Yoga for sinusitis

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Yoga is being increasingly used as an adjuvant therapy for various conditions based on research done in the past many decades. This paper attempts to focus on the scientific basis of some Yoga practices such as Neti and Nada Pranayamas that may help in the prevention and management of sinusitis. This can help us understand the mechanisms through which these Yoga practices can help as an adjuvant therapy in preventing and managing sinusitis. This provides us the confidence to use these therapies as an inexpensive and safe method even in primary health care setting.

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Yoga for sinusitis

  1. 1. YOGAYOGA FOR SINUSITISFOR SINUSITIS YOGACHARYAYOGACHARYA Dr. ANANDA BALAYOGI BHAVANANIDr. ANANDA BALAYOGI BHAVANANI M.B.B.S., A.D.Y., D.P.C., D.S.M., P.G.D.F.H., P.G.D.Y., F.I.A.Y., M.D(AM)M.B.B.S., A.D.Y., D.P.C., D.S.M., P.G.D.F.H., P.G.D.Y., F.I.A.Y., M.D(AM) Deputy DirectorDeputy Director CENTRE FOR YOGA THERAPY, EDUCATION &CENTRE FOR YOGA THERAPY, EDUCATION & RESEARCH ( CYTER )RESEARCH ( CYTER ) Puducherry, Southern India.Puducherry, Southern India. yoga@mgmcri.ac.inyoga@mgmcri.ac.in
  2. 2. INTRODUCTIONINTRODUCTION  Yoga, the ancient cultural heritage of India hasYoga, the ancient cultural heritage of India has recently become popular as a therapeutic adjuvantrecently become popular as a therapeutic adjuvant to modern scientific medicine.to modern scientific medicine.  The physiological and psychological benefits ofThe physiological and psychological benefits of Yoga have given rise to various potentialities as anYoga have given rise to various potentialities as an adjuvant therapy for numerous psychosomaticadjuvant therapy for numerous psychosomatic disorders.disorders.  Yoga is however primarily focused on preventionYoga is however primarily focused on prevention and can be said to be the original preventiveand can be said to be the original preventive medicine.medicine.
  3. 3. WHAT IS SINUSITIS?WHAT IS SINUSITIS?  Sinusitis is an inflammation of the membraneSinusitis is an inflammation of the membrane lining of any sinus, especially one of the paranasallining of any sinus, especially one of the paranasal sinuses in the human skull.sinuses in the human skull.  Acute sinusitis –a short-term condition thatAcute sinusitis –a short-term condition that responds well to antibiotics and decongestants.responds well to antibiotics and decongestants.  Chronic sinusitis -at least four recurrences of acuteChronic sinusitis -at least four recurrences of acute sinusitis that may require prolonged therapy andsinusitis that may require prolonged therapy and even surgery.even surgery.
  4. 4. HOW COMMON IS SINUSITIS?HOW COMMON IS SINUSITIS?  Common clinical problem with considerableCommon clinical problem with considerable morbidity and often-refractory symptoms,morbidity and often-refractory symptoms, accounting for millions of patient visits.accounting for millions of patient visits.  One of the top 5 conditions for which antibioticsOne of the top 5 conditions for which antibiotics are prescribedare prescribed  More than 120 million Indians suffer from at leastMore than 120 million Indians suffer from at least one episode of acute sinusitis each year.one episode of acute sinusitis each year.  The prevalence of sinusitis has soared in the lastThe prevalence of sinusitis has soared in the last decade due to increased pollution, urban sprawl,decade due to increased pollution, urban sprawl, and increased resistance to antibiotics.and increased resistance to antibiotics.  Significant negative impact on patients’ QOLSignificant negative impact on patients’ QOL
  5. 5. SYMPTOMS OF ACUTE SINUSITISSYMPTOMS OF ACUTE SINUSITIS  facial pain / pressurefacial pain / pressure  nasal obstructionnasal obstruction  nasal dischargenasal discharge  diminished sense of smelldiminished sense of smell  fever, bad breath, fatigue, dental pain, andfever, bad breath, fatigue, dental pain, and cough may be presentcough may be present
  6. 6. CHRONIC SINUSITIS - SYMPTOMSCHRONIC SINUSITIS - SYMPTOMS Following symptoms present >12 weeksFollowing symptoms present >12 weeks  facial pain / pressure,facial pain / pressure,  facial congestion / fullness,facial congestion / fullness,  nasal obstruction / blockage,nasal obstruction / blockage,  thick nasal dischargethick nasal discharge  discolored post-nasal drainage,discolored post-nasal drainage,  pus in the nasal cavity,pus in the nasal cavity,  and fever.and fever.  May also have headache, bad breath, and fatigue.May also have headache, bad breath, and fatigue.
