Honey in otorhinolaryngology: when, why and how?

Natural Compounds for Preventing Ear, Nose, and Throat-Related Oral Infections

Oral health is an essential element in maintaining general well-being. By preserving the complex equilibrium within the oral microbial community, commensal microorganisms can protect against extrinsic pathogenic threats. However, when an imbalance occurs, the organism is susceptible to a broad range of infections. Synthetic drugs can be administered to help the body fight against the fungal, bacterial, or viral burden. Nonetheless, they may produce undesirable consequences such as toxicity, adverse effects, and drug resistance. In this respect, research has focused on finding safer and more efficient alternatives. Particularly, increasing attention has been drawn towards developing novel formulations based on natural compounds. This paper reviews the plant-based, algae-based, and beehive products investigated for their antimicrobial properties, aiming to thoroughly present the state of the art on oral infection prevention in the ear, nose, and throat (ENT) field.

Potentials of Antitussive Traditional Persian Functional Foods for COVID-19 Therapy†

Coronavirus disease 2019 is a worldwide pandemic resulting in a severe acute respiratory syndrome. Remdesivir is the only FDA-approved drug for hospitalized patients older than age 12. It shows the necessity of finding new therapeutic strategies. Functional foods (FFs) could have co-therapeutic and protective effects against COVID-19 infection. Traditional Persian medicine (TPM), one of the safest and most popular schools of medicine for hundreds of years, has recommended potential FF candidates to manage such a global pandemic. To reveal the potential of TPM in terms of antitussive FFs, traditional Persian pharmacopoeia "Qarabadin-e-Salehi" was searched using the keywords "Soaal" and "Sorfeh." Also, a search of MEDLINE, PubMed Central, Google Scholar, and Science Direct was performed for the relevant literature published from the inception up to March 2021. A combination of search terms including "cough, antitussive, antioxidant, anti-inflammation, antiviral, COVID-19, mucoactive, mucolytic, expectorant, and mucoregulatory" was also applied. The potential mechanism of action in SARS-CoV-2 infection was discussed. Twelve TPM FFs were found including Laooqs, Morabbas, a Saviq, a soup, and a syrup. They are combinations of two to seven ingredients. Natural compounds of mentioned formulations have the main pharmacological mechanisms including antiviral, anti-inflammatory, antioxidant, antihistamine, bronchodilator, immunomodulatory, and mucoactive effects as well as central or peripheral antitussive activities. FFs are cost-effective, easily accessible, and safe options for both treatment and prevention of COVID-19. They might have positive psychological effects along with their pharmacological effects and nutritional virtues. They could also manage persistent respiratory discomforts after recovery from COVID-19.

Evolution of honey resistance in experimental populations of bacteria depends on the type of honey and has no major side effects for antibiotic susceptibility

With rising antibiotic resistance, alternative treatments for communicable diseases are increasingly relevant. One possible alternative for some types of infections is honey, used in wound care since before 2000 BCE and more recently in licensed, medical-grade products. However, it is unclear whether medical application of honey results in the evolution of bacterial honey resistance and whether this has collateral effects on other bacterial traits such as antibiotic resistance. Here, we used single-step screening assays and serial transfer at increasing concentrations to isolate honey-resistant mutants of Escherichia coli. We only detected bacteria with consistently increased resistance to the honey they evolved in for two of the four tested honey products, and the observed increases were small (maximum twofold increase in IC90). Genomic sequencing and experiments with single-gene knockouts showed a key mechanism by which bacteria increased their honey resistance was by mutating genes involved in detoxifying methylglyoxal, which contributes to the antibacterial activity of Leptospermum honeys. Crucially, we found no evidence that honey adaptation conferred cross-resistance or collateral sensitivity against nine antibiotics from six different classes. These results reveal constraints on bacterial adaptation to different types of honey, improving our ability to predict downstream consequences of wider honey application in medicine.

Honey as a Treatment in Otorhinolaryngology: A Review by Subspecialty

OBJECTIVES

To provide an up-to-date review of honey's effectiveness and potential applications in otorhinolaryngology.

METHODS

A literature search of the online databases PubMed, EMBASE, and Cochrane Central Register of Controlled Trials was conducted.

RESULTS

Sixty-three studies were identified within head and neck surgery (n = 23, 36%); pediatric otolaryngology (n = 18, 29%); rhinology, sinus, and skull base surgery (n = 11, 17%); otology (n = 6, 10%), facial plastic and reconstructive surgery (n = 3, 5%); and laryngology (n = 2, 3%). Studies included 6 meta-analyses, 44 randomized control trials, 5 case reports, and 8 animal models or in vitro studies. Of 55 clinical studies, 50 reported Level 1 evidence (prospective randomized control trials), and 5 reported Level 4 evidence (case series). The evidence level by subspecialty was: head and neck surgery (Level 1 n = 23), pediatrics (Level 1 n = 18), rhinology (Level 1 n = 7, level 4 n = 1), otology (Level 1 n = 1, Level 4 n = 3), facial plastics and reconstructive surgery (Level 4 n = 1), and laryngology (Level 1 n = 2).

CONCLUSIONS

Honey can be used for a variety of otolaryngology conditions. The highest quality meta-analyses support oral honey for prevention and treatment of oral mucositis in cancer patients, cough associated with upper respiratory infection in children, and pain control after tonsillectomy. Further research will likely justify broader applications.

Honey prevents oral mocositis in children undergoing chemotherapy: A quasi-experimental study with a control group

BACKGROUND

There are numerous pharmacological and non-pharmacological treatment options available in the treatment of oral mucositis. However, in spite of so many methods and products, medical professionals have not come to a consensus as to which of these offer the best results.

OBJECTIVES

This study was conducted to assess the effect of oral care with honey on children undergoing chemotherapy for the prevention and healing of oral mucositis.

