Introduction: Tonsillitis is an infection of the tonsils associated with sore throat, difficulty in swallowing, fever etc. There are about 7,455,494 cases of tonsillitis in India per year. Tonsillitis can be compared with Tundikeri in Ayurveda. Aim: To evaluate the effect of Pratisarana of Apamarga Kshara and Triphala Kashaya Kavala in the management of Tundikeri. Materials and Methods: The subject approached Shalakya Tantra OPD of Government Ayurveda Medical College, Bengaluru, with symptoms of sore throat, difficulty in swallowing, headache since 5 years was systemically reviewed and Pratisarana and Kavala line of treatment is adopted. Results: The subject showed marked improvement as depicted in the photographs taken at different levels of treatment. Discussion: The manifestation of symptoms and its severity depends on its extent of involvement of Dosha-Dushya Sammurcchana. Though the disease is Kapha and Rakta predominant, there is involvement of Vata and Pitta Dosha in the Samprapti of Tundikeri. By adopting the holistic approach with external treatment modality an attempt is made to bring about satisfactory results

Dr. Rathi S.

English

Journal of Ayurveda and Integrated Medical Sciences (JAIMS)

                                                        CASE REPORT Jan-Feb 2021  Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb  2021 | Vol. 6 | Issue 1 311  An Ayurvedic management of Chronic Tonsilitis - A Case Report Rathi S. Associate Professor, Department of PG Studies in Shalakya Tantra, Government Ayurveda Medical College, Bengaluru, Karnataka, INDIA.                     INTRODUCTION Tonsillitis is an inflammation of the pharyngeal tonsils. The inflammation may affect other areas of the back of the throat, including the adenoids and the lingual tonsils. Acute tonsillitis is an infection of the tonsils triggered by one of the several types of bacteria or viruses, and peritonsillar abscesses can also occur. Chronic tonsillitis is a tenacious infection of the tonsils which may result in tonsil stones. Recurrent tonsillitis ensues    when   an   individual   suffers   from   several Address for correspondence:  Dr. Rathi S. Associate Professor, Department of PG Studies in Shalakya Tantra, Government Ayurveda Medical College, Bengaluru, Karnataka, INDIA. E-mail: drrathi.s@gmail.com  Submission Date: 12/01/2021 Accepted Date: 05/02/2021 Access this article online Quick Response Code Website: www.jaims.in  Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CC-by-NC-SA incidents of tonsillitis per year. Both chronic and recurrent tonsillitis involve repeated occurrences of inflamed tonsils which can impact severely on a patient’s quality of life.[1] It is estimated that, 15% of all visits to family doctors are because of chronic tonsillitis.[2] Chronic tonsillitis may be a complication of acute tonsillitis. Pathologically, micro abscesses walled off by fibrous tissue have been seen in the lymphoid follicles of the tonsils. There will be subclinical infections of tonsils without an acute attack. It mainly affects the children and young adults.[3] A range of therapies from different medical faculties work on this disease, with either limited success or time bond relief and also having various limitations, side effects, including allergic reactions. If all these measures fails otolaryngologist suggests removing the tonsils i.e. tonsillectomy which also having minimal results. A disease which is similar to tonsillitis in clinical presentation in Ayurveda is Tundikeri which is described under Mukha Roga. Dealing with the A B S T R A C T  Introduction: Tonsillitis is an infection of the tonsils associated with sore throat, difficulty in swallowing, fever etc. There are about 7,455,494 cases of tonsillitis in India per year. Tonsillitis can be compared with Tundikeri in