi,
Dr. Chandrashekar, Dr. Vivek, Dr. Santosh, Dr. Sharan, Dr. Navya and Dr. Gayatri
for their kind help and co – operation throughout the work.
I sincerely thank Dr. Sumit patil for his extensive and valuable support.
I extend heartfelt and humble gratitude to Dr. Ramesh Kavalgud,
Dr. Govindaraju, ENT surgeons from KCG hospital.
I would like to take this opportunity to thank my parents
Mr. Venkatakrishna B.S and Mrs. Seetaratna for being encouraging, loving and
supportive throughout my work.
It is with deep sense of gratitude and great respect that I thank my family
members Mr Santoshkumar, Mrs. Vaani, Mr. Sujay, Manoj, Murari,
Mr. Shivarama and my friend Dr. Yogeesh who have always been besides me for
each and every event of this study.
I wish to thank all the Physicians, Staff of the hospital and librarians of
G.A.M.C, Bengaluru, for their timely help.
I would also take this opportunity to thank Mr. Mohan Reddy, DTP centre,
Bengaluru, for his timely cooperation in printing.
Last, but not the least, I render my thanks to all my patients, without whose
cooperation the work would not happen.
Date : Signature of the Candidate. Place : Dr. Sathish Shankar. B.
CONTENTS
SL.NO. CONTENTS PAGE NO.
1. Introduction 1-2
2. Objectives of the study 3
Review of literature
Historical review,
4-6
Anatomy and physiology of karna 7-11
Anatomy and physiology of ear 12-28
Ayurvedic disease review 29-37
Modern review 38-50
Procedure review 51-52
3.
Drug review 53-58
4. Methodology 59-64
5. Observation and results 65-105
6. Discussion 106-115
7. Conclusion 116-117
8. Summary 118-119
9. References 120-126
10. Bibliography 127-131
11. Annexure 132-138
LIST OF TABLES
Table
No.
NAME OF THE TABLE Page
No.
1. Karnasrava samanya nidana 29
2. Sapeksha nidana of karna srava 34
3. Study design 61
4. Subjective and objective parameters 63
5. Age wise distribution of patients trail groups 65
6. Distribution of sex in trail groups 67
7. Distribution religion in trail groups 68
8. Distribution of occupation in trail groups 69
9. Distribution of marital status 71
10. Distribution of diet in trail groups 72
11. Distribution of socio economic status in trail groups 73
12. Distribution of laterality in trail groups 74
13. Distribution of chronicity in trail groups 75
14. Distribution of prevalence of nidanas 77
15. Distribution of prakruti in trail groups 79
16. Distribution of ear discharge 80
17. Distribution of perforation 81
18. Distribution of conductive deafness 82
19. Distribution of impaired hearing 83
20. Observation in the follow up period 85
21. Periodical changes in signs and symptoms in group A 86
22. Periodical changes in signs and symptoms in group B 90
23. Periodical changes in signs and symptoms in group C 94
24. Statistical analysis of parameters in group A 98
25. Statistical analysis of parameters in group B 99
26. Statistical analysis of parameters in group C 101
27. Overall assessment of results 103
LIST OF DIAGRAMS
SL.
No.
Title Page
No.
1. Diagram showing distribution of age 66
2. Diagram showing distribution of sex 67
3. Diagram showing distribution of religion 68
4. Diagram showing distribution of occupation 69
5. Diagram showing distribution of marital status 71
6. Diagram showing distribution of diet 72
7. Diagram showing distribution of socioeconomic status 73
8. Diagram showing distribution of laterality 74
9. Diagram showing distribution of chronicity 75
10. Diagram showing distribution of prevalence of nidanas 77
11. Diagram showing distribution Prakruthi 79
12. Diagram showing distribution of ear discharge 81
13. Diagram showing distribution of perforation 82
14. Diagram showing distribution of conductive deafness 83
15. Diagram showing distribution of impaired hearing 84
16. Diagram showing observation of follow-up period 85
17. Diagram showing relief in percentage after 15 days in group A 89
18. Diagram showing relief in percentage after 30 days in group A 89
19. Diagram showing relief in percentage after 15 days in group B 93
20. Diagram showing relief in percentage after 30 days in group B 93
21. Diagram showing relief in percentage after 15 days in group C 97
22. Diagram showing relief in percentage after 30 days in group C 97
23. Diagram showing statistical analysis of parameters in group A 99
24. Diagram showing statistical analysis of parameters in group B 100
25. Diagram showing statistical analysis of parameters in group C 102
26. Diagram showing assessment of overall results 104
LIST OF CHARTS Chart
No. Title Page No.
1 Showing perception of sound 11
2 Showing blood supply of labyrinth 26
3 Showing samprapthi of karnasrava 31
LIST OF ABBREVIATIONS USED
A.H – Astanga Hrudaya
A.K - Amarakosha
A.S – Astanga Sangraha
BT – Before Treatment
B.P – Bhava Prakasha
Ca – Charaka
Cd - Chakradatta
Ch. – Chapter
Chi – Chikitsa Sthana
K.S – Kashyapa Samhita
M.N – Madhava Nidana
Ni – Nidana sthana
pp. – Printed pages
S.S – Sushruta samhita
Sl. – Sloka
su. – Sutra sthana
S- Sushruta
Sh – Shareera sthanas
S.y - Sahasrayoga
SJIIM – Sri Jayachamarajendra Institute of Indian Medicine
Ut – Uttara sthana
Utt – Uttara tantra
Sam-Samhita
‘t’ - Students test
ABSTRACT “Managament of karnasrava with sthanika Guggulu dhoopana and Rasnadiguggulu – A comparative study” Karnasrava can be compared to chronic suppurative otitis media. In both these, ear
discharge is the presenting complaint.
In the present study the efficacy of karnadhoopana is compared with internal
administration of Rasnadi guggulu in the management of karnasrava. It was a single
blind open random trail wherein 45 patients were selected and divided into three
Groups namely, Group A, Group B, and Group C each consisting of 15 patients .
Group A was treated with Shuddha guggulu dhoopana. Group B was treated with
Rasnadi guggulu internal administration. Group C was treated with both guggulu
dhoopana and Rasnadi guggulu internally. Two sittings of treatment procedure for
seven days each was followed, with an interval of 15 days in between. Whereas
Rasnadi guggulu was given for 30 days 1gm bid dose. Follow up was done for three
months.
Impaired hearing was the subjective parameter. Objective parameters were, ear
discharge and perforation by otoscopic examination, assessment of conductive
deafness by pure tone audiometry. These were suitably graded to asses the results
based on the clinical observations. Statistical tests were applied to analyse the results.
It was observed in the present study that Group c showed better results compared to
Group A and Group B. But Group A showed better results than Group B. The details
of clinical observations and results will be discussed further in the complete work
presented here forth.
Keywords: Karnadhoopana, Rasnadi guggulu, Perforation, Ear discharge, Pure tone
audiometry.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 1
INTRODUCTION
The treasure of ancient wisdom is depicted in the texts of Ayurveda.
Ayurveda is the science of life and it is the traditional treatment method of India. It
has eight branches. Shalakya Tantra is one of the specializations mentioned in these
eight branches, which deals with Urdhwanga chikitsa. It includes indriyas - Karna,
Chakshu, Nasa, Jihwa and Shiras. It is also known as Uttamanga.
Karna is considered as one of the Navadwaras and it is one among the
Panchendriyas. In Ayurveda, there are many treatment modalities explained for the
prevention and management of ear disorders such as karnapoorana, karna
avachurnana, karnaprakshalana, karnadhoopana etc. But this knowledge has to reach
the common man especially in developing countries where less expensive but
effective health care system is yet to be developed.
Karnasrava is one among the 28 karna rogas described by Acharya Sushruta.
Vagbhata has not mentioned karnasrava as a separate disease. But has explained
about karnasrava chikitsa. According to Charaka there are 4 types of karna srava.
Classical features of karnasrava can be compared to Chronic suppurative
otitis media. Chronic suppurative otitis media is fairly common infection affecting
the mucosa of the middle ear cleft. In the recent study the prevalence rate is 46
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 2
and16 persons per thousand in rural and urban population respectively. It is also the
single most important cause of hearing impairment which can be easily preventable.
The principle treatment modalities adopted in conventional system of
medicine are long duration of antibiotics orally and surgical treatment like
tympanoplasty, mastoidectomy etc. Oral medicines, if given for long duration causes
adverse effects like gastric irritation and reduces immunity, where as the surgical
methods may lead to complications like bleeding, damage to the inner ear, facial
nerve, meninges etc. Failure of the graft is one of the main drawbacks of these
surgeries. These treatments are expensive and beyond the reach of the common man.
Hence an effective treatment approach, which is simple and economical,
needs a serious consideration. In this regard, Karna Dhoopana with Guggulu
because of its ruksha, ushna teekshna, laghu guna acts as an effective shodhaka,
keeps the ear dry, reduces pain, discharge, foul smell and thus controls the infection.
It is also useful as Aadhidaivika chikitsa to protect the patient from external attacks.
It acts against any of the visible and invisible organisms.
As karnadhoopana is a simple, cost effective procedure, which can be done
even at the OPD level, the present clinical study to compare the efficacy of guggulu
karna dhoopana and rasnadi guggulu internally in the management of karnasrava
was taken up.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 3
OBJECTIVES OF THE STUDY
The objectives of present study are:
1. To evaluate the efficacy of Shuddha Guggulu Karnadhoopana in the
management of Karnasrava.
2. To evaluate the efficacy of Rasnadiguggulu internally in the management of
Karnasrava.
3. To compare the effects of Shuddha Guggulu Karna Dhoopana procedure and
Rasnadi Guggulu internal administration.
4. To evaluate importance of local therapeutic procedure- Karna Dhoopana.
5. To evaluate effect of Guggulu when administered locally and internally.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 4
REVIEW OF LITERATURE
HISTORICAL REVIEW
• Karnasrava is described in many of the samhitas. The detailed description is
available in Sushruta samhita Uttaratantra 20th and 21st chapters.
• In Astanga sangraha andAstanga hrudaya, Karnasrava is not explained as a
separate disease.But chikitsa is mentioned in 22nd chapter of Astanga
sangraha uttrratantra,18th chapter of Astanga hrudaya uttaratantra.
• Charaka did not specify karnasrava, but mentioned 4 types of karnarogas –
Vataja, Pittaja, Kaphaja, and Sannipataja and there treatment in 26th chapter
of chikitsasthana.
• Karnasrava is also explained in Bhavaprakasha madyamakhanda 64th
chapter.
• Madavakara has explained about karnasrava in 57th chapter of
madyamakhanda.
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• References for treatment of karnasrava is available in Sharangadara samhita
uttarakhanda 11th chapter.
• Yogaratnakara explained karnasrava in karnarogadhikara.
• In Gadanigraha also, Karnasrava and its treatment is mentioned in
karnarogadikara.
• Vangasena had mentioned about the disease and treatment in 69th chapter.
• Chakradatta explained Karnasrava in 57th chapter.
• Dalhana has given the commentary of pootikarna in Sushruta samhita
uttaratantra 20th and 21st chapter.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 6
KARNASRAVA
Karna srava is a type of karna roga, explained by sushruta.The term Karnasrava
comprises of two words. Karna and Srava
Karna- The organ of hearing.
Srava-Discharge.
Nirukti:1
The term Karna is derived from:
Karoti Shabda grahanam.
The term Karna srava refers to:
“Karnasya karnayorva samsravaha2”
Discharge from the Ear is reffered as karnasrava
Synonym:
→Karnasamsrava3
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 7
KARNA SHAREERA
Karna Nirukti:
• Karnyathe Akarnyate anena ithi4
It means reception and conduction of sound waves.
These are the functions of external and middle ear
Paryaya of Karna:
Shabdhapatha, Srotrapatha, Sravanam, shruti,kuharam, Dwanigraham,
Sravanapayaha etc5
Nirukti of Sravanam:
• Sruyathe anena ithi sravanam6
It means perception of sound.
It can be attributed to the internal ear function.
In Charaka Samhita, karna is described as one of the Prathyangas of the body.
Acahrya Charaka explains the word Karna as the indriya adhisthana of shabdha7. He
emphasizes that all indriyas manifest during the 3rd month of gestational period.
Sushruta while describing formation of purusha from prakrithi or Avyakta, narrated
that all indriyas are developing from the vaikarika and taijasa ahankara8. He narrated
that karna is made up of two bones which is cartilaginous9 and two sandhies10 (one
in each). Type of sandhi seen in karna is sankhavartha which is present in
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Srotashringataka11. There are two mamsa peshis12 and 16 siras13, He also told that a
person with Sthira indriyas enjoy long lifespan14.
Both Vagathata and Susruta considered karna as one of the bahir srotas15.
In Astanga Hridaya, Vagbhata has stated that all indriyas are atmaja. According to
him, lowered lobules, elevated helix, projected posterior portion, fleshy and adherent
ear are indications of long span of life16.
The length of ear is 4 angula17 and that of karna moola is 2 angula18. The distance
between two ears through the back of the neck is 14 angulas19.
Marmas of Ear
The two important marmas Vidhura and Shringataka20 are located in the ear.
Vidhuras are situated in the depressed portion in the back of the ear. Injury to them
causes loss of hearing21.
The predominant dosha of ear is vata, since it is an important seat of vata. The
predominant dhatus are asthi, mamsa and majja. The external and middle ears have
the predominance of asthi and mamsa. Ear has the predominance of Akasha
mahabhuta22.
In Ayurvedic classics, detailed description of ear is not available. Karna is one of the
panchagnanendriyas and is meant for hearing. Its various parts are mentioned in the
classics as follows.
Karnapali23: It is popularly known as Lobule of the ear. Daivakrita chidra is present
in it24.
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Karna putrika25: Ayurvedic scholars accepted two terms in this context. They are,
Karnaputraka and Karnaputrika26. The former is considered as Tragus and the latter
as Antitragus.
Karna shashkuli27 or Karna shashkulika: Charaka has mentioned this term while
describing different pratyangas of the body. Acharya Gananatha Sen has given the
clarification for it, as Pinna or Auricle
Karna peetha28: It is mentioned first by Susruta while describing the procedure of
Karnavyadana. Dalhana has clarified that it is the region above the Kamaputrika i.e.
the region which is at the bottom of the Concha. Vagbhata has mentioned that it is
the adhobhaga of Karna29.
Karna prushtha30: It can be taken as the cranial surface of the auricle or the
mastoid region.
Karnamoola31: It can be taken as parotid region.
Karna lathika32: Lobule of the ear is mentioned as Karna lathika by Dalhana.
Karnaavatu33: This term is used by Susruta while describing the measurements of
different angapratyangas. where he has mentioned that the distance between the
Karnaavatu is 14 angula. Dalhana has commented that, it can be taken as the
distance between two ears from behind (posteriorly).
Shabdhapatha34 or Shabdhavahasrotas35 or Srotrapatha36: The whole passage
through which the sound waves pass can be taken as Shabdhavahasrotas.
Shrotra shringataka37: It can be taken as the labyrinth of the ear.
Bahya karna —> External ear
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Madhya karna —> Middle ear
Antak karna —> Internal ear
Karna utpatti:
It is formed by akasha mahabhuta38.
The fundamental characteristics are as follows;
Indriya —> srotram39
Indriya adhishthana —> karna40
Indriya dravya —> akasha41
Indriyaartha —> shabdha42
Indriya buddhi —> shrotrobuddhi
Importance:
1) Both the ears are grouped under Navadwaras43.
2) Shravanendriya is one among the Panchagnanendriyas.
3) Karna is the seat of vata dosha & this vata helps in the sense of perception of
hearing44.
4) Indicative of life span:- Thick, large in size having even lobes, with elongations
downwards, bent towards back to front, having compact Tragus and a big ear
passage is the indicative of long life span according to our Acharyas.
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Physiological aspect of sound perception45:
According to Ayurveda, perception or pratyaksha of any sensation incuding
shabda occurs due to the intimate interaction of the karnendriya and the indriyartha –
shabdha resulting in shravana.
Chart No.-1 Showing the perception of sound
Atma
Manas
Indriya
Artha
Resulting in perception of buddhi (shabda) graham
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EAR ANATOMY
The Ear is divided into:88
1. External ear
2. Middle ear
3. Internal ear or the labyrinth
The External Ear:
The external ear consists of the (i) auricle or pinna, (ii) external acoustic canal
and (iii) the tympanic membrane
The entire pinna, except its lobule, and the outer part of external acoustic canal are
made up of a framework of a single piece of yellow elastic cartilage covered with
skin. The latter is closely adherent to the perichondrium on its lateral surface while it
is slightly loose on the medial surface.
