Dewi.
Anggunningrat.
Rengga.
, & Wijayani.
Fisiomu.
2025,Vol 6.
:169-187 DOI: https://10.
23917/fisiomu.
Effectiveness of Non-Invasive Physiotherapy in Optimising Mucus Drainage and Sinus Ventilation in Sinusitis: A Literature Review Luh Putu Surya Sintia Dewi1*.
Anak Agung Istri Trisia Anggunningrat2.
Duri Ray Rikardus Rengga3, 1,2,3,4 Ni Nyoman Ryanti Wijayani4 Physiotherapy Professional Study Programme.
Faculty of Medicine.
Universitas Udayana .
Indonesia Email : sintiadewi.
24031@student.
Submition :2024-07-25 .
Accepted :2025-03-12 .
Published :2025-06-01 ABSTRACT Introduction: Sinusitis is an inflammatory condition of the paranasal sinuses that can cause pain, pressure, and swelling.
From the many symptoms that can arise due to sinusitis, physiotherapy can reduce dependence on pharmacological interventions and minimise long-term side effects.
The purpose of this study was to determine the effectiveness of non-invasive physiotherapy in optimising mucus drainage and sinus ventilation in sinusitis patients.
Methods: conducted was a literature review.
The author conducted a comprehensive exploration on various academic databases that can be accessed online, including Google Scholar.
PubMed.
PEDRO, and Scopus.
The keywords used in the search were "Physiotherapy.
Intervention.
Manual Therapy.
Modalities Therapy.
Sinusitis".
The article selection process used PRISMA Results: The results showed significant differences in various clinical parameters with a p-value range between p < 0.
001 to p = 0.
039, where ultrasound therapy and lT provided more rapid improvement, while breathing exercises and manual techniques had long-term effects for impaired mucus drainage and Conclusion: Physiotherapy Interventions that can be given in cases of sinusitis, namely therapies such as ultrasound modalities, shortwave diathermy.
Low-Level Laser Therapy, manual sinus drainage, self sinus massage.
Jade Stone Mobilisation and yoga postures have proven effective in reducing symptoms of chronic sinusitis, including pain, sinus obstruction, and inflammation Keywords: Manual Therapy.
Non-invasive Interventions.
Physiotherapy.
Sinusitis.
Sinus Drainage ISSN 2722 Ae 9610
E AeISSN 2722 - 9629
INTRODUCTION
Sinusitis is an inflammatory condition of the paranasal sinuses that can cause pain, pressure and swelling.
It can be acute or chronic, with varying causes and symptoms.
Acute sinusitis is a common condition that is often caused by a viral infection, although bacteria and fungi can also be to blame.
Symptoms usually include nasal congestion, purulent discharge from the nose, facial pain, headache, fever, and general malaise.
Most people with acute sinusitis recover spontaneously within 7 to 10 days without antibiotic treatment, although 25% still experience symptoms after 14 days (Wilson & Wilson, 2.
Chronic sinusitis is sinus
FISIO MU: Physiotherapy Evidences ISSN 2722 - 9610
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inflammation that lasts more than 12 weeks.
Unlike acute sinusitis, chronic sinusitis is not always caused by a bacterial infection and does not always improve with standard treatments such as antibiotics.
This condition can be caused by infection, nasal polyps, or inflammation of the sinus lining (Kwon & O'Rourke, 2.
The prevalence of sinusitis in Indonesia is unknown, but worldwide the prevalence of chronic rhinosinusitis (RSK) ranges from 5-12%.
Epidemiological data shows that chronic sinusitis has a geographically variable prevalence, with rates in North American and European countries ranging from 4.
5% to 12% (Shi et al.
, 2.
one of the most common upper respiratory system This work is licensed under a Creative Commons Attribution-NonCommercial 4.
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Dewi.
Anggunningrat.
Rengga.
, & Wijayani.
Fisiomu.
2025,Vol 6.
:169-187 DOI: https://10.
23917/fisiomu.
disorders, sinusitis has pathophysiological and comprehensive approach in physiotherapy Inflamed sinus cavities will result reduce inflammation through drainage techniques and manual therapy.
In addition, techniques, improves blood flow, and helps prevent sinusitis recurrence holistically.
Various therapeutic strategies aim to reduce inflammation, restore mucus drainage, and improve respiratory function (Fouda et al.
