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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BENGALURU, KARNATAKA. SYNOPSIS BY Dr. BIBI AMEENA YALLAPUR FOR THE DEGREE OF AYURVEDA DHANWANTARI M.S (AYURVEDA) IN SHALAKYA TANTRA TITLE OF THE DISSERTATION “A COMPARATIVE STUDY ON ATIVISHADI TAILA KARNA POORANA AND PANCHAMULI BALA KSHIRA ORALLY IN THE MANAGEMENTOF KARNA NADA” NAME OF THE INSTITUTE GOVERNMENT AYURVEDIC MEDICAL COLLEGE, DHANWANTARI ROAD, BENGALURU – 09, KARNATAKA. 1 From, Dr. BIBI AMEENA YALLAPUR, I M.S, Dept of Post Graduate Studies in Shalakya Tantra, Government Ayurvedic Medical College, Bengaluru – 560009 To, THE REGISTRAR, Rajiv Gandhi University of Health Sciences, Bengaluru – 560041 Through, THE PRINCIPAL G.A.M.C Bengaluru – 560009, AND H.O.D OF POST GRADUATE STUDIES IN SHALAKYA TANTRA G.A.M.C. Bengaluru- 560009. Respected sir, Sub:- Submission of for Dissertation. completed proforma for registration of subject I request you to kindly register the below mentioned subject against my name for the submission of dissertation to the Rajiv Gandhi University of Health Sciences, Bengaluru, for the partial fulfillment of M.S(Ayu) in (Shalakya Tantra). TITLE OF DISSERTATION: “A COMPARATIVE STUDY ON ATIVISHADI TAILA KARNA POORANA AND PANCHAMULI BALA KSHIRA ORALLY IN THE MANAGEMENT OF KARNA NADA.” Herewith I am enclosing completed proforma for registration of subject for dissertation work. Thanking you, Yours sincerely, Place: Bengaluru. Date: (Dr. BIBI AMEENA YALLAPUR) 2 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BENGALURU, KARNATAKA. ANNEXURE II PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1. NAME OF THE CANDIDATE AND RESIDENTIAL ADDRESS Dr. BIBI AMEENA YALLAPUR, D/O ABDUL RUB YALLAPUR, MRITYUNJAYA NAGAR, 3rd CROSS, 1st MAIN, PB ROAD, RANIBENNUR – 581115. DIST- HAVERI. KARNATAKA. 2. NAME OF THE INSTITUTION GOVERNMENT AYURVEDA MEDICAL COLLEGE, DHANVANTARI ROAD, BENGALURU-09 3. COURSE OF STUDY AND SUBJECT AYURVEDA DHANVANTARI. M.S. (AYU), SHALAKYA TANTRA 4 DATE OF ADMISSION TO THE COURSE 02/11/2010 5. TITLE OF THE DISSERTATION: A COMPARATIVE STUDY ON ATIVISHADI TAILA KARNA POORANA AND PANCHAMULI BALA KSHIRA ORALLY IN THE MANAGEMENT OF KARNA NADA. 3 6. BRIEF RESUME OF THE INTENDED WORK 6.1 NEED FOR THE STUDY : Ear is considered as one of the nava dwaras. There are various diseases affecting the ears. As a preventive therapy our Acharyas have mentioned karna abhyanga and poorana , i.e application of oil and massaging ear, filling it with oil in dinacharya (daily regimen). One who doesn’t indulge in such regimens is sure to be afflicted by the disease of ear. Karna nada is one among 28 karna rogas described by Acharya Sushrutha. Acc to Vagbhata it is karna srotogata. Acc to Acharya charaka there are four types of karna roga, where in Karna nada is one of the symptom of vataja karna roga. Karna nada is a disease where vitiated vata gets lodged in shabdavaha srotas there by causing different types of sounds in the ear like bheri, mridanga, shanka etc. In the present day as the incidence of Karna nada is increasing, it is necessary to find out a solution for the same which is economical and free from side effects compared to present synthetic preparations which have potential to cause side effects. The features of Karna nada can be co-related to tinnitus. Tinnitus is the ringing sound in the ear which causes great stress and