See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/352981712

AYURVEDIC MANAGEMENT OF OTOSCLEROSIS: A CASE STUDY

Article  in  World Journal of Pharmaceutical Research · July 2021

CITATIONS READS

0 1,625

1 author:

Shrawan Sahu

25 PUBLICATIONS   4 CITATIONS   

SEE PROFILE

All content following this page was uploaded by Shrawan Sahu on 04 July 2021.

The user has requested enhancement of the downloaded file.

 World Journal of Pharmaceutical Research
Singh et al. SJIF Impact
World Journal of Pharmaceutical Factor 6.805
Research
Volume 5, Issue 11, 800-806. Case Study ISSN 2277– 7105

AYURVEDIC MANAGEMENT OF OTOSCLEROSIS: A CASE STUDY

*1
Dr. Daya Shankar Singh*, 2Dr. Shrawan Kumar Sahu, 3Dr. Abhishek Bhushan
Sharma

1,2
Assistant Professor, Shalakya Tantra Department, Patanjali Ayurveda College, Haridwar.
3
Assistant Professor, Kaya Chikitsa Department, Patanjali Ayurveda College, Haridwar.

ABSTRACT
Article Received on
23 August 2016, Otosclerosis is one of the ear problems with which people are
Revised on 12 Sept. 2016, increasingly suffering. It affects the quality of life of the sufferer by
Accepted on 02 Oct. 2016
DOI: 10.20959/wjpr201611-7198
inducing loss of hearing and often tinnitus leading to anxiety,
depression and diminished interest and enthusiasm in his/her work.
The modern healing science offers only hearing aids to combat the
*Corresponding Author
Dr. Daya Shankar Singh problem, which is not acceptable heartedly by most of the people .In
Assistant Professor, addition to it, the hearing aids is also not helpful for all. The another
Shalakya Tantra more effective measure i.e. surgery is also not free from adverse after-
Department, Patanjali
effects. Therefore it is the need of hours to make an availability of a
Ayurveda College,
conservative and effective method of treatment by the practitioners of
Haridwar.
Alternative therapies to the suffering mankind. This article is an effort
in this regard. Here an interesting case of Otosclerosis, successfully managed by adopting
Ayurvedic procedures (Ksheera dhuma Nasya, Karnapooran, Matravasti) and medicines, has
been presented. The treatment carried out was planned by assuming Otosclerosis equivalent
to Badhirya described in Ayurveda-the science, art and way of a meaningful life.

KEYWORDS: Otosclerosis, Badhirya, Ksheera dhuma Nasya, Karnapooran, Matravasti.

INTRODUCTION
Otosclerosis is a term derived from oto, meaning “of the ear,” and sclerosis, meaning
“abnormal hardening of body tissue.” The condition is caused by abnormal bone remodeling
in the middle ear. Bone remodeling is a lifelong process in which bone tissue renews itself by
replacing old tissue with new. In otosclerosis, abnormal remodeling disrupts the ability of
sound to travel from the middle ear to the inner ear.

www.wjpr.net Vol 5, Issue 11, 2016. 800

Singh et al. World Journal of Pharmaceutical Research

Histologically, otosclerosis is characterized by two phases: i) otospongiosis; and ii)

otosclerosis. In otospongiosis, affected bone becomes hypervascular and osteoclasts and
osteolytic osteocytes cause enlargement of the vascular spaces of the bone. After
otospongiosis, bone deposition characterizes the otosclerosis phase.

Etiology
While the etiology of otosclerosis remains unknown, there are two main theories regarding its
origin; genetic and viral. It is inherited in an autosomal dominant fashion with variable
penetrance.[1] The interplay of genes with environmental factors is thought to be critical in the
phenotypic activation of genetic susceptibility.[2] There is considerable genetic heterogeneity,
with at least seven loci identified via linkage studies, as well as rare monogenic
forms.[3] Environmental factors implicated in the aetiology of otosclerosis include oestrogens,
fluoride and viral infections such as measles. Measles virus RNA has been found in the
footplate of otosclerosis specimens but there are other cases of stapes fixation that appear not
to be associated with measles infection.[4] It is likely that a number of different pathways
underlie the development of otosclerosis, with different genetic and environmental risk
factors contributing to a similar final disease outcome.[2]

Epidemiology
Histological otosclerosis is present in around 2.5% of people.[5] However, the clinical
manifestations are seen in only about 0.3%. The annual incidence is thought to be declining
as measles becomes a rarer infection, due to recent childhood immunisation programmes
against the disease. In Germany, decrease in hospital treatment for otosclerosis has been
observed since the introduction of measles vaccination.[6][7]

Diagnosis
Otosclerosis is traditionally diagnosed by characteristic clinical findings, which include
progressive conductive hearing loss, a normal tympanic membrane, and no evidence of
middle ear inflammation. The cochlear promontory may have a faint pink tinge reflecting the
vascularity of the lesion, referred to as the Schwartz sign.

