Ayurvedic medicine for the treatment of chronic rhinosinusitis: a systematic review of randomized and non-randomized trials

Isaac L. Schmale; Sai V. Nimmagadda; Saiganesh Ravikumar; Charles N. Babb; Li-Xing Man

doi:10.1515/jcim-2022-0062

Article

Ayurvedic medicine for the treatment of chronic rhinosinusitis: a systematic review of randomized and non-randomized trials

Isaac L. Schmale , Sai V. Nimmagadda , Saiganesh Ravikumar , Charles N. Babb and Li-Xing Man

Published/Copyright: February 20, 2023

Published by

Become an author with De Gruyter Brill

Submit Manuscript Author Information Explore this Subject

From the journal Journal of Complementary and Integrative Medicine Volume 20 Issue 4

Abstract

Objectives

This article provides a comprehensive systematic review and qualitative analysis of the current research investigating Ayurveda chronic rhinosinusitis (CRS) treatment.

Content

PRISMA guidelines for systematic reviews was followed and our search utilized MEDLINE, Embase, Ayush Portal, and Cochrane Library databases. Articles published prior to March 2022, 10 or more patients that investigated Ayurveda as a treatment for CRS in humans were included. This resulted in thirteen articles meeting inclusion criteria. Ayurvedic treatments included herbal medications for oral consumption, nasal instillation, and steam inhalation used alone or in combination. All studies concluded that Ayurvedic therapy led to improvements in subjective CRS symptoms and objective radiographic and hematologic criteria. However, all 13 studies had a significant risk of bias due to study design and statistical methods utilized.

Summary

Ayurvedic therapy may be a useful CRS treatment for some patients and overall appears to be well tolerated. However, definitive recommendation for when Ayurvedic treatments would be beneficial in the treatment of CRS remains not possible.

Outlook

Given the overall positive effects shown in the current published evidence and growing interest in complementary and integrative therapies, Ayurvedic treatments for CRS deserve further investigation in the form of well-designed controlled trials.

Keywords: Ayurveda; chronic sinusitis; complementary; kaphaja shirsha shoola ; nasya; pratishyaya

Corresponding author: Isaac L. Schmale, MD, Department of Otolaryngology Head and Neck Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Box 629, Rochester, NY 14642, USA, Phone: 585-758-5700, Fax: 585-758-1299, E-mail: Isaac_Schmale@urmc.rochester.edu

Presented at The Triological Society Combined Sections Meeting, January 18–20, 2018 in Scottsdale, AZ.

Research funding: None.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Not applicable.
Ethical approval: Not applicable.

References

1. Clarke, TC, Black, LI, Stussman, BJ, Barnes, PM, Nahin, RL. Trends in the use of complementary health approaches among adults: United States, 2002–2012. Natl Health Stat Report; 2015:1–16 pp.Search in Google Scholar

2. Black, LI, Clarke, TC, Barnes, PM, Stussman, BJ, Nahin, RL. Use of complementary health approaches among children aged 4–17 years in the United States: national health interview survey, 2007–2012. Natl Health Stat Report; 2015:1–19 pp.Search in Google Scholar

3. Krouse, JH, Krouse, HJ. Patient use of traditional and complementary therapies in treating rhinosinusitis before consulting an otolaryngologist. Laryngoscope 1999;109:1223–7. https://doi.org/10.1097/00005537-199908000-00007.Search in Google Scholar PubMed

4. DeConde, AS, Soler, ZM. Chronic rhinosinusitis: epidemiology and burden of disease. Am J Rhinol Allergy 2016;30:134–9. https://doi.org/10.2500/ajra.2016.30.4297.Search in Google Scholar PubMed

5. Blanc, PD, Trupin, L, Earnest, G, Katz, PP, Yelin, EH, Eisner, MD. Alternative therapies among adults with a reported diagnosis of asthma or rhinosinusitis: data from a population-based survey. Chest 2001;120:1461–7. https://doi.org/10.1378/chest.120.5.1461.Search in Google Scholar PubMed

6. Rotenberg, BW, Bertens, KA. Use of complementary and alternative medical therapies for chronic rhinosinusitis: a canadian perspective. J Otolaryngol Head Neck Surg 2010;39:586–93.Search in Google Scholar

7. Jaiswal, YS, Williams, LL. A glimpse of Ayurveda – the forgotten history and principles of Indian traditional medicine. J Tradit Complement Med 2017;7:50–3. https://doi.org/10.1016/j.jtcme.2016.02.002.Search in Google Scholar PubMed PubMed Central

8. Caldecott, T. Ayurveda: the divine science of life. Mosby Elsevier; 2006.Search in Google Scholar

9. Ho, EY, Cady, KA, Robles, JS. A case study of the neti pot’s rise, americanization, and rupture as integrative medicine in U.S. media discourse. Health Commun 2016;31:1181–92. https://doi.org/10.1080/10410236.2015.1047145.Search in Google Scholar PubMed

10. Meera, S, Rani, MV, Sreedhar, C, Robin, DT. A review on the therapeutic effects of NetiKriya with special reference to JalaNeti. Review J Ayurveda Integr Med 2020;11:185–9. https://doi.org/10.1016/j.jaim.2018.06.006.Search in Google Scholar PubMed PubMed Central

