Complementary and alternative medicine in otolaryngology

Migrainous Vertigo, Tinnitus, and Ear Symptoms and Alternatives

Migraine headaches frequently coexist with vestibular symptoms such as vertigo, motion sickness, and gait instability. Migraine-related vasospasm can also damage the inner ear, which results in symptoms such as sudden sensorineural hearing loss and resultant tinnitus. The pathophysiology of these symptoms is not yet fully understood, and despite their prevalence, there is no universally approved management. This review summarizes the data on complementary and integrative medicine in treating patients with migrainous ear disorders.

Integrative Approach to Rhinosinusitis: An Update

Rhinosinusitis is characterized by inflammation of the mucosa involving the paranasal sinuses and the nasal cavity and is one of the most common and significant health care problems, with significant impairment of quality of life. Current standard conventional management of rhinosinusitis commonly uses multiple therapeutic modalities to break the cycle of chronic disease. However, to date, there is no consensus as to the optimal treatment algorithm for patients with chronic rhinosinusitis. There is a growing interest in the use of complementary and integrative medicine for the treatment of rhinosinusitis. This article update focuses on an integrative approach to rhinosinusitis.

Natural Alternatives and the Common Cold and Influenza

The use of complementary and integrative medicine has increased . It is estimated that one-third of the population of the United States uses some form of alternative medicine. Physicians should consider integrative medicine therapies . Alternative medical therapies for the common cold and influenza include herbal supplements, dietary supplements, diet, and other adjunct therapies. However, it is important to research and study these therapies. Therefore, communication with patients and other health care providers is important. This will ensure effective and positive patient care experiences. Further randomized clinical trials are necessary to further establish the role of various alternative options.

Complementary/Integrative Medicine for Pediatric Otitis Media

Complementary/integrative medicine can be used in treating otitis media, especially during the watchful waiting phase. Elimination of risk factors can be important. Products such as echinacea, xylitol, and probiotics may help in prevention. Herbal eardrop formulations can relieve symptoms in some patients. Other modalities such as homeopathy can lead to faster relief of symptoms in combination with conventional therapy. Chinese, Japanese, and other forms of traditional medicine have varying formulations with unclear safety, but initial results are promising. Most studies are limited by methodological failures and small sample sizes, emphasizing the need for continued research in this area.

Vertigoheel induced psychosis: A patient case report

Objective

To describe a case of a patient who developed psychosis after ingestion of Vertigoheel for treatment of dizziness.

Case Summary

A 28-year-old male with no psychiatric history presented with 5 days of worsening depression and psychosis. He denied current use of prescription medications, alcohol, or illicit substances. Approximately 2 weeks prior, while visiting family in Germany, he developed dizziness. A provider in Germany prescribed Vertigoheel, 1 tablet to be taken every hour until symptom improvement. This did not improve his dizziness but did cause him to feel as if he were "in a dream." He stopped taking the medication after 2 days but continued to feel amotivated with decreased appetite and insomnia. Several days later, he developed ego-dystonic auditory hallucinations. He returned to the United States; was admitted to an inpatient psychiatric unit for 4 days; and given olanzapine 5 mg at bedtime, lorazepam 1 mg every evening, and melatonin 6 mg every evening. He experienced gradual improvement in symptoms and was discharged with olanzapine 5 mg daily and outpatient follow-up.

Discussion

Vertigoheel is a homeopathic preparation containing ambra grisea, Cocculus indicus, Conium maculatum, and petroleum. Psychosis was not reported in any of the randomized controlled trials evaluating the use of Vertigoheel for treatment of vertigo. A literature search revealed no published reports of psychosis as a result of administration of any components of Vertigoheel.

Conclusion

A possible causal relationship was observed between the homeopathic supplement Vertigoheel and an acute episode of psychosis in a young male patient with no comorbidities.

