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A rare case report: Ayurvedic management of vocal cord nodules

Article  in  International Journal of Health & Allied Sciences · January 2019

DOI: 10.4103/ijhas.IJHAS_31_19

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DOI:
10.4103/ijhas.IJHAS_31_19
Departments of Shalakya
Tantra and 1Rasa Shashtra
and Bhaisajya Kalpana,
Institute of Post Graduate
Teaching and Research in
Ayurveda (IPGT and RA),
Jamnagar, Gujarat, India
Address for
correspondence:
Dr. Rozina Ashrafali Khoja,
4th Floor, Department of
Shalakya Tantra, Institute
of Post Graduate Teaching
and Research in Ayurveda
(IPGT and RA),
Jamnagar, Gujarat, India.
E‑mail: rozinakhoja28@
gmail.com
Received: 04‑05‑2019
Revised: 04‑05‑2019
Accepted: 07‑06‑2019
Published: 15‑10‑2019
282 © 2019 International Journal of Health & Allied Sciences | Published by Wolters Kluwer ‑ Medknow
Case Report
A rare case report: Ayurvedic
management of vocal cord nodules
Rozina Ashrafali Khoja, Sarika M Makwana1, D B Vaghela
Abstract:
Vocal nodules are the consequence of functional voice disorders, which are also caused by vocal
abuse or misuse. An increased vocal load, for example, due to the patient’s profession, demands
high‑volume speech for the formation of nodules. In the present case report, a 26‑year‑old female
patient acquired this disease followed by common cold cough. Her problems were aggravating
by high‑volume speech and getting fatigability also. This patient was given Anutaila Nasya with
Sitopaladi Churna, Naradiya Laxmi vilasa Rasa, Yashtimadhu Ghanvati (for chewing), and Dashmoola
Kwatha (Kavala). The patient was advised for strict voice rest and steam inhalation for better result.
After 1 month of treatment, the patient got relief from all her complaints and gained normal voice.
On examination, it was found that vocal nodules disappeared in direct laryngoscopy. Hence, this
single case report shows that ayurvedic management of vocal cord nodules gives excellent result
and improves patients’ quality of voice.
Keywords:
A rare, Ayurveda, hoarseness of voice, Nasya, vocal nodules
Introduction Acharya Shushruta has described one
whole chapter for Swarabheda, and
A vocal nodule is a benign mucosal
lesion on the vocal fold and frequently
presents in the general population.[1] Vocal
AtiUchchaBhashana is described as a main
Nidana of it. He has described Samprapti
as Dosha will take place in Shabda Vaha
nodules are typically located at the point Srotasa and will give rise to Swarabheda.[4]
of maximal amplitude during the mucosal In Kaphaja‑Swarabheda, patient speaks with
wave, and thus, that section subjected to difficulty and she/he can speak slowly and in
have the most phonotraumatic force during low tone and it gets more distinct in the day.[5]
phonation. The cause of vocal nodules is
generally laryngeal trauma due to chronic
vocal abuse or misuse. Patients often present
Case Report
with a poor vocal endurance and a quickly
A 26‑year‑old female patient presented
tiring voice. An increased vocal load, for to the outpatient department of Shalakya
example, due to the patient’s profession, Tantra with the complaints of throat pain
is usually responsible for the formation of for 2 months and hoarseness of voice for
nodules. Boys, young women, and teachers
3 months associated with fatigue in speech.
are particularly affected. [2] Treatment The complaints were increasing with
options for vocal fold nodules include frequent talks and high‑volume speech. She
both invasive and noninvasive techniques. also gets an attack of tonsillitis once in a year.
Attention to correcting the underlying
causative factors, largely through voice
Past history
therapy and education, plays an integral role She had a history of fever with common cold
in any treatment plan of action.[3] before 2 months and chronic cough for the
This is an open access journal, and articles are last 4 months. The patient’s personal history
distributed under the terms of the Creative Commons was normal.
Attribution‑NonCommercial‑ShareAlike 4.0 License, which
allows others to remix, tweak, and build upon the work How to cite this article: Khoja RA, Makwana SM,
non‑commercially, as long as appropriate credit is given and Vaghela DB. A rare case report: Ayurvedic management
the new creations are licensed under the identical terms. of vocal cord nodules. Int J Health Allied Sci
2019;8:282-4.
For reprints contact: reprints@medknow.com
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Khoja, et al.: Hoarseness of voice
Table 1: Treatment protocol
Drug
Laxmivilas Rasa
Sitopaladi Churna
Yashtimadhu Ghanvati
Dashmoola Kwatha (decoction of Dashmoola)
Anutaila
Figure 1: Before treatment – Vocal nodule both side before treatment
On examination, the following were observed:
• Nose: No any abnormality found
• Ear: No any abnormality found
• Throat: Congestion over the anteroposterior pallor
and posterior pharyngeal wall
• Telescopy:
