Deafness in Ayurveda and Modern Medicine

1. Badhirya (Deafness)
Presented By:
Dr. Jenisha Sapkota
Intern
AyurvedCampusTeaching Hospital

2. Contents:
1. Introduction
2. Anatomy and physiology
3. Types
4. Etiology
5. Pathogenesis
6. Assessment of hearing
7. Treatment and Management
8. Research papers on Badhirya
9. Conclusion
10.References 2

3. Introduction:
“उच्चैर्कृ च्छात् श्रुततिं र्
ु र्ाृत् बधिरत्विं च ।।” (अ.हृ.उ.१७)
An individual who can’t listen the loud sound eventually
suffers from Badhirya.
• Badhirya is one of the 28 karnarogas mentioned by sushrut and
25 karnarogas mentioned byVagbhat.
• Acharya charak has’t mentioned Badhirya among 4 karnarogas
he has described .
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4. • Acharya Charak has mentioned badhirya in nanatmaj vata
vyadhi. He also mentioned Indriyapradoshaj Bikara in sutra
sthana.
• “इन्द्रिर्ाणि समाधश्रत्र् प्रर्
ु प्र्न्द्रत र्दा मला:। उपघातोपतापाभर्ािं
र्ोजर्रतीन्द्रिर्ाणि ते।” (च.सू.२८/२०)
* Indriya Upatapa: Disturbed function of sense organs
* Indriya Upaghata: Complete loss of function of sense organ
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5. According to WHO
• Deafness : refers to the complete loss of ability to hear from one
or both ears.
• Hearing impairment : refers to complete or partial loss of the
ability to hear from one or both ears.The level of impairment can
be mild, moderate, severe or profound.
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6. Quantification of Hearing loss
Unable to hear sound at
• 26-40 dB Mild Hearing Loss
• 41-55dB Moderate Hearing Loss
• 56-70dB Severe Hearing Loss
• 91dB and greater Profound Hearing Loss
( Note: Intensity of whisper is nearly equal to 30dB and normal conversation is nearly
equal to 60dB.)
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7. Anatomy of Ear:
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8. Physiology of hearing:
• Sound from environment is conducted through external ear which vibrates
the tympanic membrane.There the sound wave is amplified and conducted
through ear ossicles . It enters internal ear and reaches Organ of Corti in
basilar membrane of Cochlea.There sound wave is converted into nerve
impulse and reaches brain through auditory nerve. Received and Interpreted
by temporal lobe of brain and the sound is heard.
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9. Types
1. Conductive deafness: Due to defect in the conducting mechanism of
external and middle ear.
2. Sensori-neural deafness / Perceptive deafness: Due to lesions in the
labyrinth, 8th cranial nerve & central connections. It includes psychogenic
deafness.
3. Mixed deafness: Both the above mentioned types are present.
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10. Etiology/Nidana :
र्िृरोगर्ो सामारर् तिदाि:
“अवश्र्ार्जलक्रिडार्िृर्रडूर्िैमृऊत ्।ममथ्र्ार्ोगेि शस्त्रस्त्र्
र्
ु पपतोsरर्ैश्च र्ोपिै:।।”(सू.उ.त. २०/१)
Stay in damp place ,swimming, scratching ear, improper use of
Shalakas, etc can cause ear diseases.
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11. पवमशष्ट तिदाि:
“श्लेष्मिाऽिुगतो वार्ुिाृदो वा समुपेक्षितः। उच्चैः र्क च्रात ् श्रुततिं
र्
ु र्ाृत ् बधिरत्विं िमेि च॥” (अ०ह०उ0 १७/१०)
• र्फािुगत वात = Vata Avrit by kapha
• िादो वा समुपेक्षितः = Negligence in treatment of karna nada
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12. Causes of conductive deafness
External ear:
1.Wax 6. Myringitis
2. Fungus 7. Stenosis
3. Otitis Externa 8.Atresia
4. Foreign Bodies 9.Tumours
5. Polyps
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13. Middle Ear:
• Congenital defects of the ear drum and ossicles.
• Traumatic: Barotrauma, rupture of ear drum, # of the base of the skull
• Inflammation: AOM, COM, Serous OM, Adhesive OM.
