The Effect of Aviva Exercise Intervention on Pain Level and Body Awareness in Women with Primary Dysmenorrhea

Background and Objective: Primary dysmenorrhea (PD) is one of the most common clinical disorders in women of reproductive age. Our aim was to examine whether a twice-weekly thirty-minute Aviva exercise intervention could result in improvements in pain level and body awareness in patients with PD. Materials and Methods: In our prospective observational trial, the observation period included two consecutive menstrual cycles and the period of the next menstrual bleeding. The first menstrual bleeding period was the first measurement time (T1), the second was the second measurement time (T2), and the third was the third measurement time (T3) in a total of 78 volunteers. The primary endpoint was the change in the level of menstrual pain according to the Numeric Rating Scale (NRS) questionnaire between the intervention group (IG) and the control group (CG) at T1, T2, and T3. In this study, the secondary outcomes were the differences between the IG and CG regarding the different subscales of the Hungarian version of the Body Awareness Questionnaire (BAQ-H) at T1, T2, and T3; the Borg scale results of the IG; and adherence to the intervention. Statistical tests such as independent-sample t-tests, chi-square tests, Pearson's linear correlation coefficient, and repeated-measure ANCOVA were used for the analyses. Results: In total, 78 volunteers were enrolled: 40 persons in the IG and 38 in the CG. There was a significant change in the level of menstruation pain according to the NRS questionnaire between the IG and CG (p < 0.001). There was no significant difference between the IG and CG regarding the different subscales of the BAQ-H. Only in the case of the "Note responses or changes in body process" subscale of the BAQ-H was there a trend-like effect from the Aviva exercises (p = 0.086). Conclusions: The Aviva exercise could contribute to pain relief from PD. Regarding body awareness, no significant difference was found between the two groups. Due to the short detection period and prospective observational design, our results are preliminary and need to be confirmed in larger clinical trials.

The Effect of Exercise on Pulsatility Index of Uterine Arteries and Pain in Primary Dysmenorrhea

BACKGROUND

Primary dysmenorrhea (PD) is one of the most common diseases in women of reproductive age. Our aim was to examine whether a twice-weekly thirty-minute exercise intervention could result in a difference in the pulsatility index (PI) of the uterine arteries (UAs) and level of menstrual pain in patients with PD.

METHODS

In our prospective observational trial, the observation period included one spontaneous menstrual cycle and the consecutive time of the next menstruation of all participants, aged 18-44, with no extensive sports experience. In total, 73 volunteers were enrolled: 38 persons in the intervention group (IG) and 35 in the control group (CG). The intervention program was accompanied by music, performed in groups under the supervision of a qualified instructor in Hungary. The primary outcome was the difference between the IG and CG regarding the PI values of UAs at the 1st and the 2nd ultrasound (US) Doppler flowmetry. The secondary outcome was the difference between the IG and CG regarding the PI of UAs and menstrual pain measured by using the Numeric Rating Scale and adherence to the intervention. Statistical tests such as an independent-samples t-test, chi-square test, Mann-Whitney test and analysis of covariance (ANCOVA) were used during the analyses.

RESULTS

Examining the mean of the PI of UAs in the IG and the CG at the 1st and the 2nd US measurement, a significant difference was found in the change in the measured value (Z = -2.545; p = 0.011). The IG showed a significantly higher increase in the mean of the PI of UAs (Median = 0.825) than the CG (Median = 0.130). The difference in the PI of the UAs of the IG and the CG is not related to the level of pain in any group (p = 0.336) and not related to the whole sample (p = 0.354); furthermore, the level of pain did not significantly differ between the two groups.

CONCLUSIONS

Our study is the first to document the significant effects of mild-to-moderate exercise training on the change in the PI of the UAs in individuals with PD. The IG had a reduced blood flow due to circulatory redistribution after exercise. The level of menstrual pain of primary dysmenorrhea patients is independent of the level of blood circulation regarding the PI of the UAs. Randomized controlled studies with more participants and a longer research period are needed to confirm our findings regarding the association between regular exercise and the PI of UAs. The study was registered at clinicaltrials.gov: NCT04618172.

[Modern views of fever management - about the FeverFriendTM program]

INTRODUCTION

A wealth of physiological, pathophysiological and clinical evidence of the beneficial effects of childhood fever exists already. Nevertheless, the public perception of fever has become persistently negative. Sociological research attributes this to a number of factors: unjustified fear, help-seeking behaviour, complex behavioural patterns of symptom avoidance and comfort-seeking. One of the keys to this change in attitudes, in the light of recent research, is linked to changes in the awareness and understanding of health among health professionals and lay people. The role of the young generation using media is crucial.