Alternative therapies for chronic rhinosinusitis: A review

The use of alternative medicine in chronic rhinosinus-itis (CRS) continues to increase in popularity, for the most part without meeting the burden of being based on sound clinical evidence. New and emerging treat-ments, both natural and developed, are numerous, and it remains a challenge for otolaryngologists as well as general practitioners to keep up to date with these therapies and their efficacy. In this systematic review, we discuss a number of alternative therapies for CRS, their proposed physiologic mechanisms, and evidence supporting their use. This analysis is based on our re-view of the English-language literature on alternative therapies for CRS (we did not include any therapies that are already recommended by accepted profession-al bodies). Data collection was performed using the PubMed database (not restricted to MEDLINE due to the nature of the subject matter), the Cochrane data-bases, and bibliography searches. We found that while many of the alternative therapies we reviewed might have a firm basis in science, they lack any clinical ev-idence to support their use specifically for CRS. Some emerging therapies, such as therapeutic ultrasonog-raphy and phonophoresis, show some promise, based on a growing body of positive evidence. In addition, the use of baby shampoo, thyme honey, and bromelain additives to saline lavage in CRS are all supported by clinical evidence, as is Sinupret, an oral preparation that contains echinacea. However, higher levels of ev-idence gleaned from large, well-designed, prospective, randomized, controlled trials are needed before any of these therapies can be recommended.

Chronic Pain Management in Head and Neck Oncology

Pain is epidemic in patients with head and neck cancer. Providers involved in the care of patients with head and neck cancer should be able to describe the common pain syndromes experienced by these patients, identify patients at risk of pain, and provide multimodal treatment of chronic pain. Treatment of chronic pain encompasses analgesic medications; adjuvant pharmacotherapy, including antidepressants and anticonvulsants; interventional techniques; as well as integrative medicine.

Relationship Between Diet and Tinnitus: Korea National Health and Nutrition Examination Survey

Objectives

This study aimed to analyze the association between nutritional intake and tinnitus prevalence by evaluating a large cross-sectional cohort.

Methods

Data from the Korea National Health and Nutrition Examination Survey collected between 2013 and 2015 were analyzed. The study population consisted of 7,621 individuals aged 40 to 80 years with complete tinnitus-related data. Individuals with inadequate responses to tinnitus history, noise exposure in the work place, or subjective hearing loss were excluded. Prevalence of tinnitus and tinnitus-related annoyance, and nutrition intake were measured using this questionnaire, and associations between tinnitus and nutritional data were evaluated by binary logistic regression analysis.

Results

Subjective tinnitus was reported by 1,435 individuals with subjective normal hearing (18.8%). Prevalence of tinnitus increased with age. However, among individuals with tinnitus, the proportion of individuals with tinnitus-related annoyance was similar across age groups. Older age, female sex, lower body mass index (BMI), and less vitamin B₂ intake were significantly associated with tinnitus (P<0.001, P=0.002, P=0.041, P=0.013, respectively). Vitamin B₂ intake was significantly less in individuals with tinnitus who were middle-aged (ages 51–55 and 56–60 years, P=0.012 and P=0.020, respectively). Less intake of water, protein, and vitamin B₃ were associated with tinnitus-related annoyance (P=0.038, P=0.009, and P=0.005, respectively). Prevalence of annoyance was significantly associated with less water intake in younger ages (age 45–55 years) but with less protein and vitamin B₃ intake in older ages (age 66–80 years).

Conclusion

Reduced intake of vitamin B₂ and B₃, water, and protein may be associated with tinnitus and tinnitus-related annoyance, and further studies regarding the importance of adequate nutritional intake in the tinnitus management need to be performed.

Integrative Medicine in Head and Neck Cancer

Objective Complementary and alternative medicine, or integrative medicine, has become increasingly popular among patients with head and neck cancer. Despite its increasing prevalence, many patients feel uncomfortable discussing such therapies with their physicians, and many physicians are unaware and underequipped to evaluate or discuss their use with patients. The aim of this article is to use recent data to outline the decision making inherent to integrative medicine utilization among patients with head and neck cancer, to discuss the ethical implications inherent to balancing integrative and conventional approaches to treatment, and to highlight available resources to enhance head and neck cancer providers' understanding of integrative medicine. Data Sources Randomized controlled trials involving integrative medicine or complementary and alternative medicine treatment for cancer patients. Review Methods Trials were drawn from a systematic PubMed database search categorized into cancer prevention, treatment, and symptom management. Conclusions Integrative medicine is gaining popularity for the management of cancer and is most commonly used for symptom management. A number of randomized controlled trials provide data to support integrative therapies, yet physicians who treat head and neck cancer may be faced with ethical dilemmas and practical barriers surrounding incorporation of integrative medicine. Implications for Practice In the management of head and neck cancer, there is an increasing demand for awareness of, dialogue about, and research evaluating integrative medicine therapies. It is important for otolaryngologists to become aware of integrative therapy options, their risks and benefits, and resources for further information to effectively counsel their patients.