External Acoustic Canal:
It extends from the bottom of the concha to the tympanic membrane and
measures about 24 mm along its posterior wall. It is not a straight tube; its outer part
is directed upwards, backwards and medially while its inner part is directed
downwards, forwards and medially. Therefore, to see the tympanic membrane, the
pinna has to be pulled upwards, backwards and laterally so as to bring the two parts
in alignment.
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The canal is divided into two parts: (a) cartilaginous and (b) bony
(a) Cartilaginous part: consists of fibro cartilage. It forms the outer 1/3rd of the
external canal. The skin of this part of the canal contains hair follicles,
sebaceous, and ceruminous glands; and wax secretion occurs in this part only
from sebaceous and ceruminous glands. Furunculosis of the external ear
occurs in this region from hair follicle and is very much painful as skin is
adherent to perichondrium.
(b) Bony part: forms the inner 2/3rd. Skin lining this part is thin and there is no
hair follicles, sebaceous or ceruminous glands.
Nerve Supply to external ear:89
Sensory nerve supply of the external ear: The auricle is supplied by fibres of the
great auricular nerve (C2 & C3) and lesser occipital nerve (C2). Auriculo-temporal
branch of the 5th cranial nerve and auricular branch of the vagus (Arnold’s nerve)
supply external canal. Facial nerve has small sensory contribution on the posterior-
inferior wall.
Tympanic Membrane or the Drumhead:90
It forms the partition between the external acoustic canal and the middle ear. It is
obliquely set and as a result, its posterosuperior part is more lateral than its antero-
inferior part. It is 9-10 mm tall, 8-9 mm wide and 0.1 mm thick. Tympanic
membrane can be divided into two parts:
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(a) Pars Tensa
It forms most of tympanic membrane. Its periphery is thickened to form a
fibrocartilaginous ring called the annulus tympanicus which fits in the tympanic
sulcus. The central part of parts tensa is tented inwards at the level of the tip of
malleus and is called the umbo. A birght cone of light can be seen radiating from
the tip of malleus to the periphery in the anteroinferior quadrant.
(b). Pars Flaccida (Shrapnel’s Membrane)
This is situated above the lateral process of malleus between the notch of
Rivinus and the anterior and posterior malleal folds (earlier called the malleolar
folds). It is not so taut and may appear slightly pinkish.
Layers of Tympanic Membrane:
Tympanic membrane consists of three layers:
(i). Outer epithelial layer, which is continuous with the skin lining the meatus.
(ii). Inner mucosal layer, which is continuous with the mucosa of the middle ear.
(iii). Middle fibrous layer, which encloses the handle of malleus and has three types
of fibers the radial, circular and the parabolic.
Fibrous layer in the pars flaccida is thin and not organized into various fibres as in
pars tensa.
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THE MIDDLE EAR91
The middle ear or tympanic cavity is an irregular, laterally compressed space
within the temporal bone. It is filled with air, which is conveyed to it from the nasal
part of the pharynx through the auditory tube. It contains a chain of movable bones,
which connect its lateral to its medial wall, and serve to convey the vibrations
communicated to the tympanic membrane across the cavity to the internal ear. The
tympanic cavity consists of two parts: the tympanic cavity proper, opposite the
tympanic membrane, and the attic or epitympanic recess, above the level of the
membrane; the latter contains the upper half of the malleus and the greater part of
the incus. Including the attic, the vertical and antero-posterior diameters of the
cavity are each about 15 mm. The transverse diameter measures about 6 mm. above
and 4 mm. below; opposite the center of the tympanic membrane it is only about 2
mm. The tympanic cavity is bounded laterally by the tympanic membrane; medially,
by the lateral wall of the internal ear; it communicates, behind, with the tympanic
antrum and through it with the mastoid air cells, and in front with the auditory
tube.The middle ear together with the Eustachian tube, aditus, antrum and mastoid
air cells is called the middle ear cleft. It is lined by mucous membrane and filled
with air.
The middle ear extends much beyond the limits of tympanic membrane
which forms its lateral boundary and is sometimes divided into (i) mesotympanum
(lying opposite the pars tensa), (ii) epitympanum or the attic (lying above the pars
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tensa but medial to Shrapnel’s membrane and the bony lateral attic wall), (iii).
Hypotympanum (lying below the level of pars tensa). The portion of middle ear
around the tympanic orifice of the Eustachian tube is sometimes called the
protympanum.
Middle ear can be likened to a six sided box with a roof, a floor, medial,
lateral, anterior and posterior walls.
Tegmental Wall or Roof (paries tegmentalis) is formed by a thin plate of bone, the
tegmen tympani, which separates the cranial and tympanic cavities. It is situated on
the anterior surface of the petrous portion of the temporal bone close to its angle of
junction with the squama temporalis; it is prolonged backward so as to roof in the
tympanic antrum, and forward to cover in the semicanal for the Tensor tympani
muscle. Its lateral edge corresponds with the remains of the petrosquamous suture.
The Jugular Wall or Floor (paries jugularis) is narrow, and consists of a thin plate
of bone (fundus tympani) which separates the tympanic cavity from the jugular
fossa. It presents, near the labyrinthic wall, a small aperture for the passage of the
tympanic branch of the glossopharyngeal nerve.
The Membranous or Lateral Wall (paries membranacea; outer wall) is formed
mainly by the tympanic membrane, partly by the ring of bone into which this
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membrane is inserted. This ring of bone is incomplete at its upper part, forming a
notch (notch of Rivinus), close to which are three small apertures: the iter chordæ
posterius, the petrotympanic fissure, and the iter chordæ anterius.
The Labyrinthic or Medial Wall (paries labyrinthica; inner wall) is vertical in
direction, and presents for examination the fenestræ vestibuli and cochleæ, the
promontory, and the prominence of the facial canal.
The fenestra vestibuli (fenestra ovalis) is a reniform opening leading from the
tympanic cavity into the vestibule of the internal ear; its long diameter is horizontal,
and its convex border is upward. In the recent state it is occupied by the base of the
stapes, the circumference of which is fixed by the annular ligament to the margin of
the foramen.
The promontory (promontorium) is a rounded hollow prominence, formed by the
projection outward of the first turn of the cochlea; it is placed between the fenestræ,
and is furrowed on its surface by small grooves, for the lodgement of branches of the
tympanic plexus. A minute spicule of bone frequently connects the promontory to
the pyramidal eminence
The prominence of the facial canal (prominentia canalis facialis; prominence of
aqueduct of Fallopius) indicates the position of the bony canal in which the facial
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nerve is contained; this canal traverses the labyrinthic wall of the tympanic cavity
above the fenestra vestibuli, and behind that opening curves nearly vertically
downward along the mastoid wall.
The mastoid or posterior wall (paries mastoidea) is wider above than below, and
presents for examination the entrance to the tympanic antrum, the pyramidal
eminence, and the fossa incudis.
The Carotid or Anterior Wall (paries carotica) is wider above than below; it
corresponds with the carotid canal, from which it is separated by a thin plate of bone
perforated by the tympanic branch of the internal carotid artery, and by the deep
petrosal nerve which connects the sympathetic plexus on the internal carotid artery
with the tympanic plexus on the promontory. At the upper part of the anterior wall
are the orifice of the semicanal for the Tensor tympani muscle and the tympanic
orifice of the auditory tube, separated from each other by a thin horizontal plate of
bone, the septum canalis musculotubarii. These canals run from the tympanic
cavity forward and downward to the retiring angle between the squama and the
petrous portion of the temporal bone
The auditory tube (tuba auditiva; Eustachian tube) is the channel through which
the tympanic cavity communicates with the nasal part of the pharynx. Its length is
about 36 mm., and its direction is downward, forward, and medialy, forming an
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angle of about 45 degrees with the sagittal plane and one of from 30 to 40 degrees
with the horizontal plane. It is formed partly of bone, partly of cartilage and fibrous
tissue.
The osseous portion (pars osseo tubæ auditivæ) is about 12 mm. in length. It begins
in the carotid wall of the tympanic cavity, below the septum canalis musculotubarii,
and, gradually narrowing, ends at the angle of junction of the squama and the
petrous portion of the temporal bone, its extremity presenting a jagged margin which
serves for the attachment of the cartilaginous portion.
The cartilaginous portion (pars cartilaginea tubæ auditivæ), about 24 mm. in
length, is formed of a triangular plate of elastic fibrocartilage, the apex of which is
attached to the margin of the medial end of the osseous portion of the tube, while its
base lies directly under the mucous membrane of the nasal part of the pharynx,
where it forms an elevation, the torus tubarius or cushion, behind the pharyngeal
orifice of the tube. The upper edge of the cartilage is curled upon itself, being bent
laterally so as to present on transverse section the appearance of a hook; a groove or
furrow is thus produced, which is open below and laterally, and this part of the canal
is completed by fibrous membrane. The cartilage lies in a groove between the
petrous part of the temporal and the great wing of the sphenoid; this groove ends
opposite the middle of the medial pterygoid plate. The cartilaginous and bony
portions of the tube are not in the same plane, the former inclining downward a little
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more than the latter. The diameter of the tube is not uniform throughout, being
greatest at the pharyngeal orifice, least at the junction of the bony and cartilaginous
portions, and again increased toward the tympanic cavity; the narrowest part of the
tube is termed the isthmus. The position and relations of the pharyngeal orifice are
described with the nasal part of the pharynx. The mucous membrane of the tube is
continuous in front with that of the nasal part of the pharynx, and behind with that of
the tympanic cavity; it is covered with ciliated epithelium and is thin in the osseous
portion, while in the cartilaginous portion it contains many mucous glands and near
the pharyngeal orifice a considerable amount of adenoid tissue, which has been
named by Gerlach the tube tonsil.
Ossicles of the Middle Ear:
There are three ossicles in the middle ear the malleus, incus and stapes.
The malleus: has head, neck, handle, (manubrium), a lateral and an anterior process.
Head and neck of malleus lie in the attic. Manubrium is embedded in the fibrous
layer of the tympanic membrane. The lateral process forms a knob-like projection on
the outer surface of the tympanic membrane and gives attachment to the anterior and
posterior maleal (malleolar) folds.
The incus has a body and a short process, both of which lie in the attic, and a long
process which hangs vertically and attaches to the head of stapes.
The stapes has a head, neck, anterior and posterior crura and a footplate. The
footplate is held in the oval window by annular ligament.
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The ossicles conduct sound energy from the tympanic membrane to the oval window
and then to the inner ear fluid.
Mastoid antrum:
In the posterior wall of the middle ear cavity there is an opening in the upper portion
which extends from the attic to mastoid antrum. The mastoid antrum is an air
chamber in the temporal bone that communicates anteriorly with the tympanic cavity
through the aditus. Posteriorly, it communicates with the mastoid air cells. During
the development of the mastoid process, the bone is normally filled with marrow.
Only the mastoid antrum and a few periantral cells are present at birth. With
development, the mastoid process becomes cellular in majority of cases which is
regarded as normal.
Lining of the middle ear cleft:
The mucous membrane of the middle ear cavity has a very important role in this
study. A thin delicate mucous membrane lines the whole of the middle ear cavity
and is reflected on to the ossicles and the tendons of tensor tympani and stapedius
muscles. It is continuous with the mucous membrane of the Eustachian tube and the
mastoid antrum. In general, it consists of a single non-ciliated cuboidal epithelium,
two or three cells deep, without a basement membrane, but in parts the cells may be
of simple or ciliated columnar type, especially near the Eustachian tube and in the
hypotympanum.
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The mucous membrane is thrown into a series of folds by the intratympanic
structures. They are important surgically because they divide the middle ear into
compartments and carry blood vessels to the ossicular chain. The ossicular chain,
ligaments, tendons, tensor tympani and stapedius muscles, chorda tympani nerve are
described by Procter as the viscera of the tympanic cavity. The mucosal folds are
considered as its mesenteries.
Intertympanic Muscles:
There are two muscles tensor tympani and the stapedius; the former attaches to
the neck of malleus and tenses the tympanic membrane while the latter attaches to
the neck of stapes and helps to dampen very loud sounds thus preventing noise
trauma to the inner ear, Stapedius is a 2nd arch muscle and is supplied by a branch of
CN VII while tensor tympani develops from the 1st arch and is supplied by a branch
of mandibular nerve(V).
Blood Supply of Middle Ear:
Middle ear is supplied by six arteries, out of which two are the main, i.e.
I. Anterior tympanic branch of maxillary artery which supplies tympanic
membrane.
II. Stylomastoid branch of posterior auricular artery which supplies middle ear
and mastoid air cells.
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Four minor vessels are:
I. Petrosal branch of middle meningeal artery (runs along greater petrosal
nerve).
II. Superior tympanic branch of middle meningeal arery traversing along the
canal for tensor tympani muscle.
Branch of artery of pterygoid canal (runs along Eustachian tube).
(iv). Tympanic branch of internal carotid
Veins drain into pterygoid venous plexus and superior petrosal sinus.
Lymphatic Drainage of Ear
Lymphatics from the middle ear drain into retropharyngeal and parotid nodes while
those of the Eustachian tube drain into retropharyngeal group.
Surgical importance:
1. The middle ear is part of contiguous organs including nose, nasopharynx,
Eustachian tube and mastoid bone lined by respiratory mucosa. Any
respiratory infection or allergy is likely to pass to the middle ear.
2. Moreover middle ear suppurative disease may spread to adjacent organs and
produce complications. E.g., labyrinthitis, meningitis, facial nerve palsy, etc.,
3. Lenticular process is vulnerable in suppurative ear disease and causes
ossicular disruption.
4. Prussac’s space is the site of primary acquired cholesteatoma.92
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INNER EAR:
Inner ear has two parts93
• Bony labyrinth
• Membranous labyrinth
The bony labyrinth is lined by endosteum. Between bony labyrinth and membranous
labyrinth lies the perilymph. It has three parts.
• Vestibule
• Cochlea
• Semicircular canals.
Membranous labyrinth is filled with endolymph and it consists of
• Saccule and utricle
• Membranous Semicircular ducts within the corresponding bony canals.
• The cochlear duct
Vestibule is the central part of the internal ear. On its lateral surface is the opening
of oval window which is closed by the foot plate of stapes. Bony cochlea lies in
front of the vestibule. It has 2.75 turns coiling around a bony axis called modiolus.
Cochlea is approximately 30 mm in length. The hollow centre of the modiolous is a
spiral canal containing the fibres and ganglion cells of cochlear nerve. A thin bony
sheet, the Osseous lamina winds around the modiolus. This divides the cochlear
canal into two galleries, the Scala vestibuli above and the Scala tympani below.
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Semicircular canals are three in number, superior, posterior and lateral. They are
semicircular in shape and opens into the vestibule. One of the ends of the
semicircular is enlarged and is known as ampulla.
Membranous labyrinth is situated within the bony labyrinth. It is connected to the
bony labyrinth by fibrous trabeculae and is surrounded by perilymph. Endolyrnph is
situated within the membranous labyrinth.
The Utricle lies in the upper part of the vestibule while the Saccule lies below.
Utricle and Saccule both contain a single sensory patch called Macula. Each macula
is covered by neuroepithelium. Neuroepithelium consists of sensory hair cells and
supporting cells, these cells are separated by basement membrane. Fibres from the
vestibulo cochlear nerve enter the macula and pierce the basement membrane to end
either at the base of the hair cell or cell bodies. The utricle and saccule with their
macula is refered to as otolith organs.
Membranous semicircular ducts are the membranous ducts in the corresponding
bony semicircular canals. They open into the utricle by five openings. One end of
the opening of each canal is dilated called ampulla in which the sensory organ of
each canal is located.
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The cross section of Scala media resembles a right angle. Its base is formed by
basilar membrane. Upon the surface of the basilar membrane the sensory cells are
arranged. These sensory cells with their supporting cells form a complex
neuroepithelium called the basilar papilla or Organ of corti named after an Italian
Microscopist. Organ of corti has a gelatinous membrane called tectorial membrane
and they are supported by pillar of corti. The pillars of corti enclose a space called
tunnel of corti which contains fluid called cortilymph.