OBJECTIVE

To establish a long-term research project to reduce the use of medication (antipyretics and antibiotics) and the number of medical consultations and to improve attitudes towards fever, using media-based e-health tools.

METHOD

An observational, adaptive, prospective cohort study was conducted. The intervention under study is a publicly available application and linked knowledge base. We collect self-reported data from caregivers. The application takes these into account and provides a decision-supporting condition classification based on a differential diagnosis algorithm.

RESULTS

1) The parameters, primary and secondary criteria to be captured in the application as well as the data collection and data processing methodology for the assessment were defined by 100% consensus of the expert partners in a Delphi process. 2) Based on the available national and international guidelines, the above parameters were used to create the condition assessment, decision aid algorithm, which can be a starting point for machine learning in the long term. 3) We evaluated baseline data on demographics, febrile events and antipyretic use from 01/11/2020 to 15/06/2022.

CONCLUSION

The FeverFriendTM project can contribute to reduce the burden of medicalisation and care burden on the existing healthcare system through evidence-based modern fever management in the care of children and adults with fever. The impact of the FeverFriendTM program on target behavioural change needs to be further investigated through data analysis. Orv Hetil. 2023; 164(5): 179-185.

Premenstruális szindróma és premenstruális dysphoriás zavar

A premenstruális szindróma (PMS) a reproduktív életkorú nők egyik leggyakoribb problémája. A fizikai, mentális és magatartásbeli tünetek a ciklus lutealis fázisában jelentkeznek visszatérően, és életminőség-romlást okoznak a mindennapi életben, befolyásolva a páciens szociális, munkahelyi és családi kapcsolatait. A tünetekre jellemző, hogy pár nap alatt a menstruáció kezdete után spontán eltűnnek. A PMS és a premenstruációs dysphoriás zavar (PMDD) diagnózisa a következő kritériumok alapján állítható fel a Premenstruális Rendellenességek Nemzetközi Társaságának (International Society for Premenstrual Disorders – ISPMD) ajánlása szerint: a PMS esetében a nőnek 1–4 tünete van, amelyek lehetnek fizikai, viselkedési vagy affektív/pszichológiai jellegűek, vagy minimum 5 tünettel rendelkezik, melyek fizikai vagy viselkedési jellegűek. Ha viszont egy nőnek 5 vagy több tünete van, és ezek közül az egyik affektív tünet (például ingerlékenység, hangulatingadozás, düh) a fizikai vagy viselkedési tünetek mellett, akkor a pontosabb PMDD diagnózisa állítható fel. A diagnózisok megerősítéséhez az általános és a nőgyógyászati anamnézis mellett a páciens által naponta kitöltött prospektív skálák, például a menstruációs tünetek hatásának és súlyosságának prospektív nyilvántartása, továbbá a problémák súlyosságának napi nyilvántartási skálája jelent segítséget. A terápiás terv kialakításakor fontos figyelembe venni a tünetek súlyosságát, a nő fogamzási terveit vagy fogamzásgátlási igényeit, a társuló egyéb betegségeit és a korábbi kezelési módszerekre adott válaszát. A terápiás lehetőségek közé tartozik – a PMS és a PMDD súlyosságától függően – a rendszeres aerob testmozgás, a stresszoldás, a kognitív viselkedésterápia, a gyógyszeres kezelések (szelektív szerotoninvisszavétel-gátlók, kombinált oralis ösztrogén-progesztin fogamzásgátlók, GnRH-agonisták). Orv Hetil. 2022; 163(26): 1023–1031.