11. Nuutinen, J, Holopainen, E, Haahtela, T, Ruoppi, P, Silvasti, M. Balanced physiological saline in the treatment of chronic rhinitis. Rhinology 1986;24:265–9.Search in Google Scholar

12. Orlandi, RR, Kingdom, TT, Hwang, PH, Smith, TL, Alt, JA, Baroody, FM, et al.. International consensus statement on allergy and rhinology: rhinosinusitis. Int Forum Allergy Rhinol 2016;6:S22–209. https://doi.org/10.1002/alr.21695.Search in Google Scholar PubMed

13. Ahmad, A, Gundeti, MS, Dave, PP, Jameela, S, Khanduri, S, Rao, BC, et al.. Efficacy and safety of Ayurveda interventions for sinusitis: a systematic review and meta-analysis. J Compl Integr Med 2023;20:316–27. https://doi.org/10.1515/jcim-2021-0390 34634197.10.1101/2021.03.11.21253190Search in Google Scholar

14. Man, LX, Nguyen, DK, Jueng, J, Seidman, MD. Complementary/integrative medicine. In: Rosen, CA, Gray, S, Ha, P, Limb, C, Park, S, Richter, G, editors. Bailey’s head and neck surgery: otolaryngology, 6th ed. Wolters Kluwer Health; 2022, in press.Search in Google Scholar

15. Man, LX. Complementary and alternative medicine for allergic rhinitis. Curr Opin Otolaryngol Head Neck Surg 2009;17:226–31. https://doi.org/10.1097/moo.0b013e3283295791.Search in Google Scholar PubMed

16. Nimmagadda, SV, Schmale, IS, Man, LX. Crenotherapy as a complementary and integrative treatment for chronic rhinosinusitis: a systematic review and discussion of current evidence limitations. Am J Rhinol Allergy 2022 Feb 23. https://doi.org/10.1177/19458924221081235 [Epub ahead of print].10.1177/19458924221081235Search in Google Scholar PubMed

17. Page, MJ, McKenzie, JE, Bossuyt, PM, Boutron, I, Hoffmann, TC, Mulrow, CD, et al.. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:1–9. https://doi.org/10.1136/bmj.n71.Search in Google Scholar

18. Page, MJ, McKenziea, JE, Bossuyt, PM, Boutron, I, Hoffmann, TC, Mulrow, CD, et al.. Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. J Clin Epidemiol 2021;134:103–12. https://doi.org/10.1016/j.jclinepi.2021.02.003.Search in Google Scholar

19. Maragalawaththa, MG, Ediriweera, ER, Chandimarathne, PB. A clinical trial of Sri Lankan traditional decoction of pitawakka navaya in the treatment of kaphaja shirsha shoola. Ayu 2010;31:268–71. https://doi.org/10.4103/0974-8520.77147.Search in Google Scholar

20. Ediriweera, ER, Rathnayaka, RL, Premakeerthi, WM, Weerasinghe, KD. Efficacy of Sri Lankan traditional decoction of katuwelbatu deduru katukadi in treatment of kaphaja shira shula (chronic sinusitis). Ayu 2010;31:58–61. https://doi.org/10.4103/0974-8520.68208.Search in Google Scholar

21. Sarwal, R, Ram, TS. AYUSH research portal: matching traditional Indian knowledge with modern needs. Curr Sci 2021;121:747–51.10.18520/cs/v121/i6/747-751Search in Google Scholar

22. Slim, K, Nini, E, Forestier, D, Kwiatkowski, F, Panis, Y, Chipponi, J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003;73:712–6. https://doi.org/10.1046/j.1445-2197.2003.02748.x.Search in Google Scholar

23. The Cochrane Public Health Group. Data extraction an assessment template 2011 [Accessed 21 Apr 2021].Search in Google Scholar

24. India. Ayurvedic Pharmacopoeia C, India. Dept. of Indian Systems of M, Homoeopathy. The Ayurvedic formulary of India. Controller of Publications; 2003.Search in Google Scholar

25. Chaudhari, V, Rajagopala, M, Mistry, S, Vaghela, DB. Role of pradhamana nasya and trayodashanga kwatha in the management of dushta pratishyaya with special reference to chronic sinusitis. Ayu 2010;31:325–31. https://doi.org/10.4103/0974-8520.77165.Search in Google Scholar

26. Yadhav, JS, Sharma, KK, Sharma, A. A comparative study of jala neti and chitraka haritaki avleha in pratishyaya. J Ayurveda 2009;III:15–25.Search in Google Scholar

27. Atara, A, Rajgopala, M, Pansara, KN, Maniyar, H, Naria, M. An ayurvedic management of nasal polyposis. Indian J Otolaryngol Head Neck Surg 2019;71:1876–84. https://doi.org/10.1007/s12070-018-1278-7.Search in Google Scholar

28. Dave, PP, Bhatta, KH, B, VD, S, DK. Role of vyaghri haritaki avaleha and anu taila nasya in the management of dushta pratishyaya (chronic sinusitis). Int J Ayurveda Med 2016;7:49–55.10.47552/ijam.v7i1.717Search in Google Scholar

