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Neuromusculoskeletal Medicine (OMT) Original Article
Marija Rowane, DO, Ashwin Shankar, DO, Supriya Nagireddi, DO, Amanpreet Kalkat, MD,
Cheryl Hammes, DO, FACOFP, Eshika Kohli*, BS, Meghan Callahan, BS and
Robert Hostoffer, DO, LhD, MSMEd, MBA, FACOP, FACOI, FCCP
The effect of osteopathic manipulative treatment
on chronic rhinosinusitis
https://doi.org/10.1515/jom-2024-0122
Received June 25, 2024; accepted January 16, 2025;
published online February 12, 2025
Abstract
Context: Chronic rhinosinusitis (CRS) is a prevalent inflam-
matory disease of the paranasal sinuses that may significantly
impair quality of life. CRS may also benefit from the appli-
cation of manual techniques through osteopathic manipula-
tive treatment (OMT), which aims to improve venous and
lymphatic circulation, sympathetic and parasympathetic
outflow, and cervicothoracic somatic dysfunction.
Objectives: This study aimed to assess whether OMT
focused on lymphatic drainage of cranial structures can
provide immediate, as well as sustained, relief of CRS
symptoms.
Methods: This prospective, single-blinded study (WCG IRB
study number: 1359444) was conducted at an allergy/immu-
nology practice. Study participants included 43 adult patients,
with a diagnosis of CRS, refractory to conventional medical
therapy, with prior exposure to OMT. Patients consented to
the study and wereassigned by the provider to the OMT group
or the control group 50/50. A four-question, 5-point Likert
scale survey inquiring about the severity of nasal congestion,
postnasal drainage, and facial or sinus pain/pressure, as well
as the appreciation of the opportunity for an alternative
therapy, was administered prior to the intervention. An OMT
sequence was applied by the same osteopathic physician to
each OMT group participant in the following order: thor-
acicinlet release, venous sinus drainage, occipital-atlantal
decompression, thoracic paraspinal inhibition, facial sinus
pressure, and Galbreath technique. A structural examination
involving light touch was applied to the control group par-
ticipants. The same 5-point Likert scale survey was adminis-
tered immediately after the intervention. Participants were
provided a blank copy of the survey to save and complete
10 days after the intervention. A paired t-test was applied for
statistical comparison between the pre- and postsurveys.
Results: A total of 43 patients, including 22 patients in the
treatment group (51.1 %) and 21 (48.8 %) patients in the
control group, consented to and participated in the study,
from May 1 to 30, 2024. Study demographics included 76.7 %
females (n=33), 23.3 % males (n=10), 97.7 % White (n=42), and
they patients had an average age of 54.4 years. Surveys
administered before and immediately after the intervention
were completed by 100 % of the study participants. All three
surveys, including the presurvey and postsurvey completed
immediately after and 10 days after the intervention, were
completed by 60.5 % of the study participants. The OMT
group pre-vs. immediate postsurvey results scored a statis-
tically significant decrease in the severity of nasal conges-
tion (p=0.001), postnasal drainage (p=0.002), and facial or
sinus pain or pressure (p=0.0004).
Conclusions: Our single-blinded, prospective survey find-
ings suggested that there was a benefit of OMT application for
the immediate relief of CRS symptoms, predominantly in
alleviating the severity of sinus pain or pressure. This study is
the first large study (n=43) with a control group that shows
that OMT techniques improve immediate CRS symptom relief
of nasal congestion, postnasal drainage, and facial or sinus
pain/pressure when compared to the pretreatment survey.
