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Effect of Steam Inhalation on Nasal Mucociliary Clearance in

Normal Individuals and Nasal Disease State
Atishkumar B. Gujrathi1, Vijayalaxmi Ambulgekar2, Ashwini Handal3

Aims and objectives of our study were to study the nasal

ABSTRACT mucociliary clearance in normal individuals and in patients
Introduction: Nasal Mucociliary Clearance is a basic defense of rhinitis and sinusitis. Along with that our main aim is to
mechanism of upper respiratory tract to maintain milieu interi- study the effect of steam inhalation on nasal mucociliary
or. It removes obnoxious material and particulate matter along clearance.
with pathogenic micro-organisms. Steam Inhalation is a sim-
ple, non-pharmacological method used in allopathy, ayurve- MATERIAL AND METHODS
da and naturopathy for various different purposes. Till date This was a case control study and was carried out in the de-
there are no reports to show that steam inhalation improves partment of ENT, Dr. Shankarrao Chavan Government Med-
the nasal mucociliary clearance. Hence, this study is designed ical College, Nanded, Maharashtra, India. This study was
to know the effects of steam inhalations on nasal mucociliary
conducted between the periods of April 2014 to May 2014
clearance in normal individuals and in rhinitis and sinusitis.
Objective of the research was to study the nasal mucociliary
i.e. 2 months.
clearance in normal individuals and in patients of rhinitis and Sample size was carried out according to the earlier study
sinusitis and to study the effect of steam inhalation on nasal on mucociliary clearance conducted at our department. Con-
mucociliary clearance. sidering mean value 17 with standard deviation of 7.3 and
Material and methods: A case control study. All the study allowable error of 2 minutes. We calculated the sample size
population were subjected to saccharine test and results were for this study. So the sample size for our study was 53. As
noted, steam inhalation given and after 1 hour and 24 hour this was a case control study we have taken 53 controls i.e.
saccharine test repeated and results were tabulated. Duration normal volunteers and 54 patients having nasal symptoma-
of study: April 2014 to May 2014 = 2 months. tology. Subject selection was done as per Exclusion – Inclu-
Result: The nasal mucociliary clearance is significantly im- sion criteria as
proved by steam inhalation and after repetition of remedy,
more improvement was seen. Normal individuals (control group)
Conclusions: Research shows that steam inhalation definitely Individuals who have no rhino logical disorders at least in
improves nasal mucociliary clearance. last 1 month and desirous to participate in study were includ-
ed and children below 12 years of age and those having nasal
Keywords: Nasal mucociliary clearance, Steam inhalation, disorders in recent past or present were excluded from study.
rhinosinusitis.
Study group (cases)
Individuals having nasal disorders - rhinitis and sinusitis
INTRODUCTION and willing to participate in the study were included in the
study and children below 12 years of age and also patients
Nasal Mucociliary Clearance is a basic defense mechanism with clear evidence of osteo-meatal blockage on computed
of upper respiratory tract to maintain milieu interior.1 It re- tomography of paranasal sinuses and sinus endoscopy were
moves obnoxious material and particulate matter along with excluded from study. Especially we had focused on those
pathogenic micro-organisms. Unfortunately very little atten- patients who were not responded to any conservative or op-
tion is paid to this mechanism until last few years. erative procedure and their quality of life got hampered due
Steam Inhalation is a simple, non-pharmacological method to rhinitis or sinusitis.
used in Allopathy, Ayurveda and Naturopathy for various
different purposes. There are some stray reports indicating Methodology
that steam inhalation acts as a good adjuvant in nasal disor- As per exclusion-inclusion criteria, study population was
ders like rhinitis and sinusitis. It is a method of introducing
warm, moist air into the lungs via the nose and throat for 1
Assistant Professor, 2Professor and Head, 3Senior Resident, De-
therapeutic benefit. The hot steam moistens the nasal passag- partment of ENT, Dr. S. C. Government Medical College, Nanded
es, thus clearing the blocked nose and opens up congested (431601), Maharashtra, India.
sinuses allowing breathing more easily.2
Till date there are no reports to show that steam inhalation Corresponding author: Atishkumar B. Gujrathi, Assistant Profes-
improves the nasal mucociliary clearance. However, the rea- sor, Department of ENT, Dr. S. C. Government Medical College,
Nanded (431601), Maharashtra, India.
son to believe that effects of steam inhalations in reliving na-
sal symptoms of rhinitis and sinusitis is mostly by improving How to cite this article: Atishkumar B. Gujrathi, Vijayalaxmi
nasal mucociliary clearance. Ambulgekar, Ashwini Handal Effect of steam inhalation on na-
Hence, this study is designed to know the effects of steam sal mucociliary clearance in normal individuals and nasal disease
inhalations on nasal mucociliary clearance in normal indi- state. International Journal of Contemporary Medical Research
viduals and in rhinitis and sinusitis. 2016;3(5):1262-1264.