29. Mansi, SA. A clinical study on the efficacy of ardhanarishvara rasa nasya and nimbadi guggulu in the management of kaphaja shiroroga W.S.R. to sinusitis. J Ayurveda 2018;XII:66–72.Search in Google Scholar

30. Dadrich, AP, Vyas, DS, N, KK. Mrtyunjayarasavati in chronic sinusitis a preliminary clinical study. J Res Ayurvedic Sci 2001;XIII:95–102.Search in Google Scholar

31. Lahankar, MA, Sunita, VM, Kishen, D, Amar, PD. Management of nasavivar shotha (paranasal sinusitis) by bharangyadi taila nasya and pathyadi kwatha. Int Ayurvedic Med J 2013;1:1–6.Search in Google Scholar

32. Nath, J, Panda, PK. Management of chronic sinusitis with classical ayurvedic formulation. J Res Ayurvedic Sci 2001;XXII:95–102.Search in Google Scholar

33. Panigrahi, HK. Efficacy of ayurvedic medicine in the treatment of uncomplicated chronic sinusitis. Ancient Sci Life 2006;26:6–11.Search in Google Scholar

34. Panigrahi, HK. Treatment of uncomplicated sinusitis by ayuvedic medicine-an open level, non-comparative study. J Res Ayurvedic Sci 2009;XXX:11–8.Search in Google Scholar

35. Verma, M, Sharma, A, Kumar, V, Verma, S. A pilot study on the efficacy of ardhanarishwara rasa nasya in the management of kaphaja shiroroga (sinusitis). Int J Res Ayurveda Pharm 2016;7:51–3. https://doi.org/10.7897/2277-4343.075218.Search in Google Scholar

36. Sarker, M. Therapeutic efficacy and safety of traditional Ayurvedic medicines: demands for extensive research and publications. J Homeopathy Ayurvedic Med 2014;3:3.Search in Google Scholar

37. Fokkens, WJ, Lund, VJ, Hopkins, C, Hellings, PW, Kern, R, Reitsma, S, et al.. European position paper on rhinosinusitis and nasal polyps 2020. Rhinology 2020;58(S29 Suppl):1–464. https://doi.org/10.4193/Rhin20.600.Search in Google Scholar PubMed

38. Bhardwaj, A, Sharma, MK, Gupta, M. Endoscopic evaluation of therapeutic effects of “anuloma-viloma pranayama” in pratishyaya wsr to mucociliary clearance mechanism and Bernoulli’s principle. Ayu 2013;34:361. https://doi.org/10.4103/0974-8520.127714.Search in Google Scholar PubMed PubMed Central

39. Agrawal, RG, Joshi, PC, Pandey, MJ, Pandey, G. Studies on standardisation of tribhuvanakirti rasa. Ancient Sci Life 1996;15:169–71.Search in Google Scholar

40. Li, M, Yue, PZCQX, Li, JQ, Chu, RA, Zhang, W, Wang, H, et al.. Pungent ginger components modulates human cytochrome P450 enzymes in vitro. Acta Pharmacol Sin 2013;34:1237–42. https://doi.org/10.1038/aps.2013.49.Search in Google Scholar PubMed PubMed Central

41. Patil, D, Gautam, M, Sunil Gairola, SJ, Bhushan, P, Patwardhan, B. Effect of botanical immunomodulators on human CYP3A4 inhibition: implications for concurrent use as adjuvants in cancer therapy. Integr Cancer Ther 2014;13:167–75. https://doi.org/10.1177/1534735413503551.Search in Google Scholar PubMed

42. Taesotikul, T, Nakajima, M, Tassaneeyakul, W, Yokoi, T. Effects of Phyllanthus amarus on the pharmacokinetics of midazolam and cytochrome P450 activities in rats. Xenobiotica 2012;42:641–8. https://doi.org/10.3109/00498254.2012.655703.Search in Google Scholar PubMed

43. Harwansh, RK, Mukherjee, K, Bhadra, S, Kar, A, Bahadur, S, Mitra, A, et al.. Cytochrome P450 inhibitory potential and RP-HPLC standardization of trikatu-a Rasayana from Indian Ayurveda. J Ethnopharmacol 2014;153:674–81. https://doi.org/10.1016/j.jep.2014.03.023.Search in Google Scholar PubMed

44. Ponnusankar, S, Pandit, S, Babu, R, Bandyopadhyay, A, Mukherjee, PK. Cytochrome P450 inhibitory potential of triphala-a rasayana from Ayurveda. J Ethnopharmacol 2011;133:120–5. https://doi.org/10.1016/j.jep.2010.09.022.Search in Google Scholar PubMed

Received: 2022-03-07

Accepted: 2023-01-31

Published Online: 2023-02-20

You are currently not able to access this content.

Articles in the same Issue

https://doi.org/10.1515/jcim-2022-0062

Keywords for this article

Ayurveda; chronic sinusitis; complementary; kaphaja shirsha shoola; nasya; pratishyaya