Our study also demonstrated that the symptomatic relief by
*Corresponding author: Eshika Kohli, BS, Lake Erie College of
Osteopathic Medicine at Seton Hill, Greensburg, PA, USA,
E-mail: ekohli47737@med.lecom.edu
Marija Rowane, DO, Osteopathic Medical Education Consortium of
Oklahoma, Oklahoma State University Medical Center, Tulsa, OK, USA.
https://orcid.org/0000-0002-6500-8279
Ashwin Shankar, DO, Supriya Nagireddi, DO and Amanpreet Kalkat,
MD, Department of Pulmonary and Critical Care, University Hospitals
Cleveland Medical Center, Cleveland, OH, USA
Cheryl Hammes, DO, FACOFP, Ohio University Heritage College of
Osteopathic Medicine, Cleveland, OH, USA
Meghan Callahan, BS, Lake Erie College of Osteopathic Medicine at Elmira,
Elmira, NY, USA
Robert Hostoffer, DO, LhD, MSMEd, MBA, FACOP, FACOI, FCCP,
Department of Pulmonary and Critical Care, University Hospitals Cleveland
Medical Center, Cleveland, OH, USA; and Allergy/Immunology Associates,
Inc., Mayfield Heights, OH, USA. https://orcid.org/0000-0001-8296-3588
J Osteopath Med 2025; aop
Open Access. © 2025 the author(s), published by De Gruyter. This work is licensed under the Creative Commons Attribution 4.0 International License.
OMT of rhinosinusitis was not sustained in 10 days. OMT
offers a safe, nonpharmacological complementary therapy to
relieve lymphatic congestion and improve mucociliary
clearance in CRS.
Keywords: chronic rhinosinusitis; lymphatic drainage; nasal
congestion; osteopathic manipulative treatment; postnasal
drainage; sinus pressure
Chronic rhinosinusitis (CRS) is a prevalent inflammatory dis-
ease of the paranasal sinuses that may significantly impair
quality of life and have implications on functional brain con-
nectivity [1–3]. The standard approach to CRS management
involves patient education, environmental controls, medical
management, and consideration of allergen-specificimmu-
notherapy and surgical management. CRS may also benefit
from the application of manual techniques through osteo-
pathic manipulative treatment (OMT), which aims to improve
venous and lymphatic circulation, sympathetic and para-
sympathetic outflow, and cervicothoracic somatic dysfunction
[4–9]. Application of manual lymphatic techniques in several
experimental animal models enhanced lymphatic circulation
of inflammatory mediators, suggesting restored fluid homeo-
stasis [10, 11]. Several small-scale cohort studies reported
significantly improved sinusitis-associated symptoms after
application of a consistent OMT sequence [12–14]. There is a
deficit of large-scale studies in the osteopathic literature
investigating temporary and sustained outcomes of OMT
applicationinCRS.Theobjectiveofthisstudywastoassess
whether OMT focused on lymphatic drainage of cranial
structures can provide immediate, as well as sustained, relief
of CRS symptoms. This study is the first large study (n=43) with
a control group that shows that OMT techniques improve
immediate CRS symptom relief of nasal congestion, postnasal
drainage, and facial or sinus pain/pressure when compared to
the pretreatment survey. Our study also demonstrated that the
symptomatic relief by OMT of rhinosinusitis was not sustained
for 10 days.
