Contraindications or Cautions:
1. Caution should be taken with patients who might have "bleeding disorders"or taking anticoagulant mediations, since they might not be a good candidatefor this procedure.
2. Patients with prior nasal or facial bone surgery, especially withmodification of the turbinates are not good candidates for nasal specificbecause the integrity of the structures is unpredictable. At least one
post-surgical case has been reported of a possible fracture of the cribiformplate with CSF leakage due to the nasal specific procedure by NCMIC (NationalChiropractic Mutual Insurance Company).
3. There has been at least one case reported where an asthma attachwas initiated by the nasal specific procedure. [S. Oliver noted this fromhis private practice experience] It was suggested therefore as a precaution,the clinician should be assured that the patients with a history of asthmahave their inhaler with them when they are going to undergo this therapy.
4. With a newborn or very young infant, there is a risk of respiratoryobstruction accompanying nasal balloon treatment. There has been one documentedcase where a loose finger cot was inhaled during treatment. Failure of thepractitioner to quickly retrieve the finger cot proved fatal. In anothercase, a child treated in the supine position inhaled mucous causing respiratoryobstruction, but was revived by digital clearing of the airway. Berman recommendsthat necessary emergency equipment should be present when attempting thisprocedure.
5. A recent article was published on this topic which found: A complicationfrom neurocranial restructuring: nasal septum fracture. It waspublished in Arch Otolaryngol Head Neck Surg 2003 Apr;129(4):472-4.Authored by: Davis GE, Murphy MP, Yueh B, Weymuller EA Jr. from Departmentof Otolaryngology-Head and Neck Surgery and Health Services, University ofWashington, and Health Services Research and Development, Veterans Affairs Puget Sound Health Care Sysytem, Seattle 98195-6515, USA. A commentabout the article was written entitled, "
Neurocranial restructuring" and homeopathy, neither complementary noralternative. The comment was published in the Arch Otolaryngol HeadNeck Surg. 2003 Dec;129(12):1356-7 and written by Atwood K.
Possible Side Effects:
1. Epistaxis can result from the nasal specific procedure andthe rare possibility of hemorrhage of ruptured veins.
2. Minor soreness over the maxillary-zygomatic or intermaxillary articulations,tenderness of the nasal passage regions, a tingling feeling in the centralmaxillary incisors, and mild soreness of the gums. In some cases, these mildsymptoms persist, though diminishing, for up to several days. Infrequently,a patient might experience a headache after treatment
3. Throat irritation due to increased drainage from sinuses may alsohappen following Nasal Specific Technique although this is temporary andgoes away in a short time.
4. Occasionally patients will report that they experience significantpain and say they would not undergo the procedure again.
III NCRT - STATE'S SCOPE OF PRACTICE LAWS
Lamm LC, Pfannenschmidt K, Chiropractic Scope of Practice: What theLaw Allows - Update 1999, Journal of the Neuromusculoskeletal System,Fall 1999; 7(3): 102-6.
The authors surveyed all state and provincial chiropractic regulatoryboards in North America regarding what diagnostic and treatment proceduresare permitted by statute in each of their practice acts. The following isfrom their article as it particularly relates to NCRT called "Nasal Specifics- (Balloon Inflation into Nasal Passages)".
Alaska NoResponse
Alabama YES
Arkansas NO
Arizona YES
California NoResponse
Colorado YES
District of Columbia NO
Florida YES
Georgia NO
Hawaii Qualified Response
Iowa NO
Idaho YES
Kansas YES
Kentucky YES
Louisiana NO
Massachusetts YES
Maryland NoResponse
Maine NO
Minnesota Qualified Response
Missouri No Response
Mississippi NO
Montana YES
North Carolina NO
North Dakota YES
Nebraska YES
New Hampshire NOResponse
New Jersey NO
New Mexico NO
Nevada YES
New York YES
Ohio NO
Oklahoma YES
Oregon YES
Pennsylvania YES
Rhode Island YES
South Carolina QualifiedResponse
South Dakota YES
Tennessee NO
Texas YES
Utah YES
Virginia NO
Washington NO
Wisconsin YES
West Virginia NO
Wyoming NO
IV. PUBLISHED PEER REVIEWED ARTICLE ABSTRACTS RELATED TO NCRT
Davis GE, Murphy MP, Yueh B, Weymuller EA Jr. A complicationfrom neurocranial restructuring: nasal septum fracture. Arch OtolaryngolHead Neck Surg 2003 Apr;129(4):472-4.
Department of Otolaryngology-Head and Neck Surgery and Health Services, University of Washington, and Health Services Research and Development, Veterans Affairs Puget Sound Health Care Sysytem, Seattle 98195-6515, USA.
