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Comparison of treatment experience in intranasal medicated oil application (nasya) versus saline nasal wash (jala neti) in patients with symptoms of sinusitis
*Corresponding author: Shirley Telles, Department of Yoga Research, Patanjali Research Foundation, Patanjali Yogpeeth, Haridwar, Uttarakhand, India. office@prft.co.in
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Received: ,
Accepted: ,
How to cite this article: Gandharva K, Sharma SK, Kumar S, Balkrishna A, Telles S. Comparison of treatment experience in intranasal medicated oil application (nasya) versus saline nasal wash (jala neti) in patients with symptoms of sinusitis. Indian J Med Sci. 2025;77:170-4. doi: 10.25259/IJMS_259_2025
Abstract
The study aimed to determine (i) the patient-reported treatment experience of Jala neti (JN) and Nasyam (NS) in individuals with symptoms of rhinosinusitis, and (ii) the immediate effects of JN and NS on symptoms of rhinosinusitis. Forty-one patients (group average age ± standard deviation; 43.90 ± 13.94 years) with symptoms of rhinosinusitis (i.e., nasal obstruction, nasal secretion, facial pain, and headache) with a rating of 4 or higher on a visual analog scale (VAS) for any of the two symptoms were recruited. Of these, 21 received JN and 20 received NS. Treatment experience was assessed using the treatment experience questionnaire. The intensity of rhinosinusitis symptoms (i.e., nasal obstruction, nasal secretion, facial pain, and headache) was assessed before and after the JN and NS using separate VAS. The treatment experience was compared using Mann–Whitney U-test. The immediate effect of JN and NS on the intensity of rhinosinusitis symptoms was determined using the Wilcoxon signed-rank test. The experience of negative bodily sensations differed significantly between JN and NS, with lower negative bodily sensations after JN (P < 0.05, Mann–Whitney U-test). There was a significant reduction in (i) nasal obstruction, (ii) nasal secretion, (iii) facial pain, and (iv) headache after JN and NS (P < 0.05; Wilcoxon signed-rank test). JN had lower negative bodily sensations compared to NS. Both JL and NS are effective in reducing the intensity of symptoms of rhinosinusitis. The findings suggest that JN may be preferred over NS for patients who are excessively anxious or unwell.
Keywords
Jala neti
Nasyam
Treatment experience questionnaire
INTRODUCTION
Chronic rhinosinusitis (CRS) refers to inflammation of the nasal cavity and paranasal sinuses.[1] Although most cases of CRS are managed effectively, many patients still suffer and seek alternative treatments due to a relapse rate as high as 47.5%.[2] CRS patients were twice as likely than the general population to inquire about complementary and alternative medicine (CAM).[3] A comprehensive systematic review of the literature CAM is frequently used in the treatment of CRS which was conducted by the authors using five databases from inception to July 2017 concluding that more rigorous area is needed.[4]
In India, among CAM therapies, practices from ayurveda and yoga are used to reduce symptoms of nasal stuffiness and headache associated with it. Two such practices are described here. Nasya is a well-established Ayurvedic therapy used for treating head and neck disorders by administering medicinal substances through the nasal passage. Ayurveda views the nose as a direct gateway to the brain, allowing medicines to reach the brain and eliminate toxins that cause imbalances in the head region.[5] The word Nasya is derived from “Nasa” Dhatu, which conveys meaning of “Gati.” Here, the Gati is toward the internal structures mainly to head through nose.
Neti kriya is an integral part of shatkarmas/the six cleansing techniques that form the most important aspect of hatha yoga summarize current pieces of evidence from authentic studies on the therapeutic effects of Neti Kriya with special reference to Jala Neti (JN).[6]
Both these treatments can be administered at an out-patient department. The two methods vary in (i) level of vigor and (ii) hence the way the patient may experience them. To determine patients’ experience of these two treatments, patients with symptoms of nasal rhinosinusitis were assessed (i) for treatment experience of JN and Nasyam (NS) and (ii) immediate effects of JN and NS on the intensity of nasal rhinosinusitis symptoms.
MATERIAL AND METHODS
Patients/setting
Forty-three patients with symptoms of nasal rhinosinusitis (mean age ± standard deviation [SD]: 43.0 ± 14.0 years; male: female ratio = 26:17) were recruited from a yoga and Ayurveda hospital in north India. The sample size was not determined a priori as the study was exploratory in nature. Patients were included in the study if they (i) were aged 18 years and above, (ii) showed the symptoms of nasal rhinosinusitis (i.e., nasal obstruction, nasal secretion, facial pain, and headache) with a rating of 4 or higher on a visual analog scale in any of the two symptoms,[7] and (iii) were selected for treatment with either intranasal medicated oil application (NS) or saline nasal wash (JN) by a yoga and naturopathy physician. Of the total patients, 21 were selected for treatment with JN while 20 were administered NS based on the discretion of a naturopathy physician. Patients were excluded from the study if they had (i) history of nose bleeding, (ii) active ear infections, (iii) colds or flu with a total nasal obstruction or congestion, (iv) recent ear or nose surgery, and (v) deviated nasal septum. The data of two female patients who returned the incomplete questionnaire were excluded from the study (n = 2). Therefore, the final sample size consisted of 41 patients with 21 receiving JN (group average age ± SD; 45.38 ± 12.54 years) and 20 NS (group average age ± SD; 42.35 ± 15.32 years). The post hoc power analyses indicated that with a sample size of 21, a type I error probability (α) of 0.05, and an effect size of 1.50 (based on the reduction in nasal obstruction scores on the visual analog scale after JN), the study achieved a power of 0.9999. Signed informed consent was obtained from each participant. The study had prior approval from the Institutional Ethics Committee (approval number: PRF/YRD/025/005).