, 2023.
Of the many symptoms that can arise from sinusitis, physiotherapy can reduce dependence on pharmacological interventions and minimise long-term side effects.
Therefore, this study aims to determine physiotherapy techniques that can reduce and overcome symptoms that can result from sinusitis such as impaired mucus drainage and ventilation.
in impaired mucus drainage, obstruction, and various symptoms that affect the patient's quality of life.
So physiotherapy is important in sinusitis because it can help remove mucus congestion and Figure 1.
Prima Flowchart The article selection process follows the PRISMA flow in stages (Figure .
The identification stage is carried out by searching using predetermined keywords.
Next, at the screening stage, articles are filtered based on the publication limit of the last 10 years .
At the eligibility stage, selection was made based on the relevance of the title and abstract.
Finally, articles that did not meet the criteria of text completeness and outcome measure relevance were eliminated, leaving 12 articles for analysis.
Inclusion criteria included full text articles, randomised controlled trial, quasi-experimental, cohort, cross-sectional, or systematic review research designs, and Scimago Q1-Q3 indexed.
Meanwhile, articles without full text, unsuitable design, or published more than 10 years ago were excluded from the analysis.
Selected articles were analysed using the narrative synthesis method (Rai et al.
, 2.
to identify effective physiotherapy intervention patterns in the management of sinusitis in a comprehensive and systematic manner.
METHODS
This study uses a literature review approach by systematically searching the relevant scientific literature.
This method refers to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyse.
guidelines as used in previous studies (Tsung et , 2.
Literature exploration was conducted using the academic databases Google Scholar.
PubMed.
Pedro, and Scopus, with the keywords "Physiotherapy.
Intervention.
Manual Therapy.
Modality Therapy.
Sinusitis".
The search criteria followed a Boolean logic strategy ("AND" and "OR") to increase the relevance of the results.
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Anggunningrat.
Rengga.
, & Wijayani.
Fisiomu.
2025,Vol 6.
:169-187 DOI: https://10.
23917/fisiomu.
RESULTS
Various physiotherapy interventions such as therapeutic ultrasound, manual drainage techniques, jade therapy, low-level laser therapy .
T), shortwave diathermy (SWD), nasal
septal mobilisation, yoga breathing exercises, and aerobic exercise with nasal breathing show effectiveness in improving quality of life, reducing pain, and improving symptoms of FISIO MU: Physiotherapy Evidences ISSN 2722 - 9610
E-ISSN 2722-9629
chronic sinusitis such as impaired mucus The results showed significant differences in various clinical parameters with a p-value range between p < 0.
001 to p = 0.
where ultrasound therapy and lT provided more rapid improvement, while breathing exercises and manual techniques had long-term effects for impaired mucus drainage and This work is licensed under a Creative Commons Attribution-NonCommercial 4.
0 International License.
Dewi.
Anggunningrat.
Rengga.
, & Wijayani.
Fisiomu.
2025,Vol 6.
:169-187 DOI: https://10.
23917/fisiomu.
No.
Author
and Year
Fouda et
, 2023
Title Effect of Adding
Physiotherapy Programme to the Conservative Medical Therapy on Quality of Life
and Pain in Chronic
Rhinosinusitis Patients FISIO MU: Physiotherapy Evidences ISSN 2722 - 9610
E -ISSN 2722 - 9629
Table 1.
Results Method.
Sample Size.
Variables and Intervention provided Methods:
Randomised controlled trial Sample Quantity:
Total: 68 Variables:
- Independent Variable:
Physiotherapy programme a Pulsed ultrasound therapy a Sinus manual drainage techniques a Self-sinus massage technique - Dependent Variable:
a Quality of Life (QoL): Rhinosinusitis Disability Index (RSDI) a Pressure Pain Threshold (PPT): digital Intervention:
Group A:
- Conventional medical treatment Group B:
- Pulsed Ultrasound Therapy a Frequency: 1 MHz a Intensity: 1 and 0.
5 W/cmA a Duration: 4-5 minutes/sinus - Manual Sinus Drainage Techniques a Frontal sinus drainage a Nasal passages drainage a Maxillary sinus drainage - Self-Sinus Massage Technique a Frontal sinus massage a Maxillary sinus massage a 2 times/day Results and Conclusion Research Results:
Significant differences .