Ayurveda. Aim: To evaluate the effect of Pratisarana of Apamarga Kshara and Triphala Kashaya Kavala in the management of Tundikeri. Materials and Methods: The subject approached Shalakya Tantra OPD of Government Ayurveda Medical College, Bengaluru, with symptoms of sore throat, difficulty in swallowing, headache since 5 years was systemically reviewed and Pratisarana and Kavala line of treatment is adopted. Results: The subject showed marked improvement as depicted in the photographs taken at different levels of treatment. Discussion: The manifestation of symptoms and its severity depends on its extent of involvement of Dosha-Dushya Sammurcchana. Though the disease is Kapha and Rakta predominant, there is involvement of Vata and Pitta Dosha in the Samprapti of Tundikeri. By adopting the holistic approach with external treatment modality an attempt is made to bring about satisfactory results. Key words: Chronic tonsillitis, Tundikeri, Pratisarana, Apamarga Kshara, Kavala, Triphala Kashaya. Rathi S. An Ayurvedic management of Chronic Tonsilitis - A Case Report ISSN: 2456-3110                                                             CASE REPORT Jan-Feb 2021  Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb  2021 | Vol. 6 | Issue 1 312  treatment of the disease Tundikeri particularly, Acharya Sushruta mentions that Tundikeri is the Bhedya Roga and it should be treated as per the line of treatment of the disease Galashundika.[4] All drugs should have the properties such as Lekhana, Shothahara, Sandhaniya, Ropana, Rakta Stambhana and Vedana Sthapana. The drug Apamarga Kshara has all the above properties and it is indicated in the conditions such as Granthi, Apachi, Galaganda and Shotha. Therefore, the present study was planned to evaluate the effect of Apamarga Kshara Pratisarana and Triphala Kashaya Kavala in the management of Tundikeri (tonsillitis). OBJECTIVES  1. To understand the pathophysiology of Chronic tonsillitis in the perspective of Tundikeri explained in Ayurveda classics. 2. To find a better Ayurvedic approach in Chronic tonsillitis. CASE REPORT Basic information of the patient Age: 35 years  Gender: Male Religion: Hindu Occupation: Business Socioeconomic status: Middle class Chief complaints Complaints of throat pain, difficulty in swallowing, sore throat since 10 days. Associated complaints Complaints of anorexia, halitosis and neck pain since 10 days. History of present illness Patient was apparently normal 5 years ago, gradually developed fever, throat pain, cough took antibiotic therapy and got relief, but had on and off symptoms, since 10 days the symptoms aggravated could not find any relief, so for further management he consulted Shalakya Tantra OPD of Government Ayurveda Medical college, Bangalore. History of past illness The subject is not a known case of Diabetes mellitus, Hypertension or any other systemic illness.  Personal history ▪ Aharaja: diet predominantly of Katu and Kashaya Rasa, Rooksha Ahara. ▪ Viharaja: day sleep for 1 to 2 hours regularly. ▪ Habbits: Smoking since 8 years. Examination  Asta Sthana Pareeksha 1. Nadi: Prakruta, 78/min 2. Mutra: Prakruta, 4 to 5 times/day, once at night 3. Mala: Prakruta, regular, once a day 4. Jihwa: Alipta 5. Shabda: Prakruta  6. Sparsha: Prakruta 7. Druk: Prakruta  8. Akruti: Pittavatala  Vitals were normal.  Respiratory system, Cardiovascular system, Gastro intestinal system, Central nervous system and Musculoskeletal system has shown no abnormality.  