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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 8  |  Issue : 4  |  Page : 282-284

A rare case report: Ayurvedic management of vocal cord nodules


1 Department of Shalakya Tantra, Institute of Post Graduate Teaching and Research in Ayurveda (IPGT and RA), Jamnagar, Gujarat, India
2 Rasa Shashtra and Bhaisajya Kalpana, Institute of Post Graduate Teaching and Research in Ayurveda (IPGT and RA), Jamnagar, Gujarat, India

Date of Submission04-May-2019
Date of Acceptance07-Jun-2019
Date of Web Publication15-Oct-2019

Correspondence Address:
Dr. Rozina Ashrafali Khoja
4th Floor, Department of Shalakya Tantra, Institute of Post Graduate Teaching and Research in Ayurveda (IPGT and RA), Jamnagar, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_31_19

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  Abstract 


Vocal nodules are the consequence of functional voice disorders, which are also caused by vocal abuse or misuse. An increased vocal load, for example, due to the patient's profession, demands high-volume speech for the formation of nodules. In the present case report, a 26-year-old female patient acquired this disease followed by common cold cough. Her problems were aggravating by high-volume speech and getting fatigability also. This patient was given Anutaila Nasya with Sitopaladi Churna, Naradiya Laxmi vilasa Rasa, Yashtimadhu Ghanvati (for chewing), and Dashmoola Kwatha(Kavala). The patient was advised for strict voice rest and steam inhalation for better result. After 1 month of treatment, the patient got relief from all her complaints and gained normal voice. On examination, it was found that vocal nodules disappeared in direct laryngoscopy. Hence, this single case report shows that ayurvedic management of vocal cord nodules gives excellent result and improves patients' quality of voice.

Keywords: A rare, Ayurveda, hoarseness of voice, Nasya, vocal nodules


How to cite this article:
Khoja RA, Makwana SM, Vaghela D B. A rare case report: Ayurvedic management of vocal cord nodules. Int J Health Allied Sci 2019;8:282-4

How to cite this URL:
Khoja RA, Makwana SM, Vaghela D B. A rare case report: Ayurvedic management of vocal cord nodules. Int J Health Allied Sci [serial online] 2019 [cited 2019 Nov 22];8:282-4. Available from: http://www.ijhas.in/text.asp?2019/8/4/282/269247




  Introduction Top


A vocal nodule is a benign mucosal lesion on the vocal fold and frequently presents in the general population.[1] Vocal nodules are typically located at the point of maximal amplitude during the mucosal wave, and thus, that section subjected to have the most phonotraumatic force during phonation. The cause of vocal nodules is generally laryngeal trauma due to chronic vocal abuse or misuse. Patients often present with a poor vocal endurance and a quickly tiring voice. An increased vocal load, for example, due to the patient's profession, is usually responsible for the formation of nodules. Boys, young women, and teachers are particularly affected.[2] Treatment options for vocal fold nodules include both invasive and noninvasive techniques. Attention to correcting the underlying causative factors, largely through voice therapy and education, plays an integral role in any treatment plan of action.[3]

Acharya Shushruta has described one whole chapter for Swarabheda, and AtiUchchaBhashana is described as a main Nidana of it. He has described Samprapti as Dosha will take place in Shabda Vaha Srotasa and will give rise to Swarabheda.[4] In Kaphaja-Swarabheda, patient speaks with difficulty and she/he can speak slowly and in low tone and it gets more distinct in the day.[5]


  Case Report Top


A 26-year-old female patient presented to the outpatient department of Shalakya Tantra with the complaints of throat pain for 2 months and hoarseness of voice for 3 months associated with fatigue in speech. The complaints were increasing with frequent talks and high-volume speech. She also gets an attack of tonsillitis once in a year.

Past history

She had a history of fever with common cold before 2 months and chronic cough for the last 4 months. The patient's personal history was normal.

On examination, the following were observed:

  • Nose: No any abnormality found
  • Ear: No any abnormality found
  • Throat: Congestion over the anteroposterior pallor and posterior pharyngeal wall
  • Telescopy:


    • Larynx – Congestion
    • Vocal cord – Bilateral nodule was seen [Figure 1]
    • Pyriform fossa – Clear.
Figure 1: Before treatment – Vocal nodule both side before treatment

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Treatment protocol

The patient was treated as described in [Table 1]. In treatment, the patient was given Laxmivilas Rasa 250 mg two times in a day with Anupana of Madhu and Sitopaladi Churna 3 gms two times a day with Anupana of Madhu for 1 month. She was given Yashtimadhu Ghanvati one tablet four times in a day for chewing along with Dashmoola Kwatha gargles two times a day for 7 days, Marsha Nasya with Anutaila six drops in each nostril was administered for 7 days.
Table 1: Treatment protocol

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Pathya-Apathya

The patient was advised for Pathya-apathya as summarized in [Table 2]. She was advised for strict voice rest for the first 3 days and after that it was advised to her for less use of voice with minimum use of words. She was also advised to take steam inhalation through mouth two times a day with the intake of lukewarm water for the whole day as a routine. She was strictly advised not to take any ice cream, cold drinks, chocolates, fast food, or any color chemical-containing items. She was also advised not to have long talks and not to raise her voice too much.
Table 2: Pathya-Apathya

