Comparative assessment on the efficacy of Epleys Maneuver and its combination with Kalyanaka grita Nasya,Drakshadi kashaya,Eladi vati in the management of Benign Paroxysmal Positional Vertigo(BPPV).

BPPV is characterized by vertigo lasting for seconds associated with balancing problem, nystagmus, nausea and vomiting. It is the most common cause of vertigo worldwide with a prevalence of  10.7 - 140/100,000.Though it is a benign condition, 60 % of patients with BPPV require leave from work, 86 % experience interruption to activities of daily living, 38 % of patients fall down as a direct consequence, with incidence of both BPPV and falls increasing with increasing age.

Treatment recommendation include Canalith repositioning procedure(CRP), vestibular suppression medications and rehabilitative exercises. Despite the success of CRP showing odds ratio of 4.2 in resolution of symptoms 20% of BPPV doesnot benefit from it and shows mild negative outcomes. Vestibular medications are also not advised for long as it produces drowsiness, Cognitive deficits , Interference with driving vehicles or operating machineries. Datas are also not available showing widely accepted interval regarding CRP.

Reviewing the classics the symptoms of BPPV can be correlated to bhrama where a person feels that everything around him is spinning like a wheel “chakravat bhramana” caused due to the vitiation of pitta and vata with involvement of raja. Line of treatment can be according to doshapratyaneekata and its site of manifestation. In the present study kalyanaka grita nasya is chosen. Drakshadi kashaya and eladi vati  selected for internal administration is vatapittahara tridoshahara respectively and both are advised to be effective in bhrama.

Hence the present study is to assess whether Kalyanaka grita nasya, Drakshadi kashaya, Eladi vati with Epley’s Maneuver is more effective than Epley’s Maneuver alone in the management of BPPV. The clinical study will be carried out in 30 patients with BPPV who fulfil inclusion criteria belonging to either sex from OPD and IPD of Amrita School of Ayurveda. VSS- sf, DHI questionnaire and Dix Hallpike test will be assessed. Patient will be allocated into Group A and B. Consent will be taken in their own language before treatment, subjective parameters will be assessed and recorded in CRF. Group A will be given 4ml Kalyanaka grita marsha nasya, Drakshadi kashaya and eladi vati along with Epleys manuever and group B with  Epley’s maneuver alone for 30 days. After treatment subjective parameters will be assessed, also in the 4 followup on 45th,60th,75th ,90th day to assess the sustained effect of treatment. The data obtained will be tabulated and statistically analysed using Wilcoxon signed rank test.