<0.
between the two groups with the intervention group showing greater improvements in RSDI .
03% vs 33.
68%) and PPT .
-111% vs 35-42%) scores.
Conclusion:
The combination of ultrasound, manual drainage and self-massage therapy improved the quality of life and pain threshold of CRS patients.
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23917/fisiomu.
Gandhi Gurudut Dr.
, 2022
Frequency:
- 3 sessions/week - Total 12 sessions, 4 weeks Comparative Effectiveness of Methods:
Jade Stone Mobilisation.
Randomised Control Trial Non-Abrasive Cupping, and Sample Quantity:
Manual Drainage Technique - Total: 45 .
in Subjects with Chronic Variables:
Sinusitis: A Randomised - Independent Variable:
Clinical Trial Manual therapy:
a Jade stone mobilisation.
a Non-abrasive cupping.
a Manual drainage technique.
- Dependent Variable:
a Pressure pain threshold (PPT) using a pressure algometer.
a Quality of life (QOL) using the SNOT22 (Sinonasal Outcome Tes.
Intervention:
Group A:
- Jade stone mobilisation: Mobilisation using jade stones on the frontal and maxillary sinuses, with moisturising gel as the medium.
Group B:
- Non-abrasive cupping: The use of nonabrasive suction cups on the sinus area with movement towards the lymphatic channels.
Group C:
- Manual drainage technique: Manual drainage with gentle pressure towards the tonsillar lymph nodes.
Frequency:
- 3 sessions/week Research Results:
The results showed all groups had significant improvement .
<0.
in PPT and SNOT-22 after 2 weeks, with Jade Stone Mobilisation showing superior results at week 6 compared to the other techniques, while Non-Abrasive Cupping showed no significant difference.
Conclusion:
All three manual therapy methods (Jade Stone Mobilisation.
Non-Abrasive Cupping.
Manual Drainag.
are safe and effective to improve pain threshold and quality of life in chronic sinusitis patients.
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2025,Vol 6.
:169-187 DOI: https://10.
23917/fisiomu.
Kalekar Gurudut, - Total 6 sessions, 2 weeks Effect of Therapeutic Methods:
Ultrasound Versus Randomised Control Trial Shortwave Diathermy Sample Quantity:
Combined with Suboccipital Total: 46 patients with chronic sinusitis Release and Manual Variables:
Drainage Techniques for - Independent Variable:
Chronic Sinusitis Manual therapy:
A Randomised Clinical Trial a Types of electro therapy .
ltrasound therapy or shortwave diatherm.
- Dependent Variable:
a Pain: Visual Analogue Scale (VAS).
a Pain Pressure Threshold: Measured using a Pressure Algometer.
a Quality of Life: Measured using the SinoNasal Outcome Test-22 (SNOT-.
Intervention:
Common to Both Groups:
- Suboccipital Release - Manual Drainage: frontal sinus and maxillary sinus Group A: Ultrasound - Intensity: 1 W/cmA for the maxillary sinus 5 W/cmA for the frontal sinus.
- Frequency: 1 MHz with continuous mode.
- Duration: 5 minutes for maxillary sinuses and 4 minutes for frontal sinuses.
Group B: SWD - Intensity: As per patient tolerance with minimal warm-up settings.
- Technique: Using the cross-fire method, small electrodes are placed on opposite sides of the face .
orehead and under the ja.
- Duration: 30 minutes per session, with a FISIO MU: Physiotherapy Evidences ISSN 2722 - 9610
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Research Results:
The results showed that both groups experienced significant improvements .
<0.
in VAS, pressure algometer, and SNOT-22, with the ultrasound group showing superior effectiveness compared to SWD in reducing pain and improving patients' quality of life.
Conclusion:
Both ultrasound therapy and SWD combined with suboccipital release and manual drainage techniques are effective in reducing symptoms of chronic sinusitis.
Ultrasound therapy provides faster and more significant results than SWD.
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Abishek.
Bakshi Bhavanan i, 2019 Zarneshan , 2020 change in electrode position after 10 Frequency:
- 1 session/day - Total 5 sessions, 5 days The Efficacy of Yogic Methods:
Breathing Exercise Bhramari Randomised controlled trial.
