Can you think treating Deviated Nasal Septum (DNS) without surgery. “Yes” it is possible without surgery, you can correct a deviated nasal septum by Siddha therapy. Mookadaipu which is also known as Peenisam or neerkovai in Siddha literature bears a resemblance to clinical symptoms of Nasal blockage of Modern medicine by deviated nasal structure. Our chief healer, Dr Sathya Sinduja who is the patron of alternative therapy Siddha vaidyam; an ancient and old therapy, has treated many patients with such conditions by just using hand pressure technique. Her way of treatment is purely simple: she treats by aligning body energies (mind, body and spirit) and by administering different hand pressures to stimulate “varmam” points, it helps in reducing the severity of symptoms and correction of nasal septum. The changes can be felt by patients aesthetically and in their symptoms. Clinically can be justified by pre and post x-rays.
In this article, we present a case report of 55 years old woman with deviated septum who underwent 4 siddha sessions for correction of nasal septum and has a good result without complication. According to Mladina's classification of nasal septum, the patient's DNS clinically was classified as Type III when she came for treatment which after the sessions was designated as Type I. The symptoms of nasal obstruction, blockage, sleeplessness, stiffness in neck, headache which were at scale 9 at time of start of treatment was lowered to 3-4 on completing the treatment. The range of movements (ROM) of the neck was also improved on measuring by goniometer.
Nasal septum is a bony cartilaginous wall which is located at the centre of the nose and separating the two chambers of nostril i.e right and left. The primary function of nasal septum is to provide a structural support to the nose. Deviated Nasal septum (DNS) is a condition in which there is displaced nasal septum towards one side or if septum has shifted away from the midline. Almost 75-85% of population in world have a mild form of deformity in nose anatomy and in most cases, it is asymptomatic [1-2]. But those who have moderate and severe deviated septum, they can show symptoms in form of nasal obstruction like obstructed breathing, nasal discharge, facial pain and altered smell. This can lead to other serious conditions like sleep apnea, and tinnitus. It may also cause permanent changes in the nasal and sinus mucosa due to obstructed ventilation.
In 2011, a study found that 85-88% of the cases of deviated nasal septum occurred in males and only 10-12% in females. According to literature, most of these incidents are found in patients aged between 20-40 years, while in another study, they found a low correlation between the age and the type of septum deviation [4]. Various reasons have been attributed to occurrence of deviated nasal septum with 72% of these caused by trauma and 24% caused by trauma at birth [2-3]. The higher incidence rate in men is largely due to trauma that often occurs in men. The other factors include racial factors and congenital deformities of septum.
The septum deviation is diagnosed basically on patient's clinical symptoms & physical examination or during other investigations such as, PNS X-ray & CT-Scan. Some investigations like Rhinomanometry, nasoendoscopy and Acoustic Rhinometry are done to study the nasal area in detail, helping in assessing the anatomical structure of the nose, nasal congestion, as well as any complications of septum deviation [6-7]. The treatment of septum deviation is based on the complaints and complications and can be managed by local inhalers & medications. In some complicated cases an operative procedure is required to correct the deviation for improving the nasal obstruction as well as for aesthetic purposes.
Though, in modern medicine nasal deviation can only be corrected by surgical method but recent studies shows alternative therapies like Siddha vaidyam; which is an ancient and old therapy, has proved to be significantly correcting and improving DNS and related symptoms without surgery. It works on aligning body energies (mind, body and spirit) and by use of different hand manipulation techniques like Pressure Therapy (Varmam), there is a visible improvement of overall circulation to the affected area. Along with treatment, yoga and breathing exercises are included in the management of this type of disorder. Siddha activates the body's internal healing mechanisms, thus resulting in decreased intensity of symptoms related to DNS and finally correction in septum deviation which boosts the overall appearance and symptomatically lifestyle of the patient.
Deviated septum causes nasal congestion and breathing obstruction. This produces a whistling sound during inhaling and exhaling. Other symptoms seen associated with DNS are distorted nasal shape, nosebleeds, facial pain on either side of face, snoring and inflammation of tissue lining causing sinusitis. According to some Siddhars, Mookadaipu which is also known as Peenisam or neerkovai in Siddha literature bears a resemblance to clinical symptoms of Modern medicine Nasal blockage caused by deviated nasal structure. It is a combination of sinusitis and rhinitis (Rhino sinusitis) than mere deviated septum as symptoms were considered the same [8].
The other symptoms closely resembles the symptoms of vazhi, azhal, Iyam and neer which are mentioned in siddha literature [8]. In siddha, Vazhi refers to sneezing, irritation in nose, running nose; Azhal refers to nasal blockage due to curve, inflammation in nasal mucosa; Iyam resembles irritating pain in nose, expulsion of mucous, bleeding from nose due to mass formation on either septum and Neer means stuffiness, watery discharge from nose.