Study design
The study was an exploratory, convenience-based comparative trial aimed at: (i) comparing treatment experience of JN and NS and (ii) assessing the immediate effects of JN and NS on the intensity of rhinosinusitis symptoms. Treatment experience was assessed using the treatment experience questionnaire (TEQ)[8] immediately after the administration of JN and NS. The intensity of rhinosinusitis symptoms (i.e., nasal obstruction or congestion, nasal secretion, facial pain or heaviness in head, and headache) was assessed before and after the JN and NS using 10 cm horizontal visual analog scales. The total duration of JN or NS session was 10 min.
Treatments
JN
The JN was performed using a lukewarm sterile saline solution, which was prepared by dissolving one-quarter teaspoon of salt in a glass of warm water. The application was done with a neti pot. Participants began the JN by standing with their feet shoulder-width apart, ensuring their body weight was evenly distributed. They then leaned forward slightly and tilted their head to the right. After this, they inserted the nozzle of the neti pot into their left nostril, keeping their mouth slightly open to allow the water to flow out through the right nostril. Once half of the water was used, they removed the nozzle while still bending forward, centered their head, and let the remaining water run out of their nose. Afterward, they gently blew their nostrils to expel any remaining water. Participants practiced the same procedure with water flowing through the right nostril, while continuing to breathe through their mouths. They were also instructed not to blow too hard, as this could force leftover water into the ear.[9]
NS
NS is a therapeutic procedure in Ayurveda Panchakarma in which medicated oils, ghee, herbal juices, or powders are administered through the nostrils. Since the nose is considered the gateway to the head (“Nasa hi shiraso dwaram”), NS primarily works on diseases of the head, neck, brain, and sensory organs.
Assessments
Treatment experience
The TEQ, developed by Blasche et al.,[8] was used to assess the patients’ treatment experiences of JN and NS. The questionnaire has three parts: Part A has 16 items measuring emotional states (4-items for positive mood, 4-items for psychological tension, 5-items for perceived sleepiness, and 3-items for mental absorption), Part B contains 10 items on treatment perceptions (4-items for treatment appraisal, 3-items for perceived required cooperation, and 3-items for somatosensory intensity), and Part C includes 14 questions on bodily sensations (5-items for positive bodily sensation and 9-items for negative bodily sensation). Participants rated each item on a 5-point Likert scale from 0 to 4. The questionnaire has good reliability (0.63–0.84) and was translated from English to Hindi by two independent bilingual experts for this study using a standard procedure.[8]
Intensity of rhinosinusitis symptoms
The intensity of the rhinosinusitis symptoms was assessed using four separate visual analog scales. These analog scales were for: (i) nasal obstruction or congestion, (ii) facial pain or heaviness in head, (iii) nasal secretion, and (iv) headache.
Data analysis
Data were analyzed using the Statistical Package for the Social Sciences Version 24.0. The treatment experience of the two groups was compared using Mann–Whitney U-test. The immediate effect of JN and NS on intensity of rhinosinusitis symptoms was determined using Wilcoxon signed-rank test. The predetermine level of significance (α) was set at 0.05.
RESULTS
Forty-one patients aged between 19 and 72 years completed the study. Of these, 21 (group average age, ± SD; 45.38 ± 12.54 years) were assessed for JN treatment, and 20 (group average age, ± SD; 42.35 ± 15.32 years) for NS treatment. The patients did not report any adverse outcome of the JN or NS which was especially checked with them. The baseline characteristics of patients are given in Table 1.
| Characteristics | Total (n=41) | JN (n=21) | NS (n=20) |
|---|---|---|---|
| Age (years) | |||
| Group mean age±SD | 43.90±13.94 | 45.38±12.54 | 42.35±15.32 |
| Age range | 18–72 | 19–72 | 18–72 |
| Age categories, n(%) | |||
| ≤45 | 20 (48.78) | 9 (42.85) | 8 (40) |
| >45 | 21 (51.21) | 12 (57.14) | 12 (60) |
| Gender, n(%) | |||
| Male | 26 (63.41) | 15 (71.42) | 11 (55) |
| Female | 15 (36.58) | 6 (28.57) | 9 (45) |
JN:Jala neti, NS: Nasyam, SD: Standard deviation
Treatment experience
The experience of negative bodily sensations differed significantly between JN and NS (P < 0.05, Mann–Whitney U-test).