METHODS

This quasi-experimental study was conducted on children undergoing chemotherapy. The study group consisted of 83 children who attended clinics and polyclinics for chemotherapy. All the children were included in the study period. The study was completed with a total of 76 children except for seven patients who were excluded from the study. The data were collected using a form and the World Health Organization Mucositis Assessment Index. The data were analyzed using percentage distributions, means, a chi-square test, a t-test, a variance analysis, and a Friedman test. Ethics approval of the study was obtained from the Institution Ethics Committee.

RESULTS

It was found that the severity of oral mucositis in the children in the experimental group was significantly less than the control group. The mucositis recovery period in the experimental group was significantly shorter than the control group.

CONCLUSION

Regular oral care with honey for children undergoing chemotherapy for hematological cancers prevents mucositis and also accelerates recovery of it when started after mucositis onset.

Honey and beehive products in otorhinolaryngology: a narrative review

BACKGROUND

Honey and beehive products were rediscovered as an alternative treatment in wounds. The medicinal properties also raised interest of their use in Otorhinolaryngology.

OBJECTIVE OF REVIEW

To give an overview of the effectiveness of beehive products in Otorhinolaryngology.

TYPE OF REVIEW

Narrative.

SEARCH STRATEGY AND EVALUATION

A literature search of the databases PubMed, EMBASE and Cochrane was performed from the last two decades till December 2014. The search terms 'honey', 'propolis' or 'royal jelly' were used. Articles, which evaluated the effectiveness of beehive products in Otorhinolaryngology, were included. The quality assessment of included studies was performed using the Cochrane Collaboration's risk of bias tool.

DISCUSSION AND CONCLUSION

A total of 36 studies were identified and evaluated. Eighteen studies investigated their effect in oral infections, seven in infection of the respiratory tract, six in rhino-sinusal diseases, four investigated the use in tonsillectomy and head and neck surgery and one study explored the preventive effect in otitis media. Honey can be considered as effective (additional) treatment in mucositis, childhood cough, persistent post-infectious cough and after tonsillectomy. Propolis may have a role in the treatment of (aphthous) stomatitis, mouth ulcer and prevention of acute otitis media. Royal jelly showed to reduce mucositis. In the presented studies, beehive products proved to be safe, with only minor adverse reactions. Studies showed to be diverse and had some methodological limitations.

Activity of Drill® lozenges on the main microorganisms responsible for upper respiratory tract infections

OBJECTIVES

The treatment of sore throat, considered to be essentially due to viral infection, does not require the use of antibiotics. The recommended treatment is therefore based on the use of topical anaesthetics and antiseptics. Throat lozenges play a leading role in topical treatment by allowing immediate, massive and persistent release of the active molecule at the site of infection. The objective of this study was to demonstrate the short-term and long-term in vitro antimicrobial efficacy of Drill(®) lozenges in relation to the main pathogens responsible for upper respiratory tract infections.

MATERIAL AND METHOD

The bactericidal and virucidal activity in relation to the main microorganisms responsible for upper respiratory tract infections, including the H1N1 influenza virus, was evaluated after short (5 minutes) and long (3h) contact times, according to a methodology complying with European standards for the evaluation of chemical antiseptics and disinfectants. In parallel, the global antibacterial activity was determined on 30 strains representative of the resident flora by determination of maximum inhibitory dilutions (MID) and maximum bactericidal dilutions (MBD).

RESULTS

Drill(®) lozenges presented an antibacterial activity inducing significant (>90%) destruction of the main upper respiratory tract pathogens after a 5-minute contact time at high concentration and after a 3-hour contact time after dilution. Drill(®) lozenges also exerted an antiviral activity inducing 2 log (99%) destruction of the H1N1 virus after a 5-min contact time at high concentration, with maintenance of this activity after dilution (3h). A homogeneous antibacterial activity was observed on the resident flora.

CONCLUSION

These in vitro tests confirm the value of chlorhexidine lozenges in the treatment of upper respiratory tract infections such as sore throat.

The effect of Tualang honey in enhancing post tonsillectomy healing process. An open labelled prospective clinical trial

INTRODUCTION

Tonsillectomy is a common operative procedure performed for tonsillar hypertrophy complicates with recurrent tonsillitis. Among the post tonsillectomy morbidities, post operative wound healing is of utmost importance to be effectively managed as it will interfere with patient recuperation from surgery. Tualang honey has been shown to accelerate wound healing in postoperative patients.

OBJECTIVE

The aim of this study was to investigate the effect of Tualang honey in enhancing healing process in post tonsillectomy patients.

METHODOLOGY

In this open labelled prospective study, the selected paediatric patients were randomized into two groups. The 35 subjects in the Tualang honey-antibiotic group received 3 mls of Tualang honey intraoperatively followed by 4 mls of oral Tualang honey three times daily for seven days. Concurrently, 25mg/kg of intravenous Sultamicillin was given three times daily for two days followed by oral Sultamicillin twice daily for five days. The 28 subjects in the antibiotic only group received intravenous at 25mg/kg Sultamicillin kg for two days followed by oral Sultamicillin twice daily for five days. The healing process was assessed at day 1, day 3, day 7 and day 14 postoperatively by semiquantitative endoscopic photograph examination of both tonsillar fossae.

RESULTS

The average ages for the treatment group and the control groups were 9 and 11 years old respectively. Wound healing was significantly faster in the treatment group in both tonsillar fossae compared to the control group (left: p-value = <0.001; right: p-value = <0.001).

CONCLUSION

Tualang honey has positive effect in enhancing healing process in post tonsillectomy patient. It is easy to use topically, safe to consume orally and available at low cost locally. Overall it can be used as an excellent adjunct therapy for post operative patients.