AMENDMENT SHEET

TITLE -
A Case Control Study to evaluate the Karnendriya Shaithilya in Pandu Roga (Iron
Deficiency Anemia) through Noise Sensitivity Scales and Audiometry Test

Suggestions by IEC Correction Page No.

Add Control Group of Title 1

appropriate size
Research 12
Methodology

Study Flow Chart 14

Inclusion Exclusion 15
Criteria

PG scholar Guide
Dr. Ritu Verma Dr. Nithin Krishnan
Roga Nidana evum Vikriti Vigyana MD (Ayu.)
Associate Professor
Roga Nidana evum Vikriti Vigyana
 SYNOPSIS

TITLE- A Case Control Study to evaluate the Karnendriya Shaithilya in Pandu

Roga (Iron Deficiency Anemia) through Noise Sensitivity Scales and Audiometry
Test

SHRI KRISHNA AYUSH UNIVERSITY, KURUKSHETRA

Submitted for the Partial Fulfilment of Ayurveda Vachaspati

PG. Scholar
Dr. Ritu Verma
GUIDE:
Dr. Nithin Krishnan
Associate Professor
Department Of Roga Nidana Evum Vikriti Vigyana

Department Of Roga Nidana Evum Vikriti Vigyana

Shri Dhanwantry Ayurvedic College and hospital
Sector-46 B,
CHANDIGARH
BATCH 2023-2026

1
 CERTIFICATE FOR RESEARCH TOPIC APPROVAL:

It is certified that the research work entitled “A Case Control Study to evaluate the Karnendriya
Shaithilya in Pandu Roga (Iron Deficiency Anemia) through Noise Sensitivity Scales and Audiometry
Test” has been allotted, after approval from Department Research Committee to Dr. Ritu Verma under
the supervision of Dr. Nithin Krishnan. It would be a further advancement & innovative idea in the field
of Ayurveda.
Dr. Sumit Srivastava
Professor, HOD
Department Of Roga Nidana Evum Vikriti Vigayana,
Shri Dhanwantry Ayurvedic College & Hospital,
Chandigarh.

2
PERFORMA FOR REGISTRATION OF TOPIC FOR DISSERTATION:

1. Name of the candidate and address:

Dr. Ritu Verma
Shri Dhanwantry Ayurvedic College and Hospital,
Chandigarh, Pin- 160047.

2. Name of Guide:
Dr. Nithin Krishnan
Associate Professor
Department of Roga Nidana Evum Vikriti Vigayana
Shri Dhanwantry Ayurvedic College and Hospital,
Chandigarh, Pin:160047.

3. Name of the Institution:

Shri Dhanwantry Ayurvedic College and Hospital,
Chandigarh.

4. Course of Study:
Subject- M.D. (Ayurveda)- Roga Nidana evum Vikriti Vigyana.

5. Date of commencement of course:

3
 From Dr. Ritu Verma
First Year M.D Scholar
Department Of Roga Nidana Evum Vikriti
Vigyana

Shri Dhanwantry Ayurvedic College and

Hospital Chandigarh -160047

To The principal.
Shri Dhanwantry Ayurvedic College and
Hospital Chandigarh -160047

Through Head of Department

Department of Roga Nidana Evum Vikriti
Vigayana

Shri Dhanwantry Ayurvedic College and

Hospital Chandigarh -160047

Subject: Submission of Synopsis for Registration

Respected Sir,
I, undersigned PG scholar Dr. Ritu Verma, humbly request you to register my below
mentioned topic “A Case Control study to evaluate the Karnendriya Shaithilya in Pandu
Roga (Iron Deficiency Anemia) through Noise Sensitivity Scales and Audiometry Test”- A
Case Control study for postgraduation studies in Roga Nidana Evum Vikriti Vigyana
department. With this letter, I am enclosing complete Performa of the same for registration.

Date: Yours faithfully

Dr. Ritu Verma

4
TITLE
A Case Control Study to evaluate the Karnendriya Shaithilya in Pandu Roga (Iron
Deficiency Anemia) through Noise Sensitivity Scales And Audiometry Test

NAME OF THE CANDIDATE : Dr. Ritu Verma

REMARKS OF GUIDE :

SIGNATURE OF GUIDE :

NAME OF THE GUIDE : Dr. Nithin Krishnan

SIGNATURE OF H.O.D :

NAME OF THE H.O.D : Dr. Sumit Srivastava

NAME OF THE INSTITUTION : Shri Dhanwantry Ayurvedic College

And hospital, Chandigarh Pin: 160047

SIGNATURE OF PRINCIPAL:

5
INDEX

S. NO PARTICULARS PAGE NUMBER

1 Introduction 7

2 Review of Literature 8

3 Aims and Objective 9

4 Previous Work Done 10

5 Need of Study 11

6 Research Methodology 12

7 Study Flow Chart 14

8 Criteria of Assessment 16

9 Study Timeline 19

10 Observation And Result 20

11 References 21

12 Annexure 23

13 Case Report Form 24

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TOPIC OF DISSERTATION: A Case Control Study to evaluate the Karnendriya
Shaithilya in Pandu Roga (Iron Deficinecy Anemia) through Noise Sensitivity
Scales and Audiometry Test

INTRODUCTION
Ayurveda is the study of life that focuses on the positive well-being in healthy and the treatment of
illness in unhealthy through its comprehensive methodology, way of life rehearses, dietary practices,
and more secure drugs. Ailing health either because of deficient dietary admission or absence of
adjusted eating routine in today’s time and age has led to the advancement of different diseases and
Pandu Roga is one of them.

