Ayurvedic Management of Cochlear Synaptic Tinnitus - A Case Report
*Waghmare Gangaprasad Anantrao
Department of Shalakya Tantra (ENT), Assistant Professor & ENT Consultant, India
Submission: August 24, 2017; Published: August 30, 2017
*Corresponding author: Waghmare Gangaprasad Anantrao, Department of shalakya Tantra (ENT), Assistant Professor & ENT Consultant, Mumbai-400002, Maharashtra, India, Tel: 09096566633, Email: firstname.lastname@example.org
How to cite this article: Waghmare G A. Ayurvedic Management of Cochlear Synaptic Tinnitus - A Case Report. Glob J Otolaryngol. 2017; 10(2): 555781. DOI: 10.19080/GJO.2017.10.555781
Tinnitus is the Perception of sound in the absence of an external sound source and in most cases occurs with Hearing loss. The main symptom of this disease is ringing in ear, difficulty in hearing associated with dizziness & anxiety. In Ayurveda it can be compared with disease Karnashweda. Cochlear Synaptic Tinnitus is one among the many socio-medical problems. Most studies indicate the prevalence in adults as falling within range of 10% to 15%, with greater prevalence at higher ages. A Muslim, unmarried, 17 yr old male patient visited the outpatient department of k G Mittal Ayurved hospital, Mumbai with complaint of Ringing noise in both ear, blocking of ear , difficulty in hearing & dizziness.The patient was diagnosed as Cochlear Synaptic Tinnitus. Tablet Ekang veer rasa 2 TDS. (each 250mg), tablet Geriforte 2 TDS. (each 250mg), Syp. Saraswatarishta 10ml TDS were administered for 2 months. After the 2 -month's treatment, a significant response in various symptoms such as blocking of ear, Ringing in ear, Dizziness was found, but no any improvement was found in Hearing loss.
Keywords: Cochlear Synaptic Tinnitus; Hearing loss; Ringing in ear; dizziness; Ekang veer rasa; Saraswatarishta; Karnashweda
Tinnitus is the Perception of sound in the absence of an external sound source and in most cases occurs with Hearing loss. Two main cochlear pathologies could be at the origin of tinnitus, research is providing more & more findings to support the first hypothesis, relating tinnitus to an "epileptic" reaction in the Auditory nerve (Malfunction of the glutamatergic synapse between inner hair cells & Auditory Nerve). Cochlear Synaptic Tinnitus is one among the many socio-medical problems. Most studies indicate the prevalence in adults as falling within range of 10% to 15%, with greater prevalence at higher ages. Tinnitus can interfere with person's ability to hear, work, and perform daily activities. One study showed that 33% of persons being treated for Tinnitus reported that it disrupted their sleep. Cochlear Synaptic Tinnitus can be improved by using the Maskers, but it may not be a perfect solution for all. In classics of Ayurveda this ailment has been described as karnashweda under the heading of ear diseases. Vatahar Chikitsa (Neuroprotective Treatment) is one of the major treatments for ear diseases explained in classics. Clinical observation has shown its effectiveness in the management of Cochlear Synaptic Tinnitus [1-5].
A Muslim, unmarried, 17 yr old male patient visited (June 15, 2017) the outpatient department of k G Mittal Ayurved hospital, Mumbai with OP Number 201712104 for the complaint of Ringing noise in both ear, blocking of ear , difficulty in hearing & dizziness. A history of the present illness revealed that the patient was apparently normal 1 year back. Gradually he experienced the above said symptoms. The problem increased day by day, and the patient consulted his family physician & was on internal medicine which relieved the condition for a time being [6,7]. After 1 month, the patient experienced frequent ringing sound in both ear , mild deafness & dizziness. Hence, the patient consulted ENT surgeon where the patient was diagnosed as Cochlear Synaptic Tinnitus disease through otoscopic examination of Ear, Audiometry & clinical examination. The patient was on conservative treatment for last 6 months (tablet vertin 16mg tds, tablet tinnicar 1 bd, tablet neurobion forte 1 bd) where the patient had no relief.
