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Immediate Effect of Jala Neti(Nasal Irrigation) on Nasal

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Immediate Effect of Jala Neti(Nasal Irrigation) on Nasal “IMMEDIATE EFFECT OF JALA NETI(NASAL IRRIGATION) ON NASAL PEAK INSPIRATORY FLOW ON HEALTHY VOLUNTEERS” By Dr. R.N.RANI, BNYS Dissertation Submitted to the Tamil Nadu Dr. M. G. R. Medical University, Chennai, Tamil Nadu In partial fulfillment of the requirements for the degree of DOCTOR OF MEDICINE IN YOGA Under the Guidance of Dr. S. T. VENKATESWARAN Prof. & HoD Department of Yoga Government Yoga & Naturopathy Medical College & Hospital, Arumbakkam, Chennai- 600106 2015 - 2018 TAMILNADU Dr. M. G. R. MEDICAL UNIVERSITY, CHENNAI, TAMIL NADU DECLARATION BY THE CANDIDATE I hereby declare that this dissertation / thesis entitled “IMMEDIATE EFFECT OF JALA NETI(NASAL IRRIGATION) ON NASAL PEAK INSPIRATORY FLOW ON HEALTHY VOLUNTEERS” is a bonafide and genuine research work carried out by me under the guidance of Dr. S. T. VENKATESWARAN, Prof. & Head, Department of Yoga, Govt. Yoga & Naturopathy Medical College & Hospital, Arumbakkam, Chennai. Date: Dr. R.N.RANI Place: Post Graduate in Yoga GYNMC & H, Arumbakkam, Chennai i TAMILNADU Dr. M. G. R. MEDICAL UNIVERSITY, CHENNAI, TAMIL NADU CERTIFICATE BY THE GUIDE This is to certify that the dissertation entitled “IMMEDIATE EFFECT OF JALA NETI(NASAL IRRIGATION) ON NASAL PEAK INSPIRATORY FLOW ON HEALTHY VOLUNTEERS” is a bonafide research work done by Dr.R.N.RANI in partial fulfillment of the requirement for the degree of M.D. Yoga. Date: Dr. S. T. VENKATESWARAN Place: Prof. & HoD Dept. of Yoga GYNMC & H, Arumbakkam, Chennai ii TAMILNADU Dr. M. G. R. MEDICAL UNIVERSITY, CHENNAI, TAMIL NADU ENDORSEMENT BY THE HEAD OF THE DEPARTMENT This is to certify that the dissertation “IMMEDIATE EFFECT OF JALA NETI(NASAL IRRIGATION) ON NASAL PEAK INSPIRATORY FLOW ON HEALTHY VOLUNTEERS” is a bonafide research work done by Dr.R.N.RANI under the guidance of Dr. S. T. VENKATESWARAN, Professor & Head, Department of Yoga, Govt. Yoga & Naturopathy Medical College & Hospital, Arumbakkam, Chennai. Date: Dr. S. T. VENKATESWARAN Place: Prof. & HoD Dept. of Yoga GYNMC & H, Arumbakkam, Chennai iii TAMILNADU Dr. M. G. R. MEDICAL UNIVERSITY, CHENNAI, TAMIL NADU ENDORSEMENT BY THE PRINCIPAL / HEAD OF THE INSTITUTION This is to certify that the dissertation entitled “IMMEDIATE EFFECT OF JALA NETI(NASAL IRRIGATION) ON NASAL PEAK INSPIRATORY FLOW ON HEALTHY VOLUNTEERS” is a bonafide research work done by Dr.R.N.RANI under the guidance of Dr. S. T. VENKATESWARAN, Professor & Head, Department of Yoga, Govt. Yoga & Naturopathy Medical College & Hospital, Arumbakkam, Chennai. Date: Dr. N. MANAVALAN Place: Principal GYNMC & H, Arumbakkam, Chennai iv COPY RIGHT DECLARATION BY THE CANDIDATE I hereby declare that the Tamilnadu Dr. M. G. R. Medical University, Chennai, Tamilnadu shall have the rights to preserve, use and disseminate this Dissertation / Thesis in print or electronic format for academic / research purpose. Date: Dr. R.N.RANI Place: Post Graduate in Yoga GYNMC & H, Arumbakkam, Chennai © Tamilnadu Dr. M. G. R. Medical University, Chennai v ACKOWLEDGEMENT Foremost, I express my sincere gratitude to Dr. N. Manavalan, Prinicpal, Govt. Yoga & Naturopathy Medical College, Chennai, for giving me this opportunity to pursue my Post Graduation degree M.D. YOGA from this prestigious institute. I extend my gratitude