Pandu is a disease manifested due to vitiation of Pitta Dosha. Acharya Charaka considers it a
Raktavahasroto Viddha Lakshana and Rasapradoshaja Vikara whereas Sushruta identifies Pandu as
a disease manifested due to vitiation of Rasavaha Srotas. Since Pandu Roga is a Pitta Pradhana
Vyadhi and Bhrajaka Pitta and Rakta, are responsible for the Prakrita Varna of body, so aggravation
of Pitta can cause hindrance of Prakrita Varna and pallor of skin (Panduta). Samanya Lakshanas of
Pandu Roga according to Ayurveda are Raktalpata, Medalpata, Nissarta, Vaivarnya, Ojogunakshaya,
Daurbalya, Aruchi, Bhrama, Shithilaendriya.

Pandu Roga can be correlated with Anemia in modern science due to the resemblance in clinical signs
and symptoms. Anemia is defined as a deficiency of haemoglobin in the blood. Iron deficiency anemia
(IDA) is the most common nutritional deficiency worldwide. According to WHO, it affects nearly two
billion people. It was found that nearly one-half of anemic individuals have IDA. It can cause reduced
work capacity in adults and impact motor and mental development in children and adolescents. IDA
may affect visual and auditory functioning. So the aim of the study is to correlate findings of
Audiometry & Noise sensitivity Scales with Iron Profile & Hb Levels.

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REVIEW OF LITERATURE
The word "Pandu" has been derived from the term "Padi Nasane", with the suffix "Ku", and ends with
Ni.

According to Charaka Samhita, patients with this condition exhibit discoloration of skin like Pandu,
Haridra, or greenish. According to Sushruta Samhita, Shweta raktam or Shweta pitta is more prevalent
in the patient's body, so it is called Pandu.

Different acharyas have explained the Lakshanas of Pandu. In Charak Samhita chikitsa sthana, Pandu
Lakshanas are explained as follows –

सोऽल्परक्तोऽल्पमेदस्को न िःसारिः निनिलेन्द्रियिः। वैवर्ण्य भजते, तस्य हेतुं शृण सलक्षणम् ।। (C.Ch. 16/6)
Means Raktalpata, Medalpata, Nissarta, Vaivarnya, Ojogunakshaya, Daurbalya, Aruchi, Bhrama,
Shithilaendriya.

इन्द्रियाणाुं बलुं हत्वा तेजो वीयोजसी तिा। पाण्डरोगुं करोत्याि बलवणाय नि ाि म् || (M.N. 8)
Means Indriya Bala Kshaya, Varna Nasha, Agni Nasha.

Tridosha, Saptadhatu and Trimala are the basic concepts of Ayurveda. Dhatus are seven in number.
Rasadhatu, is first among the Saptadhatu and it is having prime importance of all Dhatu. And
according to Ayurveda, there are five Indriyas , one of which is Shrotrendriya. The sense organ which
perceives sound is called Shrotrendriya. External auditory meatus and external auditory canal are
hollow structures of the ears, which show predominance of Akasha Mahabhuta. Rasadhatu in its
decreased state produces some symptoms, one of which is Shabda Asahishnuta that is intolerability
towards sound which means Rasa Dhatu Kshaya affects the functioning of Srotrendriya . Lakshanas
of Rasa Dhatu Kshaya ar as follows
रसे रौक्ष्युं श्रमिः िोषो ग्लान िः िब्दासनहष्णता| (A.H.Su. 11/17)
Means Rukshta, Shrama, Shosha, Glani, Shabdasahishnuta.
Also Pandu is one of the Rasapradoshaja Vikara.

पाण्डत्वुं स्रोतसाुं रोधिः क्लैब्युं सादिः कृिाङ्गता|

ािोऽिेरयिाकालुं वलयिः पनलतान च|| (Ch.Su. 28/9-10)

8
Since Pandu Roga ia a Rasapradoshaja Vikara and one of its symptoms is Indriyashaithilya and one
of the symptoms of Rasa Dhatu Kshaya is Shabdasahishnuta, so this study is focused on Karnendriya
Shaithilya in Pandu Roga.

Symptoms of Pandu Roga are similar to Anemia in modern science. There are different types of
Anemia as described in modern, out of which Iron Deficiency Anemia is the commonest nutritional
deficiency disorder throughout the world. Iron deficiency is the main cause of Iron Deficiency
Anemia where hemoglobin (Hb) level of less than 13g/dl in men and less than 12 g/dl in women,
Iron levels less than 60mcg/dL, and serum ferritin level of less than 15ug/l is indicative of iron
deficiency.

If you don’t get enough Iron, your cells can’t deliever oxygen properly, as iron helps blood cells
carry oxygen from lungs to the body. The inner ear require an oxygen rich, healthy blood supply to
function normally. The blood supply of inner ear is highly susceptible to ischemic damage. Therefore
it is considered, that IDA can lead to hearing impairement.

Relationship between Karnendriya Shaithilya and Pandu can be correlated with hearing loss in Iron
Deficiency Anemia. So and attempt is made to validate text in ayurvedic samhita that is Karnendriya
shaithilya in Pandu according to modern.

AIM
This study aims to investigate Karnendriya Shaithilya in Pandu (Iron Deficiency Anemia ) patients by
correlating the findings of Audiometry & Noise sensitivity Scales with Iron Profile & Hb Levels.

OBJECTIVES
• To assess Shabdasahishnuta in Pandu Rogi via Noise sensitivity Scales
• To assess Karnendriyashaithilya in Pandu Rogi via Audiometric Evaluation.