emotional handicap. It is estimated that one out of every 5 people experiences tinnitus. The treatment in allied branches is not satisfactory, surgical intervention is rare in cases and done only when presenting with complicating. Thus the main aim of the study is comparison so that, to which modality of the treatment could yield better results in giving relief to those affected by Karna nada. 6.2 REVIEW OF THE LITERATURE AYURVEDIC VIEWS :- कर्णस्रोतास्थिते वाते श्रर् ृ ोतत ववववधान्सथवरान ् । भेरर मद ृ ङ्ग शङ्खानाां कर्ण नाद: स उच्यते ॥ Vata effecting the canals of ears makes the patient to hear sounds as that produced by kettle drum, cymbal or conch. This is known as Karna nada. 3 (Ch. 57 Sl.2, p 193) 4 NIDANA & SAMPRAPTI:अवश्याय जलक्रीडा कर्णकण्डू यनैमरू ण त् । ममथ्ययोगेन शथरथय कुवितो अन्सयैश्च कोिनै: ॥ प्राप्य श्रोरमशरा: कुयाणच्छूलां स्रोतमस वेगवान ् । ते वै कर्णगता रोगा अष्टववांशततरीता: ॥ 4 ( U K.R Sl.1, p312) Exposure to snow and cold items, swimming / diving , pricking or probing the external auditory canal, improper instrumentation, sound pollution, abhighata. By above said causes, the vatadi doshas vitiates shabdavaha srotas and causes ear diseases like karna shoola , bhadirya , karna nada etc LAKSHANA:शब्दवाहि मसरा सांथिे श्रोर्ोतत िवने मुिु: । नादान ् अकथमाद् ववववधान ् कर्णनादां वदस्न्सत तम ् ॥ When vata gets localized in the sira( channels ) which convey sound, the person hears different kinds of sound often, without any reasons. This is known as Karna nada.2 (Us Ch.17 Sl.9, p 156) यदा तु नाडडषु ववमागणमागणत: स एव शब्दामभविासतु तष्टी । श्रर् ृ ोतत शब्दान ् ववववधाांथतदा नर: प्रर्ादमेनां कियस्न्सत चामयम ्॥ Ringing and various other sounds in the ear are heard when the deranged vayu of the locality gets into the wrong way and remains there stuffed in the sound carrying channels of the organ. This disease is called as Pranada 1 (Ut Ch.20 Sl.6, p 242) 5 CHIKITSA:कर्णशूले प्रर्ादे च बाधधये क्ष्वेडयोरवि । चतर् ु ाां अवि रोगार्ाां सामान्सयां भेषजां ववद:ु ॥ The course of medical treatment to be pursued in the four forms of ear diseases (all due to the action of vayu )vis., Karna shula, Pranada , Badhirya and Karna Ksveda is the same.1 (Ut Ch.21 Sl.3, p 245) ATIVISHADI TAILA: िक्वां प्रततववषा हिङ्गुमममशत्वक्थवस्जणकोषर्ै:। ससुक्तै: िूरर्ात्तैलां रूक् स्रावाश्रतु तनादनुत ् ॥ Oil cooked with prativisha, hingu, mishi, twak, sarjika and ushana and added with shukta filled into the ears cures pain, exudation and ringing in the ears.2 ( Ut Ch.18 Sl.25 p165) lÉÉSoÉÉÍkÉrÉïrÉÉåÈ MÑürÉÉïSè uÉÉiÉzÉÔsÉÉå£üqÉÉæwÉkÉqÉç || In Karnanada(ringing in the ears) and Badhirya(deafness),the treatment prescribed for Vatashula(pains caused by aggrevated vata should be done.2(Us Ch.18 Sl22,p165) PANCHAMULI BALA KSHIRA: िञ्चमूलीबलामसद्ध क्षीरां वातामये हितम ् ॥5 (Ch.26 Sl.5, p 518) Kshira prepared with brihat pancha mula and bala mula is useful in vata vyadhi. MODERN VIEW :6 TINNITUS Definition : Tinnitus is a very common and annoying symptom. It may be defined as ringing sound or noise in the ear or head. The characteristic feature is that the origin of this sound is within the patient. Tinnitus may be unilateral or bilateral. It has been variously described by the patient as roaring, hissing, swishing, rustling, or clicking type of noise. CHARACTERISTICS OF TINNITUS: 1. Intermittent : Tinnitus may be continuous or intermittent, with long or short intervals of absence of tinnitus 2. Continuous : tinnitus may be present all time . 