Chart No-2 Showing the Blood supply of Labyrinth
Blood supply of labyrinth:
Labyrinthine artery
Common cochlear Anterior vestibular artery
Vestibulocochlear artery Main cochlear artery
Cochlear branch posterior vestibular artery
PHYSIOLOGY OF HEARING:
A sound signal in the environment is collected by the pinna, passes through external
auditory canal and strikes the tympanic membrane. Vibrations of the tympanic
membrane are transmitted to stapes footplate through a chain of ossicles coupled to
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the tympanic membrane. Movements of stapes foot plate cause pressure changes in
labyrinthine fluids which move the basilar membrane. This stimulates the hair cells
of the Organ of corti. It is these hair cells which act as transducers and convert
mechanical energy to electrical impulses which travel along the auditory nerve.
Thus, the mechanism of hearing can be broadly divided into:
Mechanical conduction of sound (conductive apparatus)
Transduction of mechanical energy to electrical impulses (sensory system of
cochlea)
Conduction of electrical impulses to brain (neural pathways) Conduction of
sound:
Conduction of sound:
Under the surface of water we cannot hear the sound made in air because 99.95 of
sound energy are reflected away from the surface of water because of the impedance
offered by it. A similar situation exists in the ear when air-conducted sound has to
travel to cochlear fluids. Nature has compensated for this loss of sound energy by
interposing the middle ear which converts sound of greater amplitude, but lesser
force, to that of lesser amplitude and greater force. This function of middle ear is
called impedance matching mechanism or the transformer action. It is accompanied
by:
a) Lever action of the ossicles.
Handle of malleus is 1.3 times longer than long process of incus, providing a
mechanical advantage of 1.3
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b) Hydraulic action of tympanic membrane.
The area of tympanic membrane is much larger than the area of stapes foot plate, the
average ratio between the two being 21:1. As the effective vibratory area of the
tympanic membrane is only two- thirds, the effective areal ratio is reduced to 14:1,
and this is the mechanical advantage provided by the tympanic membrane.
c) Curved membrane effect.
Movements of tympanic membrane are more at the periphery than at the center
where handle of malleus is attached. This too provides some leverage.
Transduction of mechanical energy to electrical impulses:
Movements of stapes footplate, transmitted to cochlear fluids, move the basilar
membrane, setting up shearing force between the tectorial membrane and hair cells.
The distraction of hair cells gives rise to cochlear microphonics which triggers the
nerve impulse.
Neural pathways:
Hair cells get innervation from bipolar cells of spiral ganglion. Central axons of
these cells collect to form cochlear nerve which goes to ventral and dorsal cochlear
nuclei. From there, both crossed and uncrossed fibers travel to superior olivary
nucleus, lateral lemniscus, inferior colliculus, and medial geniculate body and finally
reach the auditory cortex of the temporal lobe94.
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DISEASE REVIEW
NIDANA:-
The common etiological factors of Karnaroga are as follows:-46
1. Avashyaya (Excessive exposure to cold)
2. Jalakreeda (Excessive swimming)
3. Karnakandooyanam (Excessive scratching)
4. Mithyayaogena shabdasya (Perverted contact of sound)
5. Mithyayogena shastrasya (improper instrumentation)
6. Abhighata (trauma)
7. Vitiation of tridoshas.
KARNASRAVA SAMANYA NIDANA:
Table No. 1 Showing the Karnasrava samanya nidana according to various
authors.
Sl.No. Samanya Nidana SU47 AH48 AS49 YR50 MN51
1 Avashyaya + + +
2 Pratishayaya + +
3 Karnakandooyana + + + + +
4 Shabda mithyayoga + +
5 Shastra mithyayoga + + +
6 Jalakreeda + + + + +
7 Abhighata + + +
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VISHESHA NIDANA OF KARNASRAVA52
• Shiroabigata
• Jala nimajjana
• Karnaprapaka
• Karna vidradhi
SAMPRAPTI:
Due to common and specific etiological factors the vitiated doshas gets
sthanasamshraya in karna and cause Karnasrava. It is the stages of samprapthi were
doshas gets lodged in srotas. And starts process of dosha dooshya sammurchana53 .
Due to shiroabhigata, jala nimmajjana, karna paka, karna vidradi, vitiates vata
dosha and karna becomes avruta by vata and results in karnasrava54.
Normal physiology of dosha, dhatus, and malas entirely depends on the normality of
srotas. Dosha dooshya sammurchana or manifestation of disease will not take place
if only vitiation of doshas takes place without deformity of srotas55.
Types of vitiation of srotas are atipravrutti sanga, vimargagamana, and siragranthi.
Here in karnasrava, Atipravrutiti, sanga and vimargagamana takes place56.
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Sanga is the obstruction of Eustachian tube; atipravrutti is being excess secretion
and discharge from the middle ear mucosa.
Vimargagamana is the propagation of discharge through external auditory meatus.
Chart No. 3 Representing the samprapti of Karnasrava57.
Samanya and vishesha nidana
↓
Vitiates vata
↓
Avarana by kapha,pitta
↓
Vimargagamana of vata
↓
Srava from karna
SAMPRAPTI GHATAKAS:
Dosha –Predominently vata,
Dooshya – Rasa,Rakta ,Mamsa
Srotas – Shabdavaha
Srotodusti – Sanga, vimarga gamana, Atipravrutthi.
Adhistana – Karna
Rogamarga - Madyama
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Poorvaroopa:
Poorvaroopa of karnasrava is not mentioned separately in any Ayurvedic
classics. In practice certain poorvaroopas are noticed. The following features can be
considered as the premonitory symptoms of karnasrava.
• Karnashoola
• Karna gurutwa (Eustachian tube blockage)
• Nasavarodha
• Prathishyaya.
• Discomfort in throat. etc.
ROOPA58:
Only puyasrava is mentioned as symptom but here puyasrava refers to different
nature of discharge like Jalasrava, rasasrava which can be considered as watery,
mucopurulent and purulent discharge.
UPASHAYA AND ANUPASHAYA:
A judicious application of Aushadhi, Ahara and Vihara, when produces relief in
the symptoms is called as Upashaya and when aggravates the symptoms is called as
Anupashaya.
There is no reference available in the classics about the Upashaya and Anupashaya
of Karnasrava.
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SADHYASADHYATA:
Sadhyasadhyata gives the clear picture of prognosis of the disease. It depends on
many factors like nature of disease, severity of the disease, Vaya, prakriti, bala of
the patient etc.
Sushruta has not mentioned specifically the sadhyaasadhyata of the karnarogas.
But Vagbhata has mentioned Karnasrava as a Sadhyavyadhi59.
UPADRAVA OF KARNASRAVA:
In the classics, there is no reference available regarding the upadrava of
Karnasrava.
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Table No.2 Showing the sapekshanidana of Karnasrava.
Karnasrava60 Pootikarna61 Karnavidradhi62 Sannipataja
Karnashoola63
Kaphaja
karnashoola64
Nidana
Shirobhighhata
Jalanimajjana
karnaprapaka
karnavidradhi
Tridoshakara
Kshata
Abhighata
TRidoshakara
Tridoshakara Kaphakara
Nature of
Srava Puyasrava
Ghanasrava
Puyasrava
Rakta, Peeta,
Aruna Varna
Raktasrava
Sita, Asita,
Rakta,
Ghanasrava
Shweta srava
Pooti
gandha - + - - -
Vedana +/- + +(severe) +(mild)
Other
symptoms -
Bahukleda,
Daha
Dhoomayana
Daha, Chosha
Jwara,
Srutijadyata
Kandu; shiro,
hanu, Greeva
guarava
Prognosis Sadhya Sadhya Sadhya Asadhya Sadhya
Dosha
involved Vata Tridhosha Tridosha Tridosha Kapha
SAMANYA CHIKITSA:
In all the karna rogas, the following principles are told as the general line of
treatment.
• Ghritapana, Rasayana sevana, Brahmacharya palana should be followed for
the preservation of dhatu samyata and restriction of vitiation of Vata65.
• Ativyayama, Atibhashana and Ashira snana should be avoided to protect the
shiras from the affliction of Vata and Kapha66.
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Samanya chikitsa for Karnasrava, Pootikarna and krimikarna67:
In all these conditions, Shirovirechana, Dhoopana, Karnapoorana, Pramarjana,
Prakshalana (Dhavana) should be done based on the necessity.
Vishesha Chikitsa for Karnasrava:
• General treatment principles of Karnasrava described in classics is closely
related to Dustavrana chikitsa68.
• In addition to that Shirovirechana, Karna dhoopana, Karna purana, Karna
Pramarjana, Karna dhavana are also indicated69.
Following treatments are also mentioned:
• Karna prakshalana with aragwadadi gana kashaya and surasadigana
kashaya70.
• Surasadigana and argwadadigana churna for avachurnana.71
Following yogas mentioned for karnapoorana:
a. Panchakashaya with kapittha swarasa and madhu .72
b. Sarjatwak choorna with karpasiphalarasa and madhu.73
c. Laksha, rasanjana with sarjachoorna.74
d. Shaivala, Mahavriksha, jambu, amra pallava kulira, kshuodra and manduki
all are taken in equal quantity and kalka is prepared and 4 times taila is taken
and 16 parts of kwatha is added and taila paka is done75.
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e. Tinduka, abhaya, lodra, samanga (manjista) kwatha of this, dravyas mixed
with madhu and kapittha rasa.76
Dhoopana yoga:
• Dhoopana with guggulu .77
• Dhoopana with the choorna of Bilvapatra, husk, haridra, palandu.78
According to vagbhata:
• Ear should be cleaned with the pichu or varthi followed by guggulu
dhoopana, karnapoorana with madhu.Followed by Avachurnana with
sukshmachoorna of surasadigana.79
Yoga rathnakar:
Mentioned following drugs for karnapoorana
• Samudra phena choorna.80
• Jambuadi taila.81
Internal medications:
• Rasnadi guggulu.82
• Triphala guggulu.83
• Sarivadi vati.84
• Gandhaka rasayana.85
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PATHYAAPATHYA:86
Pathya apathya mentioned for samanya karnaroga is recommended in karnasrava
also.
PATHYA:
Aharaja: Viharaja
• Godhuma Brahmacharya
• Shala Abhashanam
• Mudga Mitabhashanam
• Yava Avyayama
• Puranagrita Upacharaja
• Lava,Harina,Tittira mamsa Vamana
• Patola ,shigru, Vartaka Virechana
• Sunishannaka Nasya,Dhoomapana
• Kathillaka Siravyada
• Vanakukkuta Kavala, Gandoosha
• And all types of rasayana
APATHYAS:87
• Guru, Kaphakara aharas
• Abhishyandakara aharas
• Dhantadavana
• Shirasnana
• Vyayama
• Karna kandooyana
• Tushara sevana
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CHRONIC SUPPURATIVE OTITIS MEDIA
History:95
The existence of chronic suppurative otitis media in prehistoric times has
been clearly documented. [mekenzil and brothwell 1967]
Definition:
It is defined as a long standing chronic suppuration of the middle ear cleft
and its muco periosteal lining resulting in discharging ear and deafness.
Aetiology:
1. Environmental:
a. Socio-economic group: The lower groups having a higher incidence.
b. Unhygienic conditions: Leads to recurrent respiratory tract infections
2. Genetic:
The question as to wheather one race is more Predisposed to c.s.o.m
remains unanswered. The importance of genetic factor was deleted in
particular wheather the incidence was related to the size of the
mastoid air cell system which was considered to be genetically
determined.
Mastoid air cell system is smaller in individuals with otitis media, but
it is not known whether this is a primary or secondary event.
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3. Previous otitis media
It appears to be generally held that chronic otitis media is a sequel of
acute otitis media or otitis media with effusion.
4. Infective
They are mainly gram negative usually streptococci, staphylococci,
pneumococci Bacteria can almost invariably be isolated form the
mucopus or from mucosa of the middle ear in active chronic suppurative
otitis media.
5. Upper respiratory tract infections
Many patients will state that their ear starts to discharge after an upper
respiratory tract infection. The postulate here, would be that the viral
infection would also affect the mucosa of the middle ear making it less
resistance to the organisms that are normally in the middle ear, allowing
bacterial overgrowth.
6. Allergic:
Though postulated by some as an importance factor; it remains to be
proven that allergic individuals have a higher incidence.
7. Eustachian tube malfunction:
In active chronic suppurative otitis media the eustachian tube is
frequently blocked by oedema. Eustachian tube in infants and young
children is shorter ,wider and more horizontal. Breast or bottle feeding in
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a young infant in horizontal position may force fluids through the tube
into middle ear. So keep the infant propped up with head a little higher.
Specific pathology:
Inactive chronic otitis media:
By definition, tympanic membrane is abnormal in inactive chronic otitis media and
the clinical appearance depends upon the method of healing but in all instances there
is a loss of the fibrous tissue layer of the tympanic membrane. Thus, in the
replacement there is a membrane bridging the defect composed only of an outer
layer of squamous epithelium and an inner mucosal one. When a perforation is
present the squamous epithelium of the outer tympanic membrane meets the middle
ear mucosa at a variable position frequently within the middle ear. This has practical
implications for myringoplasty.
Active mucosal disease:
The extent to which mucosa of the middle ear and mastoid is affected varies. Areas
that usually have a non secreting lining are replaced by a respiratory type, mucus
secreting mucosa with goblet cells.
The mucosa is generally hyperemic with an underlying inflammatory response.
Areas of granulation tissue may form especially in non draining areas, such as round
the ossicles. Depending on its severity there can be active resorption and remodeling
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of bone, irrespective of weather a cholesteatoma is present, which can lead to a
fistula of the semicircular canal and dehiscence of the fallopian canal.
CLASSIFICATION OF CHRONIC SUPPURATIVE OTITIS MEDIA
Chronic suppurative otitis media is traditionally classified into two main groups
1. Tubotympanic (Safe from complications)
2. Attico – Antral (risk of intracranial suppuration)
Tubotympanic:
Here the disease is mainly confined to mucosa of the Eustachian tube and anterior
and inferior part of the tympanic cavity which is lined by respiratory type of
epithelium.
Tubotympanic disease is characterized by the presence of a central perforation and
the clinical presentation varies depending on extent and severity of the disease.
Factors influences the tubotympanic type are;
• Patency of the Eustachian tube
• Presence of a nidus of infection in the upper respiratory tact.
• Natural mucosal barrier to infection which is impaired in immune
compromised patients.
• The presence of mixed aerobic and anaerobic microbes.
• Extent and degree of mucosal changes
• Secondary migration of squamous epithilium
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Clinically tubotympanic disease presents as symptoms.
1. Active disease: patient reports to the clinician with a
• Discharging ear
• Deafness
2. Inactive disease:
If bilateral the only presenting feature is deafness. (Conductive) while
in unilateral disease patient may not seek medial advice.
Description of clinical signs and symptoms
1. Recurrent otorrhoea;
Discharge is watery or mucoid and sometimes mucopurulent in character.
May be profuse at times but non foetid. Ear is dry in between infection.
2. Deafness- Progressive unless disease is controlled early
• Type: Conductive
• Severity: Mild to moderate depending on site and size of perforation.
3. Pain: usually absent, but may be present due to secondary infection or
associated otitis externa.
Examination:
Includes:
• Inspection of the ear
• Otoscopic examination
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• Examination of nose, pharynx and postnasal space to assess the state of the
upper respiratory tract.
1. Inspection of the ear:
Inspection with a head mirror to evaluate
• Type of discharge, colour, consistency and odour
• Secondary otitis externa may be present .
2. Otoscopic examination:
Evaluating
1. Site and size of the perforation
2. State of the remainder of the tympanic membrane
3. Nature of the middle ear mucosa
1). Site and size of the perforation
Site – Antero – superior, Antero – inferior or postero – superior or postero – inferior
quadrant is involved.
2). State of the remainder of the tympanic membrane
Note presence of any tympanosclerosis, lack of middle fibrous layer around the
central perforation.
3). Nature of middle ear mucosa:
Note weather – oedematous, slightly injected, red and velvety, presence of
tympanosclerotic plaques.
Investigations:
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1. Examination under microscope:
It provides useful information regarding presence of granulations, in growth
of squamous epithelium from the edges of perforation.
Status of ossicular chain
Tympanosclerosis and adhesions
2. Audiogram:
To assess degree of hearing loss and its type. Usually it is conductive.
3. culture and sensitivity: to select proper antibiotic
4. Mastoid x-rays: Usually sclerotic, but may be pneumatised.
Treatment:96
1. Aural toilet: Remove all discharge and debris
It can be done by
I. Dry mopping
II. Suction clearance
2. Ear drops: Antibiotic ear drops containing neomycin, polymyxin, chloromycetin
or gentamicin are used.
