|Year : 2021 | Volume
| Issue : 1 | Page : 22-26
Management of Badhirya (hearing impairment) through Ayurvedic approaches: A case report
Shelly Tyagi, Narayan Bavalatti, Manjusha Rajagopala
Department of Shalakya Tantra, All India Institute of Ayurveda, New Delhi, India
|Date of Submission||01-Jun-2020|
|Date of Acceptance||05-May-2021|
|Date of Web Publication||17-Jun-2021|
Dr. Narayan Bavalatti
Department of Shalakya Tantra, All India Institute of Ayurveda, Sarita Vihar, New Delhi - 110 076
Source of Support: None, Conflict of Interest: None
Hearing impairment is a complete or partial loss of ability to hear from one or both ears. It can be congenital or acquired and the clinical features closely resemble to Badhirya explained in Ayurveda. Hearing impairment in the schoolgoing children is a serious problem affecting their education, skills, and social relationship with others, etc., This case report presents an 11-year-old girl with hearing impairment in the left ear since childhood. Audiometry report showed profound hearing loss in the left ear. Treatment was done with Marsha nasya by Anu taila for three days and Karnapurana (~putting oil in ears) with Asanabilwadi taila and Shiropichu (~placing cotton pad overhead soaked in medicated oil) with Ksheerabala taila for seven days each, along with Ashwagandhadi lehyam, Arogya vardhini vati, Sarivadyasava, and Trivrit churna as internal medicines for 22 weeks. After that, audiometry results improved from profound to moderate hearing loss in the left ear. Decreased hearing may be due to vitiated Vata alone or Vata and Kapha dosha, which can be managed with the help of Marsha nasya, Karnapurana, and Shiropichu along with Vata shamana and Rasayana therapy.
Keywords: Badhirya, Karnapurana, Marsha nasya, Rasayana, Shiropichu
|How to cite this article:|
Tyagi S, Bavalatti N, Rajagopala M. Management of Badhirya (hearing impairment) through Ayurvedic approaches: A case report. J Ayurveda Case Rep 2021;4:22-6
|How to cite this URL:|
Tyagi S, Bavalatti N, Rajagopala M. Management of Badhirya (hearing impairment) through Ayurvedic approaches: A case report. J Ayurveda Case Rep [serial online] 2021 [cited 2022 Sep 30];4:22-6. Available from: http://www.ayucare.org/text.asp?2021/4/1/22/318658
| Introduction|| |
Hearing is an important medium, which keeps one connected to other and with the surroundings. It is important for the cognitive development of children. Hearing impairment (~Badhirya) means complete or partial loss of the ability to hear from one or both ears. It makes conversation difficult and people experience feeling of isolation, which is barrier to both education and social integration. It is also associated with decline in cognitive impairment. 466 million (~6.1%) of the world's population are estimated to be living with hearing loss. It is estimated that over 60% of such hearing loss could be avoided through preventive measures. Etiological factors responsible for hearing loss may be present at birth or acquired. This loss can be because of genetic or non-genetic reasons. Non-genetic causes can be intrauterine as diabetes, toxemia, ototoxic drugs, and infections such as rubella, measles, chickenpox, cytomegalovirus, and HIV. According to Acharya sushruta, vitiated Vata along with Kapha in Sira (~vein) occupies Shabdanuvaha sira (~auditory nerve) in Shrotrendriya (~organ of hearing), leads to Srotorodha (~obstruction of channels), and further ignorance of this condition leads to Badhirya.
Hearing aids, implants, and assistive devices are most common instrumental devices which are used in rehabilitation of the impaired hearing. However, use of these devices itself is challenging because people using them cannot hear as many sounds as people with normal hearing. In more severe cases, where there is limited benefit from conventional hearing aids, then a cochlear implant may be an option. As it is costly and beyond the reach of common people in India, the Ayurvedic treatment can be an alternative to conventional management of hearing impairment. Here, a case report of a girl child treated with Nasya (~transmucosal nasal administration of medicated oil), Karnapurana (~putting oil in ears), Shiropichu (~placing cotton pad overhead soaked in medicated oil), and internal medicines as Ashwagandhadi lehyam, Arogya vardhini vati, Sarivadyasava, and Trivrit churna based on the therapeutic principles explained in Ayurveda.
| Case Report|| |
An 11-year-old, schoolgoing girl child, resident of Etah, Uttar Pradesh, visited to ENT Out Patient Department (OPD) with the complaint of diminished hearing in the left ear since childhood. According to the information gathered from the patient's mother, hearing impairment was more in the left ear as compared to the right. She had a history of tuberculosis at the age of two years and was managed with antitubercular drugs. As the child had shown symptoms of decreased hearing and giddiness, hence the antitubercular drugs were stopped after two months. No other significant treatment history and family history were found.