  7. 7. CAUSES OF THE PROBLEMCAUSES OF THE PROBLEM  Chronic sinusitis is a common disease in children,Chronic sinusitis is a common disease in children, especially those with allergies.especially those with allergies.  Inflammation from an allergy causes membraneInflammation from an allergy causes membrane swelling and the sinus opening to narrow, therebyswelling and the sinus opening to narrow, thereby blocking mucus movement.blocking mucus movement.  Poor sinus ventilation increases risk for sinusitisPoor sinus ventilation increases risk for sinusitis  New evidence points to a pathophysiologic linkNew evidence points to a pathophysiologic link between sinusitis, allergic rhinitis and asthma.between sinusitis, allergic rhinitis and asthma.  Smoking plays a role in the causation andSmoking plays a role in the causation and worsening of symptomsworsening of symptoms
  8. 8. GENERAL TIPSGENERAL TIPS  Regular graded exercise develops exerciseRegular graded exercise develops exercise tolerance. Brisk walking with Savitri Pranayamatolerance. Brisk walking with Savitri Pranayama (2:1-2:1) ratio while walking.(2:1-2:1) ratio while walking.  Maintain good hydration > 2 liters water /day.Maintain good hydration > 2 liters water /day.  Use a humidifier. Warm, moist air lubricates nasalUse a humidifier. Warm, moist air lubricates nasal and sinus passages and thins mucus secretionsand sinus passages and thins mucus secretions  Be aware - avoid foodstuffs that bring on an allergyBe aware - avoid foodstuffs that bring on an allergy  Carrots, papaya, mango and green leafy vegetablesCarrots, papaya, mango and green leafy vegetables have precursor of Vitamin A -vital for health of thehave precursor of Vitamin A -vital for health of the epithelial lining of the respiratory tractepithelial lining of the respiratory tract
  9. 9.  Citrus fruits have Vitamin C- useful for health ofCitrus fruits have Vitamin C- useful for health of the respiratory tract. Warm lemon or orange juicethe respiratory tract. Warm lemon or orange juice with honey helps build up the resistance of thewith honey helps build up the resistance of the respiratory tract. Amla is a rich source of Vit Crespiratory tract. Amla is a rich source of Vit C  Sprouts are useful in promoting rejuvenation. AsSprouts are useful in promoting rejuvenation. As the respiratory lining is constantly under attack,the respiratory lining is constantly under attack, they help in the epithelial regeneration.they help in the epithelial regeneration.  Avoid air polluted areas whenever possible.Avoid air polluted areas whenever possible.  Restrict all mucous-forming foods such as milk &Restrict all mucous-forming foods such as milk & milk products, groundnuts, refined products, sodamilk products, groundnuts, refined products, soda drinks, pastries and sweets, especially chocolate.drinks, pastries and sweets, especially chocolate.  Avoid smoking as it is surely your worst enemy ifAvoid smoking as it is surely your worst enemy if you are already suffering a respiratory disorder.you are already suffering a respiratory disorder.
  10. 10. NASAL IRRIGATIONNASAL IRRIGATION  Hypertonic nasal irrigation is a therapy thatHypertonic nasal irrigation is a therapy that flushes the nasal cavity with saline solution,flushes the nasal cavity with saline solution, facilitating a wash of the structures within.facilitating a wash of the structures within.  Originally part of the Yogic tradition as Neti, thisOriginally part of the Yogic tradition as Neti, this technique is anecdotally regarded as safe andtechnique is anecdotally regarded as safe and effective.effective.  It has been suggested as adjunctive therapy forIt has been suggested as adjunctive therapy for sinusitis related symptoms.sinusitis related symptoms.  Potential efficacy is supported by the observationPotential efficacy is supported by the observation that hypertonic saline improves mucociliarythat hypertonic saline improves mucociliary clearance, ciliary beat frequency thins mucus, andclearance, ciliary beat frequency thins mucus, and may decrease inflammation.may decrease inflammation.