Intensity of rhinosinusitis symptoms
There was a significant reduction in (i) nasal obstruction, (ii) nasal secretion, (iii) facial pain, and (iv) headache after JN and NS (P < 0.05; Wilcoxon Signed Rank test).
The group mean and SD values for (i) treatment experience and (ii) intensity of rhinosinusitis symptoms are presented in Tables 2 and 3, respectively.
| Variables | JN (n=21) | NS (n=20) | U-value | P-value |
|---|---|---|---|---|
| Positive mood | 13.85±1.95 | 13.6±1.87 | 191.500 | 0.622 |
| Psychological tension | 1.4±1.96 | 1.75±2.59 | 205.000 | 0.885 |
| Perceived sleepiness | 3.9±3.67 | 3.3±2.84 | 2000.500 | 0.802 |
| Mental absorption | 4.66±2.93 | 4.65±2.18 | 204.000 | 0.874 |
| Treatment appraisal | 14.33±2 | 14.35±1.75 | 209.000 | 0.978 |
| Perceived required cooperation | 7.8±2.56 | 8.5±1.57 | 173.000 | 0.293 |
| Perceived somatosensory intensity | 9.76±2.23 | 8.9±2.07 | 161.500 | 0.196 |
| Negative bodily sensations | 1.42±3.55 | 2.25±2.46 | 140.000 | 0.049 |
| Positive bodily | 9.85±2.49 | 10.8±2.37 | 160.500 | 0.185 |
P<0.05, Mann–Whitney U-test. JN:Jala neti, NS: Nasyam, SD: Standard deviation
| Variables | JN (n=21) | JN Z-value | JN P-value | NS (n=20) | NS Z-value | NS P-value | ||
|---|---|---|---|---|---|---|---|---|
| Nasal obstruction | Before | 4.58±3.91 | 3.302 | 0.001 | Before | 5.9±3.36 | 3.239 | 0.001 |
| 0.81±1.11 | 1.94±2.72 | |||||||
| Facial pain | Before | 4.24±3.89 | 2.518 | 0.012 | Before | 5.85±2.88 | 3.463 | 0.001 |
| 1.6±2.67 | 1.52±2.01 | |||||||
| Nasal secretion | Before | 0.36±0.18 | 0.419 | 0.675 | Before | 0.66±1.99 | 2.250 | 0.024 |
| 0.36±0.25 | 0.32±0.2 | |||||||
| Headache | Before | 3.13±3.76 | 2.539 | 0.011 | Before | 4.81±3.61 | 3.602 | 0.001 |
| 1.26±2.31 | 0.56±0.65 | |||||||
P<0.05, Mann–Whitney U-test. JN:Jala neti, NS: Nasyam, SD: Standard deviation
DISCUSSION
Both the yoga cleansing saline nasal wash (JN) and the ayurveda treatment involving medicated oils nasally (NS) significantly improved nasal block (82.31% and 67.11%, respectively), as well as heaviness in the head (62.26% and 74.01%, respectively) and headache (59.74% and 88.35%, respectively). Hence, while headache appeared to respond better to NS, nasal symptoms appeared to resolve with JN. These findings are comparable to previous studies which reported that NS is often considered better for headaches than JN because the therapeutic benefits of NS are produced by introducing medicated oils or powders into the nasal passages which help to dissolve and loosen mucus from the nasal passages up to the sinuses.[10,11] In contrast, JN uses saline to wash the nasal passages, hence primarily focusing on clearing physical blockages and flushing out mucus while aiming to reduce hypersensitivity in the nasal passages over time.[6,10,11]
While these findings suggest the effectiveness of both NS and JN in sinusitis, the aim of the present study was to determine differences in the patient-reported treatment experience between NS and JN. Both treatments had comparable scores for Part A which has 16 items measuring emotional states (positive mood, psychological tension, perceived sleepiness, and mental absorption), Part B which contains 10 items on treatment perceptions (appraisal, cooperation, and somatosensory intensity), and Part C which includes 14 questions on bodily sensations.
The only significant difference in patient reported treatment experience was that JN had lower scores for negative sensations such as dizziness, feeling of panic, nausea, feeling faintness, or breathlessness (as recorded with the TEQ).[6] Hence, JN may be preferred in selected cases.
Limitations
These findings are limited by a small sample size (n = 21:20 for each treatment), no randomization to NS/JN, no control group, and lack of stringent criteria to diagnose nasal sinusitis. Hence, these findings are exploratory.
CONCLUSION
In summary, both NS and JN are useful to reduce symptoms of sinusitis with marginal benefits of NS for headache and JN for nasal blockage.
JN had lower negative bodily sensations compared to NS. Both JL and NS are effective in reducing the intensity of symptoms of rhinosinusitis. The findings suggest that JN may be preferred over NS for patients who are excessively anxious or unwell.
Acknowledgment:
We are thankful to the staff of Shatkarma department, Patanjali Ayurveda Hospital, Haridwar, Uttarakhand for assisting in the data collection.
Ethical approval:
Institutional Review Board approval is not required.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
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