Local examination  Inspection Oral Cavity Soft palate Congestion ++ Movement of soft palate Normal Uvula Congestion + Tonsils Left Tonsil enlarged, Grade 3 Right Congestion+ Left Congestion+, Oedema+, Swollen+, Hypertrophied+ Rathi S. An Ayurvedic management of Chronic Tonsilitis - A Case Report ISSN: 2456-3110                                                             CASE REPORT Jan-Feb 2021  Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb  2021 | Vol. 6 | Issue 1 313  Ear Right Normal Left Normal Palpation Jugulo-digastric lymph nodes-not palpable, moderate pain+ Assessment of general condition Bowel Regular, 1-2 times/day Appetite Reduced Micturition Regular, 6-7 times/day Sleep Sound Temperature 98.6° Fahrenheit Chief complaints SN Complaints 1. Kathina Shotha (Enlargement of tonsils) 2. Galoparodha (Dysphagia) 3. Ragatwa (Hyperemia) 4. Mukha Dourgandhya (Halitosis) Treatment adopted 5/10/2020 to 11/10/2020 - Pratisarana with Apamarga Kshara for 100 Matra Kala followed by Triphala Kashaya Kavala, once a day in the morning for 7 days. Internally Triphala Guggulu one tablet thrice a day was advised for 10 days. Assessment Criteria For Tonsillar swelling Brodsky Grading Scale[5] ▪ Grade 0 - tonsils within the tonsillar fossa ▪ Grade1 - tonsils just outside of tonsillar fossa and occupy, <_ 25% of oropharyngeal width. ▪ Grade 2 - tonsils occupy 26-50% of the oropharyngeal width ▪ Grade 3 - tonsils occupy 51-75% of the oropharyngeal width ▪ Grade 4 - tonsils occupy more than 75% of the oropharyngeal width. For pain Visual Analogue Scale[6] ▪ 0 - None ▪ 1 to 3 - Mild ▪ 4 to 6 - Moderate ▪ 7 to10 - Severe For halitosis[7] Organoleptic scores ▪ No malodor. ▪ Slight malodor. ▪ Clearly noticeable malodor. ▪ Strong malodor. For Dysphasia ▪ 0 - No difficulty in deglutition. ▪ 1 - Mild pain during deglutition of hard food particles. ▪ 2 - Moderate pain during deglutition of semisolid food particles. ▪ 3 - Severe pain during deglutition of even liquid food articles. For Congestion ▪ 0 - No congestion (normal pink coloured mucosa) ▪ 1 - Congestion saw over tonsils and uvula. ▪ 2 - Congestion saw over tonsils, uvula and pharyngeal wall. ▪ 3 - Congestion with haemorrhages. Subjective Parameters ▪ Pain in the throat ▪ Dysphagia Objective Parameters ▪ Tonsillar swelling ▪ Congestion Rathi S. An Ayurvedic management of Chronic Tonsilitis - A Case Report ISSN: 2456-3110                                                             CASE REPORT Jan-Feb 2021  Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb  2021 | Vol. 6 | Issue 1 314  ▪ Halitosis ▪ Pictorial representation Investigation TC, DC, ESR, AEC. Fig. 1a: Before treatment (4/10/2020)  Fig. 1b: During treatment (7/10/2020)  Fig. 1c: After treatment (13/10/2020)  OBSERVATION AND RESULT Regression of Patient symptoms was observed from the third day of treatment and complete remission of the condition was observed by 7th day of treatment. During the treatment no minor or major complications was observed in the patient.  Table 1: Showing regression of symptoms during treatment Soft palate No congestion Movement of soft palate Normal Uvula No Congestion  Tonsils Grade 0 Right No congestion Left Mild congestion Table 1: Showing the effect of therapy SN Symptom  0th Day 3rd Day 7th Day 1. Kathina Shotha (Enlargement of tonsils) ++ + - 2. Galoparodha (Dysphagia) ++ + - 3. Ragatwa (Hyperemia) + + - 4. Mukha Dourgandhya (Halitosis) ++ + - 5. Jwara ++ - - DISCUSSION The clinical features of Tundikeri like Kathina Shotha, Toda, Paka and Galoparodha were found along with halitosis and jugulo-digastric lymphadenopathy. After assessing the chronicity of the condition treatment is adopted. Since this is a case of chronic tonsillitis, medical management, making use of different Kashaya preparations and Choornas is beneficial. Added to this, Para surgical procedure of Kshara Karma and Pratisarana is beneficial. The disease is Rathi S. An Ayurvedic management of Chronic Tonsilitis - A Case Report ISSN: 2456-3110                                                             CASE REPORT Jan-Feb 2021  Journal of Ayurveda and Integrated Medical Sciences | Jan - Feb  2021 | Vol. 6 | Issue 1 315  Kapha and Rakta predominant, there is involvement of Vata and Pitta Dosha in the Samprapti of Tundikeri.   