9
PREVIOUS WORK DONE:

1. Association of Iron Deficiency Anemia With Hearing Loss in US Adults

Kathleen M. Schieffer, BS1; Cynthia H. Chuang, MD, MSc2; James Connor, PhD3; et alJames
A. Pawelczyk, PhD4; Deepa L. Sekhar, MD, MSc5, April 2017
2. Sudden Sensorineural Hearing Loss Associated With Iron-Deficiency Anemia

A Population-Based Study Shiu-Dong Chung, MD, PhD1,2; Po-Yueh Chen, MD3; Herng-
Ching Lin, PhD2,4; et alShih-Han Hung, MD5, May 2014

3. The Relationship Between Iron Deficiency Anemia and Sensorineural Hearing Loss in the
Pediatric and Adolescent Population Kathleen M. Schieffer, James R. Connor, James A.
Pawelczyk and Deepa L. Sekhar 13June,2017
4. Auditory brainstem response in infants with iron deficiency anemia 2020, International
Journal of Pediatric Otorhinolaryngology February,2019
5. Study of Association of Sensory Neural Hearing Loss with Iron Deficiency Anemia
Original Article Published: 15 May 2021
6. Schieffer KM, Chuang CH, Connor J, Pawelczyk JA, Sekhar DL. Association of Iron
Deficiency Anemia With Hearing Loss in US Adults. JAMA Otolaryngol Head Neck Surg.
2017 April
7. Taki M, Hasegawa T, Ninoyu Y, Mohri H, Hirano S. Low-Frequency Sensorineural Hearing
Loss Associated With Iron-Deficiency Anemia. J Int Adv Otol. 2021 Sep;17.
8. Sudden Sensorineural Hearing Loss Associated With Iron-Deficiency Anemia A Population-
Based Study Shiu-Dong Chung, MD, PhD1,2; Po-Yueh Chen, MD3; Herng-Ching Lin, PhD
May 2014

9. Iron deficiency is associated with poor prognosis in idiopathic sudden sensorineural hearing
loss Published online by Cambridge University Press: 29 April 2021

10. Relationship between Peripheral and Central Auditory Abilities and Iron Deficiency Anemia
in Adolescents Girls by Chandni Jain. 9Dec,2021.
11. Dr. Suvidha M. Pazare, Dr. Achal M. Doye, Dr. Aditi A. Gandhare, Dr. Virendra Kodape, &
Dr. Madhavi Charmore. (2020). A thematic review on Pandu with reference to Iron Deficiency
Anemia. January-February, 2020

10
 12. Rai, Shalini; Kar, Anukul Chanda1. A review on role of psychological factors in the
etiopathogenesis of Pandu Roga with reference to iron deficiency anemia. AYU (An
international quarterly journal of research in Ayurveda) 37(1):p 18-21, Jan–Mar 2016. |
13. A Study on Types of Pandu Roga with Special Reference to Iron Deficiency Anemia with the
Help of Serum Ferritin Gaikwad, Anju Rajiv Gandhi University of Health Sciences
(India) 2018 .
14. Sheikh, Rozina; Chouragade, Bharat1. A survey study on correlation between symptoms of
Pandu and Anemia. Journal of Indian System of Medicine 6(4) Oct–Dec 2018.
15. Unravelling the mind-body connection: exploring the role of psychological factors in the
development of pandu roga (iron deficiency Anemia) dr. bhagyashri purushottam kamdi1 *,
prof. dr. jayashri katole2 and dr. ashish g. keche3 5 Nov,2023
16. Etio-pathogenisis of Pandu Roga w.s.r. to Iron Deficiency Anemia an Literary Study Dr.
Chetan A. H., Dr. R. Y. Timmapur Sept-Oct,2019
17. A comparative study on the assessment of clinical features of Pandu roga and its subtypes vis
a vis various types of anemia. Journal article: Indian Journal of Traditional Knowledge, 2015,
Vol. 14, No. 4, 525-530 ref. 8 Authors: Shalini Rai Shalini Rai, A. C. Kar
18. Diagnostic variations in anemia types and types of pandu according to modern science and
ayurveda –a comparative study by Dr. Shekhar G Uike, 2023.
19. A conceptual analysis on pandu roga w.s.r. to iron deficiency Anemia’’- a review study
radha mishra* and o.p. vyas
20. Effects of iron-deficiency anemia on auditory function in school-aged children Gehan M.S.
Abd El-Salama, Eman Soliman Abd El-Gaffarb, Hala M. Abd El-Samad, 2018

NEED OF STUDY:

• Since Pandu Roga ia a Rasapradoshaja Vikara and one of its symptoms is Indriyashaithilya
and one of the symptoms of Rasa Dhatu Kshaya is Shabdasahishnuta, so out of five Indriyas
this study is focused on Karnendriya Shaithilya in Pandu Roga.
• In modern study, some researches have been done which shows significant correlation
between Iron Deficiency Anemia and Hearing loss in which audiometric assessments were
correlated with Hb levels.
• The purpose of the study is to validate the Ayurvedic concepts and to evaluate the correlation
of findings in Audiometry & Noise Sensitivity Scales with Iron profile & Hb Levels.

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RESEARCH QUESTION:
Is there any correlation of findings in Audiometry & Noise Sensitivity Scales with Iron profile & Hb
Levels.

HYPOTHESIS :

According to Acharya Charak, there is significant relation between Indriyashaithilya and Pandu. If
there is any correlation, then there must be a correlation between findings in Audiometry & Noise
Sensitivity Scales with Iron profile & Hb Levels.

NULL HYPOTHESIS

There is no correlation of findings in Audiometry & Noise Sensitivity

Scales with Iron profile & Hb Levels

ALTERNATE HYPOTHESIS

There is significant correlation of findings in Audiometry & Noise

Sensitivity Scales with Iron profile & Hb Levels

RESEARCH METHODOLOGY:

Materials
Blood Sample for Hb and Iron Profile

Audiometry and Noise Sensitivity Scales

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Methods
Subjects desired for the study will be taken from OPD and IPD of Shri Dhanwantry Ayurvedic College
and Hospital, Chandigarh and associated institutes. Blood Sample will be collected for Hb and Iron
Profile. Patients having dearranged Hb and Iron profile will be enrolled for case group and those who
will be having normal Hb and Iron Profile will be enrolled for the control group in the study. Audiometry
and Noise Sensitivity Scales will be used to assess the Karnendriya Shaithilya in both groups.
Assessment of results will be done to evaluate any correlation of the findings of Audiometry and Noise
Sensitivity Scales with Hb and Iron Profile levels of the subjects.