These are combined with steroids which have local anti inflammatory effect.
1. Systemic antibiotics: in acute exacerbation of chronically infected ear.
2. Precautions; Keep water out of ear during bathing, swimming and hand wash
3. Treatment of contributory causes:
Like infected adenoids, tonsils, nasal allergy.
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Surgical treatment:
Aural polyp or granulations if present should be removed before local
treatment.
Once ear is dry myringoplasty with or without ossicular reconstruction can
be done.
Purpose: 1. To close the perforated drum and avoid recurrent discharge.
2. To restore hearing
Atticoantraltype: ::
It involves postero superior part of middle ear cleft (Attic, antrum, posterior
tympanum and mastoid.) and is associated with cholesteatoma because of its bone
eroding properties, causes risk of serious complications.
Cholesteatoma:97
Normally, middle ear cleft is lined by difference types of epithelium.
1.Ciliated columnar epithelium in antero inferior part
2. Cuboidal in middle part
3. Pavement like in attic
The middle ear is no where lined by keratinized squamous epithelium. If it is present
in the middle ear or mastoid that constitutes a cholesteatoma.
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Origin:
1. Presence of congenital cell rests
2. Invagination of tympanic membrane from attic or posteriosuperior part of
pars tensa. In the form of retraction pocket (wittmacks theory)
3. Basal cell hyperplasia (Ruedis theory)
4. Epithelial invasion (Habermanns theory)
From meatus or outer tympanic membrane surface.
5. Metaplasia of middle ear mucosa.[sades theory]
Pathological process
1. Cholesteatoma
2. Ostetis and granulation tissue
3. Ossicular necrosis
4. Cholesterol granuloma – mass of granulation tissue with foreign body
giant cells.
Symptoms:
1. Ear discharge: usually scanty, always foul smelling.
2. Hearing loss: mostly conductive but sensorineural element may be added.
3. Bleeding may occur from granulations or polyp, while cleaning the ear.
Signs:
1. Perforation: Attic or postero superior marginal type
2. Retraction pocket: an invagination of tympanic membrane is seen in the attic
or postero superior area of pars tensa.
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3. Cholesteatoma: pearly white flakes of cholesteatoma can be sucked from the
retraction pockets.
Investigations:
1. Examination under microscope: for presence of cholesteatoma its site and
extent, evidence of bone destruction, granuloma, condition of ossicles.
2. Tuning fork tests and audiogram: to confirm degree and type of hearing loss.
3. X-Ray mastoids / CT scan temporal bone.
Indicate extent of bone destruction and degree of mastoid pneumatisation
4. Culture and sensitivity of ear discharge.
To select proper antibiotic
Treatment:
Surgical:
It is the mainstay of treatment
1. Primary aim in surgical treatment is to remove the disease and render the
ear safe.
2. To preserve or reconstruct the hearing but never at the cost of the primary
aim.
1. Modified radical mastoidectomy:
The disease is eradicated from the epitympanum and mastoid bone. Outer
attic wall and posterior meatal wall are removed. So that mastoid cell area
and attic become a common cavity.
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ngaluru 48
2. Radial mastoidectomy: this operation is to eradicate disease of the middle ear
and mastoid in which the mastoid antrum, attic and middle ear are
exteriorized. So that they form a common cavity with the external canal.
Complications of Csom:98
• Postauricular abscess
• Facial nerve paresis
• Labyrinthitis
• Labyrinthine fistula
• Mastoiditis
• Temporal abscess
• Petrositis
• Intracranial abscess
• Meningitis
• Otitic hydrocephalus
• Sigmoid sinus thrombosis
• Encephalocele
• CSF leak
Pathophysiology:
Spread of infection from the ear and temporal bone causes intracranial complications
of otitis media. Spread of infection occurs through 3 routes, namely, direct
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extension, thrombophlebitis, and hematogenous dissemination. Extracranial
complications are usually direct sequelae of localized acute or chronic inflammation.
• The following signs or symptoms are suggestive of intracranial
complications:99
o Fever associated with a chronic perforation
o Lethargy
o Focal neurologic signs (eg, ataxia, oculomotor deficits, seizure)
o Papilledema
o Meningismus
o Altered mental status
o Severe headaches
• The following signs or symptoms are suggestive of extracranial
complications:
o Fever associated with a chronic perforation
o Postauricular edema or erythema
• Facial nerve paresis or paralysis
• Fetid otorrhea
• Retro-orbital pain on the side of the infected ear.
• Vertigo
• Spontaneous nystagmus associated with sensorineural hearing loss.
• An infected ear
• Presentation of extracranial complications includes the following:
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o Labyrinthitis - Fever, nystagmus, serous or suppurative otitis media.
o Mastoiditis with subperiosteal abscess - Fever, fluctuance overlying.
the mastoid area, lateral displacement of pinna, otitis media.
o Petrositis - Retro-orbital pain, otorrhea, abducens paralysis, fever.
• Presentation of intracranial complications includes the following:
o Brain abscess - Fever, possibly seizures or focal neurologic signs,
headache
o Meningitis - Fever, meningismus
o Otitic hydrocephalus - Headache, signs of increased intracranial
pressure in setting of otitis media
o Sigmoid sinus thrombosis - Spiking fever, otitis media, edema and
tenderness over mastoid cortex, headache
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PROCEDURE REVIEW
Dhoopana is administering dhuma with the help of dhupana dravya.100
There are many references regarding Dhupana in Ayurvedic classics.
In Kashyapa Samhita there are 40 types of Dhoopana advised for children.
Anesthesia (mohajanana Dhoopa) is also mentioned .For this Dhoopana, the drugs
used were herbs, hairs of animals, legs, horns, hairs of Brahman, old clothes of
Buddhist monks.101
From the references available regarding dhoopana we can understand that karna can
be protected from maggots (Krimi), bacteria (Rakshogna), lice etc. References
clearly indicate the analgesic and disinfectant effect of Dhoopana karma time and
again.
Dhoopana is mentioned for dusta vrana chikitsa. It reduces vedana, srava,
pootiganda of dustavrana. It also helps in vrana ropana. Dustavrana chikitsa is
mentioned in the treatment of karnasrava.102
Origin of Dhoopana:103
Children of the rishis were constantly harassed by the rakshasas. So the sages/rishis
approached lord agni for shelter. Agni in turn gave them Dhoopana dravya and
asked the sages to use the Dhoopana for protection against rakshasas, bhutas,
pishachas.
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Classification of Dhoopana:104
1. It is classified into Dhupa, Anudhupa and Pratidhupa.
2. On the basis of origin,It is classified into Jangama and Sthavara
Selection of guggulu for Dhoopana
1. Sayana introduced guggulu as a well known Dhoopana dravya.105
2. It is Best vatahara.106
3. It is Krimigna107.
4. As it contains oleoresin.108
5. In Astanga hrudaya Guggulu Dhoopana mentioned for Puya karna.109
Karna Dhoopana Indications:110
1. Karna srava.
2. Putikarna.
3. Krimikarna.
4. Vataja Karnashula .
5. Pakwa Puyavaha karna .111
Contraindications;
There is no mention of any contraindication of karna dhoopana in our classics
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DRUG REVIEW
In this chapter attempt has been made to review the drugs used in the present study.
Shuddha guggulu was taken for Karna dhoopana in Group A and Rasnadi guggulu
was administered internally in Group B. In Group C both Guggulu karna dhoopana
and Rasnadi guggulu internally was administered.
Historical review of Guggulu:112
Guggulu has a long history of use in Ayurveda. Atharvaveda, one of the well-
known scripture (Vedas) of the Hindus, is the earliest reference to the medicinal and
therapeutic properties of Guggulu. Detailed description regarding the actions, uses,
and indications as well as the variety of Guggulu has been described in the
Ayurvedic classics by Charaka, Sushruta and Vagbhata. In addition, various
Nigantus (Medical lexicons) were written between 12th and 14th centuries A.D was
based on the Ayurvedic literature also describes Guggulu.
The explanation of word Guggulu is that Gunjo vyadhegurdti rakshati which means
to give relief against different diseases.
Guggulu is the best medicine, because it develops through the rays of hot sun on
specific circumstances. Guggulu has an aromatic odour.
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1. GUGGULU:113
Latin name : Commiphora mukul
Family : Burseraceae
Rasa : Tikta, Katu
Guna : Laghu, Ruksha, Visada, sukshma, sara
Veerya : Usna
Vipaka : Katu
Action : Rasayana, Lekhana
Dosha karma : Tridoshahara
Chemical composition:
Oleoresin – Z- Guggulsterone, E – Guggulsterone
Gum – guggulignans I and II; gugguluTetrols, mukulol allylcembrol, c-27
guggulusterol I, II and III, Z and E – guggulusterol
Volatile oils- Phenol, euginol, cuminic aldehyde-2 pinine Limonene and
Sesquiterpines
Parts used: Gum oleoresin.
Guggulu lipid stimulates the activity of white blood cells in the body contributing to
the build up of the immune system. Guggulu lipid also helps to eliminate and expel
dead tissues, wastes, and toxins from the body.
Guggulu purity test:114
1. A yellowish brown emulsion is obtained when Guggulu is triturated with water.
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2. An ethereal solution of the drug attains reddish colour when treated with br2
vapours and purple colour, when moistened with nitric acid.
In the present study Group B was treated with Rasnadi guggulu. The ingredients are
Rasna, Guduchi, Erandamula, devadaru, shunti.
Method of preparation of Rasnadi guggulu:115
One part each of Churna of Rasna, Guduchi, Erandamoola, Devadarau and shunti
were taken, to this 5 parts of shuddha guggulu is added and vati is prepared by
adding adequate quantity of gruta
2. RASNA:116
Latin name : Alpinia officinarum
Family : Zingiberaceae
Rasa : Tikta
Guna : Guru
Virya : usna
Vipak a : Katu
Dosha karma : Kapha– vatahara
Action : Vayastapana
Chemical composition: Galangin, kaemferide, diaryl heptanoid
3. GUDUCHI:
Latin name : Tinospora cordifolia
Family : Menispermaceae
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Rasa : Tikta kashaya
Guna : guru, snigda
Virya : ushnaDahapra
Vipaka : Madhura
Dosha karma : Tridosha shamaka
Action : Rasayana, medya, deepaniya, grahi, medohara,
Kandugna, Jwarahara, shamana
Chemical composition: Tinosporin, Tinosporid and cordifolide
Pharmacological action:
C.N.S depressant antibacterial, antimicrobial, antipyretic, anti-inflammatory, anti-
arthritic, anti-allergic, hepatoprotective, analgesic, immunostimulant,
immunosuppressive, anti-neoplastic, anti-stress, anti-diabetic, anti-tumor,
adaptogenic, antioxidant , hypotensive, diuretic.
4. ERANDA:
Boranical name : Ricinus communis
Family : Euphorbiaceae
Rasa : Madhura, Katu kashaya
Guna : Snigda, Tikshna, Sukshma
Virya : Ushna
Vipaka : Madhura
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Doshakarma : Kapha – vatahara
Action : Rechana, vrishya
Chemical composition:
Seeds and leaves - Ricinine
Seed coat - Lupeol, lipids, phosphatides
Seed oil - Arachidic, ricinoluc, palmitic
Pharmacological activities:
Anti-inflammatory, spasmogenic, Hepatoprotective, antifertility, purgative,
immunizing, C.N.S depressant.
5. DEVADARU:
Botnaical name : Cedrus deodara
Family : Pinaceae
Rasa : Tikta katu, kashaya
Guna : Laghu, ruksha
Virya : Usna
Vipaka : katu
Dosha – karma : kapha- vatahara, dipana, kasahara
Action : Dipana, kasahara
Chemical composition:
Stem bark: deodarin, toxifolin
Pharmacological activities:
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Antibacterial, Atherosclerotic, Antihistaminic, Anti- arthritic, Antiviral, Anti-
inflammatory, Anti- rheumatic, hypocholestremic, hypolipedemic, Anti-fertility,
increases high density serum cholesterol. Fibrinolytic activity.
It is useful in worm infestation. It is used as lotion for wounds and as gargle in
dental carries, weak and spongy gums.
Karma: Shoolahara. Vedanastapana, Vranshodana, Vranaropana
6. SHUNTI:
Botanical name : Zingiber officinale
Family : Scitaminae
Rasa : Katu
Guna : Guru, ruksa, tikshana
Veerya : Usna
Vipaka : Madhura
Dosha karma : vata kaphahara
Action : Deepana, bhedana
Chemical composition:
Alpha and Beta zingiberenes, zingiberol, Zingerone, gingerols.
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MATERIALS AND METHODS
Aim of the study:
To evaluate the effect of Shuddha Guggulu Karnadhoopana and Rasnadi guggulu
internally in the management of Karnasrava.
The objectives of present study are:
1. To evaluate the efficacy of Shuddha Guggulu Karnadhoopana in the
management of Karnasrava.
2. To evaluate the efficacy of Rasnadiguggulu internally in the management of
Karnasrava.
3. To compare the effects of Shuddha Guggulu Karna Dhoopana procedure and
Rasnadi Guggulu internal administration.
Source of data:
Patients with classical features of Karnasrava selected from the OPD and IPD of
Shalakya tantra SJIIM Hospital Bengaluru.
Sampling method:
The patients diagnosed as Karnasrava were selected randomly irrespective of
their sex, caste, and socio economic status. The patients were examined in detail as
per the specially prepared case sheet proforma which includes both Ayurvedic and
Modern methods of examination.
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Criteria for selection of patients:
Inclusion criteria:
1. Patients in the age group of 5 yrs to 65 yrs.
2. Chronicity of Karnasrava of more than 3 months.
3. Karnasrava associated with conductive deafness.
4. Karnasrava without any systemic complications.
5. Central perforations of tympanic membrane – pin hole, small, subtotal.
Exclusion criteria:
1. Patients below 5 yrs and above 65 yrs.
2. Karnasrava of less than 3 months chronicity.
3. Attic, marginal, total perforation of tympanic membrane.
4. Blood stained and fetid ear discharge.
5. Karnasrava associated with Sensori-neural and mixed deafness.
6. Karnasrava associated with other systemic disorders.
Investigations:
• Pure tone Audiometry
• Blood for hemoglobin percentage
• Total count
• Differential count
• Erythrocyte sedimentation rate
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Research design:
Patients were randomly divided into 3 groups group A, Group B and Group C.
Table No.3 Showing the Study design:
Groups Chikitsta Prayoga Prayogaavadhi Nireekshana
A Karnadhoopana
with guggulu For 7 days
2 sittings of 7 days
each with an interval
of 2 weeks i.e30 days
3 months
B
Rasnadigugglu
interal
administration
Two tables (each
500mg) twice a
day for 30 days
30 days 3 months
C
Karnadhoopana
withguggulu
along with
rasnadiguggulu
internal
administration
Dhoopana 7 days
rasnadigugglu
two tables twice a
day
30 days of 2 sittings
of 7 days each with a
gap of 2 weeks
Rasnadi gugglu 3o
days
3 months
Method of Karnadhoopana
Poorva karma:
The patient is asked to sit comfortably on a chair, in a place having sufficient light
and devoid of dust. The effected ear is cleaned thoroughly with cotton swab.
Pradhanakarma:
The patient is asked to relax completely on the chair, and fumes are passed to the ear
with dhoopana yantra.
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Dhoopana yantra has two ends one which is funnel shaped kept covering the ear for
the passage of dhuma into the ear canal and the other end in which shudda guggulu
is sprinkled over a ignited charcoal to produce fumes. This dhoopana was given for
5 minutes.
Paschat karma:
After this procedure, the patient is advised to avoid cold and refrigerated food and
drinks, cold water bath, cold wind, fog, and prevent water from entering the ear.
Follow-up study:
After the completion of treatment all the patients are advised to attend the OPD once
in 30 days, upto a period of 3 months for the follow up study.
The drug formulations taken up for the study are;
1. Shuddha Guggulu
2. Rasnadi Guggulu
Collection of drugs:
All the raw materials and Shuddha Guggulu were procured and purchased from
reliable Ayurvedic raw material vender.
Preparation of Rasnadi guggulu:
Was done in Bhaishajya Department of G.A.M.C., Bangalore.
