The effect of osteopathic manipulative treatment on chronic rhinosinusitis
Authors: Rowane Marija , Shankar Ashwin , Nagireddi Supriya , Kalkat Amanpreet , Hammes Cheryl , Kohli Eshika , Callahan Meghan , Hostoffer Robert 
Published: February 2025

Abstract

Context
Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease of the paranasal sinuses that may significantly impair quality of life. CRS may also benefit from the 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.

Objectives
This study aimed to assess whether OMT focused on lymphatic drainage of cranial structures can provide immediate, as well as sustained, relief of CRS 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. Patients consented to the study and were assigned by the provider to the OMT group or the control group 50/50. A four-question, 5-point Likert scale survey inquiring about the severity of nasal congestion, postnasal 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: thoracicinlet release, venous sinus drainage, occipital-atlantal decompression, thoracic paraspinal inhibition, facial sinus pressure, and Galbreath technique. A structural examination involving light touch was applied to the 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. A paired t-test was applied for statistical comparison between the pre- and postsurveys.

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 they patients had 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 presurvey and postsurvey completed immediately after and 10 days after the intervention, were completed by 60.5 % of the study participants. The OMT group pre-vs. immediate postsurvey results scored a statistically significant decrease in the severity of nasal congestion (p=0.001), postnasal drainage (p=0.002), and facial or sinus pain or pressure (p=0.0004).

Conclusions
Our single-blinded, prospective survey findings suggested that there was a benefit of OMT application for the immediate relief of CRS symptoms, predominantly in alleviating the severity of sinus pain or pressure. This study is the first large study (n=43) with a control group that shows that OMT techniques improve immediate CRS symptom relief of nasal congestion, postnasal drainage, and facial or sinus pain/pressure when compared to the pretreatment survey. Our study also demonstrated that the symptomatic relief by OMT of rhinosinusitis was not sustained in 10 days. OMT offers a safe, nonpharmacological complementary therapy to relieve lymphatic congestion and improve mucociliary clearance in CRS.