STUDY DESIGN: Case Control Study

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 STUDY FLOW CHART

Screening of Subjects

Blood Sample for Hb

and Iron Profile

Inclusion Criteria Exclusion Criteria

Dearranged Hb and Normal Hb and Iron

Values of Iron Profile Profile

CASE GROUP CONTROL GROUP

Assessment through Audiometry

and Noise Sensitivity Scales

Assessment of Results
to find any correlation

Analysis of Data

Conclusion

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SAMPLE SIZE - 200
• Case Group – 100
• Control Group – 100

The minimum required sample size was calculated to be 179.This sample size was estimated using
COCHRAN(1963) formula for prevalence of 13% with 95% confidence level with critical value Z α
/2 at 1.96 & acceptable margin error is 5%

Cochran Formula is

NAME AND PLACE WHERE THE STUDY WILL BE CONDUCTED:

Patients coming to OPD of Shri Dhanwantry Ayurvedic College and Hospital,
Chandigarh. CBC, Iron Profile and Audiometric tests would be done.

INCLUSION CRITERIA:
• Subjects with Dearranged Iron Profile for case group and subjects
with normal iron profile for control group.
• All patients between the 15-49 years of age group

EXCLUSION CRITERIA:

▪ Cases suffering from

• Deafness and other pathological conditions of ear

• Causes of Anemia other than iron deficiency

Diagnostic Criteria:
• Serum Iron – Less than 60 mcg/dL
• Serum Ferritin – Less than 15 ug/L
• Total Iron binding Capacity – > 450mcg/dL
• Unsaturated Iron Binding Capacity – >343mcg/dL
• Transferrin saturation – Less than 15%

15
CRITERIA OF ASSESSMENT

SUBJECTIVE CRITERIA:
Hyperacusis Impact Questionnaire (HIQ)

Please answer each item to the best of your ability as close to your experience as possible.

Over the last 2 weeks , how often would you say each of the following has occurred because of
certain environmental sounds that seemed too loud to you but that people around you could tolerate
well?

1.Feeling anxious when hearing loud noises 0–1days 2–6days 7–10days 11–14days

2.Avoiding certain places because it is too noisy 0–1days 2–6days 7–10days 11–14days

3.Lack of concentration in noisy places 0–1days 2–6days 7–10days 11–14days

4.Unable to relax in noisy places 0–1days 2–6days 7–10days 11–14days

5.Difficulty in carrying out certain day-to-day 0–1days 2–6days 7–10days 11–14days

activities/tasks in noisy places
6.Lack of enjoyment from leisure activities in noisy 0–1days 2–6days 7–10days 11–14days
places
7.Experience in glow mood because of your 0–1days 2–6days 7–10days 11–14days
intolerance to sound
8.Getting tired quickly in noisy places 0–1days 2–6days 7–10days 11–14days

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Sound Sensitivity Symptoms Questionnaire (SSSQ)

Over the last 2 weeks, how often have you been bothered by any of the following problems ?
1. Having a problem tolerating sounds because they 0–1 days 2–6days 7–10days 11–14days
often seem “too loud” to you ?
2. Pain in your ears when hearing certain loud sounds 0–1 days 2–6days 7–10days 11–14days
? Examples: loud music, sirens, motorcycles,
buildingwork, lawn mower, train stations.
3. Discomfort (physical sensations other than ear 0–1 days 2–6days 7–10days 11–14days
pain) in your ears when hearing certain loud sounds?
4. Feeling angry or anxious when hearing certain 0–1 days 2–6days 7–10days 11–14days
sounds related to eating noises, lip smacking,
sniffling, breathing, clicking sounds, tapping ?
5. Fear that certain sounds may make your hearing 0–1 days 2–6days 7–10days 11–14days
and/or tinnitus worse?

Weinstein Noise Sensitivity Scale (WNSS)

The scale is composed of 21 items addressing affective reactions and attitudes to both general noise and
daily environmental sounds. Individual sensitivity is seen as lying on a continuum ranging from high to
low. Highly sensitive individuals are more sensitive to, and react more negatively to, perceived noise
than their less sensitive counterparts

Administration
The scale can be administered on paper or online and takes approximately 5 minutes to complete.

Scoring
Responses to each of the 21 items are scaled along 6 points with 0 indicating strong disagreement and 5
indicating strong agreement. After reverse coding relevant items, the unweighted sum of scores from
each of the items is tallied. Stronger agreement with the items results in a higher score (ranging from 0
to 105), indicating greater individual noise sensitivity.

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 Strongly disagree Strongly agree
1) I wouldn’t mind living on a noisy street if the apartment I had was nice. 0 1 2 3 4 5

2) I am more aware of noise than I used to be. 0 1 2 3 4 5

3) No one should mind much if someone turns up his or her stereo full blast 0 1 2 3 4 5
once in a while.
4) At movies, whispering and crinkling candy wrappers disturb me. 0 1 2 3 4 5

5) I am easily awakened by noise. 0 1 2 3 4 5

6) If it’s noisy where I’m studying, I try to close the door or window or move 0 1 2 3 4 5
someplace else.
7) I get annoyed when my neighbors are noisy. 0 1 2 3 4 5

8) I get used to most noises without much difficulty. 0 1 2 3 4 5

9) It would matter to me if an apartment I was interested in renting were located 0 1 2 3 4 5

across from a fire station.
10) Sometimes noises get on my nerves and get me irritated. 0 1 2 3 4 5

11) Even music I normally like will bother me if I’m trying to concentrate 0 1 2 3 4 5