Pranayama in Relieving Sample Quantity:
Symptoms of Chronic 60 patients Rhinosinusitis Variables:
- Independent Variable: Bhramari pranayama as an additional treatment.
- Dependent Variables: Sino-Nasal Outcome Test (SNOT-.
, which is used to measure symptoms and quality of life related to chronic sinusitis.
- Control Variables: fluticasone propionate nasal steroid spray and nasal irrigation with saline solution Intervention:
Group A:
- Receiving conventional treatment for chronic Group B:
- Bhramari pranayama:
A yogic breathing exercises A Humming - a day for 15 minutes each session.
Effects of Regular Aerobic Methods with Nasal Breathing A quasi-experimental study.
Exercise Training on Sample Olfactory Rehabilitation in 35 asthmatic women with chronic rhinosinusitis Asthmatic Patients with .
experimental group, 17 control group, mean Chronic Rhino Sinusitis 7A7.
5 year.
Results:
Group B showed a significant decrease in SNOT-22 score compared to Group A (P = Conclusion:
Bhramari pranayama is effective as an adjunct therapy to manage chronic This exercise helps reduce symptoms with better sinus ventilation and anti-inflammatory effects.
Results:
- The improvement in olfactory function was significant in the experimental group compared to the control .
=0.
- BMI decreased .
=0.
and FEV1
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Rathi.
Satralkar Golhar.
Effect of Nasal Septal Mobilisation on Chronic Sinusitis Patients: A Pilot Study Hegganna var et al.
A Randomised Controlled Study To Evaluate The Effectiveness Of Shortwave Diathermy In Acute Sinusitis FISIO MU: Physiotherapy Evidences ISSN 2722 - 9610
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Variables Independent variable: Aerobic exercise with nasal breathing.
Dependent variable:
Changes in olfactory function assessed through olfactory perception questionnaires and parameters such as the ability to smell specific odours .
Intervention Aerobic exercise with a 12-week nasal breathing pattern .
times per week, 60 minutes per sessio.
Methods:
Pilot study with descriptive design.
Sample 10 patients with chronic sinusitis.
Variables - Independent Variable:
Nasal - Dependent Variable: Change in Visual Analogue Scale (VAS) and Chronic Sinusitis Survey (CSS) scores.
Intervention:
- The nasal septal mobilisation technique was applied for 2 months.
- Pain measurement was performed using VAS before and after the intervention.
- Symptom change measurement is performed using CSS.
Methods:
Randomised Controlled Trial Sample:
a Number: 30 participants a Criteria: Acute sinusitis Variables:
=0.
in the experimental Conclusion:
Aerobic exercise with nasal breathing for 12 weeks is effective in improving olfactory function in asthmatics with chronic rhinosinusitis.
This intervention has potential as an inexpensive and safe rehabilitation method.
Results:
- There was a significant reduction in the VAS score with a mean reduction of 72 points .
= 0.
- There was no significant change in the CSS survey results regarding symptom recurrence and medication requirements .
= 0.
Conclusion:
The nasal septal mobilisation technique is effective in providing immediate pain reduction in chronic sinusitis patients.
This technique has no significant effect in reducing symptom recurrence or reducing the need for medication use.
Research Results:
SNOT-22 scores measured before and after the intervention showed that the group receiving active SWD (Group B) experienced a more significant reduction in sinusitis symptoms compared to the This work is licensed under a Creative Commons Attribution-NonCommercial 4.
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Independent variable a Standard .
nalgesics, antibiotics, and nasal decongestant.
a Short Wave Diathermy (SWD) Dependent variable a SNOT-22 (Sino-nasal Outcome Tes.
which measures 22 symptomatic problems faced by the subject Intervention:
Control group (A):
a Analgesics: Paracetamol tablets .
2 times daily, morning and night.
a Antibiotics: Amoxiclav tablets .
2 times a day, morning and evening a Antihistamines: Levocetirizine tablets .
once daily, at night.
a Nasal Decongestant: Xylometazoline Nasal Drops .
drops in each nostri.
3 times a day, morning, afternoon and a Steam Inhalation: 3 times a day, morning, afternoon and evening a Placebo Short Wave Diathermy Experimental group (B):
a Received the same treatment as Group A, but with the addition of Active Short Wave Diathermy for 20 minutes each session, performed for 5 days.