Methods
This prospective, single-blinded study (Western Copernicus
Group [WCG] Institutional Review Board [IRB] study num-
ber: 1359444) was conducted at an allergy/immunology
practice. Study participants included 43 adult patients, with
a diagnosis of CRS, refractory to conventional medical
therapy, with prior exposure to OMT. The exclusion criteria
included patients under 18 years old, pregnant, diagnosed
with CRS with nasal polyposis, prescribed oral
corticosteroids or acute antibiotics within the past week,
uncontrolled with moderate persistent asthma, and
currently utilizing tobacco products (Table 1). Patients con-
sented to the study and provided basic demographic infor-
mation, including their age, sex, and race. Patients were not
informed of their group assignment throughout the duration
of the study. The provider alternated assignments to the
OMT vs. control group equally (50/50), to achieve similar
study group numbers. An anonymized, four-question,
5-point Likert scale survey inquiring about the severity of
nasal congestion, postnasal drainage, and facial or sinus
pain/pressure, as well as the appreciation of the opportunity
for an alternative therapy, was administered prior to the
intervention (Figure 1). An OMT sequence was applied by the
same osteopathic physician to each OMT group participant
in the following order: thoracic inlet release, venous sinus
drainage, occipital-atlantal decompression, thoracic para-
spinal inhibition, facial sinus pressure, and Galbreath tech-
nique. A structural examination involving light touch was
applied to the control group participants. This involved brief,
gentle hand placement at the position of each OMT tech-
nique applied to the OMT group, without proceeding to
deeper palpation or the complete technique. The same,
anonymized 5-point Likert scale survey was administered
immediately after the intervention. Participants were pro-
vided a blank copy of the survey to save and complete 10 days
after the intervention. Each set of surveys was assigned a
number for identification and letters A through C to label the
presurvey (A), immediate postsurvey (B), and 10-day post-
survey (C). OMT group participants also received a handout
with a video link and guide to self-applied techniques to
practice at home. A small gift card was provided as
compensation to participants who returned their completed
third survey. A paired t-test was applied for statistical com-
parison between the presurvey and postsurvey.
Table :Inclusion and exclusion criteria.
Inclusion criteria Exclusion criteria
–Diagnosis of CRS
–Refractory to conven-
tional medical therapy
–No prior OMT exposure
–Under 18 years old
–Pregnant
–Diagnosed with CRS with nasal
polyposis
–Prescribed oral corticosteroids or
acute antibiotics within the past
week
–Uncontrolled with moderate
persistent asthma
–Currently utilizing tobacco products
CRS, chronic rhinosinusitis; OMT, osteopathic manipulative treatment.
2Rowane et al.: The effect of OMT on chronic rhinosinusitis
Results
A total of 43 patients, including 22 patients in the treatment
group (51.1 %) and 21 (48.8 %) patients in the control group,
consented to and participated in the study, from May 1 to 30,
2024. Study demographics included 76.7 % females (n=33),
23.3 % males (n=10), 97.7 % White (n=42), and an average age
of 54.4 years (range, 18–84 years). The surveys administered
before and immediately after the intervention were
completed by 100 % of the study participants (Figure 2). All
three surveys, including the pre- and postsurveys completed
immediately after and 10 days after the intervention, were
completed by 60.5 % of the study participants. OMT group
pre-vs. immediate postsurvey results scored a statistically
significant decrease in the severity of nasal congestion
(p=0.001), postnasal drainage (p=0.002), and facial or sinus
pain or pressure (p=0.0004) (Figure 3). Less statistical signifi-
cance was measured in the comparison OMT group pre- vs.
immediate postsurvey results scoring appreciation for an
alternate therapy (p=0.01). No statistically significant differ-
ence was demonstrated in all control group pre-vs. immediate
postsurvey results (average p=0.32) (Figure 4). No statistically
significant difference was computed, in comparison of pre- vs.
10-day postsurvey results, for both the treatment (average
p=0.28) and control groups (average p=0.22).
Discussion
Our single-blinded, prospective survey findings suggested
the benefit of OMT application for immediate relief of CRS
symptoms, predominantly in alleviating the severity of sinus
pain or pressure. Long-term efficacy of OMT for CRS symp-
tomatic relief was not strongly supported by the data. This
study expanded upon previous studies applying OMT to
sinusitis management [12–14], through implementation of a
control group, increased sample size, and evaluation of
Figure 2: The number of study participants that completed each of the
three surveys.
Figure 1: The survey administered to study
participants immediately before and after, as
well as 10 days after, the intervention.
Rowane et al.: The effect of OMT on chronic rhinosinusitis 3
sustained symptomatic relief. Limitations in location, racial
diversity, lack of a standardized scale, and duration vari-
ability of each encounter may be considered for future it-
erations of this study. Our study population consisted of
patients from one clinic, which may not be representative
of all patient populations. Although race identity was not
among the exclusion criteria, our study demographics re-
flected the demographics of the clinic’s patient population,
individuals who largely identified as “White”or “Caucasian.”