12) It wouldn’t bother me to hear the sounds of everyday living from neighbors 0 1 2 3 4 5
(f ootsteps, running water, etc.).
13) When I want to be alone, it disturbs me to hear outside noises. 0 1 2 3 4 5

14) I’m good at concentrating no matter what is going on around me. 0 1 2 3 4 5

15) In a library, I don’t mind if people carry on a conversation if they do it 0 1 2 3 4 5

quietly.
16) There are often times when I want complete silence. 0 1 2 3 4 5

17) Motorcycles ought to be required to have bigger mufflers. 0 1 2 3 4 5

18) I find it hard to relax in a place that’s noisy 0 1 2 3 4 5

19) I get mad at people who make noise that keeps me from falling asleep or 0 1 2 3 4 5
getting work done.
20) I wouldn’t mind living in an apartment with thin walls. 0 1 2 3 4 5

21) I am sensitive to noise. 0 1 2 3 4 5

18
OBJECTIVE CRITERIA:

Audiometry - Audiometric thresholds are measured in decibles

Normal – 0- 20 dB hearing level

Haemoglobin- less than 12g/dl in females and less than 13g/dl in males is indicative of iron
deficiency.
Serum Ferritin - Less than 15 ug/l is indicative of IDA.

Sound Sensitivity Symptoms Questionnaire -The five-item SSSQ requires respondents to rate
the number of days during the past 2 weeks that they experienced each of several symptoms,
including loudness hyperacusis, pain or discomfort hyperacusis, annoyance hyperacusis/
misophonia, and fear hyperacusis.

Hyperacusis Questionnaire - The HQ has 14-items, each rated on a 4-point Likert scale from
“no” to “yes, a lot”15. Cronbach’s α for the English version of the HQ is 0.88.19 The overall
score ranges from 0 to 42. Scores of 22 or more were taken as indicating the presence of
hyperacusis.

Weinstein Noise Sensitivity Scale (WNSS) - Responses to each of the 21 items are scaled along
6 points with 0 indicating strong disagreement and 5 indicating strong agreement. After reverse
coding relevant items, the unweighted sum of scores from each of the items is tallied. Stronger
agreement with the items results in a higher score (ranging from 0 to 105), indicating greater
individual noise sensitivity.

STUDY TIMELINE – 15 MONTHS

Literary Review 2 MONTHS

Screening and Enrollment of

Patients 6 MONTHS

Data Analysis
Data Interpretation 3 MONTHS

Writing the Thesis

Results 4 MONTHS
Conclusion

19
STATISTICAL ANALYSIS

Data will be collected using case report form (CRF) designed by incorporating all aspects (Ayurveda &
modern medicine) for the study.. Descriptive statistics will be computed to understand the central
tendencies and variabilities. SPSS will serve as the primary analysis tool, supplemented by Python and
R. Nominal & ordinal data will be analyzed using nonparametric tests like chi-square test, spearman’s
rank correlation, Kendall Tau Rank Correlation, Mann Whitney U Test as and when required. Continous
data will be analyzed using parametric test like Z-Test, Karl Pearson’s Correlation. The changes with p
value <0.05 will be considered as statistically significant.
We will utilize AI-enhanced capabilities in power BI and Tableau for advanced Statistical analysis and
data Visualization

ETHICAL CONSIDERATION:

This study will be conducted according to the prevalent standard of good clinical practices. This
protocol and any amendments will be submitted to the Institutional Ethics committee (IEC) for approval
of the study conduct.

OBSERVATIONS AND RESULT

Findings of Noise Sensitivity using HIQ, SSSQ, WNSS Scale will be done and Hb, Iron Profile,
Peripheral Blood Smear will be done. Then correlation between findings of Audiometry & Noise
Sensitivity Scales with Hb and Iron Profile will be evaluated and the result will be calculated after putting
appropriate statistical method.

EXPECTED OUTCOME:

1. Increase in intolerance of sound may be observed with decreasing levels of Hb and Iron Profile
values as per Karnendriya Shaithilya as a lakshan of Pandu.

2. Findings of the study may help to revalidate the concept mentioned in our Ayurvedic texts.

20
REFERENCES

1. Pandey K,Chaturvedi G. Vidyotini , Shrimad Agniveshena Praneeta Achaarya Charak And

Dridhabala, Chaukhambha Bharati Academy, Varanasi, Edition 2020, Charak Samhita, Vol 1,
Sutra Sthana 11/37, 200p.
2. Pandey K,Chaturvedi G. Vidyotini , Shrimad Agniveshena Praneeta Achaarya Charak And
Dridhabala, Chaukhambha Bharati Academy, Varanasi, Edition 2020, Charak Samhita, Vol 2,
Chikitsa Sthana 16/6
3. Pandey K,Chaturvedi G. Vidyotini , Shrimad Agniveshena Praneeta Achaarya Charak And
Dridhabala, Chaukhambha Bharati Academy, Varanasi, Edition 2020, Charak Samhita, Vol 1,
Sutra Sthana 28/9-10