The intensity of SWD was adjusted according to the patient's tolerance.
a The SWD electrode placement method is done in a way:
i One electrode is placed on the lateral part of the forehead, and the other control group (Group A) who only received standard treatment.
p-value <0.
001 indicates a significant difference in results between the two Conclusion:
Short Wave Diathermy when used in conjunction with medical treatment, showed better results in reducing sinusitis symptoms compared to medical treatment This was shown through a significant reduction in SNOT-22 scores in the group receiving diathermy.
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Naghdi et
, 2015
electrode on the opposite side of the face, under the angle of the jaw.
i After 10 minutes, the electrode positions were swapped to the other side to ensure even heating of the Treatment chronic Methods:
rhinosinusitis using low level Pretest-posttest clinical trial .
ilot stud.
laser: a single blind placebo- Sample:
controlled trial a Sample size: 15 controlled clinical trial a Criteria: Maxillary and frontal Chronic Rhinosinusitis (CRS).
FISIO MU: Physiotherapy Evidences ISSN 2722 - 9610
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Variables:
Independent variable:
Low-level laser therapy .
T) Dependent variable:
Total symptom score (TSS), calculated based on the patient's assessment of sinusitis Intervention:
a The participants received treatment with lT three times a week for ten treatment sessions without any other drug or physiotherapy intervention.
a The area of application of lT is the skin on the upper cheeks and forehead, customised for patients with maxillary or frontal sinuses respectively a Dosage:
Laser irradiation was delivered in continuous wave mode with an irradiation time of 33 seconds for each spot and a total treatment duration of 198 seconds .
here Research Results:
Patients receiving lT therapy showed significant improvement in total symptom score (TSS) after the treatment period.
a In pretreatment (T0, week .
, the average TSS result was 12.
47 (SD
a At posttreatment (T1, week .
, the mean TSS result was 7.
40 (SD 4.
this result showed a significant difference in TSS between T0 and T1 .
= 0.
a At posttreatment (T2, week .
, the mean TSS result was 5.
33 (SD 2.
this result showed a significant difference in TSS between T0 and T2 .
< 0.
a While for T1 and T2 p = 0.
Conclusion:
Overall, this study suggests that lT can be an effective intervention to reduce symptoms of chronic sinusitis, however further studies are needed to better effectiveness with a larger sample.
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were 6 spots on each maxillary or frontal sinus as prescribe.
for each affected maxillary or frontal sinus.
da Silva and dos Santos Isoppo.
Therapeutic ultrasound as a rhinosinusitis: A systematic Methods:
A systematic review of pre-experimental controlled trials.
Sample:
- There were 309 participants with an average age of 44.
5 years.
The number of participants per study ranged from 20 to 47.
- Participants were Ou16 years old, diagnosed with chronic rhinosinusitis, without current antibiotic or anti-allergic treatment, and without a history of head or neck cancer.
Variables:
Independent:
- Therapeutic ultrasound intervention Dependent:
- Effects on chronic rhinosinusitis symptoms, as measured by:
- Facial pain.
- Nasal obstruction.
- Nasal discharge.
- Post-nasal drip.
- Loss of smell .
- Cough .
- Fatigue.
- Scores on the sino-nasal outcome tests (SNOT-20 and SNOT-.
- Volume of expelled air (VAE.
and volume of expelled liquid (VSE.
- Changes in symptom scores using an ordinal Research Results:
- Ultrasound Mode: Ultrasound is used in two modes: pulsed and continuous.
The effects of ultrasound are evaluated both after a single session and after multiple treatment sessions .
, 10, or 15 - Symptom Reduction: The use of ultrasound, both in continuous and pulsed mode, showed a significant reduction in signs and symptoms typical of chronic rhinosinusitis.
However, only two studies had a low risk of bias.
Conclusion:
While ultrasound in both modes showed positive effects in the treatment of chronic rhinosinusitis, the study noted that the studies were small, with short duration and poor design and high risk of bias.
Therefore, ultrasound cannot yet be recommended as an adjunctive method for the treatment of chronic rhinosinusitis until
larger randomised controlled studies are FISIO MU: Physiotherapy Evidences ISSN 2722 - 9610
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2025,Vol 6.
:169-187 DOI: https://10.
23917/fisiomu.
Kumari Pagare.