towards Dr. S. T. Venkateswaran, Prof. & H.o.D., Department of Yoga, Govt. Yoga and Naturopathy Medical College and Hospital, Chennai for his constant support and encouragement. I once again thank Dr. S. T. Venkateswaran sir for his continuous support and provision of all necessary requirements needed for the completion of this dissertation. I express my heartfelt gratitude to Dr. Mahesh for giving his constant guidance and time throughout the completion of this dissertation and also for helping me throughout the statistical analysis and its interpretations needed for this study. I express my thanks to my parents Mr. P.Antony Raja and Mrs. Mariakumudha And my husband Mr.Joel franklin for always being there and helping me with their moral support. VI I specially thank Dr.P.Prema latha , Dr.Ramya, Dr. Madan for helping me throughout the completion of the study and the dissertation. My sincere thanks go out to all my Post-Graduate and Undergraduate friends who have been there at all phases of this study including the preparation of this dissertation. I also acknowledge the support of all the subjects who participated in the study. Above all I thank God for all that I am blessed with. Date: Dr. R.N.RANI Place: Chennai vii LIST OF ABBREVATIONS USED NPIF NASAL PEAK INSPIRATORY FLOW NPIFR NASAL PEAK INSPIRATORY FLOW METER CBT CILIARY BEAT FREQUENCY MCT MUCOCILIARY CLEARANCE TIME NI NASAL IRRIGATION URTIs UPPER RESPIRATORY TRACT INFECTIONS RSDI RHINOSINUSITIS DISABILITY INDEX ASL AIRWAY SURFACE LIQUID MALT MUCOSA ASSOCIATED LYMPHATIC TISSUE IG IMMUNOGLOBULINS OH HYDROXYL MCC MUCOCILIARY CLEARANCE NO NITRIC OXIDE T2Rs BITTER TASTE RECEPTORS IL INTERLEUKIN viii ABSTRACT Background: The use of nasal saline is deeply rooted in history. It has been practiced for thousands of years as part of Hatha Yoga, where it is called Jala Neti. Yogis use nasal cleansing, as well as cleansing of other areas, to attain a higher state of meditation, but practitioners also note advantages related to bodily health. On the physical level irrigation of the nasal mucosa removes accumulated mucus from the nostrils, associated passages and sinuses, allowing air to flow without obstruction. Methods: Sixty healthy volunteers of age group between 18-25yrs will participate in the study. After obtaining informed consent, the selected individuals would be subjected to two practices of Jala neti. After the practice , the individuals are made to perform Jala neti( nasal irrigation) under the supervision of yoga Experts. After obtaining informed consent the nasal peak inspiratory flow is measured using nasal peak inspiratory flow meter. The collection of first data is before the practice, Second data is taken immediately after the procedure. Results: The study group showed improved Nasal Inspiratory Flow Rate Immediately after the Practice of Jala Neti Procedure. Interpretation and Conclusion: Regular practice of Jala neti maintains healthy secretory and drainage mechanisms of the entire ear, nose and throat area. This helps to ward off colds and coughs, allergic rhinitis, hay fever, catarrh, and tonsillitis Key Words: Jala Neti, Nasal peak Inspiratory flow, Saline nasal irrigation. ix TABLE OF CONTENTS S. NO. INDEX PAGE NO. 1 1. INTRODUCTION 6 2. AIMS & OBJECTIVES 7 3. REVIEW OF LITERATURE 56 4. MATERIALS & METHODS 65 5. RESULTS 72 6. DISCUSSION 74 7. CONCLUSION 76 8. SUMMARY BIBILIOGRAPHIC 78 9. REFERENCES 92 10 ANNEXURES XI LIST OF TABLES SI.NO TOPIC PAGE NO 