4. Tripathi Brahmanand, Sutra Sthan1/13, Gupta K., Vagbhata, Asthanga Hridaya Vidyotini Tika

Chaukamba Sanskrit Sansthan, Varanasi, Ed 18 | Sutrasthana 11/17

5. Psychometric Evaluation of the Hyperacusis Impact Questionnaire (HIQ) and Sound Sensitivity
Symptoms Questionnaire (SSSQ) Using a Clinical Population of Adult Patients with Tinnitus
Alone or Combined with Hyperacusis Hashir Aazh, PhD 1,2 Chloe Hayes, BSc3 Brian
C.J.Moore, PhD4 Ali A .Danesh, PhD2 Silia Vitoratou, PhD
6. Weinstein Noise Sensitivity Scale (WNSS) (Weinstein, 1978) Profiled by: Debra L.
Worthington, PhD
7. The reliability and validity of decreased sound tolerance scale-screening Serpil Allusoglu a,∗,
Songul Aksoy
8. Brahmanand Tripathi. Varanasi: Chaukhambha Surbharati Prakashan; 1997. Hindi
Commentator, Charaka Samhita, Chikitsa Sthana16/6
9. Alvarez-Uria G, Naik PK, Midde M, Yalla PS, Pakam R. Prevalence and severity of Anemia
stratified by age and gender in rural India. Anemia. 2014;2014:176182. doi:
10.1155/2014/176182. Epub 2014 Dec 4. PMID: 25614831; PMCID: PMC4277798.
10. Ministry of Health and Family Welfare ANEMIA MUKT BHARAT, 4th Feb, 2022
11. Madhav Nidanam, Shri Vijaya Rakshit, Chaukhamba Orientalia, Chapter 8
12. Aazh H, Hayes C, Moore BCJ, Danesh AA, Vitoratou S. Psychometric Evaluation of the
Hyperacusis Impact Questionnaire (HIQ) and Sound Sensitivity Symptoms Questionnaire
(SSSQ) Using a Clinical Population of Adult Patients with Tinnitus Alone or Combined with
Hyperacusis. J Am Acad Audiol. 2022 May;33(5):248-258. doi: 10.1055/a-1780-4002. Epub
21
 2022 Feb 23. PMID: 35196727; PMCID: PMC9788912.
13. Pandey Ajay Kumar, Textbook of Kayachikitsa, Vol. 2, Chapter 2, First Edition. New Delhi;
Chaukhmbha Publications, 2019; 168.
14. Fong DYT, Takemura N, Chau PH, Wan SLY, Wong JYH. Measurement properties of the
chinese weinstein noise sensitivity scale. Noise Health. 2017 Jul-Aug;19(89):193-199. doi:
10.4103/nah.NAH_110_16. PMID: 28816206; PMCID: PMC5594924.
15. Brahmanand Tripathi. Varanasi: Chaukhambha Surbharati Prakashan; 1997. Hindi
Commentator, Charaka Samhita, Chikitsa Sthana
16. Pandey Ajay Kumar, Textbook of Kayachikitsa, Vol. 2, Chapter 2, First Edition. New Delhi;
Chaukhmbha Publications, 2019; 168.
17. Pandey Ajay Kumar, Textbook of Kayachikitsa, First Edition, New Delhi; Chaukhambha
Publications, 2019; 2(2): 167.
18. Prof. Priyavarat Sharma, Sushrut Samhita Uttar Tantra Chaukhambha Sanskrita Sansthana
Varanasi. Edited with Ayurveda Tattva Sandipika by Kaviraj Ambikadutta Shastri, Reprint,
2005; 16/6.
19. Iron-Deficiency Anemia nlhbi|nih
20. Faruqi A, Mukkamalla SKR. Iron Binding Capacity. [Updated 2023 Jan 2]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK559119/

22
 ANNEXURE

SHRI DHANWANTRY AYURVEDIC COLLEGE SECTOR-46 B, CHANDIGARH,

DEPARTMENT OF ROG NIDANA EVUM VIKRITI VIGAYANA

CONSENT FORM
For the study

“A Case Control Study to evaluate the Karnendriya Shaithilya in Pandu Roga(Iron Deficiency
Anemia)through noise sensitivity scales and audiometry test”

Case Serial No.: Phone No.

Name of Patient:

Name of MD Scholar: Dr. Ritu Verma

Name of Guide: Dr. Nithin Krishnan

I……...........….......................... aged…….…. years R/o…………………………….have been

informed adequately about the study.

I have understood the information sheet for above study i.e. “a case control study to evaluate the
karnendriya shaithilya in pandu roga (iron deficiency Anemia) through noise sensitivity scales
audiometry test. I have been given the opportunity to question Dr. Ritu Verma on all the aspects
of the study. I am also aware of my right to withdraw anytime during the course of study without
any reason. I have been informed to my satisfaction about the research and agree for the
participation in this study.

Name of patient with signature Name of witness with signature

I confirm that I have explained purpose of study to Mr/Mrs……………………………

Date Signature of the MD Scholar

23
 CASE REPORT FORM

Patient Name................................ OPD/IPD No. ..........................

TITLE
“A Case Control Study to evaluate the Karnendriya Shaithilya in Pandu Roga (Iron
Deficiency Anemia) through Noise Sensitivity Scales and Audiometry Test”
PG. Scholar
Dr. Ritu Verma
B.A.M.S. (SDAC, Chandigarh)

Guide
Dr. Nithin Krishnan
M.D. (Ayu.),
Professor, HOD
Dept. of Roga Nidan Evum Vikriti Vigyana

24
 PERFORMA

Sr. No. –
Dated -
Name of the Patient: -

DEMOGRAPHIC DATA

Name of the patient ……………………………………………………….

Age.…………………… Sex: Male Female

Marital status: Married Unmarried

Address : ………………………………………………………………………...………
…...……………………………………………………………………………

Telephone No.……………………

IPD No.: …………… OPD No.: …………………………

HISTORY OF THE PATIENT

Chief Complaints with Duration:

History of Present illness:

Drug allergy (if any):

25
 History of Past illness:

PERSONAL HISTORY:

PLACE OF RESIDENCE

Rural

Urban

Semi urban

EDUCATION

Literacy

Illiteracy

OCCUPATION

Job

Farmer

Business

NATURE OF WORK

Hard manual

Moderate manual
Sedentary

DIETIC HABIT

Vegetarian

Non vegetarian

Mix

ADDICTION

26
 Drinking

Smoking

Any other

SLEEP

Regular

Disturbed

BOWEL HABITS

Regular

Irregular

Constipation

URINE

Normal

Scanty micturition

Burning micturition

MENSTRUAL HISTORY

Age of menarche

Cycle (regular/ irregular)

