Ayurvedic Management of Presbycusis (Project TOPMAC):Protocol for an Exploratory Randomized Controlled Trial

Background: Presbycusis is characterized by sensorineural hearing loss in both ears at high frequencies, which affects morethan half of the older adults by the age of 75 years and is often accompanied by tinnitus and cognitive deterioration. Unfortunately,there are no treatments available to restore hearing loss. Treatment mainly focuses on improving the quality of life andcommunication with hearing aids. Traditional medicine like Ayurveda also explains ailments of a similar nature as Badhirya andadvises using drugs with antiaging and neuroprotective activity for treatment. In Ayurveda, Badhirya and Karnanada (seniledeafness with tinnitus) are due to vitiation of Vata Dosha. Treatments such as topical oil pooling (Karnapurana) are usuallyadvised to counter Vata, improve hearing capacity, and reduce tinnitus. Kshirabala Taila, a medicated oil formulation preparedwith Sida cordifoliaLinnaeus, is one of the most preferred oils for topical oil pooling in such conditions, as it has a definitiveindication for sensory dysfunctions. Drugs like Withania somnifera(L.) Dunal (Ashwagandha) are also used, as they ameliorateneurodegeneration and help to improve cognitive dysfunction. Objective: We propose an exploratory randomized controlled trial study for evaluating the efficacy of TOPMAC (Topical OilPooling with Kshirabala Taila and Supplementation of Ashwagandha Churna) in tinnitus suppression and hearing and cognitivefunction protection in patients aged 60-75 years with mild to moderate presbycusis. Methods: A parallel, 2-group, exploratory randomized controlled trial will be conducted in an Indian Ayurvedic research centerat its outpatient service. Participants (N=60) with mild to moderate presbycusis will be recruited by screening. Participants willbe randomized (computer-generated 1:1) to receive either basic treatment and health education (BTHE) or BTHE+TOPMAC for24 weeks. The primary objective is to compare the efficacy of TOPMAC with that of BTHE in the protection of hearing function.The secondary objective is to compare the efficacy of TOPMAC with that of BTHE in tinnitus suppression and cognitive functionprotection. Results: This project was funded in January 2023. The institutional ethics committees at National Ayurveda Research Institutefor Panchakarma (3/1/2020/NARIP/Tech/2036) and Institute for Communicative and Cognitive Neuro Sciences (IEC006) approvedthis study. The first patient was enrolled in September 2023; 22 participants were enrolled as of August 2024. The data analysisis yet to start, and the results are expected to be published by January 2025. Conclusions: If this exploratory trial is proven effective, it will steer the setting of a definitive randomized controlled trial totest whether the TOPMAC intervention can be incorporated as a cost-effective integrative approach for managing presbycusis.The Indian government has already launched a National Program for Prevention and Control of Deafness to benefit the deafpopulation. TOPMAC may later be considered for integration with the national program Trial Registration: Clinical Trials Registry India CTRI/2023/04/051485; https://tinyurl.com/2h2hry3n