Management of nasal synechiae with Kshara Sutra - A case report

Abstract

Nasal synechiae or nasal adhesions are among the most common unwanted outcomes following functional endoscopic sinus surgery (FESS) with an incidence rate of 10%–40%. Approximately 500,000 patients per year undergo FESS for the treatment of chronic rhinosinusitis (CRS). A wide number of research studies support the utility of endoscopic sinus surgery to improve health-related quality of life (HRQoL) in patients with CRS. However, failures are still reported at a rate up to 26%. About 50% who present with synechiae in the middle meatus require revision endoscopic sinus surgery. A case report of a 48-year old-male has been presented here with complaints of nasal blockage and difficulty in breathing, diagnosed as nasal synechiae after anterior rhinoscopy and endoscopic examination and managed with Ayurvedic intervention. Kshara karma with Apamarga Kshara is the choice of management in case of nasal polyp and turbinate hypertrophy [ 1 ]. But in nasal synechiae, since we have to cut open the adhesion precisely, Kshara Sutra , which is meant for cutting open the tract in case of fistula-in-ano was chosen. Nasal synechiae which was managed only with electrocautery or other surgical procedures where there is a chance of recurrence can be successfully managed with an Ayurvedic intervention viz., Kshara S utra which is strictly new to this site of occurrence (nose).