1. Concentration of ions in the nasal mucus 35 2 Comparison of Peak Nasal Inspiratory 66 Flow Rate before and after Jala neti practice 3 Comparison of Peak Nasal Inspiratory 68 Flow Rate before and after Jala neti practice among the male participants 4. Comparison of Peak Nasal Inspiratory 70 Flow Rate before and after Jala neti practice among the Female participants XII LIST OF FIGURES FIGURE NO. CONTENTS PAGE NO. 1. JALA NETI 7 2. ANATOMY OF UPPER RESPIRATORY TRACT 10 3. NASAL CAVITY 12 4. ANATOMY OF SINUSUS 16 5. BLOOD SUPPLY TO NASAL CAVITY 17 6. NERVE SUPPLY TO NASAL CAVITY 18 7. ANATOMY OF INTRNAL NOSE 20 8. LOCATION OF SINUSUS 23 9. REPRESENTATION OF CILIA IN UPPER 26 RESPIRATORY TRACT 10. COMBINATION OF MICROBES AND 27 INFLAMMATION OVER A RELATIVELY SHORT PERIOD LEAD TO LOSS XIII 11 NASAL EPITHELIUM 32 12 SCHEMATIC DRAWING OF THE CILIARY 36 STROKE IN NASAL MUCUS 13 39 BIOCHEMICAL MECHANISM IN NASAL CAVITY 14 PRACTICE OF JALA NETI 42 15 REGULATION OF CILIARY BEAT 46 FREQUENCY 16 COMMON SYMPTOMS OF UPPER 49 RESPIRATORY TRACT INFECTIONS 17 NASAL INSPIRATORY PEAK FLOW METER 53 18 PATIENT WITH NPIF METER 55 19 PRACTICE OF JALA NETI 62 20 ASSESMENT OF PEAK NASAL INSPIRATORY 64 FLOW RATE 21 GRAPHICAL REPRESENTATION OF JALA NETI ON 67 PNIFR(L/MIN) 22 GRAPHICAL REPRESENTATION OF JALA NETI ON 69 PNIFR(L/MIN) AMONG MALE PARTICIPANTS 23 GRAPHICAL REPRESENTATION OF JALA NETI ON 71 PNIFR(L/MIN) AMONG FEMALE PARTICIPANTS. XIII XIII 1.0 INTRODUCTION The nose and upper airway play a sentinel role in the respiratory tract, making an individual alert to the qualities of the inspired atmosphere. The upper airway also clears contaminants from the inspired airstream and physically conditions inspired air before entering into the lower respiratory tract. By these anatomical and functional considerations, the nose may be the initial—or even prime—target of air pollutants. Healthy people‘s respiratory tracts are protected from airborne contagion and debris by a mucociliary layer that lines the sinonasal cavity. This layer consists of columnar, ciliated epithelial cells and goblet cells bathed in mucus. Foreign particles are trapped in the sticky layer of mucus, and ciliary action propels the entire mucous layer out of the sinuses toward the nasopharynx. When this transport mechanism fails, rhinosinusitis occurs, usually in response to a virus, bacterium, irritant, or allergen.(1) Nasal hygiene has been shown to relieve congestion, reduce the viscosity of mucus and keep nasal cavity clean and moist. Nasal breathing is the only physiological type of breathing in humans, and is considered mandatory, although substituting mouth breathing is compatible with life. 1 The mucociliary layer, which covers the nostrils, actively participates in respiratory homeostasis through ciliary function, mucus secretion and the release of inflammatory mediators. The maintenance of integrity of the respiratory mucosa is essential for the airways to fulfill their role; this can justify the use of external media, such as sprays, lavage and irrigation of the nasal cavity to promote or facilitate nasal hygiene. The use of saline solutions seems to facilitate the transport of mucus, particles, irritants and microorganisms toward nasopharynx, probably by direct physical action and by increasing ciliary beating, which is reduced during inflammatory processes.(2) Yoga is one of the ancient sciences prevalent from time immemorial.
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