The personal history revealed that the patient is Non vegetarian. Patient was addicted to smoking. There was no genetic linkage of the disease observed in the family. Patient has been working in a factory for last 2 year having in a loud nosy environment. The general examination of patient showed pulse rate of 70/min, respiratory rate of 19/min, blood pressure of 130/70mm of Hg & body weight of 52 kg. Otoscopic examination of Tympanic membrane showed bilateral sclerosis with retraction of Tympanic membrane. Tunning fork test revealed positive rinne's test for both the ear while Weber's test showed sound lateralised to both the ear equally . Audiological Examination (Pure tone Audiometry) showed mild Sensory neural deafness on both the ear based on clinical examination, the patient was diagnosed as a case of Cochlear Synaptic Tinnitus.
The following oral medicines were administered for 2 months.
a) Tablet Ekang veer rasa 2 TDS. (each250mg)
b) Tablet Geriforte 2 TDS. (each250mg)
c) Syp. Saraswatarishta 10ml TDS.
The medicines were procured from outside Ayurvedic pharmaceutical shop. Follow up was taken once in 15 days for 2 months. On the first follow up, the patient reported reduction in the symptom of blocking of ear. Ringing in ear was seen once in 4 days or occasionally. Improvement was observed in Dizziness. Improvement was noted in general sound sleep, anxiety. Complete relief was noted in all the signs & symptoms by the patient on the third follow up but there was no any improvement in Hearing loss. The patient was on follow up till 2 months, without any single episode of relapse .
According to Ayurved, the patient was diagnosed as a case of Karnashweda with main dosh being Vata. Hence the line of treatment mainly includes Neuro-protection, antioxidation & vasodilation. The smoking addiction of patient was reduced by counseling & Advised to use Ear plugs during work (Factory noise). The property of Ekang veer rasa is acts Oto- neuroprotective. It also has potent antioxidant effect. Ekang veer rasa is acidic in nature, excess of hydrogen ions are useful for capillary circulation [6-10]. Increased H+ ions concentration dilate the capillary. As Ekang veer rasa is having excess of H+ ions concentration it causes dilatation of capillary. Syp. Saraswatarishta produces vasodilatation in the locality. In neurology this reflex is known as Axon reflex.
Based on clinical signs & symptoms, the disease Cochlear Tinnitus can be correlated to ayurvedic Karnashweda. In this study, Tablet Ekang veer rasa, Tablet Geriforte & Syp. Saraswatarishta was found to be safe & effective in the management of Cochlear Tinnitus (Karnashweda).
- Alxender Rosinkin, VT Palchun, NL Voznesenky (2013) Diseases of Ear, Nose and throat, MIR Publishers, Moscow, Russia.
- Venimadhav shastri Joshi (1968) Ayurvediya Shabdakosha, Maharashtra Rajyasahitya and Sanskruti Mandal. Mumbai, India.
- KB Bhargava (2000) Short text book of ENT Diseases. Usha Publications, Gopal bhavan, Tagore Road, Mumbai, India.
- Simson Hall, Barnard H, Colman Churchill (1981) Diseases of Ear, Nose and throat. Livingstone, Robert Stevension, Edinburgh, Scotland.
- PL Dhingra (1998) Diseases of Ear, Nose and throat. BI Churchill Livingstone, Janapath, New Delhi, India.
- (1994) Yadavaji Trikamji Acharya, Dalhan, Nibandha Sangraha comm. on Sushruta, Chaukhambha Sanskrit Sansthan, Varanasi, India.
- (1970) Kaviraj Ambikadatta Shastri Vidyotini Hindi Comm Edited by shri Rajeshwar Datta Shastri Bhaishajya Ratnavali- Choukhambha Sanskrit Sansthan, Varanasi, India.
- Yadavjitrikamjiaachrya, Ayurned Deepika (1941) Chakrapani data comm. on - Charak Samhita, Nirnaya Sagar Press, Mumbai, India.
- B K Mahajan (1999) Methods in Biostatistics, Jaypee Brothers Medical Publishers Pvt. Ltd. Dariyaganj, New Delhi, India.
- Acharya Priyawat Sharma, Dravya Guna Vignyana, Published By Chaukhambha Bharti Acadamy, Varanasi, India.