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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 9  |  Issue : 3  |  Page : 335-338

Clinical profile of nasal polyp in a pediatric patient: An Ayurvedic approach


Department of Kaumarabhritya, KLEU's Shri B. M. Kankanwadi Ayurved, Mahavidyalaya, Belagavi, Karnataka, India

Date of Web Publication21-Dec-2016

Correspondence Address:
Dr. Aziz Ahmed Arbar
Department of Kaumarabhritya, KLEU's Shri B. M. Kankanwadi Ayurved, Mahavidyalaya, Belagavi, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2349-5006.196338

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  Abstract 

Nasal polyp is a chronic inflammatory disease affecting the nasal cavity and the paranasal sinuses. It is a relatively common disease occurring in 1%–4% of the general population, but it is also seen in the pediatric population. Children present with nasal polyps are also known to have other underlying systemic diseases, mainly cystic fibrosis and bronchial asthma. Nasal polyp is common in the pediatric population especially in teenage, and is found usually bilateral. It is also commonly associated with bronchial asthma and many other systemic diseases. Beginning in preschool age, up to 50% of patients experience obstructing nasal polyp. In contemporary science, nasal polyp is not curable but can be clinically stabilized. When conservative measures are exhausted, surgical intervention combining endoscopic sinus surgery and supportive conservative treatment is performed. In the present paper, we aimed to present a treated patient of nasal polyp by the ayurvedic modalities such as Snehana, Swedana, Nasya, Gandusha, and Dhoompana with a positive change in the clinical picture.

Keywords: Dhoompana, Gandusha, nasal polyp, Nasya, Snehana, Swedana


How to cite this article:
Arbar AA, Verma S. Clinical profile of nasal polyp in a pediatric patient: An Ayurvedic approach. Indian J Health Sci Biomed Res 2016;9:335-8

How to cite this URL:
Arbar AA, Verma S. Clinical profile of nasal polyp in a pediatric patient: An Ayurvedic approach. Indian J Health Sci Biomed Res [serial online] 2016 [cited 2019 Nov 22];9:335-8. Available from: http://www.ijournalhs.org/text.asp?2016/9/3/335/196338


  Introduction Top


The inflammatory nasal polyp is the most common benign or malignant nasal mass seen in children. Nasal polyps in the pediatric population appear to occur as inflammatory responses to bacterial infections.[1]

Broadly defined, nasal polyps are abnormal lesions that originate from any portion of the nasal mucosa or paranasal sinuses. Polyps are an end result of varying disease processes in the nasal cavities. The most commonly discussed polyps are benign semitransparent nasal lesions that arise from the mucosa of the nasal cavity or from one or more of the paranasal sinuses, often at the outflow tract of the sinuses.

Multiple polyps can occur in children with chronic sinusitis, allergic rhinitis, cystic fibrosis (CF), or allergic fungal sinusitis. An individual polyp could be an antral-choanal polyp, a benign massive polyp, or any benign or malignant tumor (e.g., encephaloceles, gliomas, hemangiomas, papillomas, juvenile nasopharyngeal angiofibromas, rhabdomyosarcoma, lymphoma, neuroblastoma, sarcoma, chordoma, nasopharyngeal carcinoma, inverting papilloma). Clinically, one must evaluate all children with benign multiple nasal polyposis for CF and asthma.[2]

In a study, it was noted that 33% of the patients with polyps had antral-choanal polyps, and in 20% of the patients, the polyps were unilateral. In 18% of the patients, the polyps were SS bilateral, and in additional 29%, they occurred bilaterally in association with CF.[1]

Most studies suggest that polyps are associated more strongly with nonallergic disease than with allergic disease. Statistically, nasal polyps are more common in patients with nonallergic asthma (13%) than with allergic asthma (5%), and only 0.5% of 3000 atopic individuals have nasal polyps.[2]

In this study, it was also noted that the history of an allergy was infrequently associated with nasal polyps. Allergies are potentially major contributing factors to nasal polyps only in patients without CF whose nasal polyps are bilateral.