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  Results Top


After 4 days of treatment significant improvement was observed in hoarseness of voice with mild relief in throat pain. After 20 days of treatment, Size of vocal cord nodules decreased [Figure 2] and patient got complete relief from hoarseness of voice and coughing, and patient was comfortable with frequent talks and high volume speech. The patient got improvement in fatigability in speech. On telescopic examination, after 1 month, the nodules disappeared completely with normal color of laryngeal mucosa and pharynx [Table 3] and [Figure 3].
Figure 2: Twenty days – size reduced after 20 days of treatment

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Table 3: Results

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Figure 3: 1 month – nodules disappeared after 1 month

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  Discussion Top


The patient was advised to take strict voice rest for 3 days so that the vocal cords can relax and can attain its normal state. Acharya Shushruta has mentioned Samanya Chikitsa of Swarabheda as Nasya, Avapidana, Kavala, etc.[6] In Kaphaja-Swarabheda, Katu Dravya should be Lehya with Madhu.[7] Hence, Sitopaladi Churna with Anupana of Madhu has the potential for cough extraction. Naradiya Laxmivilas Rasa mainly contains Abhraka Bhasma.[8] It has Tridoshahra and Rasayana properties with Madhura-Kashaya Rasa. Hence, it will mainly pacify Vata-Kapha Dosha. Yashtimadhu is specially indicated for voice disorders due to its Swarya property which will improve voice tone and quality.[9] It will also soothe the mucosa of the throat and excrete excessive cough. AnuTaila Nasya has Sheeta-Ushna Veerya, Katu Vipaka, and Tridoshahara properties. It promotes immune modulation which will reduce frequent episodes of inflammation.[10]Dashmoola Kwatha is likely to have a hot potency and reduces mucus production (pacifies Kapha Dosha) and also has mucolytic and anti-inflammatory activities. Kavala, steam inhalation, gives Swedana effect to vocal cords which will increase flow of blood and will reduce inflammation. Sheetaahara, prolong talks and high-volume speech are mainly responsible Nidana for aggravation of Kapha and Vata Dosha. Hence, the patient in our case was also advised to take voice therapy to prevent it from occurring again due to faulty voice production.


  Conclusion Top


This single case report concludes that ayurvedic management with Nasya and Kavala procedures using internal medicines, i.e., Laxmi vilasa Rasa, Sitopaladi choorna, and Yashtimadhu Ghanavati along with voice rest and steam therapy through mouth offers excellent result in the treatment of vocal cord nodule and improves patient's voice and brings it back to normal.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rosen CA, Murry T. Nomenclature of voice disorders and vocal pathology. Otolaryngol Clin North Am 2000;33:1035-46.  Back to cited text no. 1
    
2.
Smolander S, Huttunen K. Voice problems experienced by Finnish comprehensive school teachers and realization of occupational health care. Logoped Phoniatr Vocol 2006;31:166-71.  Back to cited text no. 2
    
3.
Buckmire RA. Vocal polyps and nodule treatment Management Otorynology and Facial plastic Surgery; 2019.  Back to cited text no. 3
    
4.
Acharya VY, editor. Uttartantra. In: Sushruta, Sushruta Samhita with Dalhan Tika. Ch. 53/3. (Su. Ut. 53/3). Varanasi: Chaukhambha Surbharati Prakashan; 2008.  Back to cited text no. 4
    
5.
Acharya VY, editor. Uttartantra. In: Sushruta, Sushruta Samhita with Dalhan Tika. Ch. 53/5. (Su. Ut. 53/5). Varanasi: Chaukhambha Surbharati Prakashan; 2008.  Back to cited text no. 5
    
6.
Acharya VY, editor. Uttartantra. In: Sushruta Samhita with Dalhan Tika. Ch. 53/9. (Su. Ut. 53/9). Varanasi: Chaukhambha Surbharati Prakashan; 2008.  Back to cited text no. 6
    
7.
Acharya VY, editor. Uttartantra. In: Sushruta Samhita with Dalhan Tika. Ch. 53/16. (Su. Ut. 53/16). Varanasi: Chaukhambha Surbharati Prakashan; 2008.  Back to cited text no. 7
    
8.
Padavi DM, Makhijani BM. Study to evaluate the effect of naradiya Lakshmi vilasa rasa and goghrita nasya in the management of vertigo. Journal of Ayurveda and integrated medical sciences (ISSN 24563110) 2018;3:5.  Back to cited text no. 8
    
9.
Chunekar SK, editor. Bhavaprakasha Nighantu. 6th ed. Haritakyadi Varga shloka; 1998. p. 65-6.  Back to cited text no. 9
    
10.
Panigrahi HK. Efficacy of ayurvedic medicine in the treatment of uncomplicated chronic sinusitis. Anc Sci Life 2006;26:6-11.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Case Report
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Conclusion
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