Duration of flow

OBSTETRICAL HISTORY

GPLA

27
 GENERAL PHYSICAL EXAMINATION

General Appearance

Weight - ………………….Kg.
BMI - ……...........................
Height - ………………….cm
Respiration rate - …………………..per min.
Blood pressure - …………………..mm Hg.
Pulse Rate - ……..………….Per min Regular
/Irregular

ASHTAVIDHA PARIKSHA

NADI

Rate -
Rhythm -
Dosh gati - V/ P/ K Dvi-doshajSannipataja

MOOTRA

Colour
Quantity
Frequency a. Day time
b. Night time

MALA

Colour –
Consistency –
Odour –
Frequency -

28
JIHWA

Appearance –
Any ulcer -Present/ Absent
Any fissure -Present/Absent
Coating- -Present/Absent
Pigmentation -Present/Absent

SHABDA

SPARSHA

DRIK(EYES)

AKRITI

29
DASHAVIDHA PARIKSHA:
Prakriti

Sr. No. Character Vataja Pittaja Kaphaja

1. Appetite Laghu Bahubhuk Tikshankshudha Alpa kshudha

Dandshuka Ashanpriye

2. Thirst ……………… Tikshan Trisnan Alpa

3. Digestive Power Alpa Sheeghra- Paki ……………..

4. Economic Status Alpa dhan (poor) Madhya vitta Vasumanto

5. Dreams Sky walking, Svapne vidyuta, Jalashaya aloki,

Watching ulka pasyet Svapane
mountains, spadyaman
Watching rivers. Savihand
malam,
stoyashyam
pashyati
6. Fertility Alpa apatya Alpa apatya Prabhutapatya

7. Religious Faith Nastika ………………. Dridhbhakti

parayan

8. Likings Madhur amla Madhur Kashaya Malya-

lavana snigadha tikta, anulapena, katu
aahara, Yatra, Sheeta,Malya- tikta kashaya,
Geet hasya vilepana Ushna
Deerghsutri
9. Initiative Sheeghra arambha …………………

30
10. Knowledge Anavasthit mati Madhya Vidyavanta
Gyanvigyan

11. Sexual Desire ……………….. Alpa – Vyavaaya Prabhut,

Atimaithunsam
rath

12. Bowel ………………. Prabhut-srisht ………………

Movement

13. Bladder ……………….. Prabhut-srisht ……………….

Movement

14. Respect of ………………. ……………….. Manyita

Teachers Gurunam

15. Relation with Chala – souhard ……………….. Sthir mitra

Friends

16. Courage …………….. ………………… Maha utsaho

17. Helping Attitude …………….. Ashrit vatsal ……………….

(child loving)

18. Tolerance ……………… Klesh ……………….

Asahishanave

19. Faith in texts ………………. ……………….. Dridhshastram

ati

20. Donation ……………… ……………….. Pariganya

chirat
dadatibahu

21. Gratitude Kritghna ……………….. Kritagya

31
Sr. Character Vataja Pittaja Kaphaja
No.
1. Body Built Apachita (emaciated) Sukumar (tender), SnigdhangaSamhat,
Ruksha (dry), Alpa Avdatgatra(clear), Shalakshan,
(dwarf), Alpang, Shithilang (weak) Paripurna, Sarvang
Stabdh (Firmly fixed)

2. General Durbhaga (ugly) Durbhag (Ugly) Subhaga

Appearance
3. Look Chal Drishti Prasanna darshan

4. Color of Dhoosar gatra (grey) Gour (fair), Gour (fair)

Body Tamara

5. Strength Alpa bala Madhya bala Balvanta

6. Gait Laghu (light), Avasthit gati

Chapala
7. Skin Parush (dry), Sphutita Prabhut piplu, Soumya (clean),
(cracked) Vyanga , Tilpidi Achha (clear)
ka

8. Voice & Pratat ruksha Vigrah vakta Abhiyogvan ,

Speech (hoarse), Ksham (hostile discussion Parinishchit
(dry), Sann (low), ) vakyapad, Prasann
Sakta, Jarjar, svara
Bahubhashi

9. Sweating Alpa sveda Prabuta Alpa sveda

32
10. Hair Ruksha, Alpa, Kapil, Mridu, Sthira, Kutil ,
Sphutita, Dhusara Alpa, Kshipra Ghana, Neel
palitya, Palitya

11. Forehead ……………………… ………………….. Mahalalata

12. Eyebrows Chala (mobile), Avasthit

Anavasthit

13. Eyelashes Chala, Anavasthita Pingal, Alpa, Vishal Pakshma

Chala

14. Eyes Khar, Dhusara, Vritta Tamra, Vritta, Susnigadha, Vishal,

Himpriya, Netra Raktanta , Suvyakta
raag

15. Lips Anavasthita Tamra Upachita, Paripurna

16. Teeth Alpa, Parush, ………………… Bahula

Antkhadi

17. Tongue Anavasthita Tamra …………..........

(unstable)
18. Palate Sphutita (cracked) ……………….. …………...……

19. Chin Anavasthita (mobile) Tamra Upachita Paripurna

33
20. Face Parusha (dry) Tamra, Krodhen ………………..
madyen, ravesh
cha masa ragam

21. Limbs Sphutita (cracked) Gaur, Ushna Maha lalat Uro

22. Nails Parush, Alpa ………………. Suvibhakta

23. Hands Parush (dry), Tamra, Gaur Snigadha (oily),

Anavasthita, Sphutita (fair), Parusha saumya (clean),
(cracked) (dry) Suvibhakta

24. Feet Parush (dry), Tamra, Gaur Snigadha (oily),

Anavsthita, Sphutita (fair), Parusha Saumya (clean),
(cracked) (dry) Suvibhakta
25. Body odor ………………….. Prabhuta pooti …………………….

