Vol. 2, Issue 2, Part A (2025)

Background: Chronic Rhinosinusitis (CRS) is a prevalent, relapsing inflammatory disorder of the nose and paranasal sinuses that continues to impose a substantial symptomatic and economic burden, even when treated according to contemporary ENT guidelines. Nasya Karma, a classical Ayurvedic procedure involving intranasal administration of medicated oils, is traditionally indicated for Peenasa/Dushta Pratishyaya and other head-neck disorders, but has rarely been evaluated using modern CRS diagnostic criteria and outcome measures in an integrative framework.
Objectives: To evaluate the efficacy and safety of adding a standardized Nasya Karma protocol to guideline-based ENT management in adults with CRS, compared with standard care alone.
Methods: In this prospective, randomized, controlled, parallel-group trial conducted at an integrative ENT-Ayurveda clinic, 80 adults with EPOS-defined CRS were allocated to either Integrative Nasya + Standard Care (n=40) or Standard Care only (n=40). All patients received intranasal corticosteroid sprays, saline irrigation and short courses of systemic corticosteroids/antibiotics as indicated. The integrative group additionally received three 7-day courses of Nasya Karma at 4-week intervals over 12 weeks. Primary outcome was change in Sinonasal Outcome Test-22 (SNOT-22) score from baseline to week 12. Secondary outcomes included symptom visual analogue scale (VAS) scores, Lund-Kennedy endoscopic scores, Lund-Mackay CT scores in a predefined subset, responder rates, use of systemic rescue medications and adverse events. Analyses followed the intention-to-treat principle.
Results: Both groups showed significant within-group improvement in SNOT-22, but the integrative group demonstrated a greater mean reduction (−33.8±11.2 vs −22.8±13.0; p<0.001). A higher proportion of integrative patients achieved ≥12-point SNOT-22 improvement (75% vs 50%; p = 0.02) and an absolute SNOT-22 ≤20 at week 12 (70% vs 40%; p = 0.007). Improvements in nasal obstruction, rhinorrhoea, facial pain, hyposmia and Lund-Kennedy scores were also significantly greater with Nasya. Systemic corticosteroid use was lower in the integrative arm (25% vs 45%; p = 0.04). Nasya was well tolerated, with only mild, transient local adverse events and no serious complications.
Conclusion: The addition of a standardized Nasya Karma protocol to guideline-based ENT management provides clinically meaningful incremental benefit in CRS, improving symptom burden, disease-specific quality of life and endoscopic findings, while reducing systemic rescue medication use without compromising safety. These findings support the integration of Nasya as a viable adjunct within multidisciplinary ENT care for appropriately selected CRS patients.