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.

Crenotherapy as a Complementary and Integrative Treatment for Chronic Rhinosinusitis: A Systematic Review and Discussion of Current Evidence Limitations

BACKGROUND

Chronic rhinosinusitis (CRS) is a common condition that affects patients' quality of life. Standard treatments for CRS have known side effects and variable efficacy rates. Thus, complementary and integrative (CIM) treatments for CRS such as crenotherapy, which utilizes high mineral content water or vapor as an inhalation therapy, are of continued interest.

OBJECTIVES

To summarize and evaluate the current research investigating crenotherapy's therapeutic potential and clinical outcomes for the treatment of CRS.

STUDY DESIGN

Systematic review and qualitative analysis.

METHODS

A systematic review was performed, with a comprehensive search strategy applied to 6 databases from inception to March 2021: CINAHL, Cochrane, Embase, PubMed, Scopus, and Web of Science. Studies with at least 10 patients, which investigated crenotherapy as the sole or adjunctive treatment for CRS in humans were included.

RESULTS

In total, 10 articles out of 756 were included. Of these, 6 were randomized controlled trials. The remaining four articles were non-randomized prospective cohort studies. Six studies assessed clinical symptoms in response to crenotherapy, and there were unanimous improvements in Visual Analog Scale (VAS), Sino-Nasal Outcome Test-20 (SNOT-20), and other quality of life metrics. The studies that assessed inflammatory markers, cytology, or other measures showed significant improvement in neutrophil count, spores, ciliary motility, IgE, and manometry. Minimal to no adverse events were reported across all 10 studies.

CONCLUSION

There is limited data to support crenotherapy's effectiveness in treating patients with CRS. However, published studies suggest that for certain patients crenotherapy can both improve CRS symptoms and objective measures of nasociliary function with minimal side effects. Findings must be interpreted with caution due to study heterogeneity, inconsistent use of standard CRS definitions and outcomes measures, as well as other study design flaws. Given these results, as well as a growing interest in CIM, crenotherapy treatments for CRS deserve further investigation.