Method of preparation of Rasnadi guggulu:
One part each of Churna of Rasna, Guduchi, Erandamoola, Devadarau and Shunti
were taken. To this 5 parts of Shuddha guggulu is added and vati is prepared by
adding adequate quantity of Gruta.
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Criteria for assessment of effects of the treatment:
1. Impaired hearing
2. Otoscopic examination
A.Ear discharge
B.Perforation
3. Pure tone Audiometry
Table No.4, Showing the Subjective and objective Parameters
SUBJECTVE PARAMETERS
Impaired hearing 0 – Absent
1 – Unable to hear whispering voice
2 – Unable to hear normal voice
3 - Unable to hear loud voice
OBJECTIVE PARAMETERS
Otoscopic examination
1. Ear discharge 0 – Absent
1 – Mild - scanty secretion near Tympanic membrane
2 – Moderate - Secretion irrigating in the ear canal
3 - Severe - secretions coming out of ear canal
2. Perforation 0 – No perforation of tympanic membrane
1 – Mild - pin hole, small central perforation
2 – Moderate - large central perforation
3 - Severe – sub total perforation
Pure tone audiometry 0 – upto 25 dB
1 – 26 to 45dB
2 – 45 to 65dB
3 - more than 65dB
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Statistical analysis of the result:
The result having P value less than <0.05 is considered as statistically significant in
this study.
Criteria for assessment of overall effects:
Overall effect of the therapy was assessed in terms of complete remission, marked
improvement, moderate improvement, and mild improvement and unchanged is
observed by adopting the following criteria.
• Complete remission: 100% relief in Chief complaints and no recurrence
during follow up study were considered as complete remission.
• Marked improvement: 75-100% improvement in chief complaints is
recorded as marked improvement.
• Moderate improvement: 50-75% improvement in chief complaints is
recorded as moderate improvement.
• Mild improvement: 25-50% improvement in chief complaints is considered
as mild improvement.
• Unchanged: Less than 25% improvement in chief complaints or recurrence
of the symptoms to the similar extent of severity is noted as recurrence.
Follow up study:
After the completion of treatment, all the patients were advised to attend the O.P.D
for three months at regular interval of thirty days for the follow up study.
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CLINICAL OBSERVATIONS
DEMOGRAPHIC DATA
Table-5
Age wise distribution of patients:
Group A Group B Group C Total Age
Total No. Total No. Total No. Total No. %
5-14 2 1 1 4 8.88
15.24 6 4 5 15 33.34
25-34 1 1 4 6 13.34
35.44 3 3 4 10 22.23
45-54 13 4 1 8 17.77
55-65 0 2 0 2 4.44
Total 15 15 15 45 100
Out of 45 patients selected 4 (8.88%) were in the age group of 5-14 yrs. 15 (33.34%)
were in the age group of 15-24 yrs. 6(13.34%) were in the age group of 25-34 yrs.
10 (22.23%) were in the age group of 35-44yrs. 8 (17.77%) were in the age group
of 45-54 yrs. 2 (4.44%) were in the age group of 55-65yrs.
In group A, 2 (13.33%) were in the age group of 5-14yrs. 6(40%) were in the age
group of 15-24yrs. 1 was (6.67%) in the age group of 35-44yrs. 3 (20%) were in
the age group of 45-54yrs.
In group B, 1 (6.67%) was in the age group of 5-14yrs. 4 (26.66%) were in the age
group of 15-24yrs. 1 (6.67%) was in the age group of 25-34yrs. 3(20%) were in the
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 66
age group of 35-44yrs. 4(26.66%) patients were in the age group of 45-54yrs. 2
(13.34%) patients were in the age group of 55-65yrs.
In group C, 1 (6.67%) was in the age group of 5-14yrs. 5 patients (33.34%) were in
the age group of 15-24yrs. 4 (26.66%) were in the age group of 25-34 yrs. 4
(26.66%) were in the age group of 35-44yrs. 1 (6.67%) patient was in the age group
of 45-54yrs.
Diagram-1 showing age wise distribution
Age wise distribution
15
6
10
8
5 to 14 15-24 25-34 35-44 45-54 55-64
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 67
Table-6
Distribution of sex in trial group
Total Sex Group A Group B Group C
No.s Percentage
Male 08 07 10 25 55.55%
Female 07 08 058 20 44.45%
Total 15 15 15 45 100%
Diagram – 2 showing distribution of Sex in trial group
Among 45 patients selected, 25(55.55%) were males and 20(35.56%) were females.
In group A, out of 15 patients 8(53.33%) were males and 7(46.67%) were females.
In group B, out of 15 patients 7(46.67%) were males and 8 (53.33%) were females.
In group C, out of 15 patients 10(66.67%) were males and 5 (33.33%) were females
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 68
Table-7
Distribution of religion in trial group
Total Religion Group A Group B Group C
No.s Percentage
Hindu 11 14 12 37 82.22%
Christian 01 01 00 02 4.45%
Muslim 03 00 03 06 13.33%
Others 00 00 00 00 0.0%
Total 15 15 15 45 100%
Diagram – 3 showing distribution of Religion in trial group
Among 45 patients selected 37(82.22%) were Hindus, 2 (4.45%) were Christians,
6(13.33%) were Muslims.
In group A, out of 15 patients, 11(73.33%) were Hindus, 1(6.67%) was
Christian,3(20%) were Muslims.
In group B, out of 15 patients, 14(93.33%) were Hindus, 1(6.67%) was Christian.
In group C, out of 15 patients, 12(80%) were Hindus, 3(20%) were Muslims.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 69
Table-8
Distribution of Occupation in trial group
Total Occupation Group A Group B Group C
No.s Percentage
Executive 04 04 01 09 20.0%
House wife 02 02 03 07 15.55%
Manual workers 07 05 07 19 42.22%
Student 02 04 04 10 22.22%
Total 15 15 15 45 100%
Diagram – 4 showing distribution of Occupation in trial group
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 70
Among 45 patients selected 9(20.0%) were Executives, 7(15.55%) were
Housewives, 19(42.22%) were manual workers, and 10(22.30%) were students.
In group A, out of 15 patients 4(26.67%) were executives, 2(13.33%) were
Housewives, 7(46.67%) were manual workers, 2(13.33%) were students.
In group B, out of 15 patients 4(26.67%) were executives, 2(13.33%) were
Housewives, 5(33.33%) were manual workers, 4 (26.67%) were students.
In group C, out of 15 patients 1(26.67%) was a Executive. 3 (20%) were
Housewives, 7(46.67%) were manual workers, and 4 (26.67%) were students
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 71
Table-9
Distribution of Martial status in trial group
Total Martial status Group A Group B Group C
No.s Percentage
Married 09 10 08 27 60%
Unmarried 06 05 07 18 40%
Total 15 15 15 45 100%
Diagram – 5 showing distribution of Martial Status in trial group
Among 45 patients selected 27(60%) were married and 18(40%) were unmarried.
In group A, out of 15 patients 9(60%) were married and 6(40%) were unmarried.
In groupB, out of 15 patients 10(66.67%) were married and 5(33.33%) were
unmarried.
In group C, out of 15 patients 8(53.33% ) were married and 7(46.66%) were
unmarried.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 72
Table -10
Distribution of diet in trial group
Total Diet Group A Group B Group C
No.s Percentage
Vegetarian 04 06 07 17 37.78%
Mixed 11 09 08 28 62.28%
Total 15 15 15 45 100%
Diagram – 6 showing distribution of diet in trial group
Among 45 patients selected, 17(37.78%) were vegetarians and 28(62.22%) were of
mixed diet.
In group A, out of 15 patients, 4(26.67%) were vegetarians and 11(73.33%) were of
mixed diet.
In group B, out of 15 patients, 6(40%) were vegetarians and 9(60%) were of mixed
diet.
In group C, out o 15 patients, 7(46.67%) were vegetarians and 8(53.33%) were of
mixed diet.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 73
Table-11
Distribution of socio-economic status in trial group
Total socio-economic
status Group A Group B Group C
No.s Percentage
Upper class 03 02 03 08 17.78%
Middle Class 05 05 07 17 37.77%
Lower Class 07 08 05 20 44.44%
Total 15 15 15 45 100%
Diagram – 7 showing distribution of socio-economic status in trial group
Among 45 patients selected, 8(17.71%) were from upper class, 17(37.77%) were
from middle class, 20(44.44%) were from lower class.
In group A, out of 15 patients 3(20%) were from upper class, 5(33.33%) were from
middle class, and 7(46.67%) were from lower class.
In group B, out of 15 patients, 2(13.34%) were from upper class, 5(33.33%) were
from middle class and 8(53.33%) were from lower class.
In group C, out of 15 patients, 3(20%) were from upper class, 7(46.67%) were from
middle class, 5(33.33%) were from lower class.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 74
Table-12
Distribution of laterality in trial group
Total Laterality
Group
A
Group
B
Group
C No.s Percentage
Unilateral 9 8 9 26 57.78
Bilateral 6 7 6 19 42.221
Total 15 15 15 45 100%
Diagram – 8 showing distribution of Laterality in trial group
Among 45 patients selected, 26(57.78%) had Unilateral involvement and
19(42.22%) had bilateral involvement.
In group A, among 15 patients 9(60%) had Unilateral involvement and 6 (40%) had
bilateral involvement.
In group B, among 15 patients 8 (53.33%) had Unilateral involvement and
7(46.67%) had bilateral involvement.
In group C, among 15 patients 9(60%) had Unilateral involvement and 6(40%) had
bilateral involvement.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 75
Table -13
Distribution of chronicity in trial group
Total Duration of illness in
years Group A Group B Group C
No.s Percentage
Below 1 year 1 1 2 4 8.88%
1-2 7 6 8 21 46.66%
2-3 5 2 2 6 13.33%
Above 3 2 6 3 14 31.11%
Total 15 15 15 45 100%
Diagram – 9 Showing distribution of chronicity in trail group
Out of 45 patients selected, in 4(8.88%) the duration of illness was below 1
year, in 21(46.66%) duration was between 1-2years, in 6(13.33%) duration was 2-3
years and in 14(31.11%) duration was above 3 years.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 76
In group A, out of 15 patients in 1(6.66%) the duration was below 1 year, in
7(46.66%) duration was between 1-2 years, in 2(13.33%) duration was 2-3 years
and in 5(33.33%) duration was more than 3 years.
In group B, out of 15 patient’s in 1 (6.66%) duration was below 1 year, In 6(40%)
the duration was 1-2 years. In 2(13.33%) the duration was 2-3 years and in 6(40%)
the duration was above 3 years.
In group C, out of 15 patients, in 2(13.33%) the duration was below 1 year, In
8(53.33%) the duration was 1-2 years and in 2(13.33%) the duration was 2 -3 years
and in 3(20%) the duration was above 3 years.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 77
Table-14
Distribution of Prevalence of Nidanas in trial group
Total Prevalence of
Ndianas
Group
A
Group
B
Group
C No.s Percentage
Jala Nimajjana 5 06 08 19 42.22%
Prapakat vidradhi - - - - ---
Shiroabhigata 2 1 1 4 08.88%
Avashyaya 06 06 5 17 37.77%
Pratishyaya 15 15 15 45 100%
Karnakandooyana 02 03 02 07 15.55%
Total
Diagram – 10 showing distribution of Prevalence of Nidanas in trial group
Among 45 patients selected, 19(42.22%) had Jala Nimajjana, 4(8.88%) had
Shiroab
Prevalence of Nidanas
19
04
1745
7
Jalanimajjanat Prapakat vidradhi ShirobhighataAvashyaya Pratishyaya Karnakanduyana
igata, 7(15.55%) had Karna Kandooyana as Nidana along with pratishyaya.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 78
In group A, out of 15 patients 5(33.33%) had Jala Nimajjana as Nidana, 2(13.33%)
had Shiroabigata as Nidana, 6(40%) had Pratishyaya as Nidana, 2(13.33%) had
Karna Kandooyana as Nidana.
In a group B, 6(40%) had Jala Nimajjana as Nidana, 1(6.66%) had Shiroabigata as
Nidana, 6(40%) had Avashyaya as Nidana, 8(53.33%) had Pratishyaya as Nidana,
2(13.33%) had Karna Kandooyana as Nidana.
In group C, 8(53.33%) had Jala Nimajjana as Nidana, 1(6.66%) had Shiroabigata as
Nidana, 5(33.33%) had Avashyaya as Nidana, 7(46.66%) had Pratishyaya as
Nidana, 2(13.33%) had Karna Kandooyana as Nidana.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 79
Table-15 Prakruti wise distribution of patients
Group A Group B Group C Total Prakruti Total
No. %
Total No.
% Total No.
% Total No.
%
Vatakaphaja 8 53.33 7 46.66 10 66.66 25 55.55
Kaphavataja 5 33.34 6 40 2 13.34 13 28.89
Vatapittaja 2 13.34 2 13.34 3 20 07 15.56
Total 15 100 15 100 15 100 45 100
Out of 45 patients selected 25 (55.55%) were of vatakaphaja prakruti, 13 (28.87%)
were of Kaphavataja prakaruti, 7 (15.56%) were of vatapitiaja prakruti.
In Group A, 8(53.33%) were of vatakphaja prakarut,i 5 were of (33.34%)
Kaphavataja prakruti, 2 (13.34%) were of vatapittaja prakurti.
In Group B, 7 (46.66%) were of vatakaphaja prakruti, 6 (40%) were of kaphavataja
prakurt, 2(13.34%) were of vatapittajaprakruti.
In Group C, 10 (66.66%) were of vatakaphaja prakruti, 2( 13.34%) were of
Kaphavataja prakruti, 3(20% ) were of vatapittaja prakruti.
Diagram-11 Showing Prakrutiwise Distribution
Prakruti wise
2513
7
VK KV VP
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 80
Table-16 Showing distribution of ear discharge in trail group
Group A Group B Group C Total Percentage Ear
Discharge Rt Left Rt Left Rt left Rt left Rt left
Nil 5 4 3 5 4 5 12 14 26.67% 31.2%
Mild 0 0 1 2 1 2 2 4 4.45% 8.89%
Moderate 6 5 4 3 4 3 14 11 31.12% 24.45%
Severe 4 6 7 5 6 5 17 16 37.78% 35.56%
Total 15 15 15 15 15 15 45 45 100% 100%
Out of 45 patients selected, 19 had (42.23%) bilateral ear discharge, 12(26.67%) had
unilateral discharge only in left ear, 14 had (31.13%) only right ear discharge. In total 31
(68.88%) had left ear discharge. And 33(73.33%) had right ear discharge.
Out of 45 patients 1(6.67%) each in Group B and Group C had mild right ear discharge.
2each (13.34%) in Group B and Group C had mild left ear discharge.
6 (40%) in Group A, 4(26.67%) each in Group B and Group C had moderate Right
ear discharge.
5 (33.34%) group A, 3 (20%) each in group B and Group C had moderate left ear
discharge.
4(26.67%) in group A, 7(46.67%) in group B, 6 (40%) in group C had severe right
ear discharge.
6 (40%) in group A, 5(33.34%) each in group B and Group C had severe left ear
discharge.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 81
1214
2 4
1411
1716
05
101520
Nil Mild Moderate Severe
Ear discharge incidence
Right Left
Diagram-12 showing distribution of Ear discharge in percentage
Table-17 Showing distribution of perforation in trail Group
Group A Group B Group C Total Percentage Perforation
Rt Left Rt Left Rt left Rt Left Rt Left
Nil 5 4 3 5 4 5 12 14 26.64% 31.12%
Mild 6 6 6 7 6 7 18 20 40.00% 44.45%
Moderate 3 4 4 2 3 2 10 8 22.23% 17.78%
Severe 1 1 2 1 2 1 5 3 11.12% 6.68%
Total 15 15 15 15 15 15 45 45 100% 100%
Out of 45 patients, 6 (40%) each in group A, B and C had mild perforation in right ear
7 (46.6%) in group B, 6(40%) each in group A and Group C had mild perforation in
left ear.
3(20%) each in group A and group C, 4 (26.67%) in group B had moderate perforation
in right ear.
4(26.67%) in group A and 2(13.34%) each in group B and group C had moderate
perforation in left ear.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 82
1 (6.67%) in group A, 2(13.34%) each in group B and Group C had severe perforation
right ear.
1(6.67%) each in all 3 groups had severe perforation in left ear.