• Tuberculosis and syphilitic OM
• Neoplasms
• Otosclerosis
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14. Eustachian tube:
1. Eustachian catarrh
2. Eustachian tube dysfunction due to diseases of the nose, paranasal sinuses &
pharynx
3. Barotrauma
*Note: Catarrh = excessive discharge from nose / throat / ear
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15. Causes of sensori-neural deafness
Local causes (inner ear)
• Congenital
• Trauma: Head injury, surgical injury to labyrinth, loud sounds (acute or
chronic acoustic trauma) producing concussion.
• Infections: mumps, syphilis, tuberculous meningitis, enteric fever,
labyrinthitis.
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16. Cont…
• Tumors : Acoustic neuroma (Schwannoma of C8 nerve)
• Meniere’s disease (Tinnitus +Vertigo + Deafness)
• Ototoxic drugs :NSAIDs, Azithromycin, Dapsone, streptomycin
,Vancomycin, neomycin, salicylates,TT, Frusemide ,Quinine,etc.
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17. General causes
• Presbycusis
• CVS: atherosclerosis, HTN
• CNS: disseminated sclerosis
• DM ( Peripheral neuritis)
*Note: Presbycusis is a progressive bilateral symmetrical age-related
sensorineural hearing loss. It is also known as age related hearing loss.
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18. Cont..
• Vitamin deficiency
• Hypothyroidism
• Smoking
• Alcoholism
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19. Psychogenic deafness
2 types
• Functional: due to emotional cause, but the patient is not aware of the
cause.
• Malingering: no organic or psychological cause.The patient is aware that
he is pretending to be deaf for personal gains.
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20. Causes of mixed deafness
• Trauma: Blast injury, acoustic trauma, head injury.
• CSOM with labyrinthitis.
• Otosclerosis
• Senile deafness superimposed on conductive deafness.
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21. Pathogenesis /Samprapti:
“ स एव शब्दािुवहा र्दा मसराः, र्फािुर्ातो व्र्िुसकत्र् ततष्ठतत।
तदािरस्त्र्ाप्रततर्ारसेपविो, भवेत्तु बाधिर्ृमसिंशर्िं खलु॥” (सुoउ0 २०/८)
At the time of blockage of Shabda baha srotas due to
kaphanugata vata, if the person takes vataj and kaphaj aahara -
vihara causes Badhirya.
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22. Assessment of Hearing:
ClinicalTests Audiometric Tests
Watch and finger friction test PureTone Audiometry
Speech test Speech Audiometry
Tuning fork test Tympanometry
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23. Watch and Finger frictionTest:
• Rubbing the thumb and a finger close to patient’s ear is finger friction test.
• Clicking watch is bought near to the defected ear and the distance at which
sound heard is noted.
• These two test were in use before audiometric era for screening .
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24. SpeechTests:
• Normally a person hears conversational voice at 12 meters and whisper at 6
meters.
• But in clinical examination 6 meters distance is taken for both.
• Patient’s eye is shielded to prevent lip reading and non-testing ear is blocked
by pressing tragus. Speech test is done by using spondee words and numbers
with letters.
• Distance is noted at which the sound is heard.
• This isn’t standard test .
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25. Tuning ForkTest:
• Mostly used test in clinics.
• Tuning forks of frequencies 128, 256, 512, 1024, 2048 and 4096 Hz are used.
But 512 Hz is taken as ideal.
• By using the vibrating fork, sound wave is produced .
• Air conduction and bone conduction are tested .
• Clinically two tests are used
A. RinnesTest
B.WeberTest
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26. 26