Siegfried G, Cranial Adjustment: The Bilateral Nasal Specific,The American Chiropractor, 1998, Nov/Dec: 43
Abstract The bilateral nasal specific technique is steeped in thearchives of anecdotal chiropractic. It is also heavily based on the literatureof William G. Sutherland, DO., and many, many others. It is a technique thatis dynamic, specific, and incredibly powerful. Many patient have had cranialmanipulation, craniosacral therapy, torque release technique, condyle lift,and the list of cranial manipulative techniques goes on. However, to my knowledge,the bilateral nasal specific technique, although not be any means the onlymethod of adjusting or manipulating cranial bones, is by far the most impactful.Indeed, due to the lack of research studies, this places it in the clinicalresearch field at best, and anecdotal research at least.
Lamm L, Ginter L, Otitis Media: A Conservative Chiropractic ManagementProtocol Topics in Clinical Chiropractic 1998 Mar; (5)1: 18-28.
This article reviews current knowledge of otitis media and proposes conservativeinterventions for this disorder that are within the scope of practice formost chiropractors. Presented are alternative interventions that are supportableby the literature, are appropriate for chiropractic practice, and could diminishthe severity as well as the frequency of repeated infections. The articlesuggests that nasal specific is one of the procedures that can help preventfuture episodes of otitis media, facilitate the healing process, decreasethe virulence of the pathogen, or increase the resistance of the patienthost.
Oliver S, LeFebvre R, Sinusitis and Sinus Pain: Conservative ChiropracticCare Topics in Clinical Chiropractic 1998 Mar; 5(1): 39-47.
Abstract: Purpose: This article describes conservative approachesto the diagnosis and treatment of sinusitis and sinus pain. Methodology:A qualitative review of relevant literature is integrated with the consensusopinion and clinical experience of faculty at Western States ChiropracticCollege (using nominal group and delphi methodologies). Summary: specific,endonasal, and argyrol applications, as well as physiotherapy, nutrition,and joint manipulation. These modalities are useful and may present a usefulalternative or adjunct to common medical treatments.
Folweiler DS; Lynch OT, Nasal specific technique as part of a chiropracticapproach to chronic sinusitis and sinus headaches. J ManipulativePhysiol Ther, 1995 Jan;18(1): 38-41.
Abstract OBJECTIVE: To demonstrate the use of nasal specific techniquein conjunction with other chiropractic interventions in managing chronichead pain. CLINIC FEATURES: A 41-yr-old woman was treated for chronic sinusitisand sinus headaches. She had suffered weight loss and pain over a 2-monthperiod. INTERVENTION AND OUTCOME: Chiropractic manipulation and soft tissuemanipulation administered 2-6 times per month for approximately 1 yr hadminimal long-term effect on the patient's head pain. When additional interventions(nasal specific technique and light force cranial adjusting) were added tothe treatment regimen, significant relief of symptoms was achieved afterthe nasal specific technique was performed. The duration of the relief increasedwith successive therapeutic sessions, with minimally persistent symptomsafter 2 months of therapy. CONCLUSION: The nasal specific technique, whenused in conjunction with other therapies, may be useful in treating chronicsinus inflammation and pain. Further investigation is needed to identifythe usefulness of the nasal specific technique as an independent intervention,the use of the technique in other types of patients and presentations, andthe mechanism of therapeutic benefit.
Berman S, Skull dysfunction Cranio, 1991 Jul; 9 (3): 268-79.
Abstract Individuals commonly report a multitude of factors ortriggers as the cause for the onset of a headache or facial pain. The challengehas always been to understand the many triggers, the diverse symptoms, thechronological characteristics, and the variability of location associatedwith headache and facial pain. Part I of this article presents theories andhypotheses proposing that the etiology of the final common pathway of headacheand facial pain is from pain signals generated within the skull's joints.The model proposes to explain the variability in the triggers, symptoms,chronological aspects, and location known to be associated with headacheand facial pain. The evidence to support these theories is clinical and anecdotalat this time. These theories need controlled investigation. A review of theanatomy of the skull's joints is provided. Part II of this article is a step-by-stepdescription of the use of a nasal balloon device for the treatment of skulljoint dysfunction. A review of the history and use of this and other methodsof skull joint treatment is provided.
The article can be viewed in its entire unedited version on line at:
http://home.austin.rr.com/sberman
Nyiendo J, Goldeen A, Sears B, A Critical Study of the Effects of NasalSpecific Technique on Vision, Hearing and Craniofacial Measurements,The 1981 Haldeman Interprofessional Conference on the Spine, Los Angeles,CA, Feb 13-15, 1981: 62-3.