Diagram-13 Showing distribution of perforation
1214
1820
108
53
0
5
10
15
20
Nil Mild Moderate Severe
Perforation incidence
Right Left
Table-18: Showing distribution of conductive deafness by pure tone audiometry in percentage
Group A Group B Group C Total Percentage Pure tone
Rt Left Rt Left Rt left Rt Left Rt Left
Nil 5 4 3 5 4 5 12 14 26.67% 31.12%
Mild 9 10 9 9 9 9 27 28 60% 62.23%
Moderate 1 1 3 1 2 1 6 3 13.33% 6.67%
Severe 0 0 0 0 0 0 0 0 0.0% 0.0%
Total 15 15 15 15 15 15 45 45 100% 100%
Out of 45 patients selected 19 had bilateral conductive deafness 12 had conductive deafness
only in left ear.
14 had only right ear conductive deafness.
In total 31 patients had left ear conductive deafness and 33 had right ear conductive
deafness.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 83
Out of 45 patients, 9(60%) each in group A, B and C had mild conductive deafness in right
ear
10 (66.67%) in group A, 9(60%) each in group B and Group C had mild conductive
deafness in left ear.
1(6.67%) in group A, 3 (20%) in group B, 2 (13.34%) in group C had moderate conductive
deafness in right ear.
1 patient (6.67%) in all the 3 groups had moderate conductive deafness in left ear.
None of the patients included in the study had suffered from severe conductive deafness.
Diagram-14 Showing Distribution of conductive deafness
1214
2728
63
0 00
5
10
15
20
25
30
Nil Mild Moderate severe
Conductive deafness
Right Left
Table-19: Distribution of impaired hearing in trial group
Group A Group B Group C Total Percentage Distribution
Rt left Rt left Rt left Rt left Rt left
Nil 9 8 5 8 7 9 21 25 46.66% 55.55%
Mild 5 6 7 6 6 5 18 17 40% 37.37%
Moderate 1 1 3 1 2 1 6 3 13.34% 6.67%
Severe 0 0 0 0 0 0 0 0 0.0% 0.0%
Total 15 15 15 15 15 15 45 45 100% 100%
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 84
Out of 45 patients selected 26(57.77%) patients presented with the impaired hearing as a
symptom. 18(40%) suffered from impaired hearing in both the ears. 8(17.78%) had
unilateral involvement.
In total 24(53.34%) had impaired hearing right ear
20(44.45%) had impaired hearing in left ear.
5(33.33%) patients in Group A, 7(46.67%) in Group B, 6(40%) and Group C had mild
impaired hearing in right ear.
6 (40%) each group A and group B, 5(33.34%) in Group C had mild impaired hearing in
left ear.
1(6.67%) in group A, 3 (20%) in group B, 2 (13.34%) in group C had moderate impaired
hearing in right ear.
1 patient (6.67%) in all the 3 groups had moderate impaired hearing in left ear.
None of the patients included in the study had suffered from severe impaired hearing.
Diagram-15 Showing distribution of Impaired hearing
2125
1817
63
0 005
10152025
Nil Mild Moderate Severe
Impaired hearing
Right Left
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 85
Table-20
Distribution of observations in the follow up period in trail group
Observations Group A Group B Group C Total
Recurrence 4 12 3 19 42.23
Non
reoccurrence 11 3 12 26 57.77
Total 15 15 15 15 100
Out of 45patients selected 19 had (42.23%) reoccurrence, 26 (57.77%) had non-
recurrence.
In Group A, 4 (26.67%) had reoccurrence, 11 (73.33%) had non-recurrence.
In Group B, 12 (80%) had reoccurrence, 3(20%) had non-recurring.In Group C,
3(20%) had recurrence, 12 (80%) had non-recurrence.
follow up
19
26
reoccurence non reocurence
Diagram-16 showing the distribution of observations noticed in the follow up
period.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 86
CHANGES IN SEVERITY OF SYMPTOMS IN RESPONSE TO
TREATMENT
Table-21
Data related to periodical changes in Signs& Symptoms during treatment in
Group A
Before treatment 15th Day 30th Day
Relief Relief S Mo Mi Total S Mo Mi
No. % S Mo Mi
No. %
Rt
Ear 5 6 0 10 2 1 4 3 30 0 0 2 8 80
Ear
Discharge Left
Ear 6 5 0 11 1 3 4 3 27.3 0 2 1 8 72.3
Rt
Ear 1 3 6 10 1 3 3 3 30 1 3 3 3 30
Perforation Left
Ear 1 4 6 11 1 4 4 2 18.2 1 4 2 4 36.6
Rt
Ear 0 1 9 10 0 1 7 2 20 0 1 6 3 30
Pure tone
audiometry Left
Ear 0 1 10 11 0 1 9 1 9.9 0 1 6 4 36.6
Rt
Ear 0 1 5 6 0 1 4 1 16.6
0 1 3 2 33.4
Impaired
Hearing Left
Ear 0 1 6 7 0 1 4 2 28.5 0 1 4 2 28.5
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 87
Note: Rt-Right ear, Left-Left ear, Mod-Moderate
Group A:
Before Treatment
Ear discharge:
5 patients in right ear, 6 patients in left ear presented with severe ear discharge and 6
in right and 5 in left presented with moderate ear discharge, no one had mild ear
discharge.
After 15th day:
2 patients in right, 1 patient in left ear had severe ear discharge. 1 patient in right, 3
patients in left had moderate ear discharge. 4 patients each in right and left ear had
mild ear discharge. 3 patients each in right and left ear got relief.
After 30th day:
No patients had severe ear discharge. 2 patients had moderate left ear discharge. 2
in right ear 1 in left ear had mild ear discharge. 8 patients both in right ear and left
ear got relieved from ear discharge.
Perforation:
Before Treatment:
1 patient each in right and left ear had severe perforation 3 in right and 4 in left had
moderate perforation. 6 in both right and left ear had mild peroration
After 15th day:
1 each in right ear and left ear remained severe. 3 in right and 4 in left had mild
perforation. 3 from right and 2 in left got relieved.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 88
After 30th day:
1 each in right and left ear remained severe. 3 in right and 4 in left remained
moderate. 3 in right and 2 in left had mild perforation. 3 in right and 4 in left got
relieved..
Pure tone Audiometry:
Before treatment:
One Patient both in Right and Left ear had moderate conductive deafness.9 in right
ear and 10 in left ear had mild conductive deafness.
After 15th day:
One Patient both in right and Left ear had moderate conductive deafness.7 in Right
and 9 in left had mild conductive deafness.Two in Right and one in left got
Improvement.
After 30th day:
One patient both in Right ear and Left ear had moderate conductive deafness.6 in
both Right and left Ear had mild conductive deafness.3 in Right and 4 in Left got
improvement.
Impaired hearing:
Before treatment:
1 in both right and left ear had moderate impaired hearing.5 in right and 6 in left
hearing had mild impaired hearing impaired hearing..
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 89
After 15th day:
1 in both right and left ear had moderate impaired hearing 4 patients in both right
and left ear had mild impaired hearing, 1 in right and 2 in left ear got improvement.
After 30th day:
1 in both right and left ear had moderate impaired hearing.3 in right and 4 in left had
mild impaired hearing. 2 patients each in right and left ear got improvement.
28.5
9.9
18.2
27.3
16.6
20
3030
0
5
10
15
20
25
30
Rt Ear Lt Ear
% in Relief after 15 days
Ear dischargePerforationPure tone audiometry
Diagram-17 showing relief in percentage after 15 days in
Group A
Diagram-18 showing relief in percentage after 30 days
01020304050607080
Rt ear Leftear
Ear discharge
Perforation
Audiometry
Impairedhearing Impairedhearing
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 90
CHANGES IN SEVERITY OF SYMPTOMS IN RESPONSE TO
TREATMENT
Table-22
Data related to periodical changes in Signs& Symptoms during treatment in
Group B
Before treatment 15th Day 30th Day
Relief Relief S Mo Mi Total S Mo Mi
No. % S Mo Mi
No. %
Rt
Ear 7 4 1 12 6 4 2 0 0 2 4 3 3 25
Ear
Discharge Left
Ear 5 3 2 10 5 3 2 0 0 2 2 4 2 20
Rt
Ear 2 4 6 12 2 4 6 0 0 2 4 4 2 16.6
Perforation Left
Ear 1 2 7 10 1 2 7 0 0 1 2 6 1 10
Rt
Ear 0 3 9 12 0 3 9 0 0 0 3 7 2 16.6
Pure tone
audiometry Left
Ear 0 1 9 10 0 1 9 0 0 0 1 8 1 10
Rt
Ear 0 3 7 10 0 3 6 0 0 0 2 6 2 20
Impaired
Hearing Left
Ear 0 1 6 7 0 1 5 0 0 0 1 5 1 16.6
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 91
Group B
Before treatment:
Ear discharge:
7 in right ear and 5 in left ear had severe ear discharge. 4 in right and 3 in left had
moderate ear discharge 1 in right and 2 in left had mild ear discharge.
After 15th Day:
6 in right and 5 in left had severe ear discharge. 4 in right and 3 in left ear had
moderate ear discharge. 2 each in both right and left ear had mild ear discharge.
After 30th day:
2 each in right and left ear had severe ear discharge. 4 in right and 2 in left ear had
moderate ear discharge. 3 in right and 4 in left had mild ear discharge. 3 in right and
2 in left got relief.
Perforation:
Before treatment:
2 in 1 right in left ear had severe perforation. 4 in right and 2 in left ear had
moderate perforation. 6 in right and 7 in left ear had mild perforation.
After 15th days:
2 in right, 1 in left ear remained severe. 4 in right and 2 in left had moderate
perforation. 6 in right and 7 in left ear had mild perforation.
After 30th day:
2 in right 1 in left ear had severe perforation. 4 in right and 6 in left ear had mild
perforation. 2 in right ear, 1 in left ear got relieved.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 92
Pure tone Audiometry:
Before treatment:
3 in right and 1 in left ear had moderate conductive deafness. 9 each in right and left
ear had mild conductive deafness.
After 15th day:
3 in right ear and 1 in left ear had moderate conductive deafness 9 each in right and
left ear had mild conductive deafness.
After 30th day:
3 in right ear 1 in left ear had moderate conductive deafness. 7 in right ear and 8 in
left ear had mild conductive deafness. 2 in right ear and 1 in left ear got
improvement
Impaired hearing:
Before treatment:
3 in right 1 in left ear had moderate impaired hearing. 7 in right ear and 6 in left ear
had mild impaired hearing.
After 15th day:
3 in right, 1 in left had moderate impaired hearing 6 in right and 5 in left had mild
impaired hearing no patient in right and left ear got improvement.
After 30th day:
2 in right 1 in left ear had moderate impaired hearing, 6 in right and 5 in left had
mild impaired hearing 2 in right ear and 1 in left ear got improvement.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 93
0
0.2
0.4
0.6
0.8
1
Rt ear Leftear
Ear discharge
Perforation
Pure toneAudiometryImpairedhearing
Diagram-19 showing relief in percentage after 15 days
Diagram-20 showing Relief in percentage after 30 days
0
5
10
15
20
25
Rt ear Rt ear Leftear
Ear discharge
Perforation
PuretoneaudiometryImpairedhearing
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 94
CHANGES IN SEVERITY OF SYMPTOMS IN RESPONSE TO
TREATMENT
Table-23
Data related to periodical changes in Signs& Symptoms during treatment in
Group C
Before treatment 15th Day 30th Day
Relief Relief Severe Mod Mild Total Severe Mod Mild
No. % Severe Mod Mild
No. %
Rt
Ear 6 4 1 11 1 2 4 4 36.4 0 0 1 10 90.9
Ear
Discharge Left
Ear 5 3 2 10 0 3 2 5 50 0 0 1 9 90
Rt
Ear 2 3 6 11 2 3 3 3 27.3 2 3 2 4 36.4
Perforation Left
Ear 1 2 7 10 1 2 5 2 20 1 2 3 4 40
Rt
Ear 0 2 9 11 0 2 7 2 18.2 0 2 5 4 36.4
Pure tone
audiometry Left
Ear 0 1 9 10 0 1 8 1 10 0 1 5 4 40
Rt
Ear 0 2 6 8 0 1 6 1 12.5 0 0 4 4 50
Impaired
Hearing Left
Ear 0 1 5 6 0 0 5 1 16.7 0 0 3 3 50
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 95
Group C
Ear discharge:
Before treatment:
6 patients from right ear and 5 in left ear had severe ear discharge. 4 in right ear and
3 in left ear had moderate ear discharge. 1 in right ear and 2 in left ear had mild ear
discharge.
After 15th day:
1 in right ear remained severe. 2 in right ear 3 in left ear had moderate discharge, 4
in right ear, 2 in left ear had mild ear discharge. 4 in right and 5 in left got relieved.
After 30th day:
1 in both right and left ear had mild ear discharge .10 in right and 9 in left got relief.
Perforation:
Before treatment:
2 in right ear and 1 in left ear got severe perforation. 3 in right ear 2 in left ear got
moderate perforation. 6 in right ear 7 in left ear got mild perforation.
After 15th day:
2 in right ear and 1 in left ear remained severe. 3 in right ear 2 in left ear remained
moderate. 3 in right ear 5 in left ear had mild perforation .3 in right ear and 2 in left
ear got relieved
After 30th day:
2 in right ear 1 in left ear remained severe. 3 in right ear 2 in left ear had moderate
perforation .2 in right ear 3 in left ear had mild perforation 4 in both ears got
relieved.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 96
Pure tone Audiometry:
2 in right ear 1 in left ear had moderate conductive deafness. 9 each in both right and
left ears had mild conductive deafness.
After 15th day:
2 in right ear 1 in left ear had moderate conductive deafness. 7 in right 8 in left ear
had mild conductive deafness. 2 in right ear 1 in left ear got improvement.
After 30th day:
2 in right ear 1 in left ear remained moderate. 5 in both right and left ear had mild
conductive deafness .4 in both right and left ear got improvement.
Impaired hearing:
Before treatment:
2 in right ear and 1 in left ear had moderate impaired hearing .7 in right ear and 6 in
left ear had mild impaired hearing.
After 15th day:
1 in right ear had moderate impaired hearing 6 in right ear and 5 in left ear had mild
impaired hearing .1 each in both ears got improvement..
After 30th day:
4 in right ear and 3 in left ear had mild impaired hearing. 4 in right ear and 3 in left
ear got improvement.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 97
05
101520253035404550
Ear discharge
Perforation
Pure toneAudiometryImpairedhearing
Diagram-21 showing relief in percentage after 15 days
0102030405060708090
Rt ear Leftear
Ear discharge
Perforation
Pure toneaudiometryImpaired hearing
Diagram-22 Showing relief in percentage after 30 days
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 98
Statistical analysis was done and results was drawn using student‘t’ test of
significance.
Table-24 Showing Statistical analysis of parameters in Group A:
Group A Mean
BT
Mean
AT
Mean
differenceSD SE
T
Value P value
Ear discharge 1.73 0.234 1.496 0.86 0.1569 9.53 <0.001
Conductive deafness
(pure tone audiometry) 0.766 0.466 0.3 0.458 0.0836 3.5885 <0.05
Perforation 1.06 0.766 0.294 0.455 0.084 3.515 <0.05
Impaired hearing 0.5 0.366 0.134 0.340 0.062 2.16 <0.05
Effect of guggulu dhoopana on Ear discharge:-
Before and after treatment shows changes from 1.7 to 0.234, showing a mean
reduction of 1.496 which is statistically significant at the level of p<0.001.
Effect of guggulu dhoopana on conductive deafness:-
Before and after treatment shows changes from 0.766 to 0.466 showing a mean
reduction of 0.3 which is statistically significant at the level of p < 0.05.
Effect of guggulu dhoopana on perforation:-
Before and after treatment shows changes from 1.06 to 0.766 showing a mean
reduction of 0.294 which is statistically significant at the level of p < 0.05.
Effect of guggulu dhoopana on impaired Hearing:-
Before and after treatment shows changes from 0.5 to 0.366 showing a mean
reduction of 0.134 which is statistically significant at the level of p < 0.05.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 99
Diagram-23 Showing Statistical Analysis of Parameters in Group A
Table-25 Showing Statistical analysis of parameters in Group B:
Group B Mean
BT
Main
AT
Mean
differenceSD SE
T
Value P value
Ear discharge 1.76 1.03 0.73 0.443 0.0810 9.00 <0.001
Conductive deafness
(pure tone audiometry) 0.86 0.76 0.10 0.30 0.054 1.85 >0.05
Perforation 1.13 1.03 0.10 0.30 0.034 1.85 >0.05
Impaired hearing 0.7 0.56 0.14 0.347 0.0633 2.12 >0.05
Effect of Rasnadi guggulu on Ear discharge:-
Before and after treatment shows changes from 1.76 to 1.03 showing a mean
reduction of 0.73 which is statistically significant at the level of p < 0.001.