27. A. RinnesTest
• A vibrating tuning fork is placed 1st at patient’s mastoid and after he stops
hearing placed beside meatus.
• Air conduction(AC) is compered with Bone conduction(BC).
• AC> BC in normal ear and sensorineural Deafness.
• BC>AC in conductive deafness.
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28. B. WeberTest
• Vibrating tuning fork is placed on the middle of forehead.
• Patient is asked in which ear the sound is heard.
• In normal person, it is equal in both ears.
• In abnormal condition, it is lateralized to worse ear in conductive deafness
and lateralized to normal ear in sensorineural deafness.
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29. PureTone Audiometry:
• Audiometer is an electronic device produces pure tone can be increased or
decreased by 5dB per steps.
• Amount of intensity that has to be raised above normal level is the degree
of hearing impairment.
• Represented in graphical form called Audiogram.
• Required for prescription of Hearing Aids.
• Record for future.
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30. 30

31. Speech Audiometry
• Patients ability to hear and understand speech is measured.
• Speech reception threshold(SRT) and Discrimination score(DS) are studied.
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32. 32

33. Tympanometry
• Based on a principle that when sound strikes tympanum, some of the sound
energy is absorbed and rest reflect back.
• Stiffer tympanic membrane reflect more energy then compliant one.
• Amplification on various pressure is represented graphically called
Tympanogram.
• Diagnostic measure to detect middle ear pathology.
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34. Tympanogram
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35. Through clinical examination and hearing
assessment ,the disease is diagnosed.
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36. Treatment and Management
According to Ayurveda
Samanya Chiktsa of Karna Roga:
“सामारर्िं र्िृरोगेषु घकतपाििं रसार्िम्। अव्र्ार्ामोsमशर: स्त्िाििं
ब्रम्हचर्यर्ृमर्त्थिम्।।” (सू.उ.त.२१/३)
According to Acharya sushrut, Intake of Ghee, Rasayan drugs,
avoidance of exercise and excess speaking and following
Bhramhacharya is common treatment of all karna rogas.
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37. “न्द्स्त्िग्ििं वातहरै: स्त्वेदैिृरिं स्त्िेहपवरेधचतम्। िाडीस्त्वेदै: उपचरेत
पपरडस्त्वेदै: तथैव च।।”(सू.उ.२१/५)
• Bahya and abhyantara snehana
• Swedana with vatahara dravya (Dasmoola kwatha)
• Sneha virechaha
• Sthanik swedana as nadi and pinda sweda
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38. SpecificTreatment of Badhirya
“गवािं मूरेि बबल्वाति पपष््वा तैलिं पवपाचर्ेत ्।
सजलिं च सदुग्ििं च बाधिर्े र्िृपूरिम्।।” (सू.सिं.उ.२१/३५)
Karnapurana with oil processed by means of Bilwa Kalka pounded with
Gomutra, oil(tila taila), milk (aja dugdha) and water.
* Acharya yogaratnakar mentioned that karnapurana with Apamarga
kshara jala or Kalka in treatment of Badhirya.
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39. “वक्ष्र्ते र्: प्रततश्र्ार्े पवधि: सोsप्र्र पून्द्जत:।
वातव्र्ाधिषु र्श्चोक्तो पवधि: स च हहतो भवेत ्।।” (सू.सिं.उ.२१/३८)
• Treatment of vata vyadhi ( Snehana, Swedana , Basti and use of
vatahara dravyas)
• Treatment of Pratisyaya ( Ghrita pana, Sweda karma,Vamana
karma, Avapidana Nasya)
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40. Karnapurana
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41. • Snehana and swedana of karna moola
• Pouring medicated oil in the ear
• Retain it for 1000 matra kaala (15-20min)
• Contraindicated in inflammation ,discharge and tympanum
perforation. Karna dhupana can be done instead.
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42. According to modern medicine:
1. Treatment of underlined diseases : Diseases like Chronic Suppurative otitis
media (CSOM) , Perforation of tympanic membrane, Obstruction of External
auditory canal and Eustachian tube, etc can be the cause of deafness. So,
treatment of these disease can treat deafness.
Eg.Tympanoplasty in tympanic membrane perforation restores hearing capacity
of ear.
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43. 2. Rehabilitation of hearing impaired:
I. Instrumental devices
A. Hearing Aids - Conventional hearing aids - Bone anchored hearing aids -
Implantable hearing aids
B. Implants - Cochlear implants - Auditory brainstem implants
C. Assistive devices for the deaf
II.Training
A. Speech(lip) training
B. Auditory training
C. Speech conservation
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44. Hearing Aids:
• Device to amplify sounds which has 3 parts.
• Microphone- picks up sound and converts to electrical impulses.
• Amplifier- magnifies electrical impulses.
• Receiver-converts electrical impulses back to sound.
Types on the basis of function :
1. Air conduction hearing aids
2. Bone conduction hearing aid
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45. Types on the basis of design:
• Body worn type
• Behind the ear types
• Spectacles type
• In the ear type
• Canal types(ITC/CIC)
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46. Cochlear Implant:
• Cochlear implants are surgically placed electrical device that receive
sound and transmit the resulting electrical signals to electrodes
implanted in the cochlea of the ear.
• The signals stimulate cochlea, allowing patient to hear.
• It is also known as Bionic ear.
Parts:
External Internal
i. Microphone i. Receiver and stimulator
ii. Speech processor ii. An array of up to 22 electrodes
iii.Transmitter
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47. Cochlear hearing implant
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48. Training:
• Speech Reading
• AuditoryTraining
• Speech Conservation
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49. Steps of Rehabilitation of hearing Impaired :
• Parental guidance
• Hearing aids
• Speech & language therapy
• Education of the deaf
• Vocational guidance
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50. Research papers on Badhirya
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55. Conclusion:
From the textbooks and research papers, I come to a conclusion in that :
• Badhirya isVata byadhi associated with Kapha. So, nidan for vata and
kapha prakopa should be avoided.
• Underlined diseases and deformity should be treated as first line
treatment.
• In conductive deafness with OM, Marsa nasya with anu taila is effective .
• In sensory neural hearing loss, Bilwadi taila karna puran with Sariwadi vati
is effective. Other rasayan can also be administered.
• In senile hearing loss karna puran with Aswagandha taila with rasayan
therapy is seen effective.
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56. References:
1. Dr. Ananta Ram Sharma, Sushruta samhita of Maharsi Sushruta edited with
`sutravimarsini’ Hindi commentary, Chaukhamba Subharati Prakasana
2. AcharyaVidyadhar Shukla and Prof. Ravi DuttTripathi , Charaksamhita of Agnivesa, edited
with`Vidyamanorama’ Hindi commentary, Chaukhamba Sanskrit Pratisthana
3. Prof.K.R. Srikantha Murthy,Vagbhata’s Astanga Hridayam,ChaukhambhaOrientalia.
4. Prof.Anil Barma, ShalakyaTantra , Chaukhambha Orientalia, Banarasi, 2nd part.
5. P L Dhingra , Disease of Ear, Nose andThroat, Elsevier.
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57. 6. European Journal of Biomedical and Pharmaceutical Sciences, volume 3, Issue 12
7. International Journal of Ayush Care Reports , volume 4, Issue 1
8. International Ayurvedic Medical Journal ,Voume 7, Issue 5.
9. Global Journal of Otorhinology,Volume 4 , Issue 2.
10. Journal of Ayurveda and Integrated Medical Sciences,Volume 5, Issue 1.
11. Photos from www. Google.com.
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58. “When you lose your vision, you lose contact with things;
when you lose your hearing, you lose contact with people.”
Helen Keller
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