Premenstruális szindróma és premenstruális dysphoriás zavar

A premenstruális szindróma (PMS) a reproduktív életkorú nők egyik leggyakoribb problémája világszerte a fájdalmas menstruáció és a nemi szervi gyulladások mellett. A fizikai, mentális és magatartásbeli tünetek a ciklus lutealis fázisában jelentkeznek visszatérően, és életminőség-romlást okoznak, befolyásolva a páciens szociális, munkahelyi és családi kapcsolatait. A tünetekre jellemző, hogy pár nap alatt a menstruáció kezdete után spontán eltűnnek. A PMS súlyos formája a pszichiátriában diagnosztizált és kezelt premenstruális dysphoriás zavar (PMDD). A multifaktoriális kóreredetű PMS megjelenését és súlyosságát a hypothalamus–hypophysis–ovarium tengely ciklikus működésének hatására kialakuló pszichoneuroendokrin mechanizmusok indítják el, megváltoztatva az agy neurotranszmitter- vagy neuropeptid-funkcióit, például a szerotoninerg rendszer működését. A pszichoneuroendokrin mechanizmusok hozzájárulnak a fizikai, a pszichológiai és a viselkedésbeli tünetek kialakulásához, melyeket befolyásol még az egyéb fiziológiai (például genetikai háttér, metabolikus és krónikus gyulladásos folyamatok, kronobiológiai és cirkadián működészavarok), illetve pszichikai stresszorok együttes jelenléte, illetve azok egymásra való kölcsönhatása is. Orv Hetil. 2022; 163(25): 984–989

The Immediate Effect of Sinapis nigra and Zingiber officinale as Thermogenic Substances during Footbaths: A Randomized Controlled Crossover Trial

OBJECTIVE

Warm footbaths infused with Sinapis nigra (mustard, or MU) or Zingiber officinale (ginger, or GI) are used for various thermoregulatory conditions, but little is known about how they are perceived by individuals, both short- and long-term. We analyzed the immediate and long-term effects of MU and GI on warmth and stimulus perception in healthy adults.

METHODS

Seventeen individuals (mean age 22.1±2.4 years; 11 female) received three footbaths (mean temperature was 40 ± 0.2°C, administered between 1:30 and 6:30 p.m.) in a randomized order with a crossover design: 1. with warm water only (WA), 2. with warm water and MU, and 3. with warm water and GI. Warmth and stimulus perception at the feet were assessed at the 1st, 5th, 10th, 15th, and 20th minute of the footbaths, in the late evening (EVE), and the following morning (MG). We further assessed well-being (at EVE and MG) and sleep quality (at MG). The primary outcome measure was the warmth perception at the feet at the 10th minute of the footbath.

RESULTS

At the 10th minute of the footbath, warmth perception at the feet was significantly higher with MU and GI compared to WA. The immediate thermogenic effects pointed to a quick increase in warmth and stimulus perception with MU, a slower increase with GI, and a gradual decrease with WA. Regarding the long-term effects, warmth and stimulus perception were still higher after GI compared to WA at EVE and MG. No differences were seen for general well-being and sleep quality.

CONCLUSION

Thermogenic substances can significantly alter the dynamics of warmth and stimulus perception when added to footbaths. The different profiles in the application of GI and MU could be relevant for a more differentiated and specific use of both substances in different therapeutic indications.

COVID-19: The significance of platelets, mitochondria, vitamin D, serotonin and the gut microbiota

We provide a brief review of the significance of platelets, mitochondria, vitamin D, serotonin and the gutmicrobiome in COVID-19. We hypothesize that hyperactive platelets and mitochondrial dysfunction, as well as low vitamin D level, gut dysbiosis and increased serum serotonin produced by enterochromaffin cells, may all represent important aspects in the pathophysiology of COVID-19.

Increasing Warmth in Oncological Patients: A Randomized Controlled Cross-Over Pilot Trial Examining the Efficacy of Mustard and Ginger Footbaths

OBJECTIVE

To analyze the thermogenic effects of footbaths with medicinal powders in oncological patients (ON) and healthy controls (HC).

INTERVENTION AND OUTCOMES

Thirty-six participants (23 ON, 13 HC; 24 females; 49.9 ± 13.3 years) received 3 footbaths in a random order with cross-over design: warm water only (WA), warm water plus mustard (MU, Sinapis nigra), and warm water plus ginger (GI, Zingiber officinale). Warmth perception of the feet (Herdecke Warmth Perception Questionnaire, HeWEF) at the follow-up (10 minutes after completion of footbaths, t2) was assessed as the primary outcome measure. Secondary outcome measures included overall warmth as well as self-reported warmth (HeWEF) and measured skin temperature (high resolution thermography) of the face, hands and feet at baseline (t0), post immersion (t1), and follow-up (t2).

RESULTS

With respect to the warmth perception of the feet, GI and MU differed significantly from WA (P's < .05) with the highest effect sizes at t1 (WA vs GI, d = 0.92, WA vs MU, d = 0.73). At t2, perceived warmth tended to be higher with GI compared to WA (d = 0.46). No differences were detected between ON and HC for self-reported warmth. With respect to skin temperatures, face and feet skin temperatures of ON were colder (at t0 and t1, 0.42 ≥ d ≥ 0.68) and tended to have diametrical response patterns than HC (ON vs HC: colder vs warmer after MU).

