By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Adhijihwa is an oral disorder, compared with epiglottitis. It is explained as mukha roga i.e. disease of buccal cavity or mouth explained in the ‘kanta gata roga’ section of ‘diseases of throat’. So, Adhijihva is generally classified under disorders of buccal cavity and specifically categorized under throat disorders. Adhi = extra, Jihwa = tongue.
Read – Diseases Of Lips (Oshtagata Rogas) – Types, Symptoms Treatment
Table of Contents
Causal dosha – kapha predominant
Involved dhatu (tissue) – blood tissue
The vicious combination of vitiated kapha and blood tissue is responsible for the causation of this disorder.
Kapha and rakta (blood) aggravating foods and activities are contributory.
Read – Signs Of Person Having Enriched Blood (Rakta Sara Purusha Lakshanas)
Since the swelling is of the shape of a small tongue formed at the root of the tongue, it looks like a small tongue appearing over the tongue. Therefore it is called adhijihva i.e. double tongue or extra tongue or tongue over the tongue.
Read – Uvulitis (Galashundi) – Causes, Symptoms, Treatment
The main symptom of adhijihwa is represented in the name of the disease itself. The swelling of the shape of a tongue occurring at the root of the tongue is the main symptom of the disease.
If suppuration occurs in the swelling of adhijihva it should not be treated. This is because the infection and suppuration could spread out with great speed and intensity. This would make the prognosis difficult and the disease becomes incurable.
Read – Ayurvedic Tongue Examinations Explained In Vaidya Sara Sangraha
According to Master Charaka
The swelling which occurs above the tongue is called as upajihva. The swelling which occurs below the tongue is called as adhijihwa.
According to Master Vagbhata
‘Adijihva is a condition wherein there is an elevation along with swelling beneath the tongue. This swelling appears like the tip of the tongue. It is caused due to vicious combination of kapha, pitta and blood. Symptoms include excessive salivation, stiffness of the tongue, obstruction of voice, pain, itching, inability to speak and inability to swallow food and liquids’.
Here we can see that Master Vagbhata has mentioned pitta apart from kapha and blood in the pathogenesis of the disease against Master Sushruta and Madhavakara who have mentioned only kapha and blood. Master Vagbhata has mentioned wide array of symptoms while Master Sushruta (and Madhavakara) have just mentioned the presence of only swelling at the root of the tongue. These symptoms might be caused following the appearance of or as an effect of the swelling or if the swelling is not treated properly. This shows that Master Sushruta has mentioned the condition only until the appearance of the swelling and Master Vagbhata has gone ahead to mention the other symptoms of the disease and probably its complications like difficulty in swallowing and speaking.
Read – Dry Mouth Causes, Ayurvedic Treatment, Remedies, Tips, Diet
The treatment of adhijihwa is done on the similar lines of treating upajihwa disorder.
Master Vagbhata has mentioned a surgical process for treating adhijihwa disorder. Herein the swelling of adhijihva should be opened with the help of instruments and the contents are discharged / drained. Later it should be rubbed with powder of yavakshara – alkali obtained by burning the whole plant of barley.
Adhijihwa throat disorder is compared to ‘epiglottitis’ – a condition explained in the modern medicine. This condition is characterized by the swelling / inflammation of epiglottis.
Read – Ranula (Upajihwika) Oral Disorder – Symptoms, Ayurvedic Treatment
Epiglottis is a small structure present at the base of the tongue. Most of it is made up of cartilage. The food and liquids that we consume needs to go straight down into the stomach through the food pipe i.e. esophagus. Epiglottis prevents the entry of these things into the windpipe and thus acts like a valve.
Epiglottitis is a condition characterized by swelling / inflammation of the epiglottis. It is considered to be a life threatening illness. In this, the epiglottis tissue might get infected and get swollen. This might block the airway. This is an emergency which needs immediate medical attention. This condition is usually found in children. It is also frequent in adults. Children are more vulnerable to breathing complications and hence a prompt diagnosis and timely treatment is needed. Adults with this condition too need prompt treatment.