Effect of Rasnadi guggulu on conductive deafness:-
Before and after treatment shows changes from 0.86 to 0.76 showing a mean
reduction of 0.10, which is statistically insignificant at p >0.05.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 100
Effect of Rasnadi guggulu on perforation :-
Before and after treatment shows changes from 1.13 to 1.03 showing a mean
reduction of 0.10 which is statistically insignificant at p > 0.05.
Effect of Rasnadi guggulu on Impaired Hearing :-
Before and after treatment shows changes from 0.7 to 0.56 showing a reduction of
0.14 which is statistically significant at p< 0.05.
Diagram-24 Showing Statistical analysis of Parameters in Group B
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 101
Table-26 Showing Statistical analysis of parameters in Group C:
Group C Mean
BT
Main
AT
Mean
differenceSD SE
T
Value P value
Ear discharge 1.6 0.06 1.533 0.909 0.163 9.63 <0.001
Conductive
deafness (pure
tone audiometry)
0.8 0.46 0.34 0.508 0.0928 3.695 <0.05
Perforation 1.067 0.73 0.337 0.509 0.0928 3.631 <0.05
Impaired hearing 0.566 0.2 0.366 0.232 0.042 8.7142 <0.001
Effect of combined therapy on Ear discharge:-
Before and after treatment shows changes from 1.6 to 0.06 showing a mean
reduction of 1.533 which is statistically significant at p < 0.001.
Effect of combined therapy on conductive deafness:-
Before and after treatment shows changes from 0.8 to 0.46 showing a mean
reduction of 0.337 which is statistically significant at p < 0.05.
Effect of combined therapy on perforation :-
Before and after treatment shows changes from 1.067 to 0.73 showing a reduction of
0.337 which is statistically significant at the level of p < 0.05.
Effect of combined therapy on Impaired Hearing :-
Before and after treatment shows changes from 0.566 to 0.2 showing a reduction of
0.366 which is statistically significant at the level of p < 0.05.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 102
Diagram-25 Showing Statistical analysis of Parameters in Group C
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 103
ASSESSMENT OF OVERALL RESULTS:
Table-27
Assessment of overall results in Group A, B and C at the end of treatment
Response Group A Group B Group C Total
No %
Marked 3 1 5 9 20.00%
Moderate 8 3 7 18 40.00%
Mild 2 4 2 08 17.77%
poor 2 7 1 10 22.23%
Total 15 15 15 45 100%
In Group A, out of 15 patients 3(20.00%) had marked response. 8(53.34%) had
moderate response. 2 (13.34%) had mild response. 2(13.34%) had poor response.
In Group B out of 15 patients 1 (6.67%) had marked response. 3 (20.0%) had
moderate response.4 (26.66%). had mild response.7 had (46.67%) poor responce
In Group C out of 15 patients 5(33.34%) had marked response. 7 (46.67%) had
moderate response. 2(13.34%) had mild response. And 1(6.67%) had poor response.
In total out of 45 patients 9 (20.00%) had marked response. 18(40.00%) had
moderate response. 8(17.77%) had mild response. And 10(22.23%) had poor
response.
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02468
1012141618
totalresponse
MarkedModerateMildpoor
Diagram-26 showing assessment of overall results
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 105
DISCUSSION
DISCUSSION ON REVIEW OF LITERATURE
Sushruta has explained 28 types of karnarogas and karna srava is one among them.
The features of Karnasrava can be correlated to chronic suppurative otitis media,
because the main symptom in both is ear discharge. Chronic suppurative otitis media
is the most common cause of conductive deafness which is more prevalent in the
population.
According to our classics, Vata dosha is responsible for karnasrava. Madukosha
commmentory of Madava nidana clarifies about the involvement of doshas in
karnasrava. He opines that as there is puya there should be involvement of pitta, the
dense discharge is attributed to kapha and sravana is due to the nature of vata.. As
sravana is main laxana in Karnasrava, vata is considered as predominant dosha.
In the present study it was observed that recurrent attacks of pratishyaya were
present in all the patients. Jalanimajjana, avashyaya were other most prevalent
nidanas.
This study was designed as a comparative study, in order to compare the efficacy of
Guggulu karnadhoopana with internal administration of Rasnadiguggulu and also to
find out the combined effect of these two procedures.
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DISCUSSION ON OBSERVATIONS
AGE
In this study slightly more number of patients was in the age group of 15-25 years.
As acute suppurative otitis media is more prevalent in children, repeated attacks of
this would have lead to chronic suppurative otitis media in this age group.
SEX
It was observed that number of male patients (55.55%) suffering from karnasrava
were more than female(45.55%).This may be because the number of males in the
community is more and does not have any significance with the disease karnasrava.
RELIGION
Religion wise distribution of patients showed that majority of patients (82.22%)
were Hindus. This might be because Hindus outnumber other communities in the
general population. Hence it has no research significance.
SOCIOECONOMIC STATUS
Socioeconomic wise distribution of patients in this study showed that karnasrava is
more prevalent in lower class (44.45%) than in middle class (37.77%) and upper
class17.7%. It might be due to the fact that poor living standards, poor nutrition, lack
of health education, lack of timely treatment in lower class predisposes to chronic
suppurative otitis media.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 107
DIET
Dietary wise distribution in the patients of karnasrava showed that 62.22% of the
patients have mixed diet and 37.78% have vegetarian diet. This did not have any
research significance.
OCCUPATION:
Labour class or manual workers were affected more (38.4%). Exposure to dust, poor
nutrition, and poor living standards could be a major reason for such an observation.
LATERALITY
Although karnasrava can be unilateral or bilateral, in the present study, out of 45
patients 26 (57.78%) had unilateral involvement and19 (42.22%) had bilateral
involvement.
PRAKRUTI
Prakruti wise distribution showed that maximum number of patients in this study
were of vatakaphaja (55.55%) followed by kaphavataja prakruti and Vatapittaja
prakruti. This shows that Vata predominent persons are more predisposed to
karnasrava.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 108
DISCUSSION ON CLINICAL FEATURES
The cardinal feature of karnasrava, conductive deafness (evaluated by pure tone
audiometry) and perforation was present in all the patients. Impaired hearing
(subjective) was present in 46.67% of patients in group A, 66% of patients in Group
B, 53.34% in Group C.
Response in Group A after treatment
Karnasrava was relived in 86.54% of patients. There was improvement in
conductive deafness in 39% of patients and perforation was relived in 28.12%.
Improvement inImpaired hearing was seen in 26.7% of patients.
Response in Group B after treatment
Karnasrava was relieved in 41.55% of patients.There was improvement in
Conductive deafness in 8.9%, and perforation was relieved in 11% of patients.
Improvement in Impaired hearing was seen in 19% patients.
Response in Group C after treatment
Karnasrava was relieved in most of the patients. There was improvement in
conductive deafness in 42% of patients. Perforation was relieved in 33% of patients
and improvement in impaired hearing was seen in 64.7% of patients.
It was observed in the present study that most of the patients had mucopurulent ear
discharge.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 109
In our classics only srava is mentioned as a symptom in karnasrava. But it was
observed that all patients had mild- moderate conductive deafness. But in present
study most number of the patients had only mild conductive deafness, because of
this most of the patients presented with ear discharge as a main symptom and
impaired hearing as a associated symptom which was not very significant to the
patient. But it was detected by pure tone audiometry.
Though it is not mentioned directly in our classics, according to the modern textual
information, it is clear that patients with CSOM suffer with deafness of mild to
moderate degrees. The present study also supported this by showing that all the
patients had mild to moderate deafness.
Ear ache is not a feature of CSOM It will be present if CSOM is associated with
otitis externa.
It was observed in the present study that large, subtotal perforations were not healed
with either with Guggulu dhoopana or Rasnadiguggulu internally.
Puretone audiometry test showed that patients with only mild conductive deafness
associated with pinhole or small perforation showed changes. Patients with mild-
moderate deafness with large peerforation did not respond.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 110
Discussion on recurrence:
It was observed in the present study that patients who have not followed
pathyapathya like exposure to cold, water entering into the ear etc had more
recurrence. Reccurence rate was also observed in patients in whom tympanic
membrane perforation was not healed. By this we can conclude that following
pathyapathya very important in preventing recurrence.
ASSESMENT OF RESULTS IN COMPARISION WITH GROUP A, B & C
Objective parameters
Ear discharge
Percentage of Success in Group A- 86.54% Group B- 41.5% and Group C-96%
The difference in success between Group A and Group B is statistically highly
significant at (P<0.001) by students‘t’ test of significance
The difference in success between Group C and Group B is also statistically highly
significant at (P<0.001).
The difference in success between Group C and Group A is also statistically
significant at (P<0.05).
PERFORATION
Percentage of success in Group A-28.12% Group B -8.82%, Group C-33%
The difference in success between Group A and Group B is statistically significant
at (P<0.05).
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The difference in success between Group C and Group B is also statistically
significant at (P<0.05)
The difference in success between Group C and Group A is statistically insignificant
at (P>0.05)
PURETONE AUDIOMETRY
Percentage of success in Group A-39%, Group B- 11.5%, Group C-42%
The difference in success between Group A and Group B is statistically significant
at (P<0.05).
The difference in success in Group C and Group B is statistically significant at
(P<0.05)
The difference in success in Group C and Group A is statistically insignificant at
(P>0.05).
SUBJECTIVE CRITERIA
IMPAIRED HEARING
The percentage of success in Group A-26.67% Group B-19% and Group C-50%
The difference in success in Group A and Group B is statistically significant at
(P<0.05).
The difference of success in Group C and Group B is also statistically highly
significant at (P<0.001).
The difference of success in Group C and Group A is also statistically highly
significant at (P<0.001).
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 112
DISCUSSION ON
PROBABLE MODE OF ACTION OF KARNA DHOOPANA:
Karna dhoopana is a procedure wherein the fumes coming out on burning any drug
is administered directly into the external ear canal. Prior to this procedure the ear
canal is cleaned thoroughly to remove the discharge and other debris to facilitate the
better absorption of the drug. Sushrutha and Vaghbhata has mentioned that
karnasrava can be treated on the lines of Dustavrana. Charaka, while mentioning
dhoopana for dustavrana quotes that dhoopana reduces srava. The fumes of the
dhoopana may bring about the sudative effect and dries up the srava. Another
feature of fumes of dhoopana is that fumes can reach the middle ear where the
pathology of karma srava lies. Heat also causes vasodilation and increased blood
circulation thereby helping in better absorption of the drug and healing. Srava is the
main symptom in karna srava and one of the most important feature of ruksha sweda
is to dry. So in karna srava the karnadhoopana not only dries up the srava but also
creates an unfavourable condition for the growth of the microbes. This not only
helps in controlling the srava but also prevents further progression of the disease.
PROBABLE MODE OF ACTION OF SHUDDA GUGGULU DHOOPANA:
In this study Shudda Guggulu is the drug selected for karna dhoopana.
Guggulu is mentioned as devadhupa in our classics. It tells about importance of
Guggulu as a dhupana dravya. The word meaning of Guggulu is that “Gunjo
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 113
vyadegurdti rakshati” which means to give relief against different diseases.
Guggulu also has an aromatic odour. Sushruta says that guggulu has ksharana
property and gives a simile in Mahavatavyadhi chikitsa that Guggulu cures the
diseases as quickly like thunder burns the tree.
As per our classics vitiated vata dosha is mainly responsible in causing karnasrava.
Charaka emphasises that Guggulu is one of the agra dravya in alleviating vata. In
the present study we can infer that control of karnasrava may be because of the
alleviation of vata dosha.
Guggulu is an oleo gum resin having anti inflammatory, antiseptic, antimicrobial
property. Guggulu has volatile oil as one of its main chemical constituent. A new
active ingredient triterpene, myrrhanol A, has been discovered to have potent anti
inflammatory effect. Volatile oil is capable of volatization and they do not leave any
spot on paper on heating. This fact can be taken into consideration and probably
acknowledge that karna dhoopana with shuddha Guggulu will not leave any residue
in the ear. Removal of fibrin, keratinocyte migration and ingrowth of connective
tissue plays a major role in healing of tympanic membrane. Fibrinolytic property of
guggulu may help in removal of fibrin and thereby healing of the tympanic
membrane.
PROBABLE MODE OF ACTION OF RASNADIGUGGULU INTERNALY:
Rasnadi guggulu was selected for the present study because it has been referred to as
one of the best vata hara dravya in Baishajya Ratnavali. It contains Rasna,
Devadaru, Shunti, Guduchi, Eranda in equal parts and five parts of Guggulu.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 114
Guggulu, because of its katu tiktha rasa and ushna virya reduces vata and medas. It
is proven drug for its anti-inflammatory and antiseptic effect. Guggulu lipid
stimulates the activity of white blood cells in the body contributing to the build up of
the immune system. Rasayana drugs are indicated as samanya chikitsa for all
karnarogas in our classics. Hence it can be inferred that guggulu which is the main
ingredient in the above preparation has cumulative effect of anti-inflammatory and
immunomodulator, thereby bringing relief to the patients suffering from karnasrava.
Plasminogen is a protease enzyme which plays a key role in healing of perforated
tympanic membrane. It is established that guggulu is a plasminogen activator which
in turn helps in healing of tympanic membrane.
Rasnadiguggulu contains Rasna, Guggulu, Devadaru, Eranda, Guduchi. Almost all
drugs have usna veerya, madura vipaka and are kaphavatahara in property whereas
Guggulu and Guduchi has tridoshahara property. The disease Karnasrava taken for
the study is mainly due to Vata and Rasnadiguggulu helps in alleviating Vata and
other doshas associated with it. Thereby reducing srava and other symptoms.
Drugs like Guggulu, Guduchi, Devadaru have Rasayana property, which in turn
helps in alleviating Karnasrava and its symptoms because it is said by our Acharyas
that “Samanyam karnarogeshu grutapanam rasayanam”.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 115
In this study karna dhoopana had better effect than internal administration of
Rasnadiguggulu. This may be because; the absorption of drug taken internally will
be reduced by the action of gastric juices in the G.I system. More over it does not
have local direct effect in the ear canal where the discharge takes place or in the
middle ear where the pathology lies. Dryness of the ear is an important aspect in
arresting ear discharge and further growth of microbes. Guggulu dhoopana has local
antiseptic effect and acts directly in the place of manifestation of karna srava making
the area dry, Thereby making its action better.
Karnadhoopana acts locally as antiseptic, antimicrobial and keeps the ear dry. And
Rasnadiguggulu given internally is also Vatahara and rasayana drug which helps to
further prevents the infection. Hence in my study I have come to a conclusion that
combination of both therapeutic procedure of karnadhoopana and internal
administration of Rasnadi guggulu gives a better result in the management of
karnasrava.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 116
CONCLUSION
Karnasrava can be compared to chronic suppurative otitis media. In both, ear
discharge is the chief complaint.
Most common etiology of karnasrava is recurrent attacks of pratishyaya
followed by jalanimajjana in the present study.
In the present study Karnasrava was found to be more prevalent in the
lower strata of the society and labour class workers.
Theraupetic procedure with Sthanika Guggulu dhoopana along with internal
administration of Rasnadi Guggulu proved more efficacious when compared
to only Shuddha guggulu dhoopana or only internal administration of
Rasnadi guggulu.
Karna dhoopana with shudda guggulu proved to be more efficacious than
internal administration of Rasnadi guggulu.
Karna dhoopana was found to be effective only in the healing of pin hole and
small central perforations of tympanic membrane.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 117
Karna dhoopana with shudda guggulu is cost effective, safe and easy
proceeedure which cane be perfomed at O.P.D.level without any
complications.
Follow up study showed reccurrence of Karnasrava in those who did not
follow pathyaapathya.
RECOMMENDATIONS FOR FURTHER STUDY
Present study pattern can be contributed in the form of prospective clinical
study with increased sample size.
Karna dhoopana with other drugs can be selected for the further study;
The effect of Karna dhoopana along with Nasya or Nasya alone can be tried
in karma srava in future research studies.