Abstract The nasal specific technique is currently being used totreat a variety of condition, including cranio-facial asymmetries and aberrationsin sight and hearing. The purpose of this study was to perform a controlled,blind investigation of three parameters reportedly changed following theuse of nasal specifics. This study is an attempt to secure reliable informationabout a technique which enjoys increasing acceptance among chiropractors,particularly in the Pacific northwest. In spite of the continued trainingof future chiropractors in the utilization of this technique, there remainsan alarming lack of acceptable scientific evidence to support the claimswhich have been and are being made. Therefore, the significance of this researchlies in its total impact on present knowledge and the clarity it can bringto an area of speculation.
.
V. UNPUBLISHED RESEARCH STUDIES RELATED TO NCRT
Nyiendo J, Goldeen A, "A study of the effects of the nasal specifictechnique on vision, hearing, and dental/craniofacial measurements "Western States Chiropractic College Library (call number of WB 905.9 N994s),
Their study concluded that claims for improved vision and hearing followingnasal specific treatment could neither be supported nor refuted. They didfind, however, changes in craniofacial measurements that did not reach significancewhen compared to a control (sham-treated) group.
VI CHIROPRACTIC COLLEGES AND NCRT RELATED TECHNIQUES
A. Western States Chiropractic College:
1. A text was developed for clinicians in the Western States ChiropracticCollege Clinic System designed for use with patients presenting to the WXCCclinic system with pain over the sinuses and/or other symptoms of rhinitis,upper respiratory infection, sinusitis, or headache pain in which sinusitisis a reasonable differential. The primary and main contributing authors areSteven E. Oliver and Ron LeFebvre respectively.
Oliver SE, LeFebvre R, Adams B, Callander W, "Nasal Specific Technique- specific procedures for treatment of - Sinusitis and Sinus Pain" ConservativeCare Pathways, Western States Chiropractic College [Adopted 5/96, Revised2/00, and to be reviewed 2/02] 2000 (Feb):15-16, 25.
In the section "Management: Specific Procedures" [pages 15 &16] Nasal Specific technique is described as follows:
"Two or three finger cots are unraveled within each other and tied tothe end of a sphygmomanometer bulb. The cots are lubricated with a watersoluble lubricating gel and guided into the nasal passage ways. The noseis lightly compressed around the valve of the sphygmomanometer bulb. Thepatient is asked to take a deep breath in and hold it. The practitioner inflatesthe sphygmomanometer bulb and quickly releases the air valve. This procedureis
repeated for each of the six nasal meatuses." [This was referenced toStephen Berman's article "Skull Pain"
2. Dr. Lester Lamm for the past 14 years has taught classes in clinicalear, nose, and throat with particular emphasis on the Endonasal Techniqueand Nasal Specific Technique. He has just recently taught three seminarsthrough the post graduate program at Western States Chiropractic College(WSCC), entitled "Chiropractic Management of Common Ear, Nose and ThroatDisorders".
March 27-28, 2000 Denver Colorado
April 24-25, 2000 Salt Lake City, Utah
June 12-13, 2000 Boise, Idaho
This extensive class covered diagnosis and treatment of ear, nose andthroat disorders with a "hands-on, skill proficiency lab" to help seminarparticipants learn how to perform Nasal Specific Technique and other relatedtherapies. Dr. Lamm is the Dean of Postgraduate Education, Deputy to theVice-President of Academic Affairs, and is a classroom instructor at WSCC.
B. Logan College of Chiropractic
Logan College of Chiropractic has a postgraduate program that teachesa 4-hr EndoNasal Technique, during the Diplomat Chiropractic Neurology (Farmington,CT), Diplomat Chiropractic Rehabilitation #4.
C. Life College of Chiropractic - West
There are reports that Dr. Daniel Murphy has been demonstrating the NCRTtechnique at Life West for 18 years.
VII BOOKS RELATED TO NCRT
Lake TT, Endo-nasal, aural and allied techniques- a manual of manipulativetechniques for conditions of anoxia and anoxemia, 3rd ed., Self PublishedManuscript, Philadelphia, PA 1942
The earliest intranasal treatments of skull joint dysfunction were knownas "finger techniques". In 1942 Lake, a chiropractor and naturopath, describeda finger technique where the practitioner works his/her little finger inthe patient's nostrils and nasal passageways.