CONCLUSION

Among adult oncological patients and healthy controls, footbaths with mustard and ginger increased warmth perception of the feet longer than with warm water only. The potential impact of regularly administered thermogenic footbaths over extended periods merits further investigation for the recovery of cancer-related sense of cold.

Gut dysbiosis and serotonin: intestinal 5-HT as a ubiquitous membrane permeability regulator in host tissues, organs, and the brain

The microbiota and microbiome and disruption of the gut-brain axis were linked to various metabolic, immunological, physiological, neurodevelopmental, and neuropsychiatric diseases. After a brief review of the relevant literature, we present our hypothesis that intestinal serotonin, produced by intestinal enterochromaffin cells, picked up and stored by circulating platelets, participates and has an important role in the regulation of membrane permeability in the intestine, brain, and other organs. In addition, intestinal serotonin may act as a hormone-like continuous regulatory signal for the whole body, including the brain. This regulatory signal function is mediated by platelets and is primarily dependent on and reflects the intestine’s actual health condition. This hypothesis may partially explain why gut dysbiosis could be linked to various human pathological conditions as well as neurodevelopmental and neuropsychiatric disorders.

The Contribution of Complementary and Alternative Medicine to Reduce Antibiotic Use: A Narrative Review of Health Concepts, Prevention, and Treatment Strategies

AIM

The aim of this narrative review was to explore the potential contributions of CAM to reduce antibiotic use.

METHODS

We searched PubMed, Embase, and Cochrane Database of Systematic Reviews with a specific, limited set of search terms and collected input from a group of expert CAM researchers to answer the question: What is known about the contribution of CAM health and health promotion concepts, infection prevention, and infection treatment strategies to reduce antibiotic use? Results. The worldview-related CAM health concepts enable health promotion oriented infection prevention and treatment aimed at strengthening or supporting the self-regulating ability of the human organism to cope with diseases. There is some evidence that the CAM concepts of health (promotion) are in agreement with current conceptualization of health and that doctors who practice both CAM and conventional medicine prescribe less antibiotics, although selection bias of the presented studies cannot be ruled out. There is some evidence that prevention and some treatment strategies are effective and safe. Many CAM treatment strategies are promising but overall lack high quality evidence.

CONCLUSIONS

CAM prevention and treatment strategies may contribute to reducing antibiotic use, but more rigorous research is necessary to provide high quality evidence of (cost-)effectiveness.

Celiac plexus block increases quality of life in patients with pancreatic cancer

Background

Pancreatic cancer is a malignant disease with a high mortality rate and severe pain that is challenging to manage. To reduce the excruciating abdominal pain, opioids and adjuvant agents are conventionally used.

Objectives

PRNCPB is a treatment of neural therapy. The number of studies assessing the effect on patients' QoL is limited and inconsistent. With this study, we intended to address this issue.

Study design

A prospective nonrandomized study with a series of cases of unresectable pancreatic cancer was conducted.

Setting

The study was performed at our pain clinic under real life conditions.

Materials and methods

A total number of 16 patients with severe abdominal pain were enrolled in the study all of whom had responded to combined systemic analgesic therapy inadequately and had intolerable side effects contraindicating further increase in dose. The efficacy of this invasive, palliative analgesic procedure was evaluated 35 days after PRNCPB was performed. Primary outcomes were changed in pain intensity using the VAS questionnaire. Secondary outcomes were improved in QoL using the SF-36 questionnaire. Changes in pain medications and adverse reactions were monitored.

Results

After PRNCPB patients experienced a significant decrease (P=0.002) in pain intensity as shown by the VAS score, and a decreased opiate demand. Their QoL scores considering effect sizes also improved (P<0.001). No complications attributable to PRNCPB were observed during the study period. Additionally, no adverse drug reactions were observed.

Limitations

Detection, observation, and reporting bias can be estimated as moderate. Selection bias was not detected.

Conclusion

Our results give preliminary evidence that PRNCPB might be helpful as an additional treatment to conventional pain management in end-stage pancreatic cancer patients. PRNCPB seems to improve QoL in these patients in a time frame of at least 5 weeks after intervention.