A 55-year old homemaker came to Chakrasiddh centre in Sept-2022 with complaint of nasal congestion since 10 years. Patient also complained of frequent nasal obstructions, colds and headaches, stiffness in left neck region and insomnia. She occasionally has symptoms like sneezing, nosebleeds, breathing issues and often has difficulty in smelling. The headaches were moderate in day with severity increasing till evening and were observed whole day especially in summers. She has had multiple episodes of acute sinus infections over the years and were managed by steams and antibiotics. The stiffness in neck on left side is grave so she has to sleep sideways on right side. She feels pain on left lateral flexion on turning her head.
The patient is a diabetic and hypertensive from last 5 years and is on medication for that. She had cataract surgery 7 years back and noticed increase in headaches and sleep disorders after that. In recent months, the severity of her symptoms related to nasal obstruction has become aggressive. She failed multiple courses of medical treatment including antibiotics, nasal steroid, oral steroid, and antihistamine. Her symptoms are now interfering with her lifestyle and work.
Her ENT report showed the ear and throat within normal limit, but the PNS x-ray reported both sides of nasal cavity as narrow; the mucosa is slightly inflamed, inferior turbine hypertrophy and a deviated septum to the right.
According to Mladina's classification of nasal septum, the observed DNS clinically was classified as Type III- Posterior vertical deviation at level of OM and middle turbinate (Table-1; Figure-1). This type of septal deviation in the posterior part of the nose has incidence rate of approx 16.5%. There is higher rate of sinusitis if there is greater degree of septal deviation and more horizontal deviation towards uncinatus process plane [4,5,10].
The symptoms of nasal obstruction, blockage, sleeplessness, stiffness in neck, headache which were at scale 9 at time of start of treatment was lowered to 3-4 on completing the treatment. The range of movements (ROM) of the neck was also improved on measuring by goniometer. The aim of presenting this case is to show how Siddha therapy worked on curing the symptoms of DNS along with correction of nasal septum without surgery and involvement of any steroids. This was confirmed by noting her symptoms on VAS scale for pain and pre-post ROM (Range of Motion) assessment. Clinically, pre and post x-rays also verified the success of treatment.
For the assessment of nasal obstruction symptoms, Visual Analog Scale (VAS) was used [11] to see the effect in severity of symptoms before starting and after completing the treatment. A symptom wise chart for DNS which is prepared by the centre itself is given below in Table-2, which was filled pre and post treatment as on scale 0-10 where 0 refers to mild symptoms and 10 being severe effect. For neck ROMs, the physiotherapist recorded the degree of movements by goniometer to analyze the difference in stiffness pre and post treatment (Table-3).
The treatment was started on 12th Sept, 2022; it was planned for 15 days for Cervical Stiffness along with 3 sessions of Nasal septum once a week. The rest 2 sessions after gap of 1 month. The patient had complaints of constipation so special diet was prepared and daily physio exercise for 1/2 hr were initiated.
In initial week, patient could see difference in her neck stiffness. She could notice that she was able to sleep on left side while earlier she could not sleep sideway even for 5 mins. She could identify her stiffness reduction as now she was able to bend while earlier she could not bend at all in all directions. Pain in neck reduced from 8/10 to 4/10 in just first week. The chief healer did the septum correction session by hand pressure therapy (Varmam). She initiated by putting her fingers into nasal cavity and manipulating with hands.
It is thought that constipation is closely related to headaches. For her constipation, a gut session was performed on stomach region by initiating the varmam points with hand manipulation techniques and aligning body energies (mind, body and spirit). After the session, she was monitored for feedbacks related to her sleep and headaches. The patient could feel a lot of difference in nasal blockage and there was no heaviness in head. She was able to sleep without medications which was not possible earlier. In subsequent week, she noticed there was no nose bleeds, breathing is improved and tiredness is reduced. Headaches was on/off but with very less severity and only when she has stressed herself. It was noticed by her relatives that her snoring was not there and sneezing had reduced drastically. She could now smell the flowers and while cooking now she could smell the aroma
Along with treatment, strict diet, water intake, yoga and breathing exercises were included in the management of this type of disorder. Total in all 3 sinus sessions were performed in inital phase and 12 days for cervical treatment . Depending upon the feedback, X-rays were taken out for pre and post appearance of DNS.
The patient's DNS clinically was classified as Type III when she came for treatment which after the sessions was designated as Type I. The symptoms of nasal obstruction, blockage, sleeplessness, stiffness in neck, headache which were at scale 9 at time of start of treatment was lowered to 3-4 on completing the treatment. The range of movements (ROM) of the neck was also improved on measuring by goniometer recorded by physiotherapist at centre.
The patient was advised to take a break for a month and monitor her symptoms along with instructions for cervical exercises, diet management and steam inhalation.
In modern medicine, DNS can be managed by continuous use of steriods and finally a surgery but this case study proved that Siddha Vaidya, an ancient science by just using hand manipulation techniques can correct the deviated septum with simple methodology: By aligning body energies (mind, body and spirit), which empowers and activates the body's internal healing mechanisms thus, resulting in cure and an improved lifestyle. Siddha therapy along with diet and physiotherapy rehabilitation played a vital role in this case in reducing pain and stiffness in neck; reducing symptoms related to nasal blockages, functional independence, and quality of life in patients.
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