A review on the therapeutic effects of NetiKriya with special reference to JalaNeti

Practices and Techniques of Jal Neti Across Indian Institutions: A Cross-sectional Study

Background

Nasal irrigation, including the traditional practice of Jal Neti, is increasingly used as an adjunctive treatment for various sinonasal disorders. It enhances mucociliary clearance, reduces mucus contact with irritants, and helps alleviate sinonasal symptoms. Despite its benefits, the practices and techniques vary widely across yoga traditions, necessitating a systematic examination of these differences.

Methods

This cross-sectional observational study was conducted at nine renowned yoga and naturopathy institutes in India to document and analyze the diverse practices of Jal Neti. Data were collected through direct interviews with experts, observations, and a review of institutional practices. Parameters studied included water source, purification methods, salt type and measurement, water temperature, and quality testing.

Results

The study revealed significant variations in Jal Neti practices among institutions, influenced by expertise, philosophy, and environmental factors. Water sources ranged from municipal to natural sources such as dams and ground water with purification methods including reverse osmosis and chlorination. Water temperatures varied seasonally, and salt types included rock, sea, and iodized salts, with measurement techniques often subjective. The pH, total dissolved solids, and salinity levels differed, reflecting the influence of local water characteristics. Although consistent water quality testing was observed, the frequency and parameters varied, affecting practice safety and effectiveness.

Conclusion

Jal Neti practices across major Indian yoga institutes exhibit significant diversity in methods, reflecting the individualistic yet systematic nature of this ancient technique. These findings highlight the need for standardized guidelines to ensure safety and efficacy, especially concerning water quality and salt concentration. The clinical relevance of these findings lies in the potential for improving the safety and effectiveness of Jal Neti for sinonasal disorders. Variations in salt types, concentrations, and water temperatures could influence mucosal irritation, symptom relief, and overall therapeutic outcomes. Standardizing these parameters could enhance the consistency and reliability, ensuring better patient outcomes in both traditional and clinical settings.

Eight months of integrated yoga, hydrotherapy and acupuncture on serum IgE levels and symptoms severity of a patient with chronic allergic rhinosinusitis: A case report

A 27-year-old man with Allergic rhino sinusitis presented to our hospital in July 2020 with complaints of continuous sneezing, coughing while rising from bed for half an hour, and the same complaints repeated in the afternoon for half an hour, as well as a continuous dry cough for half an hour in the evening. He also had complaints of itching and skin rashes, particularly in his limbs. He underwent yoga (45 minutes, 5-6 days a week) including Jalaneti (a yogic cleansing technique, i.e. nasal irrigation with warm salt water for twice a week), hydrotherapy (enema using neem leaves paste mixed with water and steam bath on first day, followed by facial steam on alternate days) and Acupuncture (one session a week) for 8 months. Results showed a reduction in immunoglobulin E (IgE) levels and symptom severity suggesting that integrated yoga, hydrotherapy, and acupuncture are effective in the management of chronic allergic rhinosinusitis. All treatments were well tolerated without adverse effects. Though the result is encouraging, further studies are required with a larger sample size.

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

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.

Sinonasal Irrigation After Endoscopic Sinus surgery - Past to Present and Future

Functional endoscopic sinus surgery (FESS) is the gold standard treatment for medically refractive chronic rhinosinusitis, aimed at removing diseased tissue and improving natural sinus drainage and aeration. Irrigation of the sinuses has been known to improve sinus mucosal health and is an essential adjunct to surgery. There are a number of methods, devices, and solutions available which are used for nasal irrigation. Neti Pot, squeeze bottle, syringe, rubber bulb and commercially available nasal sprays are some of the simpler used devices used for douching. Electric devices like flosser, Hydropulse and the Navage nasal irrigation systems are available but it's not clear if they provide any advantage over the other methods. We use and propose a gravitational pressure-pulsed device which provides adequate volume and force without the need for external pressure. Salt with sodium bicarbonate is the most used solution base. Hypertonic saline has been described to be more efficacious compared to isotonic saline. Additives such as sodium hypochlorite, antibiotics, corticosteroids, manuka honey and xylitol have proven to be beneficial. Large volume positive pressure irrigations have proven to be beneficial. Optimal position for irrigation varies for low or high-volume irrigation systems. Patient education regarding precautions and disinfection of the device is a must.

The Effects of Yoga Practice on Lung Function and sIL-2R Biomarkers in Individuals Working and Living in the Lonavala Industrial Area: A Randomized Controlled Trial

Context

Pollution-related health hazards are very common among people living and/or working in industrial areas, particularly near industries and metro cities. These air pollutants contribute to allergens, increase inflammation, and affect lung function.

Aim

The present study aimed to examine the effect of yoga training on lung functions and inflammation in terms of soluble interleukin-2 receptor (sIL-2R) in people working and living in a polluted area.

Settings and Design

This is a randomized controlled interventional pilot study.

Methods and Materials

Forty-eight male volunteers from the industrial area, aged 20-50 years, were randomly assigned to the experimental group and the control group. Each group comprises 24 study participants. Lung function and sIL-2R were studied at the baseline and post-yoga intervention period of 16 weeks.

Statistical Analysis Used

Study data were analyzed using descriptive methods, a one-tailed t-test, a paired t-test, and an independent t-test.