26. Joints Chal, Anavasthita, Mridu sandhi Goodha, Snidha,

Satata sandhi (loose & Sushlishta
shabdagamini softjoints)

27. Sira kandara Bahu kandar, Bahu ……………… …………………

dhamani sira pratan,
Bahudhama ni

34
PSYCHOLOGICAL FACTORS

Sr. No. Character Vataja Pittaja Kaphaja

1. Nature & Sheeghra kshobha, Ashrita Shanta

behaviour Sheeghra trasa vastsala,
raag, Stena (thief) Abhimani

2. Memory Alpa (short), …………… Smritimaan

Sheeghra shruta
grahi, Chala

3. Jealousy Matsarya (jealous) Irshyalu Vineeta

4. Anger Krodhi Kshipra kopa - Alpa

kshipra prasad kroadh,Shaant

5. Truthfulness ……………….. …………….. Satyavadi

6. Intellect Chala, Medhavi Gambhir

Avyavasthita buddhi

7. Greed Lolupa …………. Alolupa

8. Self-control Ajitendriya, …………. …………..

Heensatva

9. Dignity ………………. …………… Sulajja

35
DOSHAJA - ………………………………………………

Vataja-Alpakesh/Krisha/Ruksha/Vachal/Chalmanas/Akashchariswapaneshu

Pittaja - Akal palit/ Dhiman/Swedi/Krodhi/Jyotishamdristeswapaneshu

Kaphaja-Gambhirbuddhi/Sthoolang/Snigdhkesh/JalashyaavlokiSwapaneshu

MANASA - ………………………………………………

Satvika- Anryshanshaya/Samvibhagauruchita/Titiksha/Satya/Dharam /Gyanum / Budhi /

Medha/ Smriti/ Dhriti/ Anabhishangi

Rajas -Dukh bahulata/ Atan shilata/ Adhriti/ Ahankar// Akarunya/ Dambh Mana/ Harsh/
Kama krodh

Tamas -Vishaditvam/ Nastikyam/ Adharam shilata/ Budhi nirodh/ Agyanam/

Durmedhastvyam/ Akaramshilta/ Nidralutvam.

1. Vikriti :
Lakshnanimitta Lakshya nimitta Nimittanurupa

2. Sara: …………………………

Twaka (rasa) – Snigdha/ Slakshana/ Mridu/Prasan/Sukshma/Alpa/

Gambhir/Sukumaraloma/Tvakparabha

Rakta - Snigdha, Rakta, Bhrajishnu –Karna, akshi, mukha, jivha, nasa,

osth,Pani-padtal, nakh, lalat, mehan.

Mansa- Sthira /Guruta/ Mansa upachit- shankha, lalata, akshi, gandh,

hanu,griva, skandh, udar, kaksha, vaksh, pani- padsanthi etc.

36
 Meda -Snigdha – varna, swara, netra, kasha, loma, nakh, dant, ostha,
mutra,purish.

Asthi -Sthoolaparava – parshani, gulfa, janu, aratni, jatru, sira, Sthool –

asthi, nakha, dant.

Majja -Mriduanga/ Balvan/ Snigdhavara, svara/ Sthool, vritasandhi

Shukra- Saumya/ Ksheerpurnalochanta, praharsha, Snigdha, sam-

samhat,Prassan, snigdha vran swara, bhrijishnu, mahasphik

Satva - Smriti, Bhakti, suchi, maha-utsaha, daksha, gambhir budhi

chesta,gyana, pavitra, dheer, kalyankaribudhi

3. Samhanana

Balwan Madhayma Bala Alpa Bala

4. Parmana
Adhik Sama Heena

5. Satmava
Ekarasa Sarvarasa Misrarasa

6. Satva

Pravara Madhyam Avara

7. Aahara
• Abhayaransha 4 important meals and snacks in between 3 important meals
• Jaranshakti

Fluctuating Excessive
Fairly good Dull

37
8. Vyayam

Pravara Madhyama Alpa

9. Vaya

Pravara Madhyama Alpa

Samprapti Ghatak:

Dosha - …………………………………

Dushya - …………………………………

Srotas - ………………………………….

Srotodushti - ……………………………

Roga marg- …………………………………

38
SROTAS PAREEKSHA:
SROTAS LAKSHANA
Pranavaha Atisrushta Alpashabda Atibadha Shoolauchvasam
Udakavaha Shosha of jihwa Atipipasa
/talu/oshta/kantha/kloma
Annavaha Anannaabhilasha Arochak Avipaka Chardi
Rasavaha Ashradha Aruchi Asyavairasya
Arasagyta Hrillasa Angmarda
Gourava Tandra Jwara
Tama Pandutwam Srotorodha
Klaibya Sada Krisha
Agninasha Akala-Valaya-Palita
Raktavaha Kushta Visarpa Pidaka
Raktapitta Asrkdara Guda-Medra-
Asyapaka

Gulma Vidradhi Pleeha

Neelika Kamala Vyanga
Piplava Tilakala Dadru
Charmadala Switra Pama
Kotaasra Mandalam
Medovaha Dandatinammaladhyatwam Tritt
Dahapanipadayo Dehachikkanata Madhurasyata
Asthivaha Adhyasthidantha
Danta asthi – Bheda – Sula – Vivarnta
Kesa – Loma – Nakha – Smashru – Dosha
Majjavaha Parvaruk Bhrama Murcha
Tamadarshnam Parvasthulamoola – Murcha
Shukravaha Klaibya Aharshana Garbhapata – Srav
Pureeshavaha Krichrenaalpa Sabda
Atidrava Atigrathita Atibahuupavishantam
Mutravaha Atisrushta Atibadha
Alpa mootra Bahushoolamootra
Svedavaha Aswedam Atiswedam
Parushyam Paridaha
39
Whether fulfils inclusion criteria : Yes/No

If yes –

Patient ID no –

Date –

Signature of Guide -

Signature of Research Scholar

40