1262
International Journal of Contemporary Medical Research
Volume 3 | Issue 5 | May 2016 | ICV: 50.43 | ISSN (Online): 2393-915X; (Print): 2454-7379
Gujrathi, et al. Effect of Steam Inhalation on Nasal Mucociliary Clearance

selected. After thorough ENT examination and necessary ciliary clearance 1 hour and 24 hour after steam inhalation
investigations they were subjected to saccharine test. Sac- among control group i.e. normal volunteers. We found that
charine test was done by using Anderson’s technique. Af- the nasal mucociliary clearance time of normal individuals
ter noting the results patients were given steam inhalation was shortened in 75.5% of individuals after 1 hour and 24
in presence of investigator through commercially available hour of steam inhalation, means there is improvement in na-
inhaler for period of three minutes. Saccharine test was re- sal mucociliary clearance in 75.5% of individuals.
peated after 1 hour and results were noted. After a period Table No. 3 showing effect of steam inhalation on nasal mu-
of 24 hour again steam inhalation given for same duration cociliary clearance 1 hour and 24 hour after steam inhalation
and saccharine test done after 1 hour and results were noted. among study group i.e. symptomatic patients. We found that
Similar method was applied for control group. the nasal mucociliary clearance time of patients was short-
Blinding was done to avoid bias in the study. Patient’s clin- ened in 72.2% of cases after 1 hour and 83.3% of cases after
ical examination and selection in study and control group
were done by departmental residents. Patients were given
Subjects Mean NMCC SD
unique patient identification number (patient _ id) and inves-
Controls 53 8.2 min 3.8
tigators were only got patient _ id and no other information.
Cases 54 10.9 min 4.4
Investigator divided into 2 groups. They were conduct sac-
Total 107
charine test without the knowledge whether the individual
NMCC – Nasal Mucocilicary Clearance
belong to study or control group and saccharine test is pre or
Table-1: Nasal mucociliary clearance time of cases and con-
post therapy. They were submitting the report to the principal trols before steam inhalation.
investigator. Results so obtained were tabulated, analyzed
and inferred.
Effect No. of Per- No. of Percent-
Saccharine Test (Anderson’s Technique)3 of steam subjects centage subjects age
The saccharin test is inexpensive and simple to perform, and inhala- (Out of (Out of
its results are similar to those obtained using a radioactively tion on 53) 53)
labeled particle.3 Recently it has been proposed as a screen- NMCC After 1 hr After 24 hr
ing test to detect abnormal mucociliary clearance.4 We have
used the test to measure nasal mucociliary clearance. Prolonged 5 9.4 10 18.9
After taking informed and written consent, patients were No effect 8 15.1 3 5.6
subjected for saccharine test using saccharine tablet of size Shortened 40 75.5 40 75.5
1 × 1 × 1 mm. Total 53 53
The test was performed as follows Table-2: Effect of steam inhalation on control group
- Patients were kept in sitting position.
- One nostril tested at a time. Effect No. of Percentage No. of Percentage
- Saccharine tablet kept in inferior meatus 1 cm posterior of steam subjects (Out of 54) sub- (Out of 54)
to the anterior end of inferior turbinate with Tilly’s for- inhala- jects
ceps. tion on After After
- Patient was asked to do swallowing movements every NMCC 1 hr 24 hr
30 sec. Prolonged 10 18.5 6 11.1
- Patients must be instructed not to sniff, eat or drink and No effect 5 9.3 3 5.6
to avoid coughing and sneezing if possible. Shortened 39 72.2 45 83.3
- Time noted between the placement of tablet and feeling Total 54 54
of first sweet taste. Table-3: Effect of steam inhalation on Case group.
- Then patient was asked to blow nose to remove undis-
solved tablet. 45
males
After collecting all the data, we considered a hypothesis, 40
“Steam inhalation accelerates nasal mucociliary clearance” females
and applied statistical analysis was done. 35
30
RESULTS
25
In our study, among case group we found 37 males and 17
females i.e. total 54. And among control group we found 39 20
males and 14 females i.e. 53 15
Table No. 1 showing nasal mucociliary clearance time of
study population before steam inhalation. In normal indi- 10
viduals the nasal mucociliary clearance time of normal vol- 5
unteers was 8.2 minutes with standard deviation of 3.8 and
0
in symptomatic patients it was 10.9 minutes with standard study control
deviation of 4.4. group group
From table No. 2, effect of steam inhalation on nasal muco- Figure-1: Bar diagram showing sample size

