jala neti

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380 Ras togi e t a l India n J Phys io l Pharma col 2009; 53 (4)

Ind ian J Phys io l Pharmaco l 2009 ; 53 (4 ) : 380–382

SHORT COMMUNICATION

NON-PHARMACOLOGICAL MANAGEMENT OF NASAL POLYP :

A CASE REPORT

RAJIV RASTOGI* 1, B. T. C. MURTHY 2 AND VINUDHA 3

Central Counci l for Research in Yoga & Naturopathy,

61-65, Inst i tut ional Area, Janakpuri ,

New Del hi – 11 0 05 8

( R ece iv ed o n Ja nua ry 2 8 , 2 00 9 )

Abstract : Nasal polyp causes difficulty in breathing due to blockage of

nasa l passage . The pathogenes i s o f nasa l po lypos i s i s no t known. The

pr imary medical therapy avai lable fo r nasa l po lyposi s i s s t ero id

administration. Antihistamines, decongestants and cromolyn sodium provide

little benefit. With this background of nasal polyp pathophysiology and the

existing management, a case of nasal polyp was treated with the cleansing

process o f yoga i . e. ne t i k riya and naturopathy with good resul t . This

isolated case report warrants a need for control led cl inical t r ial of net i

kriya to establish its role in the management of nasal polyposis.

Key words : yoga n a t u r o p a t h y net i kriya

*Correspondi ng Author : Ph.: 011-28520430, 31, 32; E-mail : [email protected]

INTRODUCTION

Nasal polyps are caused by over

pro duc ti on of flu id in the ce ll s of the na sal

mucus membrane resul t ing from condit ions

such as allergic rhinitis. They are harmless

but i f suf f ic ient ly large , can obs t ruct the

nasal airway to make the breathing difficult.

They can also lead to headache or facial pain

if the ostia of sinuses are blocked with the

po lyp (1).

Besides surgery, there is no satisfactory

medical t rea tment avai lable to manage the

condition (2). Oral and topical nasal steroid

adminis t ra t ion i s the pr imary medical

therapy for nasal polyposis. Antihistamines,

deconges tants , and cromolyn sodium offer

lit t le benefit . Immunotherapy may be useful

to t rea t a l lergic rhini t i s , but when used

a lone , does not he lp resolve the exis t ing

polyps. CT and MRI scan can help diagnosing

a nasal polyp (3, 4). With this background, a

s ingle case of nasal polyp was t rea ted

with non-pharmacological methods involving

yoga and naturopathy and has shown good

improvement .

MATERIALS AND METHODS

C ase report

A 55 year male ar r ived a t yoga and

naturopathy clinic for his complaints of nasal

obstruction and difficulty in breathing for 2

years. He was investigated and pre-diagnosed

for nasal polyp and on conventional medical

therapy. A recent CT scan and a follow-up

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Indian J Physiol Pharmacol 2009; 53(4) Non Pharmacological Management of Nasal Polyp 381

reveal any abnormality of nasal mucosa. He

was again referred to the ENT expert, who

seeing no obvious pathology in hi s nasal

cavi ty, cancel led the surgery.

RESULTS AND DISCUSSION

Net i i s one of the shatka rma (s ixcleansing pract ices) of yoga, pract iced for

internal cleansing. Jala net i is a procedure

in which sal ine water is used to clean the

nasal passages . A deta i led account of the

pr oce dure is give n in an cie nt te xts an d al so

in some recent references (5 , 6 , 7) .

Presumed benef i t s of j a la net i inc lude

removal of mucous and pollutants from the

nasal cavi ty al lowing unobstructed f low of

a i r . I t may help in prevent ion and

management of upper respi ra tory t rac t

di seases and re l ieve a l lergies , colds and s inus i t i s . Mouth breathing in chi ldren can

be reduced by practicing jala neti.

Jala neti relieves muscular tension of the

face, nervous tics, and Bell’s palsy and helps

the pract i t ioner to mainta in a f resh and

youthful appearance . I t has a cool ing and

soothing inf luence on the bra in and i s

beneficial in the treatment of epilepsy and

ENT consul ta t ion was in favor of the

diagnosis and a functional endoscopic sinus

surgery (FESS). He had been advised pre-

surgical s teroidal nasal spray.

Unwilling to go for surgery, the patient

visited Yoga & Naturopathy OPD functioning

at the same Hospi ta l . On examinat ion,

he was found to have blocked nose ,

brea thlessness , cons t ipat ion and d is turbed

s leep. CT-PNS revealed an i r regular sof t

t i ssue th ickening in r ight maxi l lary s inus

and minimal mucosal th ickening in lef t

maxillary and frontal sinuses. There was soft

t i ssue th ickening in anter ior , middle and

pos ter ior e thmoidal s inuses. The case was

diagnosed as bi lateral maxil lary, ethmoidal

and frontal sinusitis leading to formation of

nasal polyps.