Currently, patients with antral-choanal polyps are mostly managed by simultaneous Caldwell-Luc antrostomy and polypectomy. They generally have the risk of recurrence. The surgeries are also associated with complications, including epistaxis and intranasal synechia, in about 3% of the cases. Therefore, a different approach is needed to tackle the disease condition in a safer and noninvasive way.[1]

Pathophysiology

The pathogenesis of nasal polyposis is unknown. Polyp development has been linked to chronic inflammation, autonomic nervous system dysfunction, and genetic predisposition. Most theories consider polyps to be the ultimate manifestation of chronic inflammation; therefore, conditions leading to chronic inflammation in the nasal cavity can lead to nasal polyps.[2]


  Case Report Top


A 14-year-old, 40 kg moderately built male child belonging to a lower middle class family, suffering from nasal polyp presented to Kaumarabhritya outpatient department for the complaints of difficulty in nasal breathing, mouth breathing, especially at night, stuffy nose, frequent sneezing, and headache. All since 2 years with gradual onset, increased since last 2 months. The patient was a k/c/o/bronchial asthma, for which he undertook the classical virechana (Snehapana f/b Swedana for 5 days and after which virechana was given with trivrit leha on 7th day) at the age of 6 years. The patient was diagnosed with right-sided nasal polyp and was admitted in indoor patient department for the same for 10 days, in which he was treated with Tulas yadi Taila Nasya and Shamanaushadhi based on yuktivyapashrayachikitsa, and discharged with follow-up advice which included oral medicines. During this period, child had shown decrement in the symptoms.

On physical examination

Physical examination revealed the presence of right nostril polyp and hypertrophied posterior turbinate on the left side with inflamed mucosa bilaterally.

(Computed tomography scan could not be done due to economic constraints; it would have helped know the origin of polyp).

During the treatment, the patient was advised to remain in Nivatasthana, and to avoid cold, spicy, oily food, Divaswapna and Ratri Jagran, the patient was advised to take Lukewarm water, Shunthijala (water prepared by decoction of ginger), Ganji (gruel prepared with rice), Upma, Krushra, or Khichadi (prepared with green gram and rice) as Pathya Ahara and Vihaara.

Treatment administered [Table 1]
Table 1: Treatment administered

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Treatment at discharge

  • Shamanaushadhi: for 1 month:
    • Arsha kuttara Rasa[4] 250 mg tablet, 1 bd, A/F
    • Haridra Khanda[5] 2.5 g BD with milk boiled in Shunthi
    • KriminashakaKadha 10 ml BD.
  • Follow-up was done after 1 month.



  Observation and Results Top


After the 3rd day of treatment, the patient had shown improvement - no mouth breathing, sound sleep, and increased appetite [Table 2]. After the 4th day of treatment, there was reduction in the inflammation of nasal mucosa and gradually, reduction in the size of the polyp [Figure 1] and [Figure 2].
Table 2: Parameters used BT and AT

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Figure 1: Image of nasal polyp after treatment

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Figure 2: Examination through nasal speculum after treatment

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  Discussion Top


Since the disease Samprapti had Kapha and Jala Bahulyata, it was indicated to bring about the Apatarpana and Rukshana. Since the childhood age is very tender age in terms of easy fluctuation of doshas as it is avastha of Aparipakwadhaatu, Aarohanakramanasya drops were used. The treatment was intended to bring about the sthaanik doshas to normalcy, to repair the inflamed mucosa, and to drain the polyps. Shodhana form of nasya was also beneficial looking at the chronicity in this case. The clinical success was achieved by the adapted treatment due its specificity in healing the vitiated Doshas.

