Kshara application for turbinate hypertrophy
A 45-year-old male presented with the complaints of frequent nasal obstruction, nasal discharge, discomfort in nose, and headache since 3 years.\nOn local examination of the nose [] the external nose was normal with widened anterior nares. On anterior rhinoscopic examination, inferior turbinate in left side of the cavity was markedly hypertrophied with congestion of the nasal mucous membrane []. In right side of the nasal cavity also there was mild hypertrophy of middle turbinate present. Routine hematology tests (hemoglobin, total count, differential count, erythrocyte sedimentation rate, and absolute eosinophil count) investigations were done. The erythrocyte sedimentation rate and absolute eosinophil count were slightly increased. Hemoglobin, total count, and differential count were within normal limits.\nPatient had taken medical management which included a variety of antihistamines, decongestants, and topical and systemic corticosteroids since 3 years; but was of no use. After discontinuation of medication recurrence of the nasanaha was observed.\nAs the disease was not manageable with medical treatment and leading to complications like sleep apnea and mouth breathing, kshara application was selected in this case.\nAll the aseptic precautions were measured throughout the procedure. Patient was advised not to eat or drink anything (nil by mouth) for 4 h preceding the ksharakarma procedure. Ligno × 10% spray was sprayed into the left nostril to anesthetize the turbinate in order to avoid sneezing reflex and sensitivity. Patient was placed in supine position with the head extended by placing a pillow under the shoulders to expose the nasal cavity properly. A gauze piece soaked in lime water was placed into the left side of the nasal cavity away from the turbinate to avoid involvement of other normal structures.\nThe left nasal cavity was exposed using Thudicum's Nasal Speculum and a secretion over the turbinate was wiped out using gauze piece. Apamargakshara was applied over the medial surface of the exposed turbinate, by using the cotton rolled over Jobson probe. Applied kshara was kept for 2 min.[] After sometime, the color changed to reddish brown (Jambuphalavat, i.e. the fruit of Syzizium cumini Linn.). The kshara was then removed with cotton rolled with Jobson probe. Lemon juice was applied over the turbinate to neutralize the remaining kshara. Yastimadhu ghrita was applied over the burnt wound to overcome daha (burning sensation).\nThe patient was advised to avoid exposure to air or breeze, dust, smoke, etc., The patient was advised to take light diet.\nThe patient was advised to follow-up for twice weekly for 15 days.