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Research Article | DOI: https://doi.org/10.31579/2639-4162/164
Dept of Siddha Medicine, Chakrasiddh health centre, Hyderabad, India
*Corresponding Author: Shweta Tiwari, Dept of Siddha Medicine, Chakrasiddh health centre, Hyderabad, India.
Citation: Shweta Tiwari, (2024), Use of Self-Healing Mechanism in Treating Deviated Nasal Septum Cases by Siddha Therapy- A Comparative Study!, J. General Medicine and Clinical Practice, 7(7); DOI:10.31579/2639-4162/164
Copyright: © 2024, Shweta Tiwari. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 16 March 2024 | Accepted: 27 March 2024 | Published: 05 April 2024
Keywords: deviated nasal septum, mookadaipu, siddha varmam therapy, mladina’s classification
Aim: Severe cases of DNS can cause nasal obstruction, epistaxis, sinusitis, migraine and obstructive sleep pane. To avoid surgery and relapse of symptoms, patients take up alternative methods. The aim of our study was to determine the incidence of DNS with respect to age, gender, type of septal deviation, presenting symptoms and to highlight if traditional Siddha therapy can prove to be another treatment modality in such cases by reducing the present symptoms and correction of nasal structure without intervention of conventional surgery.
Materials and methods: The present study was conducted in 60 subjects who were divided into Group I (pure siddha treatment cases) and Group II (CMM with little facial massage). The intervention outcomes measured four different clinical variables: sleep, nasal, facial pain, and emotional symptoms assessed at baseline and after the intervention period. Data was collected using the SNOT-22 Questionnaire pre-treatment and after 6 months following therapy. Data analysis involved comparing mean changes in these variables, with the significance set at P<0.05. Also, Reliability of the assessments was determined using Cronbach's Alpha.
Results: The male to female ratio was found to be 2.3:1. Majority (41.6%) patients were of age group 20-30 years with left side deviation (53.28%). Commonest presenting complaint was Nasal obstruction (86.3%) with sleep apnea (43%) associated with it. Post treatment, a significant relief of symptoms were observed in 91.2% in Gp I and only 61.3% in Gp II. Significant improvement was observed in nasal obstruction (92.33%) and nasal discharge (86.8%). Dependency on medications reduced by 89.4% in Gp I while in Gp II only 43.9% showed a little improvement in this aspect. Only 2 patients showed relapse of symptoms in Gp I while in Gp II 92% had same symptoms. Post-treatment nasal correction was achieved in Gp I (73%) as compared to Gp II (35.23%).
Conclusions: Our study showed that functional outcome was achieved in all Siddha treated patients in all variables. Siddha therapy with just hand pressures can prove to get good results both symptomatically and aesthetically.
DNS (Deviated nasal septum),
CMM (Conventional medical management),
SNOT-22 (Sino Nasal Outcome Test-22
DNS is a condition in which there is displaced nasal septum towards one side or if septum has shifted away from the midline [1]. It is a frequently occurring condition that can cause nasal obstruction in an individual and may result in permanent changes in the nasal and sinus mucosa because of altered ventilation of the nasal cavity [2,4]. Generally, the cause is due to trauma either during intra-uterine life or accidental [3]. Almost 75-85% of population in world have a mild form of deformity in nose anatomy and in most cases, it is asymptomatic. But those who have moderate and severe deviated septum, they can show symptoms in form of nasal obstruction like obstructed breathing, nasal discharge, facial pain, migraine and altered smell [4,18]. This can lead to other serious conditions like sleep aponea, and tinnitus. Nasal obstruction frequently has been associated with sleep-disordered breathing as a potential etiologic factor [5,19].
In 2011, a study found that 85-88% of the cases of deviated nasal septum occurred in males and only 10-12% in females [5]. According to literature, most of these incidents are found in patients aged between 20-40 years, while in another study, they found a low correlation between the age and the type of septum deviation [2,4]. Various reasons have been attributed to occurrence of deviated nasal septum with 72% of these caused by trauma and 24
The study included 60 patients with DNS and variable degree of nasal obstruction who came to ChakraSiddh center, Hyderabad for consultation from January 2023 to June 2023 with a follow-up after 6 months to see the improvement symptomatically. In our study we had included two groups of patients of 30 each; Gp I(Intervention) consists of patients who underwent complete siddha therapy. Gp II(Control) consists of patients who went with medical management and little facial massage. 8 out of these 30 Gp II cases already had DNS surgery in some point of time but they had relapse of symptoms. The criterion to include these 8 post surgery patients in Gp II was due to hesitance of patients and less pressure application in treatment [15].