The patient took conventional treatment for approximately one and half month. Hearing aids, capsule Nurokind Gold once a day, tablet Allercet-DC once at bedtime, and Otrivin drops (2 drops thrice a day) were prescribed for 15 days. Further, she went to higher centre with the same complaints and took treatment for about a month. She was advised to continue the hearing aids. She was not satisfied with the conventional treatment and no significant relief was noticed.
She was moderately built with height and 42.70 kg weight. Pulse rate was 72/min, blood pressure was 110/84 mmHg, and respiratory rate was 23/min. The Prakriti (~body constitution) and Nadi (~pulse) were Vata-kaphaj. Urine and feces were normal. Jihwa (~tongue) was uncoated and Shabda (~voice) was soft and unaffected. Vision was unaffected.
Examination of ear
Shape and size of bilateral pinna were normal. Neither swelling, redness, vesicle, nor scars were found. Concha and retro-auricular groove were normal. Wax, debris, discharge, polyp, and swelling of external auditory canal were not found. Otoscopy of bilateral external auditory canal revealed dry and normal aural canal. No benign or malignant growth was found. Bilateral tympanic membranes appeared pearly white in color, transparent, and were obliquely set at the medial end of the meatus. Cone of light was seen. Neither vesicles nor perforation was seen. The Rinne's test was positive in the right ear and negative in the left ear. Weber's test was laterlized toward the right ear.
Routine hematology reports such as hemoglobin, total leukocyte count, differential leukocyte count, platelet count, erythrocyte sedimentation rate, and urine reports were within normal limits. Pure-tone audiometry revealed normal hearing sensitivity in the right ear and profound hearing loss in the left ear which was done on May 3, 2019.
Patient was advised to take Laghu (~light), Supachya (~easy to digest) and Ushna (~warm) ahara, Ghritapana (~intake of medicated ghee), wheat, rice, green gram, drum sticks, bitter gourd, etc., to pacify Vata dosha. The patient was advised to avoid a head bath during the Nasya and Karnapurana procedures. She further advised to stop drinking cold drinks, spicy food, cleaning frequently of ears at home (putting stick or probe in ears), exposure to cold wind, and excessive exercise. She was asked to keep the auditory canal dry and not allow water to enter in, which may lead to aggravation of Vata dosha.
| Timeline|| |
The written consent for the treatment was obtained from the patient's mother. The patient was given Ayurvedic treatment with a holistic approach, i.e., Shodhana (~detoxificatin of body) and Shamana (~pacification of exacerbated Doshas) followed by Pathya-Apathya as per classical Ayurvedic text [Table 1] and [Table 2].
| Follow up and outcome|| |
The patient got symptomatic relief with mild improvement in hearing after the first sitting of Nasya, Karnapurana, and Shiropichu. Hence, she continued the treatment following internal medicines, i.e. Ashwagandhadi lehyam, Arogya vardhini vati, Sarivadyasava, and Trivrit churna for period of 22 weeks. Pure-tone audiometry done before treatment revealed normal hearing sensitivity in the right ear and profound hearing loss in the left ear which was done on May 3, 2019. After 22 weeks of treatment, significant improvement was found in hearing. Repeat pure-tone audiometry was done after treatment on December 24, 2019, which showed moderate hearing loss in the left ear [Table 3].
| Discussion|| |
Badhirya is one of the most common disorders and is a challenging problem to all ENT surgeons. The condition looks simple, but medical management adopted for hearing impairment in modern system of medicine is not satisfactory in all the patients. Despite their successes, hearing aids and cochlear implants are not perfect in all situations. Particularly frequency discrimination and performance in noisy environments and general efficacy of the devises vary among individuals.
Ears are said to be the seat of Vata dosha and are responsible for hearing mechanism as quoted in Ashtanga Hridayam “Pakwashaya katisakthi shrotra asthi sparshanindriyam.” Badhirya mainly occurs due to vitiation of Vata along with Kapha dosha that occupies Shabdavaha sira in Shrotrendriya leading to Shrotorodha. With lack of proper treatment, this condition ultimately leads to Badhirya.