Read – Laryngitis (Swelling of voice box) – Causes, Ayurvedic Treatment
Infection – The most common cause is bacterial infection, mainly H. influenza type B (Hib). This can enter your body when you inhale germs spread by an infected person through cough, sneeze or blowing of nose.
Hib infection was considered as the most common cause for swelling and inflammation of epiglottis and the tissues surrounding it in the past. Now days it is less common especially in developed countries. This is mainly due to Hib immunization in children. Hib mainly spreads through infected droplets through cough or sneeze. Hib can stay in the nose and throat without causing any sickness. In this case the person would be able to spread the bacteria to the others.
Other agents – In case of adults the inflammation of epiglottis can also be caused by other bacteria and viruses including
Streptococcus A can cause strep throat. S. pneumonia is a common cause of bacterial pneumonia.
Immaterial of the cause, the symptoms of epiglottitis are the same. The symptoms may differ between adults and children. This condition may develop within few hours in children while it develops slowly in adults.
Symptoms common in children
Symptoms common in adults
In adults the signs and symptoms may develop slowly in comparison to the children. They may develop over number of days rather than in few hours as happens in children. The symptoms include –
Epiglottitis would block your airways completely if it is not promptly treated. There will be lack of oxygen which would present as bluish discoloration of the skin. This is a grave emergency and needs immediate medical attention.
Anyone, children or adults, as already said can develop epiglottitis. On the other hand, there are many factors which can increase the risk of developing this condition. They include –
Respiratory failure – Due to swelling of epiglottis the airways become narrow and may get completely blocked. This can lead to respiratory failure. It is a life threatening condition. Herein the blood oxygen levels drop to dangerously low levels or the carbon dioxide levels become excessively high.
Spreading infection – The same bacteria that causes epiglottitis might cause infection in other places of the body also leading to many conditions like pneumonia, meningitis or bloodstream infection.
Medical history and physical observations help in clinching the diagnosis of epiglottitis.
On priority basis one should ensure that the child’s airway should be kept open and enough oxygen is getting through. Breathing and blood oxygen levels shall be recorded regularly. After the breathing has been stabilized the below mentioned tests may be conducted / advised so as to support the diagnosis –
If there is severe difficulty in swallowing or breathing one should call or report to the doctor or nearest emergency department as soon as possible since epiglottitis is a medical emergency. The person should be kept upright and quiet. This position would ease the breathing process.
Read – Dyspnoea – Difficulty in breathing: Causes, Pathophysiology, Diagnosis
One should follow precautions in spite of having taken Hib vaccine since the vaccine doesn’t assure the non occurance of the disease. Epiglottitis is found to happen even in children who have been vaccinated. And other germs too can cause epiglottitis. Precautions include –
As a priority, the breathing is restored. Following this, any identified infection shall be treated.
Protection of airways – will be the first approach towards treating epiglottitis. While doing this, the physician would also keep an eye and constantly monitor the blood oxygen levels. Oxygen may be provided if blood oxygen levels are too low.
Help to breathe
It is important to see that the patient is receiving enough air. This includes –
Other measures – Along with this, the below mentioned also may be included as and when required –
Treating the infection
Intravenous antibiotics will be given if epiglottitis is caused due to infection.
Broad spectrum antibiotics – The infections need to be quickly handled and treated. For this the doctor would prescribe broad-spectrum drugs (antibiotics) immediately, without even waiting for the results of blood and tissue cultures.
Tracheostomy or Cricothyroidotomy – procedures may be needed in severe cases of epiglottitis.
Full recovery can be expected in most cases of epiglottitis if immediate medical attention is sought for.
Read – Atelectasis Causes, Symptoms, Treatment, Ayurveda Concept
Epiglottitis can occur at any age. This condition has now become rare since Hib vaccination are given promptly. But the condition is still a point of concern. Emergency help needs to be sought out if there is a suspicion of someone suffering from epiglottitis. Life threatening complications of epiglottitis can be prevented if this condition is treated promptly.