Effect of Steam Inhalation Versus Combination of Steam
Inhalation and Various Yoga
Postures on Chronic Sinusitis Patients: An Interventional Study FISIO MU: Physiotherapy Evidences ISSN 2722 - 9610
E -ISSN 2722 - 9629
scale or visual analogue scale (VAS).
Intervention:
Use of therapeutic ultrasound to treat symptoms of chronic rhinosinusitis.
- Ultrasound Mode:
A Pulsed: Ultrasound is delivered in pulse mode with a specific duty cycle .
1:9 or 20% duty cycl.
Continuous: Ultrasound is delivered in continuous mode without - Ultrasound Parameters:
A Frequency: 1 MHz.
A Intensity: Varies between 0.
5 W/cmA to 1 W/cmA.
A Duration: Maxillary sinus .
axillary sinu.
5 minutes per session.
Frontal sinus .
rontal sinu.
: 4 minutes per session.
- Number of sessions: 6 to 15 sessions, with a frequency of 2-3 times per week.
- Application sites: Maxillary sinus and frontal Methods:
- The study used a comparative interventional study design.
Participants were divided into two groups: Group 1 received only steam inhalation therapy and Group 2: Received a combination of steam inhalation with specific yoga postures.
- The duration of the intervention was 6 weeks.
- Evaluation was conducted using the SinoNasal Outcome Test (SNOT-.
before and after the intervention.
- The sampling technique was purposive Research Results:
The results showed that both steam inhalation alone and the combination of steam inhalation with yoga postures were equally effective in reducing symptoms of chronic sinusitis, as measured by the SinoNasal Outcome Test (SNOT-.
In the group receiving steam inhalation only, the mean SNOT-20 score dropped from 32.
A 8.
90 to 15.
29 A 7.
08 after 6 weeks.
Whereas in the group receiving a combination of vapour inhalation and yoga postures, the mean SNOT-20 score This work is licensed under a Creative Commons Attribution-NonCommercial 4.
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Mortazavi Comparison of Therapeutic .
Effects of Intra and Extra Oral Low Level Laser Radiation Maxillary Chronic Sinusitis Sample:
dropped from 31.
35 A 12.
01 to 12.
- Total number of samples: 34 individuals.
- Each group consists of 17 participants.
Conclusion:
Variables:
- Steam inhalation alone and steam Independent:
inhalation combined with yoga postures Type of intervention provided:
are both effective in reducing the - Vapour inhalation only (Group .
symptoms of chronic sinusitis.
- Combination of steam inhalation with yoga postures (Group .
Dependent:
- Changes in SNOT-20 scores, which reflect the severity of chronic sinusitis symptoms.
Intervention:
- Vapour inhalation: Using a vaporiser with a water temperature between 54.
5AC and 7AC.
Performed for 3 minutes per session.
- Yoga postures (Group .
: Performed after steam inhalation.
Each posture was repeated 5 times, with a duration of 45 seconds per Postures used: Sasankasana.
Paschimottanasana.
Uttanasana.
Adhomukhasvanasana.
Methods:
Research Results:
- This experimental - Intraoral and extraoral lT significantly .
method with a before/after improved symptoms of chronic sinusitis (SNOT-.
Sample:
- Rhinomanometry showed increased The sample consisted of 40 patients with airflow and decreased nasal resistance .
chronic sinusitis.
< 0.
Variables:
- Intraoral lT was more effective than Independent:
< 0.
- SNOT-22 .
-item Sino-Nasal Outcome Conclusion:
Tes.
Effectiveness lT Therapy:
- Rhinomanometry test results Low-level laser therapy .
T) both FISIO MU: Physiotherapy Evidences ISSN 2722 - 9610
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Dependent:
intraoral and extraoral is a safe and - Type of laser therapy .
ntraoral vs extraora.
effective method to reduce the symptoms Intervention:
of chronic maxillary sinusitis.
The intervention was lT through two approaches: intraoral .
n the oral vestibule from the canine to the first mola.
and extraoral .
long the ala-tragus line at an angle of 15-30 degrees negative to the zygomatic arc.
, with a duration of 40 minutes per session for 8 sessions every two days, where irradiation was performed at 10 points 3 mm apart for each FISIO MU: Physiotherapy Evidences ISSN 2722 - 9610
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DISCUSSION