Sampling Size: 60
Study Design: Prospective observational study
Inclusion Criteria [16]:
Study included patients between 20-50 years. A thorough clinical examination and diagnostic PNS x-ray or CT scan is done to evaluate the nasal cavity and nasal septum in all the patients. Each patient was subjected to SNOT-22 Questionnaire pre and post treatment [17]. Because of many of the questions in the SNOT-22, we conducted hypothesis tests related to determine which questions provided uniquely/independently predictive information about post-therapy improvement. For these analyses, we took symptoms which were common to all patients and were main concerns of patients like nasal related issues and quality of life and were designated under these 4 variables: sleep, nasal, facial pain, and emotional symptoms [15].
Complete history taking, history of obstruction, any previous nasal surgeries along with external nose examination, the type of deviation was evaluated according to side of deviation. The follow-up period ranged from 4-6 months (mean= 5 months) to evaluate the functional and aesthetic outcomes of the performed therapy [16,18].
Data analysis utilized Cronbach’s Alpha to assess reliability and statistical significance was determined using means, standard deviations (SD), and P-values less than 0.05.
The study included a sample for a total number of 60 out of 250 screened patients. Majority (42.18%) patients were of age group 20-30 years [15] out of hich 56% were males. The male to female ratio was found to be 2.6:1. (Table 1) which is already in agreement with study done by Ranjan [16]. Left side deviation (53.28%) was found more in both Gp I and Gp II followed by 37.82% of the cases having deviation to the right and 9.70% presented with bilateral deviation. (Table 2).
Commonest presenting complaint was Nasal obstruction (98.3%) with sleep apnoea (43%) associated with it in both patient Group (Table 3). In the present study, other commonest complaints were: 48 patients had headache, Nasal discharge was seen in 29 patients, 25 patients had sleep apnoea and Hyposmia was present in 16 patients. Post treatment, a significant relief of symptoms were observed in 92.3% in Gp I and 61.3% in Gp II (Table 4). The difference between the two groups (control and intervention) was statistically significant considering parameters like nasal obstruction, nasal discharge, sleep apnea and hyposmia. Data was analyzed using chi-square test to test for statistical significance of the findings. Significant improvement was observed in nasal obstruction (91.13%) and sleep apnea (86.8%) in Gp I patients (p<0>
Following the therapy, statistically significant improvement was observed in the entire patient population with respect to clinical outcome measures: Nasal obstruction (p<0 p=0.4003), p=0.6436) p=0.4574)>Bio-demographic Data No. Of patients (n=60) Percentage (%) Age (in years) < 20> 08 13.3 20-30 yrs 25 42.18 30-40 yrs 16 26.6 >40 yrs 11 18,3 Gender Male 37 (E=21; C=16) * 61.6 Female 23 (E=9; C=14) * 38.4
Table 1: Bio-demographic data of patients with DNS in Chakra Siddh center
*E= (Gap I) Experimental gp; C= (Gap II) Control gap
| Side of Septal Deviation | No. Of patients (n=60) | Percentage (%) |
| Left | 33 | 53.2 |
| Right | 23 | 37.8 |
| Bilateral | 4 | 9.7 |
Table 2: Distribution of patients according to septal deviation
| Symptoms | No. Of patients (n=60) * | Percentage (%) |
| Nasal obstruction | 58 | 96.3 |
| Nasal discharge | 29 | 41 |
| Loss of smell | 16 | 21.2 |
| Sleep apnoea | 29 | 43 |
| Headache | 22 | 35 |
| Mouth breathing | 05 | 9.3 |
| Snoring | 06 | 11.2 |
| Nasal bleeding (epistaxis) | 03 | 4 |
| Medicine dependency | 58 | 97 |
| Nasal deviation/deformity | 60 | 100 |
* A patient might have multiple presenting symptoms so the total number may vary
Table 3: Distribution of patients according to symptoms presentation (SNOT-22 with significant results)
| Complaints | Gap I (n=30) Pre Rx-Post Rx* | % of benefit | Gap II (n=30) Pre Rx-Post Rx* | % of benefit | p value** S (<0> | ||
| Nasal obstruction | 27 | 4 | 91.1 | 24 | 16 | 45.2 | 0.0196 |
| Nasal discharge | 18 | 2 | 88.2 | 18 | 15 | 25 | 0.0326 |
| Loss of smell (Hyposmia) | 4 | 1 | 78.5 | 3 | 2 | 25 | 0.011 |
| Sleep apnea | 19 | 3 | 86.8 | 20 | 10 | 50 | 0.0231 |
| Headache | 14 | 05 | 67.7 | 12 | 09 | 75 | NS |
| Mouth breathing | 03 | 01 | 70.4 | 02 | 01 | 68 | NS |
| Snoring | 04 | 01 | 75 | 02 | 01 | 70 | NS |
| Nasal bleeding (Epistaxis) | 02 | 00 | 100 | 01 | 00 | 100 | NS |
| Nasal deviation/ deformity | 30 | 13 | 63 | 30 | 23 | 35.2 | 0.0311 |
| Medicine dependency | 30 | 06 | 89.4 | 30 | 28 | 15 | 0.0454 |
* No of Patients who C/O same symptom on/off with less intensity post therapy after 4-6 months
Table 4: Comparison of pre- and post-therapy SNOT-22 analysis of Gp I and Gp II patients