Result

Study results showed directional and significant improvements in forced vital capacity, forced expiratory volume in the first second, and peak expiratory flow rate compared to the control group participants. The results pertaining to sIL-2R showed a directional and significant decrease in the experimental group compared to the control group.

Conclusion

The present study showed that yoga helps to promote better health, improve lung function and reduce inflammation among people residing in polluted environments.

Yogic Neti-Kriya Using Povidone Iodine: Can it have a Preventive Role Against SARS-CoV-2 Infection Gateway?

During this COVID-19 pandemic, except steroid, none of the therapeutic measures have showed any evidence of efficacy. Traditionally jala-neti using lukewarm salted water remains a yogic way of maintaining upper airway hygiene. Saline irrigation decreases the concentration of inflammatory mediators (e.g. histamine, leukotriene etc.) in nasal secretions, reduces the severity and frequency of sinusitis, reduce need of antibiotic therapy and restores competency of nasal mucosa. Jala-neti is an integral part of six cleansing techniques of yogic kriyas practised in India since thousands of years. Jala-neti can clean the upper airways, prevents colonization of infectious agents, removes foreign bodies, prevents stasis of mucous and subsequently enhances the drainage of paranasal sinuses and maintain health. Regular practice of Jala neti improves nasal symptoms and overall health status of patients with sinusitis. Jala-neti sample can even be used for COVID-19 diagnosis. Povidone iodine (PVP-I) has been utilized as a time tested antimicrobial agent with broad spectrum coverage against wide range of bacteria and viruses. Anti-SARS-CoV-2 action of PVP-I was seen at a concentration as low as 0.45%. PVP-I is generally well tolerated upto 5%, however nasal ciliotoxicity is reported at this concentration, however, this toxicity is not reported with lower concentrations(1.25% and 0.5%). So, theoretically, by using neti-kriya with povidone iodine (0.5-1%) as irrigation solution can combine and enhance the protection against COVID-19 and this can be an important armor in the fight against COVID-19. However, this hypothesis needs to be validated in real life clinical trial scenario before implementing.

The Role of Seawater and Saline Solutions in Treatment of Upper Respiratory Conditions

The history of saline nasal irrigation (SNI) is indeed a long one, beginning from the ancient Ayurvedic practices and gaining a foothold in the west at the beginning of the 20th century. Today, there is a growing number of papers covering the effects of SNI, from in vitro studies to randomized clinical trials and literature overviews. Based on the recommendations of most of the European and American professional associations, seawater, alone or in combination with other preparations, has its place in the treatment of numerous conditions of the upper respiratory tract (URT), primarily chronic (rhino)sinusitis, allergic rhinitis, acute URT infections and postoperative recovery. Additionally, taking into account its multiple mechanisms of action and mounting evidence from recent studies, locally applied seawater preparations may have an important role in the prevention of viral and bacterial infections of the URT. In this review we discuss results published in the past years focusing on seawater preparations and their use in clinical and everyday conditions, since such products provide the benefits of additional ions vs. saline, have an excellent safety profile and are recommended by most professional associations in the field of otorhinolaryngology.

Jalaneti (saline nasal irrigation) as primary intervention in suspected rhino-orbito-cerebral mucormycosis helps improving the recovery: A case report

The ongoing COVID-19 pandemic has resulted in several opportunistic infections like mucormycosis (MCR) to surface. Although this is commonly afflicting immunocompromised people managed through prolonged ICU care, epidemiological observations suggest that it is also associated with conditions like uncontrolled diabetes. Due to its invasive nature and systemic reach, MCR has high mortality warranting an early diagnosis and treatment. We present here a case of a non-COVID, diabetic patient having acute onset paranasal and periorbital swelling with headache suspected for rhino-orbito-cerebral MCR. The case was innovatively dealt with jalaneti (saline nasal irrigation) seeing a delay in the institution of definitive anti-fungal therapy. Six sittings of jalaneti in four days had been able to give near complete symptomatic relief in paranasal swelling and headache even before the endoscopic nasal debridement and anti-fungal therapy was initiated. Seeing the urgency of diagnosis and treatment in any suspected case of MCR, a simple and self-administrable procedure like jalaneti seems to have a high value for its possible role in reducing the sinus inflammation and reducing the disease intensity in order to find more time for the proper diagnosis and treatment initiation. Negligible cost of jalaneti, its easy administration, and minimal adversity potential are additional advantages for proposing jalaneti as a possible prophylaxis in MCR. More serious clinical research is urgently required to confirm the observations made in this single case report and to extend its benefits to the people suffering with MCR.

Jal Neti Sample for COVID Detection: A Novel Hypothesis

The current standard method of diagnosing COVID status has low sensitivity which led the authors to ponder on alternative ways of taking the sample. Various studies have explored the role of nasal wash, a sample taken by injecting and aspirating saline with the help of a syringe but to the best of our knowledge, the use of Jal Neti kriya sample to detect coronavirus has not been reported in the literature so far. Jal Neti kriya is an integral part of shatkarmas-six actions of purification of the human body, written in the Yogic system of healthcare. It involves pouring water in one nostril and flushing out through the other nostril with the help of special equipment called "Neti pot", to keep the nasal passage clean. The authors find it worthwhile to share their hypothesis, which can pave a way to future research in COVID-19 detection.