3. Fluctuant: tinnitus may vary in intensity. It is more marked when the patient is emotionally perturbed ,or when he is in a quiet atmosphere. 4. Pitch : may be high or low. Sometimes pitch may vary. CLASSIFICATION : 1. Subjective: which can only be heard by patient. 2. Objective: which can even be heard by the examiner with the use of a Stethoscope. Causes of tinnitus : A) SUBJECTIVE Otologic Non Otologic * Impacted wax * Diseases of CNS * Fluid in the middle ear * Anaemia * Acute & Chronic otitis media * Arteriosclerosis * Abnormally patent Eustachian tube * Hypertension * Meniere’s Disease * Hypotension * Otosclerosis * Hypoglycaemia Otologic Non Otologic 7 * Presbyacusis * Epilepsy * Noise trauma * Migraine * Ototoxic drugs * Tumours of VIII nerve * Drugs B) OBJECTIVE – Otologic Vascular tumours of middle ear (Glomus tumour) Aneurysm and arteriovenous shunt around the ear. Live insects in the ear. Clonic contractions of the Palatal or tympanic muscles MANAGEMENT OF TINNITUS In all forms of medicine, the first and most ideal line of treatment is to treat the cause. When no cause is found, management includes : 1. Re assurance and psychotherapy. 2. Techniques of relaxation and biofeedback 3. Sedation and tranquillizers 4. Masking of tinnitus – use of fan, loudly clicking clock or a similar device may mask the tinnitus, use of hearing aid, in persons with hearing loss. 5. Surgical treatment – sectioning of Chorda tympani nerve, or tympanic plexus of nerves or cochlear nerve may be tried, but usually it does not help the patient.6(p145-146),7(p101-102) ABBREVIATION : Ut - Uttara tantra Us - Uttara sthana KR - Karna roga chikitsadhikara Ch - Chapter Sl - Shloka P - page number U - Uttarardha PREVIOUS DISSERTATION WORKS DONE : 8 1. Maheshwar S Guggari – a clinical study on karna nada and its management with Apamarga Kshara taila- Bengaluru: Rajiv Gandhi University of Health Sciences 1998. 2. Seetha Lakshmi B S – A study on Karna poorana & its role in the management of karna nada- a clinical study- Bengaluru: Rajiv Gandhi University of Health sciences 2005. 3. Apeksha D Rao- A comparative study of karna poorana with nasya karma using bala taila in the management of karna nada-Bengaluru: Rajiv Gandhi University of Health Sciences 2009-2010. 6.3 OBJECTIVES OF STUDY : 1. To evaluate the efficacy of karna poorana with Ativishadi taila in the management of Karna nada. 2. To evaluate the efficacy of internal administration of Panchamuli bala kshira in the management of Karna nada. 3. To evaluate the comparative efficacies of Ativishadi taila karna poorana with internal administration of Panchamuli bala kshira in the management of Karna nada. 7.0 METHODOLOGY: 7.1 SOURCE OF DATA: The patients with lakshanas of karna nada will be selected from OPD and IPD of Shalakya Tantra of Sri Jayachamarajendra Institute of Indian Medicine, Bengaluru. 7.2 METHODS OF COLLECTION OF DATA : A total number of 45 patients having clinical features namely various kinds of sounds in the ear like hissing, rustling, vertigo, deafness and with no association of other systemic disease are selected for study. INCLUSION CRITERIA : 9 1. The subjective features of tinnitus with associated symptoms like impaired hearing, vertigo (giddiness) and fullness sensation are included. 2. Patients aged between 20-60years. 