Apamarga Kshara being Raktha Sthambaka and having Kapha Rakthahara property Pratisarana has shown very good improvement in the present study.[8] Triphala being Tridoshahara and Shothahara, was given in Kashaya form to gargle after Pratisarana, helped to reduce the inflammation.[9] Triphala Guggulu is Shothahara, Vedanahara hence helps in anti-inflammatory action and reduces pain.[10] The patient was advised not to consume sour taste (Amla Rasa), fish (Matsya), Meat of animals residing in marshy land (Anupa Mamsa), curd (Dadhi), milk (Ksheera), black gram (Masha), dry and hard food stuffs (Ruksha, Katina Anna), sleeping with head inclining down (Adhomukha Shayana), substances which are hard to digest (Guru Ahara), food stuffs causing obstruction of body channels (Abhishyandi) and sleeping during day (Divaswapna).[11] CONCLUSION The cardinal features of Tundikeri described in our classical texts are similar to that of tonsillitis in contemporary science. It is a clinical condition which is very common in today’s practice. The timely treatment is most essential to avoid surgery. The medicines used in this case study have shown significant results (complete remission of the symptoms occurred after 7 days of treatment i.e., the patient obtained 100% relief in symptoms). The effectiveness of Ayurvedic treatment has proved that, satisfactory result may be found in this case.   REFERENCES 1. American Academy of Otolaryngology Tonsillitis. 2018. [Accessed January 6, 2018]. Available from: http://www.entnet.org/content/tonsillitis. 2. Tonsillitis [Internet].  [Cited 2013 Jun 13]. Available from: http: // chealth. Canoe. ca/ channel_condition_info_details.asp? disease_id=210 & channel_id  =  1020  & relation_id=71085  3. ENT world – Diseases of the Ear, Nose and Throat [Internet]. [Updated 2010 Dec 28; cited 2013 Jun 13].  Available from: http://earnosethroatclinic.blogspot.in/2010/12/chronic-tonsillitis-causes-types-signs.html  4. Acharya YT, editor. Sushruta Samhita of Sushruta, Chikitsa Sthan. Reprint Edition. Ch. 22 Ver. 57. Varanasi: Chaukhambha Surabharti Prakashana; 2012. p. 484. [Google Scholar] 5. Siu Kwan Ng, Dennis Lip Yen Lee et .al, reproducibility of clinical grading of tonsillar size, www.ARCHOTO.COM,2018, available at https://jamanetwork.com, accessed on 26/22019 at 9 pm. 6. McCaffery M, Beebe,A., et al.(1989).pain: clinical manual for nursing practice,  7. Mosby st. Louis,MO. Alasqah M,Khan S, et.al. Assessment of halitosis using the organoleptic, method and volatile sulphur compounds monitoring Dent Res Rev (serial online) 2016 (cited 2019 Feb 25) 9pm Available from http://ww.jdrr.org/text.asp?2016/3/3/94/194833. 8. Vagbhata. Ashtanga Hridaya edited with Vidyotini Hindi commentary, Uttaratantra. Edited by Kaviraj Atridev Gupta and Vaidya Yadunandana Upadhyaya. 14th ed. Varanasi: Chaukhambha Sanskrita Samsthana; 2003. p 717 9. Vangasena. Vangasena Editor Kavivara Shri Shaligramaji Vaishya. 1st ed. K. Shrikrishna Das; Mumbai. p 72. 10. S.Das. A Concise Text Book of Surgery,8th Edition,2014, published by Dr.S. Das,13, Old Mayor’s, Court, Kolkata, PP.1358, Pg No.2-6.  11. Sushruta. Sushruta Samhita. Edited By Kaviraj Ambikadutta Shastri. Chikitsa sthana. 13th ed. Varanasi: Chaukhambha Sanskrit Bhavana; 2002. p 681.   ******************************* How to cite this article: Rathi S. An Ayurvedic management of Chronic Tonsilitis - A Case Report. J Ayurveda Integr Med Sci 2021;1:311-315.  Source of Support: Nil, Conflict of Interest: None declared. 

An Ayurvedic management of Chronic Tonsilitis - A Case Report

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An Ayurvedic management of Chronic Tonsilitis - A Case Report

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