International Journal of Contemporary Medical Research 1263

ISSN (Online): 2393-915X; (Print): 2454-7379 | ICV: 50.43 | Volume 3 | Issue 5 | May 2016
Gujrathi, et al. Effect of Steam Inhalation on Nasal Mucociliary Clearance

24 hours of steam inhalation, means there is improvement in was seen.

nasal mucociliary clearance in 72.2 % and 83.3 % of patients ‘p value’ after 1 hr of steam inhalation (p1) and after 24 hr
after 1 hour and 24 hours of team inhalation. of steam inhalation (p2) was calculated, both are (< 0.05)
statistically significant and found that p2 > p1.
DISCUSSION
Mucociliary clearance is a key defence mechanism in human CONCLUSIONS
upper and lower airways, and its impairment, both acquired The nasal mucociliary clearance time for the cases before
and genetically determined, predisposes to chronic infection steam inhalation was 10.9 minutes with the standard devia-
of the nose, paranasal sinuses, and respiratory tree.6,7 It pro- tion of 4.4. 1 hour after steam inhalation it was 9.3 minutes
tects the airway against ambient microorga­nisms, foreign with standard deviation of 4.2 and after 24 hours 8.7 minutes
particles and noxious substances. Its mechanism is delicate with standard deviation of 4.1 were found.
but vigorous to entrap and remove particles. Many chronic Similarly, the nasal mucociliary clearance time for the con-
nasal con­ditions may have detrimental effects on mucocil- trols before steam inhalation was 8.2 minutes with standard
iary transport. Acute upper respiratory tract infections may deviation of 3.8. 1 hour after steam inhalation it was 7.1 min
reduce the nasal mucociliary clearance by direct damage to with standard deviation of 3.2 and after 24 hours 6.7 minutes
the cilia and change in the rheological properties of the na- with standard deviation of 3.2 were found.
sal secretions.9-11 The Results of our study confirm those of Hence, Steam Inhalation Definitely Improves Nasal Muco-
Stanley et al8 that the saccharin test is an useful screening ciliary Clearance and also symptomatology of our patients
technique for measuring nasal mucociliary clearance as it is were drastically reduced.
inexpensive, simple to do and reproducible.
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10. Carson JL, Collier AM, Hu SS. Acquired ciliary defects
tients of rhinosinusitis was shortened in 72.2% of cases after
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1 hour and 83.3% of cases after 24 hours of steam inhalation, respiratory infections. N Engl J Med. 1985;312:463-8.
means there is improvement in nasal mucociliary clearance 11. Wilson R, Alton E, Rutman A, et al. Upper respirato-
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and 5.6% of patients after 1 hour and 24 hours of steam in-
halation. All the patients of nasal chronic rhinosinusitis in Source of Support: Nil; Conflict of Interest: None
whom there were improvement in NMCC, the symptoms
were drastically reduced and they were satisfied with steam Submitted: 12-03-2016; Published online: 12-04-2016
inhalation.
Hence from these results, we proudly say that the nasal mu-
cociliary clearance was significantly improved by steam in-
halation and after repetition of remedy, more improvement

1264
International Journal of Contemporary Medical Research
Volume 3 | Issue 5 | May 2016 | ICV: 50.43 | ISSN (Online): 2393-915X; (Print): 2454-7379