Effects of Footbaths with Mustard, Ginger, or Warm Water Only on Objective and Subjective Warmth Distribution in Healthy Subjects: A Randomized Controlled Trial

OBJECTIVE

To analyze the short-term thermogenic effects of footbaths with warm water alone (WA) versus when combined with medicinal powders.

DESIGN

Randomized controlled trial with cross-over.

INTERVENTIONS AND OUTCOMES

Seventeen healthy volunteers (mean age 22.1 years, SD = 2.4; 11 female) received three footbaths with WA or WA combined with mustard (MU) or ginger (GI) in a randomized order. Self-perceived warmth (Herdecke warmth perception questionnaire) and actual skin temperatures (thermography) were assessed before (t0), immediately after footbaths (t1), and 10 minutes later (t2). The primary outcome was perceived warmth in the feet. Secondary outcomes were warmth perception in the face, hands and overall, as well as actual skin temperature in the feet, face, and hands.

RESULTS

Perceived warmth at the feet (primary outcome) increased significantly (all p's < .001) for MU and GI at t1 as well as for GI at t2 when compared to t0 with high effect sizes. At t2, GI differed significantly from WA (p < .001) and MU (p = .048). With regards to the secondary measures of outcome, no significant effects were seen for perceived warmth at the face or hands. Overall warmth was significantly higher at t1 compared to t0 (p = .01). Thermography assessments of skin temperature at the feet at t1 increased after all conditions (p < .001). No effects were seen in the face. At the hands, temperature decreased at t1 (p = .02) and t2 compared to t0 (p < .001).

CONCLUSION

The present study provides preliminary evidence that mustard and ginger increase warmth perception at the feet more than warm water alone, with only the effects for GI enduring at the brief follow-up.

[Effects of neural therapy on quality of live in patients with inoperable lower extremity artery disease]

Background and purpose

Our aim was to evaluate the effects of percutaneous neurolysis of lumbal sympathetic ganglions on pain and the resulting changes in quality of life with validated objective and subjective methods. To follow the adverse effects and complications of the procedure.

Methods

A prospective, non-randomized, interventional, clinical cohort study under real life conditons was conducted. The time of the observation was 6 months. Palliative neural therapy was performed to reduce the ischemic pain of the affected leg of the patients involved in the study. Prior to treatment and after 35 days, Visual Analogue Scale (VAS) was used to measure the intensity of lower limb pain. The related changes in the quality of life were followed by a general 36-Item Short-Form Health Survey (SF-36) questionnaire. We measured the changes of the patients' skin temperature and ankle/arm index. The post-treatment results were compared to the pre-treatment results. We compared the results of objective and subjective measures. We followed the side effects and complications of the pain therapy. Each of the examined subjects had obliterative (Fontaine II/b stage) arterial disease of the lower limbs, in which no revascularization intervention was feasible and their ischemic pain was of VAS≥7.

Results

Data of 124 patients (69 male, 55 female) could be evaluated. The decrease in intensity of limb pain in the post-treatment period was significant (p=0.001). Quality of life also indicated a significant improvement (p=0.004). Changes in skin temperature and ankle/arm index demonstrated significant improvement (p≤0.005): skin temperature increased from 27.6°C to 31.2°C, the ankle/arm index inceased from 0.67 to 0.83 on average. Changes in objective and subjective measures correlated with each other. No worthening of symptoms, serious adverse events or complications were observed.

Conclusion

The chemical denervation of the lumbar sympathetic ganglions with percutaneous application is a minimally invasive intervention, useful in outpatient care, which can be well tolerated by the patient without any significant side effect or complication. Its hyperaemic effect and the pain reduction of the leg can improve the quality of life of the patients.

Phosphene perception is due to the ultra-weak photon emission produced in various parts of the visual system: glutamate in the focus

Phosphenes are experienced sensations of light, when there is no light causing them. The physiological processes underlying this phenomenon are still not well understood. Previously, we proposed a novel biopsychophysical approach concerning the cause of phosphenes based on the assumption that cellular endogenous ultra-weak photon emission (UPE) is the biophysical cause leading to the sensation of phosphenes. Briefly summarized, the visual sensation of light (phosphenes) is likely to be due to the inherent perception of UPE of cells in the visual system. If the intensity of spontaneous or induced photon emission of cells in the visual system exceeds a distinct threshold, it is hypothesized that it can become a conscious light sensation. Discussing several new and previous experiments, we point out that the UPE theory of phosphenes should be really considered as a scientifically appropriate and provable mechanism to explain the physiological basis of phosphenes. In the present paper, we also present our idea that some experiments may support that the cortical phosphene lights are due to the glutamate-related excess UPE in the occipital cortex.

