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Introduction

Chronic sinusitis affects approximately 18.7% of the Indian population and is currently the 5th most common condition treated with antibiotics, accounting for 34 million GP’s visits and costing over 7 billion annually. Sinusitis or the inflammation of the paranasal sinus mucosa may be acute or chronic. Acute and Chronic sinusitis have similar signs and symptoms. Acute sinusitis is a temporary infection (< than 1 week) of the sinuses often associated with cold and sometimes fever. Also, treatment is OTC available antiinflammatory or antibiotics, steroids which completely relieves the patient from the infection. Another way of classifying sinusitis is by determining it is ‘open’ or ‘closed’ depending upon whether the sinus drainage can drain freely into the nasal cavity through the natural ostia or not. A ‘closed’ sinusitis causes more severe symptoms and is also likely to cause complications.

Chronic sinusitis occurs when the spaces inside the nose and head (sinuses) are swollen and inflamed for >3 months, despite treatment. Fever isn't a common sign of chronic sinusitis, but if it is associated with an infection, there might be weakness and fever as a symptom. Though, most commonly involved sinus is the maxillary sinus followed by ethmoid, frontal and sphenoid. If all the sinuses are involved, this condition interferes with the normal breathing, thick mucosal drainage and severe nasal congestion. The area around eyes might feel swollen or tender. There might be reduced sense of smell and taste and few may have heaviness and headaches. The retention of nasal discharge compromises the immune system of patient. Symptoms like continuous headache, heaviness in frontal region, watery eyes disturbs patients working capacity makes him physically and mentally distressed. Other signs and symptoms can include ear pain, cough, throat pain, aching upper jaw, sore throat, halitosis and fatigue.

Studies reveal cause of chronic sinusitis can be an infection, allergies such as pollen or chemicals, by growths in the sinuses (nasal polyps) or by swelling of the lining of sinuses. Also called chronic rhinosinusitis, the condition can affect both adults and children.Another most common cause of chronic sinusitis is an uneven wall of tissue between the nostrils. This is known as a deviated septum, and it can limit air flow in one or both of the nostrils.In modern Science, the treatment of Sinusitis is allergy tabs or corticosteroids with nasal sinus irrigation but recently the alternate therapies like Ayurveda, Homeopathic and others have started gaining more preference than allopathic medicines. Reason is simple, they use natural products and does not have any side effect. Siddha therapy is also one unique, ancient alternative treatment process that relies mainly on natural remedies, dietary and lifestyle changes to cure a particular condition, it has been effective in curing sinusitis as well. In Siddha system of medicine, it is known as Mookadaippu or Peenisam or Sinusitis. The physiological functioning of the body is mediated by three humours, namely Kabam, Pittam and Vatham. The popular belief in the Siddha system is that sinusitis occurs when two out of these three humours, Vatham and Piitam are deranged. The line of treatment focuses on normalizing the balance of the humour, so the disease is cured and body normalcy is regained.

Case Report

In this article, we present a case report of 29 years old woman with Chronic Sinusitis who underwent 4 siddha sessions for reliving the nasal obstruction and has a good result without complications. The treatment protocol included a multidisciplinary plan: Siddha, Yoga and physio with diet modifications for overall improvement

Participant Information

A 29-year old female homemaker visited Chakrasiddh in Jan, 2023 with complaints of difficulty in breathing which was severe from last 10 days, Nasal blockage, cough from last 6 months, mild headache in frontal region, heaviness since last 6 months. Her associated complaints included fever especially on weather change, and body aches on off. Due to Nasal blockage, she was forced to do mouth breathing, and had heaviness feeling in chest area. She felt her symptoms got aggravated on exposure to dust, weather change esp in cold climate, cold and fridge foods, tonsils and family stress (loss of father a year before). She always tried to avoid the aggravating factors and preferred to stay in warm environment.

History of Present Complaints

Patient was apparently healthy 2 years back. In 2020, after she was admitted in hospital due to tonsils, her complaints of cough and heaviness in chest area increased. She noticed her weight increased by 15 kgs as she was unable to walk and do exercise due to her asthma and heaviness in breathing. When she lost her father in 2021, her condition aggravated due to stress. The intensity of dust allergy and coughing increased many folds that she stopped going out for family functions too. She noticed stuffy nose which lasted about 6 hours and then followed with heaviness around eyes, cheeks and head. At the end of the day symptoms used to subside by taking medication like Citrizine or Montac. She started getting repeated attacks of stuffy nose with on off obstruction in airflow in her nose. The condition of nasal obstruction worsened followed with increased habit of oral breathing and halitosis with dry mouth feeling in morning. After 4 months of suffering she developed additional symptom of on off headache in frontal region with temporal region. She had disturbed sleep, was irritated on noise and wanted to just keep quite. On aggravation of the symptoms, she visited her physician who advised her rest and kept on steroids. Patient had been on steroids for 2 years which did not work so from last 1 year she is on Homeopathic medicine that gives her relief but she wants complete relief from the issue of Sinus. She has failed multiple courses of medical treatment including antibiotics, nasal steroid, oral steroid, and antihistamine. Her symptoms are interfering with her lifestyle and work. She wanted a complete relief so visited Chakrasiddh for her chronic condition.


