Efficacy and safety of Ayurveda interventions for Sinusitis: A systematic review and meta-analysis

Abstract

Objectives To provide a broad evaluation of the efficacy and safety of Ayurveda interventions (procedural and non-procedural) for the management of sinusitis, and also of the relative efficacy and safety of different Ayurveda therapies for Sinusitis. Methods: Two reviewers independently screened search results from electronic databases viz. Cochrane Library, PubMed(central), AYUSH Research Portal, and DHARA for published research articles and Shodhganga, RGUHS library, and ARD-IPGT&RA for the unpublished doctoral thesis. Trial registries (CTRI, Clinicaltrials.gov & WHO-ICTRP), and hand searches were also done for other relevant studies from inception to August 2020. All comparative clinical trials recruiting sinusitis patients of any age group, receiving Ayurveda intervention, regardless of forms, dosages, ingredients, and mode of interventions, for not less than one week were included. The data extraction and the risk of bias assessment were done by two reviewers independently. Protocol registration number: RD42018103995. Results We included 10 trials (387 participants) for qualitative analysis and 07 trials (287 participants) for quantitative analysis. Ayurveda intervention demonstrated potential in reducing signs and symptoms of sinusitis compared with placebo (Risk Ratio ranges 6.33 to 12.67, 1 trial, 80 participants). Combined Ayurveda therapy (CT) was statistically more beneficial compared with either procedural or non-procedural Ayurveda therapy alone in reducing symptoms nasal discharge (standardized MD -0.71, 95% CI -1.16 to -0.26, I2 58%, 10 comparisons, 210 participants) and headache (standardized MD -0.44, 95% CI -0.86 to -0.02, I2 56%, 10 comparisons, 218 participants), however, no significant difference was found in reducing symptoms nasal obstruction and loss of smell. Also, there was no significant difference found in similar outcomes while comparing Ayurveda procedural therapy with non-procedural therapy. No numerical data related to the safety of Ayurveda intervention was found in included trials. Conclusions Despite very low certainty in results (downgraded twice for RoB, once for inconsistency, indirectness, and imprecision each), Ayurveda intervention (CT) may have some beneficial effects in the management of Sinusitis. However, due to insufficient data, we could not conclude on the safety aspect. There is a need for well-designed-executed-reported clinical studies for the generation of evidence. Keywords Ayurveda, Systematic Review, Meta-analysis, Sinusitis, Rhinosinusitis, Pratishyaya, Peenasa.