  11. 11.  David Shoseyov and colleagues have shown thatDavid Shoseyov and colleagues have shown that hypertonic saline improves both clinical scores andhypertonic saline improves both clinical scores and plain Waters’ projection radiology scores inplain Waters’ projection radiology scores in children with chronic sinusitis.children with chronic sinusitis.  They have also commented that the treatment isThey have also commented that the treatment is tolerable, inexpensive, and effective.tolerable, inexpensive, and effective.  Dr. Marple, professor of otolaryngology at theDr. Marple, professor of otolaryngology at the University of Texas says that saline nasal irrigationUniversity of Texas says that saline nasal irrigation is a highly effective, minimally invasiveis a highly effective, minimally invasive intervention for people suffering from nasal issues.intervention for people suffering from nasal issues.  He however adds,He however adds, “But it’s just not as sexy to talk“But it’s just not as sexy to talk about. People want to hear about surgery orabout. People want to hear about surgery or antibiotics.”antibiotics.”
  12. 12.  DG Heatley and colleagues at the University ofDG Heatley and colleagues at the University of Wisconsin have shown that daily nasal irrigationWisconsin have shown that daily nasal irrigation using a bulb syringe, nasal irrigation pot, and dailyusing a bulb syringe, nasal irrigation pot, and daily reflexology massage were equally efficacious andreflexology massage were equally efficacious and resulted in improvement in the symptoms ofresulted in improvement in the symptoms of chronic sinusitis in over 70% of subjects.chronic sinusitis in over 70% of subjects.  Medication usage was decreased in approximatelyMedication usage was decreased in approximately one third of participants regardless of intervention.one third of participants regardless of intervention.  LT Tamooka and colleagues at the University ofLT Tamooka and colleagues at the University of California have shown that patients who used nasalCalifornia have shown that patients who used nasal irrigation for the treatment of sinonasal diseaseirrigation for the treatment of sinonasal disease experienced statistically significant improvementsexperienced statistically significant improvements in 23 of the 30 nasal symptoms queried.in 23 of the 30 nasal symptoms queried.
  13. 13.  David Rabago and colleagues at the University ofDavid Rabago and colleagues at the University of Wisconsin have shown that daily hypertonic salineWisconsin have shown that daily hypertonic saline nasal irrigation improves sinus-related quality ofnasal irrigation improves sinus-related quality of life, decreases symptoms, and decreaseslife, decreases symptoms, and decreases medication use in patients with frequent sinusitis.medication use in patients with frequent sinusitis.  They also recommended that primary careThey also recommended that primary care physicians can feel comfortable recommendingphysicians can feel comfortable recommending this therapy.this therapy.
  14. 14. CHANT YOUR WAY TOCHANT YOUR WAY TO HEALTHY SINUSESHEALTHY SINUSES  Chanting creates sound vibrations encouraging airChanting creates sound vibrations encouraging air to move back & forth between sinus membranesto move back & forth between sinus membranes and nasal passages.and nasal passages.  This helps open the tiny ducts connecting the noseThis helps open the tiny ducts connecting the nose to the sinuses, allowing the sinuses to drainto the sinuses, allowing the sinuses to drain properly.properly.  Sinuses are effectively ventilated by humming.Sinuses are effectively ventilated by humming.  Previous research has shown that poor sinusPrevious research has shown that poor sinus ventilation increases the risk for sinusitis.ventilation increases the risk for sinusitis.
  15. 15.  Daily humming or "Om" chanting may preventDaily humming or "Om" chanting may prevent infections from actually taking hold, according toinfections from actually taking hold, according to Jon Lundberg and Eddie Weitzberg of theJon Lundberg and Eddie Weitzberg of the Karolinska Institute, Sweden.Karolinska Institute, Sweden.  They found that humming increased nitric oxideThey found that humming increased nitric oxide levelslevels fifteenfoldfifteenfold, compared to quiet exhalations, compared to quiet exhalations without sound.without sound.  The exhalations of people with healthy sinusesThe exhalations of people with healthy sinuses tend to have high nitric oxide levels, indicatingtend to have high nitric oxide levels, indicating that more air is able to flow between the sinusesthat more air is able to flow between the sinuses and the nose.and the nose.  Nada Pranayamas of Yoga such as Bhramari andNada Pranayamas of Yoga such as Bhramari and the Pranava are similar to the humming used inthe Pranava are similar to the humming used in the study.the study.
