Clinical study to evaluate the combined effect of apamarga kshara taila prathimarsha nasya and oral administration of kumarabharana rasa in the management of hypertrophied adenoids in children.

Respiratory diseases are the greatest cause of pediatric medical visits,  nasal obstruction is most common.1Adenoid hypertrophy(AH) is an obstructive condition due to increased size of adenoids2. Adenoids being a part of immune system and act as the first line of defence mechanism of aerodigestive tract3, they can get inflamed and enlarged by allergy of upper respiratory tract  recurrent attacks of  rhinitis , sinusitis or chronic tonsilitis4..

Adenoid hypertrophy occupies the most among all diseases of the upper respiratory tract in paediatric, accounting for about 34.5% according to NCBI a systematic review and Metaanalysis5. 0-75% adenoids enlargement is diagnosed at 3-10 years. The symptoms of adenoid hypertrophy tend to occur more among young children, because of the increased frequency of upper respiratory tract infections and the small volume of the nasopharynx.  Even though  this condition is generally self-resolving due to age-related adenoid atrophy,  AH can lead to a series of serious complications including sleep-disordered breathing and sleep apnea which in children can lead to growth failure, and neurocognitive abnormalities such as low intelligence quotient, learning and behavioral problems, poor attention span,ear infections, temporary hearing loss and Pulmonary hypertension6.

    The treatment options available for  adenoid hypertrophy are antibiotics, antihistamines  , nasal steroidsand surgical management called adenoidectomy may result in postoperative complications such as immediate and late bleeding (0.7%)7 ,vomiting  ,difficulties in swallowing and pain .recurrence of adenoid tissue is 20% The  risk of adenoid re-growth is slightly more common in patients who undergo adenoidectomy at a young age8.The complications arising from the medical and surgical management makes us to find out the alternative line of management with no added adverse effect .

In Ayurveda, adenoid enlargement can be well correlated with Kanthashaluka9owing to the marked similarities of the clinical presentations of hypertrophied adenoids like margarodha,kolavath granti10.As it is  an urdhwajatrugatavikara and nasya is widely adopted and effective treatment modalityfor the management11, in the present study pratimarshanasya is taken as choice of intervention . As the disease is kaphapradhana the drug of choice should have,katu rasa,ushnateekshna guna12hence apamargataila is selected for pratimarshanasya and kumarabharana tablet internally.

As apamarga is having katutikta rasa ushnaveerya,shodana and ropana property, it is  taken as drug of choice and Kumarabharana Rasa is Anubhuta Yoga (formulation) which is very effective in management of chronic respiratory diseases especially in children as it is observed during the clinical practice13 .Hence in the present study an attempt is made to evaluate the combined effect of prathimarshanasya with apamargaksharatailaand kumarabharana tablet internally in hypertrophied adenoids