This study also did not establish specific duration for
each patient’s intervention, in an effort to individualize the
OMT to each patient’s variable somatic dysfunctions, while
maintaining consistency with the OMT sequence of tech-
niques. We did not apply a standardized scale, such as the
Sino-Nasal Outcome Test applied in Nishida et al. [12], and we
developed our survey to evaluate the impact on key symp-
toms and interest in alternative treatments.
Several small-scale studies have been documented in
the literature. Lee et al. [13] conducted a before-and-after
intervention study on 22 participants who consented to
receiving OMT for the management of sinusitis. Lee et al. [13]
applied various techniques, including: cervical soft tissue,
myofascial release (MFR), and high-velocity, low-amplitude
(HVLA); thoracic muscle energy, scapular release, and HVLA;
Chapman points; and intra-oral sphenopalatine ganglion
release. Nishida et al. [12] applied thoracic inlet MFR, su-
praorbital and infraorbital nerve release, and suboccipital
decompression in a prospective, randomized, controlled pi-
lot study that demonstrated reduced duration and severity
of symptoms in the use of select OMT compared with con-
ventional medical treatment alone. Our study also involved
thoracic inlet MFR and other variants of MFR and soft tissue,
such as thoracic paraspinal inhibition, facial sinus pressure,
and occipital-atlantal decompression, but it also explored
cranial and lymphatic techniques, such as venous sinus
drainage and the Galbreath technique. We selected these
OMT techniques based on osteopathic approaches previ-
ously described in the literature for head, eyes, ears, nose,
and throat disorders [4–6, 8, 9]. Our study offered a larger
cohort with 43 participants and was designed as single-
blinded to mitigate the risk of bias.
Lee-Wong et al. [14] also described an intervention study
conducted on 15 participants interested in receiving another
possible treatment for relief of their sinus symptoms. Results
show an immediate improvement in symptoms for 9 out
of the 15 patients, after the use of direct pressure and sinus
Figure 3: A symptomatic comparison of the treatment group short- vs. long-term presurvey vs. postsurvey. A statistically significant improvement was
demonstrated for all immediate postsurvey symptoms (p=0.0004-0.002), but it did not extend to the 10-day postsurvey symptomatic assessment
(p=0.28).
4Rowane et al.: The effect of OMT on chronic rhinosinusitis
drainage techniques [14], similar to OMT techniques applied
in the present study. However, no control group was involved
for comparison [14]. We included a control group of 21 par-
ticipants to assess the improvement in rhinosinusitis symp-
toms, in comparison to the OMT treatment group (n=22). Our
study results support these previous studies, suggesting that
OMT provides significant improvement in symptoms for
rhinosinusitis patients.
Conclusions
OMT offers a safe, nonpharmacological complementary
therapy to relieve lymphatic congestion and improve
mucociliary clearance in CRS [4–9, 12–14]. Previous studies
demonstrate that OMT techniques are an effective method to
relieve rhinosinusitis [12–14]. This study is the first large
study (n=43) with a control group that demonstrates that
OMT techniques improve immediate CRS symptom relief of
nasal congestion, postnasal drainage, and facial or sinus
pain/pressure when compared to the pretreatment survey.
Future clinical studies are needed to investigate the role of
OMT in long-term outcomes.
Research ethics: WCG IRB granted ethical approval for this
study (#1359444) on 8/23/2023. This study was conducted in
accordance with the Declaration of Helsinki (as revised in
2013).
Informed consent: Written informed consent was obtained
from all individuals included in this study.
Author contributions: All authors have accepted re-
sponsibility for the entire content of this manuscript and
approved its submission.
Use of Large Language Models, AI and Machine Learning
Tools: None declared.
Conflict of interest: None declared.
Research funding: None declared.
Data availability: The data that support the findings of this
study are available from the corresponding author, upon
reasonable request.
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