The effectiveness of Ayurvedic oil based nasal instillation (Nasya) medicines in the treatment of facial paralysis (Ardita)

Abstract

Background: Ardita (facial paralysis) is a medical condition that disfigures or distorts the facial appearance of the sufferer, causing facial asymmetry and malfunction. Ardita patients may benefit from considering alternative treatments such as Ayurveda, including Taila Nasya (nasal instillation of medicated oil). Objectives: To synthesize the best available evidence regarding the effectiveness of different Nasya oils in the treatment of Ardita. Secondly, to draw evidence based recommendations from the synthesis for practitioners and Ardita sufferers. Inclusion criteria: Types of participants Studies conducted with adult sufferers (18-70 years of age) of Ardita (chronic or acute) in any setting were considered. Studies including participants who were pregnant or suffered allergic rhinitis, fever, intracranial tumour/haemorrhage and bilateral facial palsy were excluded. Intervention(s)/comparator(s) Taila Nasya (at all dosages and frequencies), either as a standalone treatment or in combination with other Ayurvedic treatments, was the intervention considered. Comparators considered were different Taila Nasya stand-alone treatments, Taila Nasya in combination with other Ayurvedic interventions and Ayurvedic interventions that did not include Taila Nasya. Outcomes and measures The outcomes of interest were changes in Ardita symptoms including facial distortion, speech disorders and facial pain. All measures of these symptoms were considered. Types of studies All quantitative study designs (experimental, quasi-experimental and observational) were considered. Search strategy: A three-step search strategy was initially used to identify published and unpublished studies. Studies published in the English language were considered, irrespective of publication date. Following an initial limited search of MEDLINE and CINAHL, the text words contained in the title and abstract, and of the index terms used to describe each articles were analysed. From the identified keywords and index terms, searches were undertaken across all relevant databases. Thirdly, reference lists of identified thesis and articles were searched for additional studies. Universities and website operators related to Ayurvedic research in India were contacted, including the National Institute of Ayurveda for relevant studies. Besides this, the University of Adelaide librarian was contacted to retrieve those studies identified in the reference lists of thesis and articles. Due to the dearth of studies identified, a fourth step was added to the search strategy commonly used for systematic reviews based on the Joanna Briggs Institute systematic review methodology. This involved contacting Indian universities and relevant institutions to locate and obtain studies that match the inclusion criteria of this review. Methodological quality: Studies matching the inclusion criteria were independently assessed by the author and a secondary reviewer using the relevant standardised critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (MAStARI). Data extraction and synthesis: Data was extracted by the primary reviewer using a standardised data extraction tool from the Joanna Briggs Institute. The intention was to conduct a meta-analysis. However, this was not possible because only two studies were identified, and these examined different interventions and comparators. A narrative synthesis was therefore conducted, aided by tables. Results: Only two pseudo-randomised studies, with a small number of participants and which met the inclusion criteria, were accessible and included in the review. One study with 20 participants, divided equally into two groups, compared the effectiveness of two alternative nasal instillations, namely Anu Taila and Mashadi Taila for alleviating four Ardita symptoms. Although the researchers claimed that Anu Taila Nasya is better than Mashadi taila Nasya for controlling facial distortion, they stated that Mashadi taila Nasya offered statistically highly significant outcome values. Furthermore, they made an unsupported statement that Mashadi taila Nasya if administered with Shamana medicines will give better results in short duration. The second study, which included 30 participants split evenly between the intervention and comparator groups, compared the effectiveness of Nasya with Shirobasti for alleviating seven Ardita symptoms. Both studies used observational measurements and graded Ardita symptoms as ‘mild’, ‘moderate’ or ‘marked’ at baseline and after one month. In the study that included 30 participants, the 15 patients who received the Nasya intervention experienced relief from the symptoms of facial pain, speech disorder and earache within the range of 78.2% to 90.9%, graded as ‘marked’. The review found scant and low level of evidence favouring the Taila Nasya intervention compared to Shirobasti. Conclusions: This systematic review presents extremely limited evidence, from only two small experimental studies, that administration of Nasya oil alone may provide some relief from Ardita symptoms of facial distortion, speech disorder, inability to shut eyelids and dribbling of saliva in adult patients. Of the two studies, one had very weak methodology and did not offer any robust results. No strong conclusions may be drawn from the evidence included in this review due to the limited number of studies, limited number of participants and poor quality of studies. Inferences for practice Practitioners should advise Ardita patients that there is extremely limited evidence that suggests that Mahamasha Taila Nasya alone may provide some relief from Ardita symptoms of facial distortion, speech disorder, inability to shut eyelids/upward eye rolling, and dribbling of saliva in adult patients. Given the absence of a strong evidence base, practitioners should be guided by clinical wisdom and patient preference. Inferences for research Well controlled clinical trials comparing the effects of standalone Nasya therapy and Nasya combined with other Ayurvedic treatments and/or conventional medicine on Ardita symptoms should be conducted. High quality clinical trials examining the relative effectiveness of different Nasya oils for treating Ardita are also required.