  16. 16. NETI: THE YOGIC NASALNETI: THE YOGIC NASAL CLEANSING TECHNIQUECLEANSING TECHNIQUE TYPES OF NETI:TYPES OF NETI:  Jala NetiJala Neti -Nasal irrigation with lukewarm saline-Nasal irrigation with lukewarm saline  Sutra Neti -cleaning with a thread or catheterSutra Neti -cleaning with a thread or catheter  Dugdha Neti -Nasal irrigation with milkDugdha Neti -Nasal irrigation with milk  Ghrta Neti -Nasal irrigation with melted gheeGhrta Neti -Nasal irrigation with melted ghee  Jala KapalabhatiJala Kapalabhati  Vyutkrama KapalabhatiVyutkrama Kapalabhati  Seetkrama KapalabhatiSeetkrama Kapalabhati
  17. 17. JALA NETIJALA NETI  Fill the Neti pot with the lukewarm saline and holdFill the Neti pot with the lukewarm saline and hold it in your right hand.it in your right hand.  If your right nostril is dominant insert the nozzleIf your right nostril is dominant insert the nozzle into your right nostril .into your right nostril .  Tilt your head slightly forward, downward andTilt your head slightly forward, downward and sideward to the left, so that the water from the potsideward to the left, so that the water from the pot enters the right nostril and comes out through theenters the right nostril and comes out through the left by gravity. Allow the flow till the pot is empty.left by gravity. Allow the flow till the pot is empty.  Breathe through your open mouth during the KriyaBreathe through your open mouth during the Kriya  Repeat the same on the left side.Repeat the same on the left side.  Perform Kapalabhathi or Anunasika Pranayama toPerform Kapalabhathi or Anunasika Pranayama to clean the nasal passages of the remaining water.clean the nasal passages of the remaining water.
  18. 18. BENEFITS OF NETI KRIYABENEFITS OF NETI KRIYA  Removes mucus and dust particles from the nasalRemoves mucus and dust particles from the nasal passages and the sinuses.passages and the sinuses.  All the five Jnanendriyas are purified, cleansed andAll the five Jnanendriyas are purified, cleansed and activated by Neti Kriyaactivated by Neti Kriya  Excellent preventive against cold, cough, sinusitisExcellent preventive against cold, cough, sinusitis and infections of the respiratory tract.and infections of the respiratory tract.  Neti also renders the nose resistant to irritants likeNeti also renders the nose resistant to irritants like water, cotton, rubber, ghee, milk and thus helps inwater, cotton, rubber, ghee, milk and thus helps in hypersensitivity eg. Allergic Rhinitis.hypersensitivity eg. Allergic Rhinitis.  Helps to overcome addictions especially to tobaccoHelps to overcome addictions especially to tobacco and alcohol.and alcohol.
  19. 19. SURYA NAMASKARSURYA NAMASKAR  Ancient Yogic method of worshiping the sunAncient Yogic method of worshiping the sun through a sequence of 12 postures that streamlinethrough a sequence of 12 postures that streamline the functioning of all systems of the human body.the functioning of all systems of the human body.  Includes a breath sequence & chantingIncludes a breath sequence & chanting  Helps improve all aspects of physical fitnessHelps improve all aspects of physical fitness including cardio-respiratory efficiency.including cardio-respiratory efficiency.  When done with the Surya Namaskar Mantras itWhen done with the Surya Namaskar Mantras it has the added benefits of ventilating the sinuses.has the added benefits of ventilating the sinuses.  Helps develop breath-body movementHelps develop breath-body movement coordination - corrects psychosomatic disorders bycoordination - corrects psychosomatic disorders by reuniting the body and mind through the breath.reuniting the body and mind through the breath.