T r e a t m e n t

The pat ient was advised yogic shodhan

(cleansing process) through jala neti (saline

nasal i r r iga t ion) a long wi th shavasana and

pranayam. A one week follow-up found the

pat ient part ia l ly rel ieved. In the fol lowing

week, practice of surya namaskar (a flowing

ser ies of 12 yoga pos tures) was a l so

recommended. Breathing was cons iderably

improved in the second week. A fur ther

addit ion of suryabhedi pranayam was done

this t ime with dietary advise consist ing of

high fibre, fresh vegetables, sprouted moong

and fruit juices (Table I).

The regimen was continued for 6 months

followed by a subsequent follow-up. Besides

improvements in hi s v i ta l s igns ( i . e . no

constipation, normal BP, normal sleep), there

was no discomfort in breathing during the

follow-up period. A repeat CT scan did not

T A BL E I : S u mm e ry of th e t r ea t me n t.

Primary treatment Ad di ti onalt r e a t m e n t

1st week Jala net i, shavasana , p r a n a ya m

2nd week Jala ne ti , shavasana, p r a n a ya m Surya namskar

3rd week Jala neti, shavasana, Suryabhedi pr anayam, su rya nama skar pranayam,

diet advise

4 th week Jala net i, shavasana,

o n w ar d p ra na ya m, surya na ma ska r,suryabhedi pranayam,diet advise

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382 Ras togi e t a l India n J Phys io l Pharma col 2009; 53 (4)

removed paving the way for a clear airway.

Jala neti, besides cleaning the nasal passage,

also helps in acclimatization of nasal mucosa

to the var ious temperature and humidi ty

changes to enable the nose to adjus t i t s

vasomotor rhythm in tune wi th weather

changes .

Inspi te of ne t i be ing the most

recommended therapy in yoga and

naturopathy c l in ics , very l i t t l e work has been done to support its efficacy. We have

at tempted ja la net i in an i sola ted case of

nasal polyp and found complete c l in ica l

improvement and regress ion of the polyp.

This case report suggests that jala neti is a

poss ible mode of therapeut ic in tervent ion

in nasal polyps . Our s tudy sugges ts the

need for cont rol led c l in ica l t r i a l s of the

ef fec t iveness of j a la net i in var ious nasal

condi t ions .

migra ine . I t a l levia tes anxie ty , anger and

depress ion, removes drowsiness and makes

the head fee l l ight and f resh. Ja la net i

s t imula tes nerve endings in the nose ,

improving the ac t iv i t i es of the bra in and

overall health of the individual. A balance is

brought abou t between the r ight and lef t

nostrils and the corresponding left and right

bra in hemispheres , inducing a sta te of

harmony and balance throughout the body

and the sys tems governing c i rcula t ion and diges t ion. Most impor tant ly , ne t i he lps to

awaken a jna chakra .

As described in yoga texts, neti kriya is

highly effect ive in t reat ing ENT disorders.

The technique is commonly used in al l the

yoga and naturopathy hospi ta l s in India .

In the present case , j a la net i reduced

the size of nasal polyp by gentle cleansing

and hence the nasal obs t ruct ion was

REFERENCES

1 . F a mi l y H ea l th M e di c al E n c yc l op e di a , Wi l l ia m

Collins Sons & Co. Ltd . , 1978; p . 373–374.

2 . T h e N e w M a cm i l la n Gu i de t o Fa m il y He a lt h ,

Macmillan Press Ltd. of London, 1987; p. 357–368.

3 . F o kk e ns e t a l . E A AC I Po s it i on P ap e r o n

R h inos inus i t i s and Nasa l Po lyps , 584 .

4 . M e di c a l tr e at m en t o f st a ge 1 N a sa l p ol y po s is

over a 3 year fo l low up , 1 : ORL J

Otorh ino laryngo l Re la t Spec 2004 ; 66 : 27–34 .

5 . G h ar o te M L , Y o gi c T e ch n iq u es . The Lonav la

Yoga In s t i tu te ( Ind ia ) , Lonav la , 1999; 44–91.

6 . S a ra s wa t i S S. A s a na P r a na y am M u dr a B an dh a .

Yoga Pub l ica t ion Trus t , Munger , B ihar , I nd ia ,

2004; 477–483.

7 . R a st o gi S , R a nj a na , Ra s to g i R . Ja l a ne t i

app l ica t ion in acu te rh ino - s inus i t i s . Ind ian

Journa l o f Tradi t i ona l Knowl edge 2007 ; 6 :

328–333 .

jala neti

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