Usually noticeable hearing loss begins at middle-age, but can start much sooner. The hearing
loss was long believed to grow worse during pregnancy, but recent research does not support
this belief.[8][9]

www.wjpr.net Vol 5, Issue 11, 2016. 801

Singh et al. World Journal of Pharmaceutical Research

Investigations
Audiometry is the primary investigation of choice. Bone and air conduction test typically
reveal a purely conductive, predominantly low-tone loss. If the cochlea is also involved ,
there will be mixed sensorineural/conductive loss.

It is difficult to distinguish the sensorineural loss of otosclerosis from other causes of

sensorineural hearing loss. Audiogram patterns such as Carhart's notch (a drop in bone
conduction thresholds of 20-30 dB, most pronounced at 2000 Hz) and excessive
sensorineural loss (beyond any likely presbycusis) may help to discriminate.

Tympanometry may show a stiffness curve, indicating low compliance of the tympanic
membrane and ossicular chain.

Fine-slice CT scanning may be used to demonstrate new abnormal bone deposition in the
temporal bone via the so-called 'halo' sign, which appears to be a useful diagnostic adjunct in
this condition.[10]

Treatment
I) Medical treatment
Earlier workers suggested the use of calcium fluoride; now sodium fluoride is the preferred
compound. Fluoride ions inhibit the rapid progression of disease. In the otosclerotic ear, there
occurs formation of hydroxylapatite crystals which lead to stapes (or other) fixation. The
administration of fluoride replaces the hydroxyl radical with fluoride leading to the formation
of fluorapatite crystals. Hence, the progression of disease is considerably slowed down and
active disease process is arrested. This treatment cannot reverse conductive hearing loss, but
may slow the progression of both the conductive and sensorineural components of the disease
process. Recently, some success has been claimed with a second such
treatment, bisphosphonate medications that inhibit bone destruction.[11][12] However, these
early reports are based on non-randomized case studies that do not meet standards of clinical
trials.[13] There are numerous side-effects to both pharmaceutical treatments, including
occasional stomach upset, allergic itching, and increased joint pains which can lead to
arthritis.[14] In the worst case, bisphosphonates may lead to osteonecrosis of the auditory
canal itself.[15] Finally, neither approach has been proven to be beneficial after the commonly
preferred method of surgery has been undertaken.

www.wjpr.net Vol 5, Issue 11, 2016. 802

Singh et al. World Journal of Pharmaceutical Research

II) Surgical treatment

There are various methods to treat otosclerosis. However the method of choice is a procedure
known as Stapedectomy. Early attempts at hearing restoration via the simple freeing the
stapes from its sclerotic attachments to the oval window were met with temporary
improvement in hearing, but the conductive hearing loss would almost always recur. A
stapedectomy consists of removing a portion of the sclerotic stapes footplate and replacing it
with an implant that is secured to the incus. This procedure restores continuity of ossicular
movement and allows transmission of sound waves from the eardrum to the inner ear. A
modern variant of this surgery called a stapedotomy , is performed by drilling a small hole in
the stapes footplate with a micro-drill or a laser, and the insertion of a piston-like prothesis.
The success rate of either surgery depends greatly on the skill and the familiarity with the
procedure of the surgeon.[8] However, comparisons have shown stapedotomy to yield results
at least as good as stapedectomy, with fewer complications, and thus stapedotomy is
preferred under normal circumstances.[16]

CASE REPORT
A 20 year old boy reported shalakya OPD of Patanjali Ayurved Hospital in February 2016 as
a diagnosed case of otosclerosis .He had developed sensorineural deafness and tinnitus along
with progressive conductive hearing loss during last 2 years. Having heard the surgery as a
single solution to his problem, that too not free from possible side effects, the patient
presented himself for Ayurvedic management to avoid the surgery.

On the basis of similar clinical presentation of otosclerosis with that of Badhirya , the patient
was switched on to following procedures:
1. Ksheera dhuma Nasya Ksheerabala Taila (101A)
2. Karnapoorana with Dhanvantara Taila
3. Shirodhara with Ksheerabala Taila
4. Matravasti

The above procedures were carried out for 7 days and were followed by these drugs:
1. Ekangveer ras -250mg
Mahavaat Vidhwans Ras 125mg
Swarnamakshika 125mg
Ashwagandha churna 2gm
Brihat Vata chintamani ras125m

www.wjpr.net Vol 5, Issue 11, 2016. 803

Singh et al. World Journal of Pharmaceutical Research

1 dose x BD
2. Saraswatarista- 20 ml x BD with equal amount of water after meal
3. Sariwadi vati- 2 x BD
4. Bilva Taila 5-5 drop each ear x BD

RESULTS
After 2 months the patient visited with his symptoms (hearing loss and tinnitus) very much
minimized. His Audiometry test was repeated .the report was in accordance with the splendid
improvement in the condition of the patient. Audiometric tests before and after therapy are
depicted in figure 1 and figure 2 respectively.