Treatement Protocol

In Siddha following Diagnostic and Line of Treatment is followed for chronic sinusitis:

  1. Primary Kutram (defect) Affected: Vatham
  2. Secondary Kutram Affected: Pitham

Siddha Pathogenesis: It is explained by aggravation of Vatham which influences Pitham. In seven udalthathukal Saaram and senneer gets affected.

Envagai Thervu

(Eight Fold System of Clinical Assessment):

  • Naadi - Vathapitham
  • Sparisam - Warmth
  • Naa - Pallor
  • Niram - Normal
  • Mozhi - Low pitched
  • Vizhi - Normal
  • Malam - constipation
  • Neerkuri - Yellowish in colour, tamarind odour
  • Neikuri - Normal

Modern Medical Investigations:

  • Monitor blood pressure - 128/82
  • Complete Blood Count(CBC)- NAD
  • X-ray- PNS (Showed opaque sinus, mucosal thickening)
  • Ophthalmic Examination- NAD
  • MRI –Brain (plain)- CT showed mild DNS

The treatment was started on 30th Jan, 2023; it was planned for 10 days for Cervical Stiffness along with 3-4 sessions of Sinusitis twice a week. The main focus initially was on releasing the stuffiness in nose so that patient gets relief from wheezing and shortness of breath. A multidisciplinary plan including nasal sessions with special diet and daily Pranayam for 1/2 hr were initiated for the patient ,therapies are really helpful in this condition and gives a remarkable relief. Nasal powders and Steam inhalation were been advised to bedone twice daily to the patient (Table-1).Patient could see difference in her sleep from 3 hrs to 8 hrs after 1 sinus session and the stiffness in neck became moderate. The chief healer did the sinus session by hand pressure therapy (Varmam). She initiated by pressurizing her fingers into nasal cavity and manipulating with hands. She used different hand pressures like Thadaval and Amartthal to stimulate "varmam" points at neck and nasal area, to clear the nasal blockage and open the nasal passage. Various special therapies like Varma maruthuvam (varmam points) and Yoga Maruthuvam were incorporated for 10 sessions to give relief in cervical region with flexibility (Table-1).

Results

Significant changes in signs and symptoms were noticed before treatment and after treatment with short course duration of 10 days.Patient felt good response after 1st sinus session. After each sinus session, she was monitored for feedbacks related to her nasal blockage,sleep and headaches. The patient could feel a lot of difference in nasal blockage and there was decreased head heaviness. She was able to sleep for 8-9 hrs without disturbance while earlier she could not sleep even for 2-3 hrs without disturbance.. In subsequent week, she noticed there was no mouth breathing and snoring was reduced. Headaches was on/off but with very less severity and only when she has stressed herself. She was able to sleep straight with decrease in snoring. Early morning dry throat was reduced too much. Pain in neck reduced from severe to mild in intensity in just 10 days. At the end of treatment, the symptoms presented by patient at time of admission like nasal obstruction, breathlessness, sleeplessness, stiffness in neck, headache, mouth breathing, snoring which were at scale 9 was lowered to 2 on VAS scale (Table 2). Depending upon the feedback, X-rays were taken out for pre and post appearance of PNS and cervical region (Fig 1). On the day of discharge 10th day, she was happy and feeling better. On regular follow up the sign and symptoms reduced progressively and on 5th follow up after 6 months,patient was having mild symptoms.

Discussions

Chronic sinusitis occurs when the spaces inside the nose and head (sinuses) are swollen and inflamed for >3 months, despite treatment. In modern Science, the treatment of Sinusitis is allergy tabs or corticosteroids with nasal sinus irrigation but recently the alternate therapies like Ayurveda, Homeopathic and others have started gaining more preference than allopathic medicine. In Siddha system of medicine, it is known as Mookadaippu or Peenisam. The popular belief in the Siddha system is that sinusitis occurs when two out of these three humours, Vatham and Piitam are deranged and line of treatment is to balance these humors. The retention of nasal discharge compromises the immune system of patient. Symptoms like continuous headache, heaviness in frontal region, watery eyes disturbs patients working capacity makes him physically and mentally distressed. There is long term dependency on medications and diet restrictions which make him weak. In above case, a multidisciplinary approach of External therapies like (Vedhu) steam inhalation, Nasiyam (liquid nasal application) proved beneficial in opening up passage giving relief in nasal blockage. Subsequently, the headache was down with help of natural products like Piper Nigerium. Varmam Maruthuvam (Different varmam points), and Yoga maruthuvam worked well on the stiffness and flexibility of the neck regions and overall improvement in ability to do different activities by the patient. Diets specific to patient’s triggers designed gives better results.

Conclusions

In modern medicine, PNS can be managed by continuous use of steriods and Sinus surgery is finally solution but this case study proved that Siddha Vaidya, an ancient science reduced symptoms by just simple methodology of using hand pressures in the nasal cavity and opening up blockages. By channelizing body energies, Siddha therapy empowers and activates the body’s internal healing mechanisms thus, resulting in cure and an improved lifestyle. No unwanted effect of therapy was observed during treatment and during followup period. Along with modified diet and Yoga asanas, there was a marked improvement in pain and stiffness in neck; reducing symptoms related to nasal blockages, functional independence, and quality of life in patients.

It can be concluded that these Siddha procedure along with external medicines are very effective in management of Chronic Sinusitis.but to establish this effect further study of longer duration and larger sample is required