• Larynx – Congestion
• Vocal cord – Bilateral nodule was seen [Figure 1]
• Pyriform fossa – Clear.
Treatment protocol
The patient was treated as described in Table 1. In
treatment, the patient was given Laxmivilas Rasa 250 mg
two times in a day with Anupana of Madhu and Sitopaladi
Churna 3 gms two times a day with Anupana of Madhu for
1 month. She was given Yashtimadhu Ghanvati one tablet
four times in a day for chewing along with Dashmoola
Kwatha gargles two times a day for 7 days, Marsha Nasya
with Anutaila six drops in each nostril was administered
for 7 days.
Pathya‑Apathya
The patient was advised for Pathya‑apathya as
summarized in Table 2. She was advised for strict voice
rest for the first 3 days and after that it was advised to
her for less use of voice with minimum use of words. She
was also advised to take steam inhalation through mouth
two times a day with the intake of lukewarm water for
the whole day as a routine. She was strictly advised
not to take any ice cream, cold drinks, chocolates, fast
food, or any color chemical‑containing items. She was
International Journal of Health & Allied Sciences - Volume 8, Issue 4, October‑December 2019 283
Dose Root Duration
250 mg BD with honey Orally 1 month
3 g BD with honey Orally 1 month
One tablet four times in a day Chewing (Chusanarthe) 1 month
Two times in a day Gargles (Kavala) 7 days
Six drops in each nostril in morning Nasya 7 days
Table 2: Pathya‑Apathya
Do’s Don’ts
Three‑day strict voice rest Ice cream, cold drinks,
After that, less use of voice and chocolate, fast food
usage of minimum words Misuse of voice
Steam inhalation with mouth Long talks
two times in a day
Lukewarm water for drinking
also advised not to have long talks and not to raise her
voice too much.
Results
After 4 days of treatment significant improvement was
observed in hoarseness of voice with mild relief in throat
pain. After 20 days of treatment, Size of vocal cord
nodules decreased [Figure 2] and patient got complete
relief from hoarseness of voice and coughing, and patient
was comfortable with frequent talks and high volume
speech. The patient got improvement in fatigability in
speech. On telescopic examination, after 1 month, the
nodules disappeared completely with normal color of
laryngeal mucosa and pharynx [Table 3 and Figure 3].
Discussion
The patient was advised to take strict voice rest for
3 days so that the vocal cords can relax and can attain
its normal state. Acharya Shushruta has mentioned
Samanya Chikitsa of Swarabheda as Nasya, Avapidana,
Kavala, etc.[6] In Kaphaja‑Swarabheda, Katu Dravya should
be Lehya with Madhu.[7] Hence, Sitopaladi Churna with
Anupana of Madhu has the potential for cough extraction.
Naradiya Laxmivilas Rasa mainly contains Abhraka
Bhasma.[8] It has Tridoshahra and Rasayana properties
with Madhura‑Kashaya Rasa. Hence, it will mainly pacify
Vata‑Kapha Dosha. Yashtimadhu is specially indicated for
voice disorders due to its Swarya property which will
improve voice tone and quality.[9] It will also soothe
the mucosa of the throat and excrete excessive cough.
AnuTaila Nasya has Sheeta‑Ushna Veerya, Katu Vipaka,
and Tridoshahara properties. It promotes immune
modulation which will reduce frequent episodes of
inflammation.[10] Dashmoola Kwatha is likely to have a hot
potency and reduces mucus production (pacifies Kapha
Dosha) and also has mucolytic and anti‑inflammatory
activities. Kavala, steam inhalation, gives Swedana effect
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Khoja, et al.: Hoarseness of voice

Table 3: Results
Duration Result Laryngoscopy
4 days of Significant improvement was observed in hoarseness of voice Mild improvement in congestion
treatment Mild relief in throat pain and size of nodules
21 days Complete relief in hoarseness of voice and were decreased Nodule size decreased as a half
complaints with frequent talks and high‑volume speech
1 month The patient got improvement in fatigability in speech Nodules disappear
Normal color of the mucosa

Figure 2: Twenty days – size reduced after 20 days of treatment Figure 3: 1 month – nodules disappeared after 1 month

to vocal cords which will increase flow of blood and References

will reduce inflammation. Sheetaahara, prolong talks and
high‑volume speech are mainly responsible Nidana for
aggravation of Kapha and Vata Dosha. Hence, the patient
in our case was also advised to take voice therapy to
prevent it from occurring again due to faulty voice
production.
Conclusion
This single case report concludes that ayurvedic
management with Nasya and Kavala procedures using
internal medicines, i.e., Laxmi vilasa Rasa, Sitopaladi
choorna, and Yashtimadhu Ghanavati along with voice
rest and steam therapy through mouth offers excellent
result in the treatment of vocal cord nodule and improves
patient’s voice and brings it back to normal.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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