  20. 20. SOMESOME ASANASASANAS FORFOR SINUSITISSINUSITIS
  21. 21. POSTURES DONE FROM THEPOSTURES DONE FROM THE STANDINGSTANDING Mehru AsanaMehru AsanaArdha Kati ChakrasanaArdha Kati Chakrasana
  22. 22. POSTURES DONEPOSTURES DONE FROM THE SITTINGFROM THE SITTING Ushtra AsanaUshtra Asana ArdhaArdha MatsyendrasanaMatsyendrasana Chatus Pada Asana and Vyagrah PranayamaChatus Pada Asana and Vyagrah Pranayama
  23. 23. POSTURES DONE FROM LYING DOWNPOSTURES DONE FROM LYING DOWN Bhujanga AsanaBhujanga Asana Matsya AsanaMatsya Asana Bala AsanaBala Asana Pawan Mukta AsanasPawan Mukta Asanas
  24. 24. SOME PRANAYAMAS FORSOME PRANAYAMAS FOR SINUSITISSINUSITIS  Bhastrika PranayamaBhastrika Pranayama  Bellows breathingBellows breathing  Surya BhedanaSurya Bhedana  Breathe in right andBreathe in right and out left nostrilout left nostril  Pranava PranayamaPranava Pranayama  Chanting Akara,Chanting Akara, Ukara, Makara andUkara, Makara and OmkaraOmkara  Anu Nasika PranayamaAnu Nasika Pranayama  Blasting out through theBlasting out through the nostrils in a specificnostrils in a specific patternpattern  Kukkriya PranayamaKukkriya Pranayama  Dog pant breathingDog pant breathing  Bhramari PranayamaBhramari Pranayama  Bee sound breathingBee sound breathing
  25. 25. YOGA RELAXATIONYOGA RELAXATION Makara AsanaMakara Asana Shpanda Nishpanda KriyaShpanda Nishpanda Kriya KayaKaya KriyaKriya
  26. 26. CONCLUSIONCONCLUSION  Yoga offers a possible adjuvant therapy for sinusitisYoga offers a possible adjuvant therapy for sinusitis  Nasal irrigation with Hypertonic saline (Jala Neti) isNasal irrigation with Hypertonic saline (Jala Neti) is a proven and effective modality of treatment ina proven and effective modality of treatment in RhinosinusitisRhinosinusitis  Nada Pranayamas can help ventilate the sinusesNada Pranayamas can help ventilate the sinuses effectivelyeffectively  Yoga is inexpensive and quite safe when done underYoga is inexpensive and quite safe when done under proper supervisionproper supervision  Yoga has numerous side benefits such as theYoga has numerous side benefits such as the improved quality of life and healthy sense of wellimproved quality of life and healthy sense of well beingbeing
  27. 27. REFERENCES  Bachmann G, Hommel G, Michel O. Effect of irrigation of the nose with isotonic salt solution on patients with chronic paranasal sinus disease. Eur Arch Otorhinolaryngol 2000; 257: 537–41.  Bauman, Alisa. Sinusitis survival: Vibrations created from chanting Om can help clear your sinuses and ward off infections. Yoga Journal, Jan/Feb 2003, p. 34.  Bhavanani AB. “Yoga Practicals -I &II”. 2008. Dhivyananda Creations. Pondicherry, India  Bhavanani AB. Yoga Chikitsa: Application of Yoga as a therapy. 2013. Dhivyananda Creations. Pondicherry, India  David Rabago, Bruce Barrett, Lucille Marchand, et al. Qualitative Aspects of Nasal Irrigation Use by Patients with Chronic Sinus Disease in a Multimethod Study. Annals of family medicine. 2006;4:295-301.  Heatley DG, McConnell KE, Kille TL, Leverson GE. Nasal irrigation for the alleviation of sinonasal symptoms. Otolaryngol Head Neck Surg 2001;125: 44-48.  Homer JJ, Dowley AC, Condon L, El-Jassar P, Sood S. The effect of hypertonicity on nasal mucociliary clearance. Clin Otolaryngol 2000; 25: 558–60.
  28. 28. REFERENCES (Contdd..)  Homer JJ, England RJ, Wilde AD, Harwood GRJ, Stafford ND. The effect of pH of douching solution on mucociliary clearance. Clin Otolaryngol 1999; 24:312–5.  Melissa A. Pynnonen, Shraddha S. Mukerji, H. Myra Kim, et al. Nasal Saline for Chronic Sinonasal Symptoms. Arch Otolaryngol Head Neck Surg. 2007; 133 (11):1115-1120.  Rabago D, Pasic T, Zgierska A, et al. The efficacy of hypertonic saline nasal irrigation for chronic sinonasal symptoms. Otolaryngol Head Neck Surg. 2005;133:3-8.  Rabago D, Zgierska A, Mundt M, et al. Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: a randomized controlled trial. J Fam Pract 2002;51:1049-55.  Robinson M, Hemming AL, Regnis JA, et al. Effect of increasing doses of hypertonic saline on mucociliary clearance in patients with cystic fibrosis. Thorax 1997; 52:900–3.  Shoseyov D, Bibi H, Shai P, et al. Treatment with hypertonic saline versus normal saline nasal wash of pediatric chronic sinusitis. J Allergy Clin Immunol. 1998;101:602-605.  Taccariello M, Parikh A, et al. Nasal douching as a valuable adjunct in the management of chronic rhinosinusitis. Rhinology. 1999;37:29-32.  Talbot AR, Herr TM, Parsons DS. Mucociliary clearance and buffered hypertonic saline solution. Laryngoscope 1997; 107:500–3.  Tamooka LT, Murphy C, Davidson TM. Clinical study and literature review of nasal irrigation. Laryngoscope 2000; 110:1189–93.

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