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The Effect of Osteopathic Manipulative Treatment in Chronic Rhinosinusitis
Rowane, M. [12]
Shankar, A. [2]
Nagireddi, S. [3]
Kallat, A. [1]
Callahan, M. [3]
Kohli, E. [2]
Hammes, C. [3]
Hostoffer, R. [18]

Journal: Journal of Osteopathic Medicine Date: 2024/12, 124(12):Pages: A36-A38. doi: Subito , type of study: controlled clinical trial

Full text    (https://www.degruyter.com/document/doi/10.1515/jom-2024-2000/html)

Keywords:

controlled clinical trial [316]
OMT [3752]
osteopathic manipulative treatment [3772]
rhinosinusitis [10]

Abstract:

Context: Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease of the paranasal sinuses that may significantly impair quality of life (1-2). The standard approach to CRS management involves patient education, environmental controls, medical management, and consideration of allergen-specific immunotherapy and surgical management. CRS may also benefit from application of manual techniques through Osteopathic Manipulative Treatment (OMT), which aims to improve venous and lymphatic circulation, sympathetic and parasympathetic outflow, and cervicothoracic somatic dysfunction (3-8). Application of manual lymphatic techniques in several experimental animal models enhanced lymphatic circulation of inflammatory mediators, suggesting restored fluid homeostasis (9-10). Several small-scale cohort studies reported significantly improved sinusitis-associated symptoms, in comparison of pre- versus post-surveys, after application of a consistent OMT sequence (11-12). There is a deficit of large-scale studies in the osteopathic literature investigating temporary and sustained outcomes of OMT application in CRS. Objective: To assess if OMT focused on lymphatic drainage of cranial structures can provide immediate, as well as sustained, relief of chronic rhinosinusitis symptoms. Methods: This prospective, single-blinded study (WCG IRB Study Number 1359444) was conducted at an allergy/ immunology practice. Study participants included 43 adult patients, with a diagnosis of CRS, refractory to conventional medical therapy, with prior exposure to OMT. Exclusion criteria included patients who were under 18 years old, pregnant, diagnosed with CRS with nasal polyposis, prescribed oral corticosteroids or acute antibiotics within the past week, uncontrolled with moderate persistent asthma, and currently using tobacco products. Patients consented to the study and were assigned by the provider to the OMT group or the control group 50/50. A 4-question, 5-point Likert scale survey inquiring about the severity of nasal congestion, post-nasal drainage, and facial or sinus pain/ pressure, as well as the appreciation of the opportunity for an alternative therapy, was administered prior to the intervention. An OMT sequence was applied by the same osteopathic physician to each OMT group participant in the following order: Thoracic Inlet Release, Venous Sinus Drainage, Occipital-Atlantal Decompression, Thoracic Paraspinal Inhibition, Facial Sinus Pressure, and Galbreath Technique. A structural exam involving light touch was applied to control group participants. The same 5-point Likert scale survey was administered immediately after the intervention. Participants were provided a blank copy of the survey to save and complete 10 days after the intervention. OMT group participants also received a handout with a video link and guide to self-applied techniques to practice at home. A small gift card was provided as compensation to participants who returned their completed third survey. A paired t-test was applied for statistical comparison between the pre- and post-surveys. Results: A total of 43 patients, including 22 patients in the treatment group (51.1%) and 21 (48.8%) patients in the control group, consented to and participated in the study, from May 1 to 30, 2024. Study demographics included 76.7% females (n = 33), 23.3% males (n = 10), 97.7% white (n = 42), and an average age of 54.4 years. Surveys administered before and immediately after the intervention were completed by 100% of the study participants. All three surveys, including the pre-survey and post-surveys completed immediately after and 10 days after the intervention, were completed by 60.5% of study participants. OMT group pre- versus immediate post-survey results scored a statistically significant decrease in the severity of nasal congestion (p = 0.001), post-nasal drainage (p = 0.002), and facial or sinus pain or pressure (p = 0.0004). Less statistical significance was measured in the comparison OMT group pre- versus immediate post-survey results scoring appreciation for an alternate therapy (p = 0.01). No statistically significant difference was demonstrated in all control group pre- versus immediate post-survey results (average p = 0.32). No statistically significant difference was computed, in comparison of pre-survey versus 10-day post-survey results, for both the treatment (average p = 0.28) and control groups (average p = 0.22). Conclusion: Our single-blinded, prospective survey findings suggested the benefit of OMT application for immediate relief of CRS symptoms, predominantly in alleviating the severity of sinus pain or pressure. Long-term efficacy of OMT for CRS symptomatic relief was not strongly supported by the data. This study expanded upon previous studies applying OMT to sinusitis management (11-12), through implementation of a control group, increased sample size, and evaluation of sustained symptomatic relief. Limitations in location, racial diversity, and duration variability of each encounter may be considered for future iterations of this study. OMT offers a safe, non-pharmacological complementary therapy to relieve lymphatic congestion and improve mucociliary clearance in CRS (3-8, 11-12).

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