The efficacy of the therapeutic procedure karma dhoopana can be established
in A.S.O.M and other external ear infections by further research.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 118
SUMMARY
This dissertation work is entitled “Management of Karnasrava with sthanika
Guggulu dhoopana and Rasnadi guggulu - A comparative study”. This study
comprises of 7 chapters i.e Introduction, Review of literature, Methodology,
Observation and Results, Discussion, Conclusion and lastly Summary.
The introductory part includes the need for selection of the topic, therapy, drug of
present study with its aims and objects.
The review describes historical aspects of karnasrava, anatomical and physiological
considerations of karna as per Ayurveda, followed by anatomy and physiology of
ear. Next chapter deals with disease review of Karnasrava & its management. Its
relation to chronic suppurative otitis media and its management in contemporary
science .In next chapter dhoopana is explained. The drugs for dhoopana and rasnadi
guggulu have been explained in drug review.
The third part deals with methodology, which was carried out on 45 patients in 3
groups. Group A, Group B, Group C in the biginining, Source of patients, materials,
plan of study and criteria for inclusion, exclusion and assessment of results have
been given.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 119
The 4th part deals with observations and results. Observations made and results
obtained from the study have been presented in table and chart forms. The signs and
symptoms are analysed statisticaly.
The 5th part deals with discussion on literary part, observation and results.
The 6th part deals with conclusion drawn on observation made.
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 120
REFERENCES
1.Amarakosha page.463
2.Shabdakalpadruma page.42
3.Su.ut 20/11
4.Shabdakalpadruma,Vol II, Page. 37
Vachaspatyam Vol III Page .1706
5.Su.ut 20/9
Su.ni1/83
A.H.SU 4/30
6. Vachaspatyam Vol VI Page.5149
7.Cha.sha 7/7
8.Su.sha ¼
9.Su.sha5/20
10.Su.sha5/26
11.Su.sha 5/27
12.Su.sha 5/37
13.A.h.Sha 3/31
14.Su.su35/4
15. A.h.sh.3/40
16.A.h.sha 3/108
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 121
17.Su.su 35/12
18.Su.su 35/12
19. Su.su 35/12
20.Su.sha.6/27
21. Su.sha 6/27
22. cha sha 7/16
A.h.sha 3/3
23.Su.su 16/11
24.A.h .u 1/31
25.Cha.sha 7/11
26 Dalhana on su.su 16/10
27.Ch.sh 7/11
28.SU.su 16/11
29 A.h ut 1/30
30 Su.sh 6/37
31.A.h.su 22/32
32. Su.su 16/11
33. Su.su 35/12
34. Su.ut 20/11
35. su.ni 1/83
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 122
36.A.h.su 4/30
37. Su.sha 5/32
38. cha.sh. 7/16
A.h.sh 3/3
39. cha.sha 7/7
Cha.su 8/9
40.Cha.sha 7/7
41. Cha.sha 7/16
A.h.sh3/3
42.Ch.su.8/11
43. Su.sh 5/10
A.h.su 11/35
44.Ch.chi.28/5
45.Ch. su.11/20
46. Su.ut 20/1,2
A.h.ut17/1-3
A.sam.ut 21/2-4
47. Su.ut 20/1-2
48. A.h ut 17/1-3
49.A.sam. ut 21/2-4
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 123
50. Y.R Karnarogadikara/!-2
51. M.n57/1
52. Y.R Karnarogadikara21/10
Su.ut 20/10
53. Ch.ni 1/11
54. Su.ut 20/10
55. ch.vi 5/6
56. Ch.vi 6/24
57. Su ut.20/10,11
58. Su.ut 20/10,11
59. A.h.u 17/25,26
60. Su.ut 20/10,11
61. Su.ut 20/15
A.h.ut 17/12
A.sam .ut 21/13
62.Su.ut 20/14
63.A.h.ut 17/7
64. A.h.ut 17/5
65. Su.ut 21/3
66. Su ut. 21/3
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67. Su ut 21/40
68. A.h.ut 18/17,18
69. Su ut 21 /39,40
70. Su.ut 21/41
71. Su.ut 21/42
72. Su.ut 21/43
73. Su ut 21/43
74. Su.ut 21/44
75. Su.ut 21/45
76. su.ut 21/46
77. Su.ut 21/43
78. Chi. M Karnarogadikara/124
79. A.h ut 18/17,18
80. Y.R Karnarogadikara/1
81. Y. R Karnarogadikara/1
82.Y.R Karnarogadikara/78
83. SH.sam. mad 7/82,83
84. Bhai. Rat 62/69-74
85. Rasaypga sagara 1793-1799
86. Y.R Karnarogadikara /86-88
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 125
87. Y.R karnarogadikara/89
88. Ear,Nose,Throat by P.L Dhingra, page. 3,4
89. Ear,Nose,Throat by S.k De ,page. 15
90.Ear,Nose,Throat by P.L Dhingra , page . 4,5,6
91.Grays Anatomy page No.1367
92. Ear,Nose,Throat by S.K De page. 18-19
93. Ear,Nose,Throat by P.L.Dhingra page . 11,12,13
94.. Ear,Nose, Throat by P.L Dhingra page. 21
95.Scott –Browns otolaryngology. Vol III
96.Ear,Nose-Throat by P.L Dhingra.Page 80
97.Ear,Nose,Throat by P.L Dhingra Page.75
98.http:/as.web med.com
99.http:/as.web med.com
100.Hemadri on A.h.su 30/48
101, 103-104. Ka.kal 47/4
102 Ch.Chi 25/109
105. Dravyaguna vignana by J.L.N shastry page. 113
106. Ch.su 25/40
107.Su.ch.5/42
108. Dravyaguna vignana by J.L.N Shastry page. 104
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 126
109. A.h.ut 18/17-18
110. su.ut.21/11,39-40
111. A.h.ut 18/17-18
112. www.gugulipid.com/trad.htm
113. Database on medicinal plants used in Ayurveda ,vol 2 page. 224-226
114.Dravyaguna vignana by J.L.N Shastry page . 33, 113,483,507,821
115. Yogaratnakara karnarogadikara . Page. 318
116.Dravyaguna vignana by J.L.N Shastry Page .821
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 127
BIBILOGRAPHY
1. Vagbhata. Astanga Hrudayam – English translation by Prof. K.R. Srikantha
Murthy, Reprint. Varanasi: Chowkhamba Krishnadas Academy; 2004. Vol I.
2. Raja Radhakantadeva. Shabda Kalpa Druma, 3rd ed. Delhi: Naga Publishers;
2006. Vol 2.
3. Amarasimha. Amarakosha – Edited by Prof. Ramanathan, Adyar library and
research; 1971. Vol 1.
4. Sir Monier Monier–Williams. Sanskrit – English Dictionary – with the
collaboration of Prof. E. Leumann and Prof. C. Cappeller, First ed. Reprint.
Delhi: Motilal Banarsidas; 1981.
5. Sushruta. Sushruta Samhita – English translated by Kaviraj Kunjalal
Bhishagratna. Edited by Dr. Laxmidhar Dwivedi, 2nd ed. Varanasi:
Chowkhamba Sanskrit Series office; 2002. Vol II. pp.
6. Sushruta. Sushruta Samhita – English translation and edited by P.V. Sharma,
Reprint. Varanasi: Chowkhamba Vishvabharati; 2004. Vol I.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 128
7. Sushruta. Sushruta Samhita – Nibandha Sangraha Sanskrit commentary of Sri
Dalhanacharya and Nyayachandrika Panjika of Sri Gayadasacarya on
Nidanasthana, Reprint. Varanasi: Chwkhamba Krishnadas Academy; 2008.
8. Charaka. Agnivesa’s Caraka Samhita – English Translated by Dr Ram Karan
Sharma and Vaidya Bhagawan Dash, 2nd ed. Varanasi: Chowkhamba Sanskrit
Series office; 1985. Vol II.
9. Mohammad Maqbool, Suhail Maqbool. Textbook of Ear, Nose and Throat
Diseases, 11th ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd;
2007.
10. Gray,s Anatomy.38th edition.New york;Churchil Livingstone;
11. Bhargava KB, Bhargava SK, Shah TM. A short book of E.N.T Diseases, 8th
ed. Mumbai: Usha Publications; 2009.
12. Sushruta. Sushruta Samhita – Edited and translated in English by Prof. K.R.
Srikantha Murthy, 2nd ed. Varanasi: Chowkhamba Orientalia; 2005. Vol III.
13. Vagbhata. Astanga Hrudayam – English translation by Prof. K.R. Srikantha
Murthy, Reprint. Varanasi: Chowkhamba Krishnadas Academy; 2008. Vol III.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 129
14. Charaka. Agnivesa’s Caraka Samhita – English translated by Dr Ram Karan
Sharma and Vaidya Bhagawan Dash, Reprint. Varanasi: Chowkhamba
Sanskrit Series office; 2004. Vol III.
15. Chakrapanidatta. Chakradatta – Sanskrit text with English translation, edited
and translated by Priyavrat Sharma, 2nd ed. Varanasi: Choukambha Publishers;
1998.
16. Charaka. Agnivesa’s Caraka Samhita – English translated by Dr Ram Karan
Sharma and Vaidya Bhagawan Dash, Reprint. Varanasi: Chowkhamba
Sanskrit Series office; 2005. Vol IV.
17. Yogaratnakara with vidhyotini Hindi commentary. Commentator, Vaidya Sri
Lakshmipathy Shastry, Edited by Bhishgratna Sri Brahmashankar shastri,
Reprint. Varanasi: Chowkambha Sanskrit Samsthana; 2005.
18. Scott–Brown WG. Diseases of the Ear, Nose and Throat, London: Butterworth
and Co. (Publishers) Ltd; 1952. Vol I.
19. Dingra PL. diseases of Ear, Nose and Throat, 4th ed. Reprinted. New Delhi:
Elseviar Publications; 2008. Vol III.
20. Astanga Sangraha of Vagbhata – translated by Prof. K. R. Srikantha Murthy,
Second ed. Varanasi: Choukhambha Orientalia; 2005. Vol I.
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 130
21. Charaka. Agnivesa’s Caraka Samhita – English translated by Dr Ram Karan
Sharma and Vaidya Bhagawan Dash, Reprint. Varanasi: Chowkhamba
Sanskrit Series office; 2004. Vol III.
22. Sharangadhara. Sharangadhara Samhita – translated by Ayurveda Vidwan
Prof. K. R. Srikantha Murthy, 5th ed. Varanasi: Choukambha Orientalia; 2003.
23. Shastry JLN. Illustrated Dravya Guna Vijnana, 3rd ed. Varanasi: Chowkambha
Orientalia; 2008. Vol 2.
24. Sharma PV. Dravya Guna Vijnana, Reprint. Varanasi: Choukambha Bharati
Academy; 2003. Vol II.
25. Govind dasa – Bhaishajyaratnavali vidhyodhini hindivyakya vimarsha by
Kaviraj Sri Ambikadatta sastry, Chaukamba Sanskrit samstana, Varanasi, 15th
edition.2002.
26. Database on medicinal plants used in ayurveda- P.C Sharma, M.B Velne,T.J
Dennis. CCRAS and sidda Javaharlal Nehru Bharatiya chikitsa Avum
Homeopathy anusandhan Bhavan-New delhi.Edition-2002.
27. Madhavakara- Madava nidana with Madukosha commentary by Sri
Vijayarakshita and Srikantadutta with Vimala hindi commentary and notes by
A Study on Karnasrava
Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 131
Dr. Bhramananda tripathi, published by Chaukhamba surabharathi
prakashana,Varanasi,2nd edition 1998.
28. Bhavamishra-Bhavaprakash, Vidyotini Hindi commentary, Chaukambha
Sanskrit Sansthan, Varanasi, 7th edition-2000.part II.
29. Kashyapa-Kashyapa samhita with English commentary,chaukambha Sanskrit
Sansthan,Varanasi,1st edition-1996
30. Websites;
a. http:/www.gugulipid.com/trad.htm
b. http:/www.ncbi.nlm.nih.gov/pmc/articles/PM279506
c. http:/www.ncbi.nlm.nih.gov/pubmed/17003931
d. http:/www.drugs.com/npp/guggul.html
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Department of PG Studies in Shalakyatantra, GAMC, Bengaluru 132
DEPARTMENT OF SHALAKYATANTRA G.A.M.C BANGALORE
CASE SHEET PROFORMA
Name : Socio economic status:
Age: OPD/I.P No.
Sex: Date:
Religion: Case No.:
Occupation: Address:
Marital Status:
1. Pradhana Vedana:
2. Anubandha Vedana:
3. Poorva vyadi Vruttanta:
4. Kula Vruttanta:
5. Vaiyaktika vrittanta:
6. Adyatana Vyadhi Vruttanta:
(i) Onset of Complaint : Acute / Chronic gradual
(ii) Duration of the complaint :
(iii) Laterality : uni/Bilateral
(iv) Nature of complaint : Continuous / Intermittent
(v) Severity of compliant :
(vi) Treatment taking so far :
(vii) Associated with :
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(viii) Discharge : Quantity :
With / without foul smell :
Consistency :
7. Vikruti pareeksha.
8 a. Hetu: Jala nimajjana
Prapakat vidradhi
Shiroabhigata
Exposure to cold wind
Pratishyaya
Jalakreeda
Karnakandooyana
Exessive intake of Ruksha, Sheeta, Laghu aahara
Ratri jagarana
Vega dharana
8b. Aggrevating factors
Ahara
Vihara
Oushada
Rutu
Dina/ratri
8c. Poorvaroopa
8d. Roopa
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8e. Upashaya/Anupashaya
9. ASHTAVDIA PAREEKSHA
Nadi Shabda
Mutra Sparsha
Mala Drik
Jihwa Aakriti
10. DASHAVIDA PAREEKSHA
Prakruti Satwa
Vikruti Pramana
Sara Aaharashakti
Samhanana Vyayamashakti
Satmya Vaya
11. UTTAMANGA PAREEKSHA
Facial asymmetry : present / not present
Congenital abnormality : Yes / No
Of face & neck
Skin over face & neck texture : normal / abnormal
Shape of the face :
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12. EXAMINATION OF AUDITORY SYSTEM
External examination. Inspection: Deformity:
Swelling :
Discharge:
Palpation: Tenderness around ear;
1.PINNA
a. Shape : normal / abnormal
b. Congenital abnormalities : present / not present
c. Extra growths : present / not present
d. Infectious foci : present / not present
1. External auditory canal
a. Infectious foci : Present / nor present
b. Tumors or any growth : Present / not present
c. Foul smell : Present / not present
d. Wax : Impacted / Not
2.Karna Srava:
(i) Consistency of Srava
: Watery/ mucous / mucopurulent/ purulent.
II Quantity
(1.) Scanty/ moderate/ profuse.
(ii) Stage of discharge : Active / Inactive / Quiescent
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(iii) Smell : without foul smell / with foul smell
3.Tympanic membrane:
1. Cone of light. Present / absent
2. Perforation. Present / absent
3. Type of perforation. Central / marginal / total / subtotal
4. Colour:
5. Mobility:
6. Quadrant: anterosupeiror / antierionferior / Postersupirior /
posterioinferior
4. Middle ear
Eustachian tube patency test. Present / absent
5. Examination of mastoid : Swelling : present/Absent
Tenderness: present/Absent
Auditory function
6. Tuning fork tests;
Rinnes test
Webers test
Examination of Nose
6. External nose: Skin, Scar
Vestibule :
7. Anterior. Rhinoscopy : Nasal discharge / deviated septum
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Turbinate: Hypertrophy
Posterior Rhinoscopy: Postnasal discharge /adenoids.
8. Examination of paranasal sinus
Tenderness : Present / absent
9. Examination of Throat
10. Investigations. Blood for. Hb% -
TC –
DC –
ESR –
RBS –
Auditory evaluation (Pure Tone Audiometry)
11. SAPEKSHA NIDANA.
Karna srava
Putikarna
Karna vidradi
Sannipataja karnashoola
Kaphaja karnashoola
12. Vyadhi vinischaya
13. Sadya sadhyata
14. Chikitsa
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Group A:
Group B:
Group C:
Periodical observation :
Subjective parameters:
A. Impaired hearing:
Objective parameters:
Sl.No. 0th day 15th day 30th day 60th day 90th day
1. Ear discharge
2. Conductive
Deafness
3. Perforation
Follow up = for 3 months
Results = good / moderate / poor
Reoccurrence / non reoccurrence
Signature of the scholar Signature of the Guide