Ayurvedic chemical cauterization in the management of Traumatic Tympanic Membrane Perforation - A Case Study

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.