Ayurvedic management in Badhirya is based on Vatavyadhi chikitsa vidhi (~neuroprotective treatment) and Rasayana chikitsa (~rejuvenation therapy). These principles probably help in regeneration and repair of damaged hair cells which have improved hearing.
Anu taila nasya gets easily spread into Shira (~head) where it is absorbed and eliminates the Kapha dosha from Urdhva jatrugata pradesha (~supraclavicular region), thereby clearing the Srotorodha further improves the function of Indriyas (~sense organs). This nasal administration of medicine in oily form that pacifies the aggravated Vata dosha in the supraclavicular region that facilitate normal functions of the central nervous system by nourishing the nervous system and possibly balancing the blood circulation. The practice of Anu taila nasya gives sound health of the sense organs. As Shringataka marma (~vital point) in Shira is the junction of all sense organs. Any medicine reaching over this area targets the vitiated Doshas related to all sense organs and helps in nourishment of structures connecting to these areas. Laghu (~light) and Vyavayi (~pervades quickly) qualities of Anu taila help in spreading of the oil throughout the supraclavicular region. Snehana (~oilation) and Shamana (~pacification) of vitiated Doshas may take place due to Snehana and Balya (~strenghtening) qualities of Anu taila, hence removing the obstruction and may facilitate better absorption of medicine.
Asanabilwadi taila was used for Karnapurana. Karnapurana does the Vata shamana and maintains normal hearing capacity, as quoted by Acharya Charaka “Na karnaroga vatottaha nochchav shrutihi na badiryam syannityam karna tarpanaat.” Abhyanga (~gentle massage with lukewarm oil) and Swedana (~sudation) done as Purva karma (~preprocedure) cause vasodilation and facilitate further absorption of drug. Lukewarm Asanabilwadi taila possess Vata shamana property and removes Aavarana of Kapha. It gets absorbed from external auditory meatus and tympanic membrane, which may reach systemic blood flow. Further, ingredients of Asanabilwadi taila can be easily assimilated through nerve endings. As a combined effect of active principles present in the drug and oil helps in repair and regeneration of damaged hair cells which lead to better hearing.
According to the modern science, local application like ointment passes through the stratum corneum into the blood vessel and reaches the appropriate organ. Similarly, Shiropichu with Ksheerabala taila can also be absorbed and easily reaches the brain cortex. Most of the ingredients of Ksheerabala taila are best Vata shamaka and the oil acts as Rasayana, Indriyaprasadana (~rejuvenate senses), Jeevana (~life), and Brumhana, thus restoring of hearing function.
Ashwagandhadi lehyam also helps in pacification of vitiated Vata dosha and is a potent regenerative tonic. Ashwagandha improves the body's defense against disease by improving the cell-mediated immunity. It also possesses antioxidant properties that help to protect against cellular damage caused by free radicals and promote intellectual capacity, which, in turn, related to development of communication skills. Probably, these properties rejuvenate hearing capacity and further help in management of hearing impairment.
Arogya vardhini vati improves overall health by balancing the three Doshas in the body. The ingredients of Arogya vardhini vati act as antibacterial, carminative, hypoglycemic, stomachic, hypotensive, and astringent. Arogya vardhini vati has antioxidative, anti-hepatotoxic, and immune modulator properties. The mineral Shuddh shilajit (Asphaltum punjabium) is an effective agent for renewing vitality. It acts like nectar; it has powerful antioxidant properties and it helps in maintenance of healthy digestive system along with clearing the body channels for the nutrients to reach to the tissues.
Sariva (Hemidesmus indicus L.) is the basic ingredients of Sarivadyasava. It is potent anti-inflammatory, antioxidant, hepatoprotective, diuretic, and useful in neurological disorders. 70% methanolic extract of Sariva root, which contains large amount of flavonoids and phenolic compounds, exhibits high antioxidant and free radical scavenging activities. It acts as natural source of antioxidant and through circulation in blood, it ensures healthy hearing mechanism in the body. Thus, the combined effect of the above-mentioned procedures and internal medicines acts as Vatashamaka and Rasayana, which possibly helped in improvement of the symptoms.
| Conclusion|| |
Childhood hearing loss can be a distressing condition that affects a significant degree of physical, mental, and social health of an individual. In Ayurveda, Badhirya is basically treated on lines of Vatashamana and Rasayana therapy. Anu taila nasya, Asanabilwadi taila karnapurana, and Ksheerabala taila shiropichu with internal medicines have provided significant improvement in the present case. This infers that effective management of Badhirya can be done based on the principles of Ayurveda. The patient is still continuing the treatment and in longer duration, she may get further improvement. The study if carried out in larger sample can provide concrete conclusions.
