Hello, my name is Maria Rowane and it's my pleasure to present to you the effect of osteopathic manipulative treatment, or OMT, in chronic rhinosinusitis. My co-authors on this study are Drs. Ashwin Shankar, Supriya Nakhredi, Amman Calcutt, and student doctors Megan Callahan, Ishika Coley, and Drs. Cheryl Hammes and Bob Hostoffer. And our institutions are Oklahoma State University Medical Center, my institution, as well as University Hospitals, Cleveland Medical Center, Lake Erie College of Osteopathic Medicine, Ohio University Heritage College of Osteopathic Medicine, and Allergy Immunology Associates. So chronic rhinosinusitis, or CRS, is a common inflammatory disease of the paranasal sinuses that can significantly impact quality of life. This is often managed with medications, environmental controls, patient education, considering allergen-specific immunotherapy, and possibly surgical management. Osteopathic manipulative treatment, or OMT, aims to improve venous and lymphatic circulation, sympathetic and parasympathetic outflow, and cervical thoracic somatic dysfunction. Therefore, CRS may benefit from application manual techniques through OMT. Several experimental animal models applied manual lymphatic techniques to enhance lymphatic circulation of inflammatory mediators, suggesting restored fluid homeostasis. At the next level, several small-scale cohort studies, clinical studies, and clinical studies reported significantly improved sinusitis-associated symptoms when comparing pre- versus post-surveys after applying a consistent OMT sequence. There is a deficit, however, of larger-scale studies in osteopathic literature, also those involving controls and investigating temporary versus sustained outcomes of OMT application in CRS. The goal of the study is to assess if OMT-focused on lymphatic drainage of cranial structures can provide immediate as well as sustained relief of chronic rhinosinusitis symptoms. This was a prospective single-blinded study. I re-approved recruiting patients of an allergy immunology clinic based on these inclusion and exclusion criteria you see in Table 1. The patients that were recruited, the inclusion criteria with those that were diagnosed with CRS, refractory to conventional medical therapy, and had no prior OMT exposure. Those that were excluded were pediatric patients, pregnant patients, those that had a more complicated CRS with nasal polyposis, those that were currently or recently, within the last week, on oral corticosteroids or antibiotics, and those with uncontrolled asthma and patients using tobacco products. Patients who consented to the study were assigned 50-50 to the OMT or control group, and all patients were provided immediately before, immediately after, and then as well as 10 days after they were provided a copy of this survey you see in Appendix 1. There's a short four-question survey based on the five-point Likert scale that assessed CRS symptom severity in the first three questions, and then interest in alternative therapy in that last question. For the OMT group, the following OMT sequence was applied to each of those participants and starting with thoracic inlet, followed by venous sinus drainage, then occipital lental decompression, and thoracic paraspinal inhibition, facial sinus pressure, gallbladder technique. And then those OMT group participants were also provided a handout with some pictures and a video link guiding them through self-applied techniques to practice at home. The control group did not receive that handout. They received a structural exam that involved LifeTouch in those general areas that the OMT sequence was applied for the OMT group. And the surveys, after collection, were statistically analyzed using a paired t-test. The results showed we had a total of 43 participants, including 22 in the OMT group, 21 in the control group, and the majority were female. The majority identified their race as white. The average age was 54 years old. All of the participants completed the survey immediately before and after their intervention. 60.5% or 26 completed the survey 10 days later as well. The OMT group, as you can see in figure one here, overall demonstrated a statistically significant decrease in severity of all those symptoms, nasal congestion, post-nasal drainage, and sinus pain or pressure, with the most significant difference with the sinus pain or pressure in immediate outcomes. However, that effect was not sustained for the long-term survey that was completed 10 days out. In the control group, there's a minor difference, but statistically insignificant difference in the control pre- versus post-group. So both the OMT and control groups scored an insignificant difference with the pre- versus the longer-term outcomes. So overall, this study suggests the benefit of OMT for immediate relief of CRS symptoms, predominantly in alleviating the severity of sinus pain or pressure. The long-term efficacy of OMT for CRS symptomatic relief was not strongly supported by this data, but has yet to be further investigated. This study did support prior smaller cohort studies applying OMT for sinusitis relief, but also involved a control group, increased the M number, and evaluated the sustained relief. There were some limitations in just being a single site, limited in racial diversity and duration of variability with each encounter. But overall, this does show that OMT is a safe non-pharmacologic complementary therapy to relieve lymphatic congestion involved in CRS. Thank you for your time.

osteopathic manipulative treatment

chronic rhinosinusitis

symptom relief

non-pharmacologic therapy

Maria Rowane