Ayurvedic chemical cauterization in the management of Traumatic Tympanic Membrane Perforation - A Case Study
Abstract
Introduction: Traumatic Tympanic Membrane perforation (TTMP) which heals within 2-3 weeks doesn’t heal after the squamous cell formation at the edges of the TMP. Such TTMPs are managed by surgical procedures such as myringoplasty which is costly and invasive. In recent advancements, trichloroacetic acid (TCA) cauterisation found effective as the first line of treatment in adults with small to medium-sized TMP. Such Non-Healing TTMP can be correlated with Dustavrana. Ksharajala is one such medicine indicated in the management of Dustavrana. Methodology: A 33-year-old female patient presented to our OPD with a history of trauma to the left ear two months back complaining of mild reduction in hearing. On examination, the edges of TTMP were covered by squamous cells inhibiting the healing of TMP. Hence, the patient was recruited for the study and was subjected to Apamarga Ksharajala application followed by lemon juice application, and Karna Pichu with Jatyadi Taila was done for 5 alternative days. Orally Sarivadi Vati and Ashwagandha Gritha were advised. Result: White eschar after every application of Ksharajala suggested cauterisation of edges of the TMP. Jatyadi Taila Karna Pichu helped in Vrana Shodhana. After 30 days of the last Ksharajala application, it was noticed that the complete TMP was healed without any complications. Discussion: Ksharajala cauterizes the edges of the TMP destroying the squamous epithelium enabling the growth of fibroblastic proliferation and healing of the perforated tympanic membrane. Jatyadi Taila helps in Vrana Shodhana and Vranaropaka. Sarivadi Vati which is Vrana Shodhana and Kledashoshaka and Ashwagandha Gritha as Balya, Yogavahi and Rasayana help heal the TMP.
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References
Uppal KS, Singh R, Singh J, Popli SP. Closure of tympanic membrane perforations by chemical cautery. Indian J Otolaryngol Head Neck Surg. 1997;49:151–153.
Lim DJ. Structure and function of the tympanic membrane: a review. Acta Otorhinolaryngol Belg. 1995;49(2):101–15. [PubMed: 7610903].
Guenzani S, Mereu D, Messersmith M, Olivari D, Arena M, Spanò A. Inner-ear decompression sickness in nine trimix recreational divers. Diving Hyperb Med. 2016;46:111–6.
Yetiser S, Hidir Y, Birkent H, Satar B, Durmaz M. Traumatic ossicular dislocations: etiology and management. Am J Otolaryngol. 2008;29:31–6.
Eagles K, Fralich L, Stevenson JH. Ear trauma. Clin Sports Med. 2013;32:303–16.
Neuenschwander MC, Deutsch ES, Cornetta A, Willcox TO. Penetrating middle ear trauma: a report of 2 cases. Ear Nose Throat J. 2005;84:32–5.
Conoyer JM, Kaylie DM, Jackson CG. Otologic surgery following ear trauma. Otolaryngol Head Neck Surg. 2007;137:757–61.
Jellinge ME, Kristensen S, Larsen K. Spontaneous closure of traumatic tympanic membrane perforations: observational study. J Laryngol Otol. 2015;129:950–4.
Smith M, Darrat I, Seidman M. Otologic complications of cotton swab use: one institution's experience. Laryngoscope. 2012;122:409–11.
Lou Z, Yang J, Tang Y, Fu Y. Topical application of epidermal growth factor with no scaffold material on the healing of human traumatic tympanic membrane perforations. Clin Otolaryngol. 2016 Jan 30. doi:10.1111/coa.12627. [Epub ahead of print].
Bilge A, Gunes A, Dagli M, Koybasioglu FF, Guvey A. The impact of topical and systemic enoxaparin sodium use on traumatic tympanic membrane perforation and myringosclerosis. Eur Arch Otorhinolaryngol. 2016 Jan 21. [Epub ahead of print].
Güneş A, Mutlu M, Akın İ, et al. The impact of systemic and local administration of ascorbic acid on traumatic perforation of tympanic membrane and myringosclerosis. J Int Adv Otol. 2015;11:48–52.
Namasivaya RB, Gowthame K, Dhanasekaran B, et al. Effectiveness of trichloroacetic acid and trichloroacetic acid with gel foam for closure in patients with central perforation of tympanic membrane—a randomized controlled trial. Egypt J Otolaryngol. 2023;39:191. https://doi.org/10.1186/s43163-023-00556-3.
Lee JH, Lee JS, Kim DK, Park CH, Lee HR. Clinical outcomes of silk patch in acute tympanic membrane perforation. Clin Exp Otorhinolaryngol. 2015;8:117–22.
Levin B, Redmond SL, Rajkhowa R, Eikelboom RH, Atlas MD, Marano RJ. Utilising silk fibroin membranes as scaffolds for the growth of tympanic membrane keratinocytes, and application to myringoplasty surgery. J Laryngol Otol. 2013;127 Suppl 1:S13–20.
Park MK, Kim KH, Lee JD, Lee BD. Repair of large traumatic tympanic membrane perforation with a Steri-Strips patch. Otolaryngol Head Neck Surg. 2011;145(4):581–5.
Makwana P, Berwal D, Jha SG, Tu S, Dadhich S, Sinha V. Efficacy of chemical cauterisation in tympanic membrane perforation: a prospective study. Int J Res Med. 2016;5(3):89–92.
Ambikadatta Shastri K. Sushruta Samhita of Maharshi Sushruta with Ayurveda Tatvsandeepika Hindi commentary. Vol. 1. Sutra Sthana, 11th chapter, sl no 7. Varanasi: Chaukhambha Sanskrut Sansthana; 2018. p.47.
Brar S, Watters C, Winters R. Tympanoplasty. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. [cited 2023 Jul 24]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK565863/.
Mishra SN. Sridhiprada Hindi Commentary on Bhaishajya Ratnawali. Chaukhamba Surbharati Prakashan; Varanasi; 2015. Chapter 62, verse 69–74. p.174–5.
