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Background: Tinnitus, the perception of sound without an external source, is common and can be highly distressing, affecting sleep, concentration and mood. There is no cure, and evidence-based management focuses on assessment, hearing care, education, sound therapy and cognitive behavioural therapy. Ayurveda describes Karnanada (ringing in the ears) and Karnakshveda (whistling sounds) as Vata-dominant ear diseases and treats them with Karnapurana (oil instillation in the ear), Nasya, Snehapana and Rasayana. Objective: To review the classical description of Karnanada, its correlation with tinnitus, current evidence-based management, and the evidence for Ayurvedic interventions. Methods: Narrative review of classical texts, clinical guidelines, systematic reviews and Ayurvedic clinical reports. Results: Clinical guidelines recommend audiological assessment, education, hearing aids for associated hearing loss and cognitive behavioural therapy, which has the strongest evidence for reducing tinnitus distress. Ginkgo biloba is not effective. Ayurvedic evidence consists of case reports and a small case series reporting improvement with Nasya and Karnapurana; no controlled trials of Ayurvedic treatment for tinnitus have been published. A randomised trial of Kshirabala Taila Karnapurana and Ashwagandha in presbycusis, with tinnitus as a secondary outcome, is in progress. Conclusion: Karnanada closely resembles tinnitus, and Ayurvedic treatments are plausible for distress and associated symptoms. Evidence is very limited. Ayurvedic care should include proper assessment and referral and be tested in controlled trials using validated tinnitus questionnaires.

KEYWORDS: Karnanada; Karnakshveda; tinnitus; Karnapurana; Nasya; Shalakya Tantra; Kshirabala Taila; cognitive behavioural therapy