FIG.1- AUDIOMETRY BEFORE THERAPY

FIG. 2- AUDIOMETRY AFTER THERAPY

www.wjpr.net Vol 5, Issue 11, 2016. 804

Singh et al. World Journal of Pharmaceutical Research

DISCUSSION
As mentioned earlier, otoscerosis can be correlated with Baadhirya which is due to vitiation
of Vata and Kapha Dosha. The procedure like Ksheeradhuma Nasya, Karnapoorana with
Dhanvatara Taila, Shirodhara and Matravasti –all are very much capable of alleviating Vata
and Kapha Dosha. The very process of Dosha alleviation was further enhanced by the
medicines i.e. Ekangveer ras,Mahavat vidhwans ras, Swarn mashk bhasm,Ashwagandha
churna, Brihat Vata Chintamani ras. Rest of the morbid Dosha was expelled by Sarswatarista,
Sariwadi Vati, Bilva Taila.

CONCLUSION
The potential of Ayurvedic procedures and medicines have not been exploited yet. There is
extensive need of the same to improve the quality of life of the patients suffering from many
disorders like otosclerosis. Alternative therapy must be tried in recalcitrant disorders the
treatment for which are not promising in the mainstream healing system.

REFERENCES
1. Uppal S, Bajaj Y, Rustom I, et al; Otosclerosis 1: the aetiopathogenesis of otosclerosis.
Int J Clin Pract. 2009 Oct; 63(10): 1526-30.
2. Schrauwen I, Van Camp G; The etiology of otosclerosis: a combination of genes and
environment. Laryngoscope. 2010 Jun; 120(6): 1195-202.
3. Thys M, Van Camp G; Genetics of otosclerosis. Otol Neurotol. 2009 Dec; 30(8): 1021-
32.
4. Karosi T, Konya J, Petko M, et al; Two subgroups of stapes fixation: otosclerosis and
pseudo-otosclerosis. Laryngoscope. 2005 Nov; 115(11): 1968-73.
5. Declau F, van Spaendonck M, Timmermans JP, et al; Prevalence of histologic
otosclerosis: an unbiased temporal bone study in Caucasians. Adv Otorhinolaryngol.
2007; 65: 6-16.
6. Arnold W, Busch R, Arnold A, et al; The influence of measles vaccination on the
incidence of otosclerosis in Germany. Eur Arch Otorhinolaryngol. 2007 Jul; 264(7): 741-
8. Epub 2007 Feb 13.
7. Niedermeyer HP, Arnold W; Otosclerosis and measles virus - association or causation?
ORL J Otorhinolaryngol Relat Spec. 2008;70(1):63-9; discussion 69-70. Epub 2008 Feb
1.

www.wjpr.net Vol 5, Issue 11, 2016. 805

 Singh et al. World Journal of Pharmaceutical Research

8. de Souza, Christopher; Glassock, Michael (2003). Otosclerosis and Stapedectomy:

Diagnosis, Management & Complications. New York, NY: Thieme.ISBN 1-58890-169-6.
9. Lippy WH, Berenholz LP, Schuring AG, Burkey JM (October 2005). "Does pregnancy
affect otosclerosis?". Laryngoscope. 115(10): 1833–6.
10. Vicente Ade O, Yamashita HK, Albernaz PL, et al; Computed tomography in the
diagnosis of otosclerosis. Otolaryngol Head Neck Surg. 2006 Apr; 134(4): 685-92.
11. Brookler K (2008). "Medical treatment of otosclerosis: rationale for use of
bisphosphonates". Int Tinnitus J. 14(2): 92–6.
12. http://www.freshpatents.com/-dt20090716ptan20090181108.php?type=description
13. Chole RA & McKenna M, Pathophysiology of otosclerosis, Otology & Neurotology,
2001; 22(2): 249-257.
14. Otosclerosis at the American Hearing Research Foundation Chicago, Illinois 2008.
15. Polizzotto MN, Cousins Polizzotto & Schwarer AP, Bisphosphonate-associated
osteonecrosis of the auditory canal, British Journal of Haematology, 2005; 132(1): 114.
16. Thamjarayakul T, Supiyaphun P & Snidvongs K, Stapes fixation surgery: Stapedectomy
versus stapedotomy, Asian Biomedicine, 2010; 4(3): 429-434.

www.wjpr.net Vol 5, Issue 11, 2016. 806

View publication stats