Karnapichu Varti with Jathyadi Taila in Acute Otitis Externa - A Review Article

 Introduction

Otitis externa (OE) is an inflammation of the External Auditory Canal (EAC) commonly caused by Pseudomonas aeruginosa also caused by Staphylococcus aureus and staphylococcus epidermis. Common causes of OE are excessive humidity, trauma to external auditory canal due to cotton swabs, hearing aids, dermatological conditions. Common around 10% of population with predominant symptoms as otalgia and otorrhoea. OE can be classified as acute (lasts less than 6 weeks) or chronic (lasts more than 3 months).^1,2

Acute OE (AOE)-An abrogation of hydrophobic ceruminous coating of EAC exposes the underlying epithelium to water, infection and other contaminants and lead to progressive erythema and edema. Pre disposing factors are contaminated water, humid environment, EAC obstruction and any trauma. The main complaint of AOE is otalgia which aggravated with jaw movements, otorrhea. In early stage there will be erythematous canal with scanty discharge. Later on, they will develop as edematous and exquisitely tender canal associated with purulent discharge.³ Enlarged and tender regional lymph nodes and periauricular cellulitis will be present in severe variety of AOE.¹

Chronic OE (COE)-No prior history of trauma or water contamination. Usually not painful. Acute exacerbation is usually preceded by itching.³

Treatment includes debridement of EAC clears infections and acidification of EAC. Antibiotic impregnated ear wicks and quinolone antibiotic drops along with oral antibiotics for both acute and chronic variety of OE.
Karnapichu varti is modified procedure of karnapoorana where packing of medicated wick in EAC for certain time period which enhance better absorption of medicine. Much commonly indicated in Karnashoola, Pranada, Bhadirya type of Karnarogas where vitiated Vata get settled in Srotas present in Karna and leads to Vyadhi utpatthi.⁴ Jathyadi taila with major ingredients of Jati, Nimba, Patola, Madhuka, Katurohinyadi Dravya which have Vata pitta dosha shamaka along with anti-inflammatory and anti-infective property.⁵ The present article proffers a conceptual elucidation of Karnapichu varti in OE along with a discussion of its management within the context of ancient Indian medical knowledge.

The global recognition of India's substantive contributions on medical interventions remains underacknowledged. This review article aims to enhance readers to understand the ancient way of treating the OE.

Methodology

Karnapichu Varti Karma

Karnapichu varti karma is modified procedure of Karnapoorana where the wick made up of sterile gauze with height of approximately 10cm and thickness of 1.5-2cm is preferred.⁶ Varti is soaked in medicated oil such as Jathyadi taila and made lukewarm and inserted into the affected EAC.

Indication: Karnaroga which mainly cause due to Vata pradhana dosha Karna shoola, Bhadirya, Pra-nada type of Karnaroga and which are all karnarogas where Karnapoorana is indicated. Karnapichu varti is indicated only in acute variety of OE were patient present with otalgia.

Contra indicated: Karna roga present with Srava kandu etc. It is also contraindicated in chronic and bullous type of OE.

Poorva karma

• Instruments required: Sterile wick, medicated oil (preferred based on Vyadhi avasta), Hartman Alli­gator forceps, Stove (to warm the medicated oil).

• Medicated oil is selected based on vyadhi. Taila having property of Vrana ropana such as Nimbadi taila, Jatyadi taila have the property of antibiotics.

• Debridement of infection present in EAC.

• Make ready of all instruments and informed consent should be taken from patient before starting the procedure. Medicated oil is heated (until lukewarm condition where the temperature of oil should be of 34-36°C).

• Patient is made to sleep in position where affected ear should be exposed superiorly and Karna abyanga should be done around the affected ear pinna and posterior part of ear.

• Sterile wick (pichu varti) which of 10cm length and 1.5-2cm thick is soaked in medicated oil for about 2-3 minutes. Later the excessive oil present in varti removed with Hartman Alligator forceps.

Pradhana karma

• Karnapichu varti is slowly inserted into EAC through Hartman alligator forceps. Varti is inserted with moderate pressure until the upper part of varti reaches concha of the ear. Later Mridu Karna aby-anga should be done for around 10 minutes around the ear pinna and posterior part of auricle for better absorption.

• Duration: Karnapichu varti should be retained in EAC for about 15-20 minutes. As for Vata Pradhana vikara the Sneha matra kala is of 1000 which is around 20 minutes. The procedure should be done for 5-7 continuous days for proper result.⁷

Paschat karma

• Karnapichu varti should be removed slowly and Karna dhoopana made up of Sneha pradhana Dravya such as Ghrita along with Haridra, Tulasi, Dhanyaka can be given to reduce the prakupita kapha present in srotas. Later patient is advised to follow Pathya and Apathya ahara vihara.

Jathyadi Taila

Jathyadi taila made up of Jati (Myristica fragrans), Nimba (Azadirachta indica), Patola (Stereospermum suaveolens), Naktamala ( Pongamia pinnata), Madhuka (Glycyrrhiza glabra), Kushta (Saussurea lappa), Haridra (Curcuma longa, Daruharidra (Berberis aristata), Manjista (Rubia cordifolia) and other dravyas with the property of Vata pitta shamaka, Vrana ropaka, Vedana sthapaka, Shothahara and along with Krimigna property (Table1).⁸

As OE is cause due to infection and inflammation, Jathyadi taila will reduce the infection due to Krimigna guna and inflammation also will get reduced as because of Vrana ropana and Shotahara guna.

Disscussion

Otitis Externa is an inflammation of EAC. Generally, it is caused by Pseudomonas aeruginosa which present with otalgia and otorrhea. The treatment protocols include debridement of EAC and insertion of sterile wick smeared with antibiotic cream (Nadofloxacin, Ciploxacin) as topical along with oral intake of antibiotics used to reduce the pain and swelling present in EAC. Karnapichu varti karma is a modified Karnapoorana one among Ayurvedic therapeutic procedure similar to that of aural packing is done with sterile wick smeared with medicated oil which is having property of Vrana Ropaka which is done once after the aural toileting. Karnapichu varti should be done for minimum of 5-7 continuous days once after complete aural toileting for better result and retention period of 20 minutes per day.
Jathyadi taila with the property of Krimigna, Shothahara and Vrana ropaka have similar property to antibiotic can be used as alternative ayurvedic medicine for OE. Jathyadi taila is smeared over the sterile pichu Varti tight packed inside in EAC which assures better absorption of the medicine due to higher therapeutic concentration.

Conclusion

As the Karnapichu varti karma is similar to that of aural packing enhance the better absorption of drug and the Jathyadi taila having the property of Vrana ropaka, Shothahara and Krimigna property works similar to that of aural packing with antibiotic ointments so procedure is preferred for acute variety of OE.

Conflict of Interest

Nil