Use of complementary alternative medicine in pediatric otolaryngology patients: a survey

OBJECTIVE

Limited data are available about complementary alternative medicine (CAM) use in children attending otolaryngology services. We investigated the pattern of CAM use among children and adolescents attending a pediatric otolaryngology clinic.

METHODS

A cross-sectional survey. Anonymous questionnaires were administered, prior to doctor's admission, to parents accompanying young patients attending the pediatric otolaryngology clinic. Parents were asked about their general attitude toward CAM and whether they had ever consulted or considered a consultation with a CAM therapist. Subsequently, CAM users were asked to provide details on CAM modalities used and on their overall satisfaction with CAM therapy.

RESULTS

Of 308 questionnaires administered, 294 parents responded (95% response rate). Ninety-four parents (32%) reported considering CAM, or previous or current CAM use. Commonly used CAM treatments were acupuncture (44%), homeopathy (36%), and naturopathy (6.7%). CAM users assessed success rate as being: successful (37%), unsuccessful (24%) or undetermined (39%). Successful treatment was described in terms of cure, improvement and better awareness of the problem being addressed. In most cases parents stated that the primary physician was aware of CAM use by the child (74%).

CONCLUSIONS

CAM plays a substantial role among parents of children referred to pediatric otolaryngology consultation. The otolaryngologist awareness of parents' preference and interest may contribute to decision making regarding pediatric patients' management. Further investigations regarding CAM are warranted and clinical collaboration with CAM therapists should be considered.

Complementary and integrative treatments: rhinosinusitis

Rhinosinusitis is characterized by inflammation of the mucosa involving the paranasal sinuses and the nasal cavity and is one of the most common health care problems, with significant impairment of quality of life. There is a growing amount of interest in the use of complementary and integrative medicine for the treatment of rhinosinusitis. This article focuses on an integrative approach to rhinosinusitis.

The role of alternative medicine in rhinology

Complementary and alternative medicine (CAM) includes treatments from traditional Chinese medicine, homeopathy, naturopathy, herbal medicine, Ayurvedic medicine, mind-body medicine, chiropractic or osteopathic manipulations, and massage. More than 40% of patients in the United States use CAM, with 17% of CAM use related to otolaryngology diagnoses, but nearly half of CAM users do not communicate their use of these medications to their physicians. Perioperative risk of bleeding is a particular concern in surgical specialties, and knowledge of these therapies and their potential adverse effects is critical.

What do patients with chronic rhinitis do with their disease?

There are numerous patients suffering from chronic rhinitis. What kind of doctors do they consult? What are their symptoms? What kind of examinations do they do? What kind of medication do they use? Are they ever treated surgically? The objective of this study was to give answers to such questions. This is a study of 269 patients suffering from chronic rhinitis aged from 3 to 72 years. Of the 269 patients, 198 had already visited another physician before consulting us. The most common symptom was nasal obstruction. The most commonly used oral medication was antihistamines, whereas the most commonly used topical medication was sympathomimetic agents. Additionally, 2.2% of them had used natural herbs intranasally, herbs they had collected by themselves and not sold in drugstores. The operation most commonly performed was polypectomy. Sufferers from rhinitis most commonly consult general practitioners. The percentage of patients using alternative medication is limited in comparison with other studies.

Medical management in functional endoscopic sinus surgery failures

Functional endoscopic sinus surgery has a high rate of success, ranging from 75 to 95% improvement in symptoms for patients who have medically refractory chronic rhinosinusitis. However, symptom improvement does not necessarily correlate with disease resolution, and even asymptomatic patients may require long-term medical management and endoscopic surveillance if late recurrence is to be avoided. The 5 to 25% percent of patients who continue to have symptoms create a challenge for the rhinologist. Correct diagnosis is the hallmark of successful treatment of this recidivistic population, carried out through history, nasal endoscopy, and radiologic (computed tomography) studies. Particularly in patients with a primary complaint of headache or facial pain, the initial preoperative diagnosis should also be revisited, particularly before further surgical intervention is considered. Once a proper diagnosis is made, management is multifaceted, including topical and systemic medications, and mechanical improvements in the sinus drainage pathways, either through treatments in the office or revision surgery. Therefore, we strongly recommend that chronic rhinosinusitis be viewed as a medical disease in which surgery plays a therapeutic role. Frequently, persistent inflammation slowly settles down over time with appropriate medical management.