3. Karna nada with intact ear drum. EXCLUSION CRITERIA : 1. Patients below the age of 20years. 2. Patients suffering from chronic suppurative otitis media. 3. Karna nada due to abhigata (injury). 4. Perforated ear drum. 5. Tinnitus associated with other diseases like vascular tumour of middle ear, aneurysms of carotid artery, palatal myoclonus,meningitis. STUDY DESIGN : Total 45 patients will be selected for the study. They will be divided into 3 groups – Group A : will be treated with Karna poorana using Ativishadi taila for 7 days with a gap of 7 days for three sittings of about 35 days. Group B : will be treated with Panchamuli bala kshira orally 50ml twice a day for 7 days with a gap of 7 days for three sittings of about 35 days. Group C : will be treated by Ativishadi taila karna poorana along with panchamuli bala kshira orally for 7 days with a gap of 7 days for three sittings of about 35 days. DURATION : Total duration of treatment will be 35 days in each group. In all the three groups clinical findings and symptoms before treatment and changes in the same with treatment shall be observed and same shall be recorded in the proforma of case sheet. FOLLOW UP PERIOD : Duration shall be fixed for 60 days in all the 3 groups after treatment for observing the 10 possible recurrences. ASSESSMENT CRITERIA : Assessment will be done on the basis of clinical observations (subjective and objective) before, during and after treatment. PARAMETERS : Subjective Parameter : 1. Ringing sound in the ear. 2. Impaired hearing. 3. Fullness sensation. 4. Vertigo. Objective Parameter : 1. Pure tone Audiometry. 7.3 INVESTIGATIONS : Audiometric evaluation ETHICAL CLEARANCE : has been obtained from ethical committee, Government Ayurvedic Medical College, Bengaluru, for the above said clinical trial. 8. BIBLIOGRAPHY: 11 1. Sushruta.Sushruta Samhita, Translated by Kaviraj Kunjalal Bhishagratna, Edited by Dr.Laxmidhar Dwivedi, 1st ed. Varanasi : Chaukambha Sanskrit Series Office; 1999. vol III. pp646. 2. Vaghbata.Ashtanga Hridayam, Translated by Prof K.R.Srikanth Murthy, 3rded. Varanasi : Krishnadas Academy;2000.vol III. pp586. 3. Madhavakara.Madhava Nidana (Roga Viniscaya), Translated by Prof K.R.Srikanth Murthy,3rd ed. Varanasi : Chaukambha Orientalia;2000.pp329. 4. Yogaratnakara, with ‘Vidyotini’ hindi commentary by Dr.Srilakshmipati Shastri, edited by Bhishagratna Sri Brahma Shankar Shastri, Varanasi: Chaukambha Publications; 2005. pp504. 5. Govinda Das Sen. Bhaishajya Ratnavali with ‘Siddhiprada’ hindi commentary by Prof Siddhi Nandan Mishra,1st ed. Varanasi: Chaukambha Sur Bharati Prakashan;Vol I. 2005.pp614. 6. P L Dhingra. Diseases of Ear, Nose and Throat, 5th ed. New Delhi: A division of Reed Elsevier India Private Limited;2010.pp486. 7. K B Bhargava,S K Bhargava,T M Shah.A short text book of E.N.T Diseases, 7th ed. Mumbai:Usha Publications;2005.pp426. 12 9. SIGNATURE OF THE CANDIDATE 10. REMARKS OF GUIDE 11. NAME AND DESIGNATION OF THE GUIDE 11.1 SIGNATURE OF THE GUIDE 11.2 CO-GUIDE IF ANY 11.3 SIGNATURE OF CO-GUIDE 11.4 NAME AND DESIGNATION OF HEAD OF THE DEPARTMENT 11.5 SIGNATURE OF THE H.O.D. 12.1 REMARKS OF PRINCIPAL 12.2 SIGNATURE OF PRINCIPAL Dr. SUMITRA .T. GOWDA. MD(AYU) PROFESSOR, DEPT. OF P.G. STUDIES IN SHALAKYA TANTRA, GOVERNMENT AYURVEDA MEDICAL COLLEGE, BENGALURU-560009 Dr. B.N. RAMESH.MD (AYU)(SHALAKYA) PROFESSOR AND HOD, DEPT OF P.G. STUDIES IN SHALAKYA TANTRA, G.A.M.C.,BENGALURU-560 009 13