Rationale of treatment

Nasaarsha has been mentioned in Sushruta and Vagbhata in which they have clearly mentioned that patient feel difficulty in breathing, therefore patient breathes from mouth, fluid discharge from the nose, constant sneezing, nasal voice, bad smell in the nose, and headache are the common symptoms.[6]

  • Dosha according to age: Kapha
  • Dosha of VyadhiSthana: Kapha
  • Dhatu: Mamsa
  • Predominant lakshanas such as srava, shotha, and jalabahulyata indicate predominance of Kapha dosha
  • This indicates the Kapha dosha prabalata, along with alpa Pitta and Vata
  • Looking at the above samprapti, the treatment modality would be Apatarpana
  • Looking at the reversal of pathology, Teekshna nasya was chosen with gradual increase in number of drops to get dosha shodhana without aggravating other Doshas[7]
  • The Shamanaushadis given at the time of discharge are used for the treatment of Nasa Arsha (mentioned in the classics)[4] as it contains the drugs which are Katu and Teekshna in nature ultimately which cases Lekhana and Ksharana of Nasa Arsha.


Nasya was planned because of following reasons

  • Chronicity of the disease
  • Progressive nasal congestion
  • Association of kapha and mamsa
  • Physical presence of Nasa Arshas
  • Udaka and kaphabahaulyta
  • Tulsyadi tailam was chosen, because Tulsi is known for its shirovirechaniya action, and teekshnata.[8]


Management of Ama

  • Jatharagni and dhatvagnimandhaya – amanirhrana by panchkolaphanta – 15 ml tid × 3 days
  • Nirama awastha was confirmed by the following after the 3rd day:
    • Deeptaagni
    • Prakruta mala
    • Aliptajihwa.



  Conclusion Top


Ayurvedic management has been found very effective in this case if followed by proper yukti, also keeping pathya and apathya for the patient. Shodhanachikitsa with Nasya was found beneficial in the management of nasal polyp (Nasa Arsha) in the present case.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Schramm VL Jr., Effron MZ. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7401851. [Last accessed on 2016 Oct 04].  Back to cited text no. 1
    
2.
McClay JE, Isaacson GC, editor. Available from: http://www.emedicine.medscape.com/article/994274-overview. [Last accessed on 2016 Oct 04].  Back to cited text no. 2
    
3.
Nishteswar K, Vidyanath R, editor. Taila prakarana Sahasrayogam. Ch. 3., Second ed. Varanasi: Chaukhamba Sanskrit Series; 2008. p. 129.  Back to cited text no. 3
    
4.
Mishra S, editor. Arsharogaadhikara. Bhaisjyaratnavali of Kaviraj Govinda Das Sen. Ch. 9. Varanasi: Chaukhamba Subharti Prakashan; 2011. p. 330.  Back to cited text no. 4
    
5.
Mishra S, editor. Udardasheetapittakothaadhikara. Bhaisjyaratnavali of Kaviraj Govinda Das Sen. Ch. 55. Varanasi: Chaukhamba Subharti Prakashan; 2011. p. 898.  Back to cited text no. 5
    
6.
Shastri KA, editor. Nasagataroga Vijnaniya Adhyaya. Shushrutasamhita of Maharishi Susruta edited with Ayurveda Tattva Sandipika, Uttaratantra. Vol. 2, Ch. 22. Varanasi: Chaukhamba Sanskrit Sansthana; Reprint 2014. p. 144.  Back to cited text no. 6
    
7.
Srikantha Murthy KR, editor. Nasarogapratishedha Adhyaya. Ashtanga Samgraha of Vagabhata. Uttarsthana. 4th ed., Vol. 3, Ch. 24. Varanasi: Chaukhambha Orientalia; 2005. p. 212.  Back to cited text no. 7
    
8.
Sharma PV, editor. Krimighana Adhyaya. Dravyaguna Vijnana. Vol. 2. Varanasi: Chaukhambha Bharti Academy; Reprint 2005. p. 513, 709.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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Abstract
Introduction
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Observation and ...
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