In the traditional Siddha system, Mookadaipu which is also known as Peenisam or neerkovai bears a resemblance to clinical symptoms of Nasal blockage caused by DNS [10]. It is also stated DNS causing sinusitis in 45% of the patients so treating the symptoms of sinus can be one treatment modality for DNS [15]. The present study confers the outcome of other studies in which most frequent noted symptoms of DNS is nasal discharge (96.66%), followed by nasal congestion (93.33%), sleep disturbance (90%), head ache (90%) [16]. A study by Moorthy et al. also showed same cause of nasal obstruction as the most common symptom [19]. Shoib et al study found patients (58%) had headache as predominant symptom in cases of septum deviation and in this study 48% patients showed headache as symptom [9]. In another study by Rehman, headache, also, was a predominant symptom seen in over 80% of the cases associated with nasal blockage [18]. David.H et.al concluded that physical correction of anatomic abnormalities of the septum and turbinate resulted in predictable improvement in outcome measures with respect to headache frequency and severity, nasal obstruction and results were statistically significant [22].
In Siddha literature, both internal and external medicines are prescribed for sinusitis and manipulation techniques to improve the nasal septum [8]. Intranasal corticosteroids, Oral corticosteroids, Antibiotics, Antihistamines and Topical decongestants are recommended for treatment of symptoms of DNS but in severe cases, Septoplasty is only options. However, chances of relapse of symptoms in both cases are high [3]. Different studies have projected that relief in symptoms generally decreases the dependency of patients on steroids like in this study [18].
In Siddha, deviated septum is treated through a technique by Nasaya to stimulate the Varmam points to activate body’s internal healing mechanism. Nasiyam includes facial massage, fumigation and specific Eucalyptus oil application into the nostrils [11]. Studies shows eucalyptus oil helps to curb inflammatory issues that can lead to problems like sinusitis in the longer run. It kills the germs that are responsible for causing allergy, irritation, and nasal blockage [14].
Varmam treatment involves manipulating specific energy spots to restore vital energy and facilitate healing processes [8]. These energy spots, known as Thodu Varma, correspond to junctions of muscles, nerves, veins, arteries, and capillaries, believed to regulate bodily functions [8]. Our study by Thokkanam type of Varmam with gentle pressure strokes incorporated in nasal cavity, neck and upper back, is used to alleviate pain and promote healing internally [10].
The potential of Siddha therapy lies in its holistic approach, addressing the physical, mental, and spiritual aspects of an individual. While the conventional management of DNS primarily involves surgical or pharmacological interventions [7]. Siddha therapy offers a non-invasive alternative that aligns with the patient-centered approach, emphasizing overall well-being by improving his lifestyle [16]. The findings from this case report serve as a catalyst for exploring the efficacy of Siddha therapy in managing DNS. By addressing the underlying energy imbalances and stimulating healing through non-invasive interventions, Siddha therapy presents a promising adjunct or alternative to conventional treatments [8].
SNOT–22 scale was used to assessment of symptom severity, social and emotional impact, productivity and sleep consequences of the patient. SNOT- 22 total score 8-20 represents mild, more than 20 to 50 represents moderate and more than 50 represents severe condition [13]. Snot-22 total score decreased from 41(moderate) before treatment to 08 (mild) after completion of treatment. No recurrence of any clinical features like sneezing, nasal congestion and snoring was observed during the five months of follow-up of siddha intervention [18].
The study is a prospective, standalone treatment research. It is an open-labelled, single-arm, non-randomized trial with minimal sample size. Hence, the study has its own limitation and further controlled studies are required. The participants were recruited to the study based on their willingness. Hence, selection bias may also be there. The study lacks evidence in the management of the disease, as there are very few siddha studies available on this topic.
In modern medicine, DNS can be managed by continuous use of steroids and finally a surgical correction of the nasal deviation. But in this study, Siddha Vaidya, an ancient science proved that by just using hand manipulation techniques the deviated septum can be corrected and there can be significant improvement in clinical outcomes including nasalobstruction, headache, sleep apnea and nasal dischargecompared to standard treatments. By simple methodology of aligning body energies (mind, body and spirit), the siddha therapy instigates internal healing mechanisms thus, resulting in cure and an improved lifestyle. Siddha therapy along with diet and physiotherapy rehabilitation played a vital role in reducing symptoms related to nasal blockages, functional independence, and quality of life in patients.
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