Introduction
Otomycosis is an infection of the external auditory canal caused by a fungus commonly observed in the general otology clinic. It has a global prevalence of 9% to 30% among patients with otalgia and otorrhea symptoms [1]. The occurrence of otomycosis differs according to various climatic factors, with higher prevalence in tropical and subtropical regions, where it is warm and humid. The most prevalent pathogenic fungi isolated in otomycosis are Aspergillus niger andCandida albicans. There is currently no standardized medication regimen for otomycosis that offers novel therapeutic choices, including herbal medication [2].
According to the World Health Organization, herbal plants are one of the ideal sources for obtaining a range of medicines. Hence, these plants should be studied further to discover their benefits, safety, and effectiveness. Henna leaf (Lawsonia inermis) has long been valued for its healing and medicinal properties since ancient times.  The therapeutic effects of various components of Henna are due to its biologically active compound of 2-hydroxynapthoquinone (Lawsone) [3]. Studies have shown that henna leaf extracts in Malaysia inhibit the development of pathogenic fungi [4].
For centuries, henna leaves have been used in Africa, the Middle East, and Asian countries due to their healing attributes, such as antifungal, antibacterial, anti-amoebiasis, and antihemorrhagic effects [5]. This is via the action of its phytoconstituents β-sitosterol glucoside, flavonoids, quinoids, naphthalene derivatives, luteolin, betulin, lupeol galic acid, coumarins, xanthones, and phenolic glycosides [6]. Every part of the henna tree has been studied and found to have antifungal and antitubercular activity [7], while the bark has been found to show anti-inflammatory activity [8]. While its capacity to inhibit the growth of pathogenic fungi causing otomycosis has been well established [4, 5, 7, 9], this medicinal plant’s ototoxicity status is still unknown. Ototoxicity is defined as cellular and functional impairment of the inner ear by therapeutic agents and can be classified into cochleotoxic and vestibulotoxic [10].
This study aims to determine the vestibulotoxic effect of the henna extract with the possibility of developing it as an antifungal preparation in otomycosis. Balance disruptions as a drug-side effect are frequently overlooked by doctors, whereas patients often see it as part of their condition and affecting their overall health. Most drug-induced ototoxicity findings in patients are only restricted to the cochleotoxic effect. However, studies of the vestibulotoxic effect are scarce. This is a pilot project to evaluate the ototoxic effects of the henna extract by analyzing specifically the vestibulotoxicity in a rat animal model. To date, there is only one study assessing the vestibular side effects of neem leaf extract in an animal study [10].