Newer application of Oncothermia to non-malignant diseases such as Dupuytren's contracture of the hand and chronic lower back pain lasting more than 4 weeks

Oncothermia (OTM) is based on electromagnetic interactions with the living matter. Its nano-targeting approach establishes a new paradigm. OTM could be applied not only to treat malignancies but it is feasible to apply for other diseases too. OTH is well proven method from the laboratory level to the clinical applications, promoting the natural processes, re-establishing of the synchronization between the cells. This approach allows therapy of some non-malignant diseases too. Our objective is to use OTM for the irregularities of tissue-growth and for pain syndromes as well. OTM uses precisely tuned radiofrequency (RF) current flowing through the treated part of the body. We made extensive study, proving in details the applicability of the OTM for Dupuytren's contracture and chronic low back pain, in conjunction with permanent acupuncture method, a modified process of traditional Chinese Medicine (TCM). The synergy of the ancient and the state-of-art medical knowledges is the basic method of the present research. Our results with application of OTM for chronic low back pain and Dupuytren's contracture shows definite improvements of the patients involved in the study. We measured the success with the Visual Analog Scale (VAS), with anecdotic quality of life (QoL), and the shortening of the of-work period due to the disease. We measured that VAS decreased significantly, the hand contracture became less rigid and less contracted. The QoL of patients improved and their complaints which blocked their regular activity has significantly reduced. OTM method was safe & no adverse effects were observed. Recognition of the distortions in the healthy tissue have some common principles and possibilities in TCM and OTM: both the methods recognize the loss of complexity of the living organization. Data of our recent study verified the relevant end-points of our present study: the safety, the quality of life (QoL), the prolonged painless status of the patient.

Possible role of biochemiluminescent photons for lysergic acid diethylamide (LSD)-induced phosphenes and visual hallucinations

Today, there is an increased interest in research on lysergic acid diethylamide (LSD) because it may offer new opportunities in psychotherapy under controlled settings. The more we know about how a drug works in the brain, the more opportunities there will be to exploit it in medicine. Here, based on our previously published papers and investigations, we suggest that LSD-induced visual hallucinations/phosphenes may be due to the transient enhancement of bioluminescent photons in the early retinotopic visual system in blind as well as healthy people.

Integrative versus Conventional Therapy of Chronic Otitis Media with Effusion and Adenoid Hypertrophy in Children: A Prospective Observational Study

BACKGROUND

Chronic otitis media with effusion (COME) and adenoid hypertrophy (AH) are common entities in the pediatric population. The conventional treatment approach (conventional medicine; COM) involved mainly surgery after a period of close observation. In this study, we aimed to introduce an integrative, non-invasive approach (integrative medicine; IM) for COME, AH, and associated episodes of recurrent acute otitis media, and compared outcomes with conventional treatment.

METHODS

We conducted a prospective, non-randomized study in an integrative primary care pediatric practice and a conventional pediatric otolaryngological clinic, where treatment modality was determined by patient preference. Out of a total 101 patients aged 1-8 years, integrative therapy was chosen by 46, and conventional treatment by 55. All patients had COME and AH diagnosed by an otolaryngologist and had moderate to severe hearing impairment. COM treatment was based on close observation over time, nasal decongestants and surgical intervention. In contrast, the IM involved a complex personalized approach with non-invasive interventions, non-allopathic medications, diet and patient education.

RESULTS

The number of surgical interventions (adenoidectomy, pressure-equalization tube insertion, myringotomy) was significantly less in the IM cohort (1 of 28 vs. 15 of 35 in the COM group, p < 0.001). The frequency of antibiotic use was significantly less in the IM group (p < 0.001). The frequency of analgesic use was also significantly less in the IM group (p = 0.029). Improvement in tympanometric measures (normal A-type curve) was higher in IM patients compared to expected spontaneous remission during the observation period. Improvement in audiometric measures (intact hearing) of IM patients was also higher than expected compared to spontaneous remission during the observation period.

CONCLUSION

Compared to conventional treatment, integrative treatment of patients with COME and AH showed significantly lower invasive surgical intervention rates and significantly decreased antibiotic and analgesic use. The integrative treatment was effective, safe and well tolerated.