Declaration of patient consent
Authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the images and other clinical information in the journal. The patient/caregiver understands that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dhingra PL, Dhingra S, editors. Diseases of Ear, Nose and Throat. Hearing Loss. 6th
ed. Delhi: Published by Elsevier; 2014. p. 33-4.
Hazarika P, editor. Textbook of Ear, Nose, Throat and Head-Neck Surgery, Hearing Loss. 4th
ed. Delhi: CBS Publishers and Distributors Pvt. Ltd.; 2007. p. 64-5.
Shastri AD, editor. Sushruta Samhita of Sushruta, Uttara Tantra. Ch. 20., Ver. 8. Varanasi: Chaukhamba Sanskrit Sansthana; 2012. p. 116.
Shastri AD, editor. Sushruta Samhita of Sushruta, Uttara Tantra. Ch. 21., Ver. 3. Varanasi: Chaukhamba Sanskrit Sansthana; 2012. p. 127.
Tripathi B, editor. Ashtanga Hridayam of Vagbhata, Uttara Tantra. Ch. 18., Ver. 6. Delhi: Chaukhamba Sanskrit Pratishthan; 2017. p. 1004.
Oshima K, Suchert S, Blevins NH, Heller S. Curing hearing loss: Patient expectations, health care practitioners, and basic science. J Commun Disord 2010;43:311-8.
Tripathi B, editor. Ashtanga Hridayam of Vagbhata, Sutra Sthana. Ch. 12., Ver. 1. Delhi: Chaukhamba Sanskrit Pratishthan; 2017. p. 170.
Tripathi B, editor. Ashtanga Hridayam of Vagbhata, Uttaratantra. Ch. 17., Ver. 10. Delhi: Chaukhamba Sanskrit Pratishthan; 2017. p. 1000.
Shastri AD, editor. Sushruta Samhita of Sushruta, Uttaratantra. Ch. 21., Ver. 38. Varanasi: Chaukhamba Sanskrit Sansthana; 2012. p. 130.
Tope SD, Mamata N, Swapnil A, Chaudhary V. Conceptual study of Nasya and Shiro Pichu in management of Nidranash (primary insomnia). Int Ayurvedic Med J 2016;4:249-54.
Makhija D, Dua M, Ota S, Jadhav N, Vedi SK, Bharti, et al.
Clinical Evaluation of Efficacy of Mahatriphaladya Ghrita and Anu Taila Nasya in the Management of Computer Vision Syndrome. J Res ayurvedic Sci 2018;2:156-63.
Shastri KN, Chaturvedi GN, editors. Charaka Samhita of Agnivesha, Sutra Sthana. Ch. 5., Ver. 84. Varanasi: Chaukhamba Sanskrit Sansthana; 2009. p. 128.
Angadi SS, Kotrannavar VS. A case discussion on presbyacusis. J Ayurveda Integr Med 2013;4:48-51.
] [Full text]
Kundu C, Shukla VD, Santwani MA, Bhatt NN. The role of psychic factors in pathogenis of essential hypertension and its management by Shirodhara and Sarpagandha Vati. AYU 2010;31:436-41.
] [Full text]
Tripathi B, editor. Ashtanga Hridayam of Vagbhata, Chikitsa Sthana. Ch. 22., Ver. 46. Delhi: Chaukhamba Sanskrit Pratishthan; 2017. p. 821.
Singh N, Bhalla M, de Jager P, Gilca M. An overview on ashwagandha: A Rasayana (rejuvenator) of Ayurveda. Afr J Tradit Complement Altern Med 2011;8:208-13.
Pal S, Ramamurthy A, Mahajon B. Arogyavardhini vati: A theoritical analysis. J Sci Innov Res 2016;5:225-7.
Ravishankara MN, Shrivastava N, Padh H, Rajani M. Evaluation of antioxidant properties of root bark of Hemidesmus indicus
R. Br. (Anantmul). Phytomedicine 2002;9:153-60.
[Table 1], [Table 2], [Table 3]