Janse J, Houser RH, Wells BF, Chiropractic principles and technic,Chicago: National College of Chiropractic, 1947: 623
Janse et al in 1947, described a technique for distention of the nasalchamber by using a "carefully lubricated and sterile finger cot" attachedto the detached cuff Janse et al in 1947 described a technique for distentionof the nasal chamber and inflated by using a carefully lubricated and sterilefinger cot" attached to the detached cuff of a sphygmomanometer. The cotis inserted into the nasal chamber and inflated by squeezing the bulb ofthe folded sphygmomanometer cuff. They describe using a slow increase inbulb pressure that causes a "widening and distention of all the sinus openings"into the meatus. Janse advocated releasing the bulb and repeating the procedureseveral times. No indication or contraindications for the procedure weregiven in the text.
Finnell FL, Constructive chiropractic and endonasal-aural and alliedoffice techniques for eye-ear-nose and throat. 1st ed. Portland, OR:Ryder Printing Co., 1951: 145-9.
Finnell, an optometrist and chiropractor, described the nasal specificprocedure for "lymph stasis", deviation of the septum, nasal congestion,ethmoidal irritation causing asthma and frontal and maxillary sinusitis"in the 1951 edition of his EENT manual.
Finnell FL, Constructive chiropractic and endonasal-aural and alliedoffice techniques for eye-ear-nose and throat. 3rd ed. Portland, OR:Ryder Printing Co., 1955: 149-50.
Finnell describes attaching a single finger cot to the bulb of a "bloodpressure instrument" with its valve. He advocated attaching the cot to thebulb with a rubber band and inflating it to the size of a fist to check forleaks. The cot would then be deflated and wetted with cold water. Standingbeside the patient with the head supported, the cot is introduced into thenose with a lubricated wooden applicator along the floor of the inferiormeatus. When the cot is inserted as far as possible, the wooden applicatoris removed, the valve closed and the nostrils squeezed closed. The cot isinflated with a quick pressure on the bulb, forcing the inflated cot intothe throat. He describes leaving the cot inflated for 1-2 minutes in themiddle and lower meatus. A sharp instrument is kept handy for piercing thecot in the mouth, if necessary.
Failor R, McDowel B, Zapf P, Dr. Ralph Failor soft tissue manipulationseminar notes, Self Published, Palm Desert, CA 1981.
In 1981 Failor, a chiropractor and naturopath, et al, described a nasalballoon device.
VIII. AUDIO AND VIDEOTAPES RELATED TO NCRT
There are some Video and Audio Tapes of Dr. Stober which we are in theprocess of locating and hopefully gain access to for the study group.
IX. "CHIROPRACTIC" INTERVIEWS RELATED TO NCRT
The following is an excerpt from: An Interview with Dr. Richard VanRumpt(The purpose of this is to show his early involvement with nasal cranialrelease technique) 1987 American Chiropractic
Richard VanRumpt DC, Ph.C., graduated from the National College of Chiropracticin 1923 and did postgraduate work at Palmer College of Chiropractic. He isthe founder and developer of Directional Non-Force Technique (D.N.F.T.) andhas done research and taught thousands of students since 1923. He is 82 yearsold and retired. This is the first interview and information ever publishedon Dr. VanRumpt and his technique. He was very well known as a foot adjuster,teacher, and researcher and wrote a pamphlet on foot adjusting that was alsoprinted in one of Dr. Major Bertrand DeJarnette's books in 1929 or 30.
Interviewer for The American Chiropractor (TAC): What other degrees orqualifications have you acquired?
DR: I earned a Doctor of Science degree in physiotherapy from the MetropolitanSchool of Physiotherapy by attending night classes for 2 years. I also havea Naturopathic degree I obtained by teaching dissection for 4 years at PhiladelphiaCollege of Naturopathy, owned by Dr. Tom Lake. I learned Endonasal and Cranialtechniques and taught Endonasal prior to Dr. Lake, although he deserves fullcredit for popularizing it and writing a book on the subject. We were verygood friends.
X. NCRT COMMITTEE
Dr. Stephen Berman a member of the NCRT Committee Study Group. Aside frombeing a published author and all round nice guy, Dr. Berman notified us,as follows, that following testifying "On Thursday, January 11, 2001, atthe Texas Board of Chiropractic Examiners offices here in Austin, Texas,I appeared before the Technical Standards committee to give testimony onNasal Cranial Release Technique. Following my presentation, the committeevoted and found that NCRT is "SCOPE OF PRACTICE" in the state of Texas. (Noifs, ands or buts.)
I am confident now that I can prove and establish that NCRT is withinthe chiropractic scope of practice in any State or other jurisdiction andwill make myself available as an expert witness whenever and wherever my
services may be useful. "
NCRT Information