Further Reading
2. Articular temporomandibular disease: joint dysfunction related either to (a) displacement of the meniscus disk, or (b) diseases causing degen-
1.8.8 Complementary and Alternative ENT Medicine
O’Malley BW Jr, Weinstein GS. Robotic anterior and midline skull base surgery: preclini- cal investigations. Int J Radiat Oncol Biol Phys 2007;69(2, Suppl)S125–S128 O’Malley BW Jr, Weinstein GS, Snyder W, Hockstein NG. Transoral robotic surgery
(TORS) for base of tongue neoplasms. Laryngoscope 2006;116(8):1465–1472 Terris DJ, Haus BM, Gourin CG, Lilagan PE. Endo-robotic resection of the submandibular
gland in a cadaver model. Head Neck 2005;27(11):946–951 PubMed
Weinstein GS, O’Malley BW Jr, Snyder W, Hockstein NG. Transoral robotic sur- gery: supraglottic partial laryngectomy. Ann Otol Rhinol Laryngol 2007;116(1):
19–23
Weinstein GS, O’Malley BW Jr, Snyder W, Sherman E, Quon H. Transoral robotic sur- gery: radical tonsillectomy. Arch Otolaryngol Head Neck Surg 2007;133(12):
1220–1226
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CAM for Allergic Rhinitis, Acute Sinusitis, and Asthma
The herb butterbur ( Petasites spp.) contains the active ingredient petasin.
This appears to act upon leukotrienes. The supplement Petadolex, stan- dardized to 7.5 mg petasin, has been shown to be as effective as cetirizine hydrochloride for allergic rhinitis.
The use of probiotics (bacteria that are ingested in the form of a nutritional supplement to restore the normal gastrointestinal tract flora) has shown effectiveness in the prevention of seasonal allergic rhinitis symptoms.
A combination of herbs from traditional Chinese medicine (Reishi, shrubby Sophora, and Chinese licorice) has been advocated for asthma therapy in an effort to avoid systemic steroids. It is reported that both the herbal combination and prednisone improve FEV1 and decrease Th2 inflammatory cytokines; the herbal combination increases cortisol and interferon gamma levels whereas prednisone has the opposite effect.
The African herb Pelargonium sidoides has been positively reviewed by the Cochrane Database for use in acute sinusitis and acute bacterial bronchitis.
The report comments on “. . .eight randomized clinical trials with acceptable methodologies. Two trials showed that P. sidoides was effective in relieving all symptoms, and in particular cough and sputum production in adults with acute bronchitis. . . . Similarly, P. sidoides was effective in resolving symptoms of acute bronchitis in two out of three pediatric studies. In acute sinusitis and the common cold P. sidoides was effective in resolving all symptoms including headaches and nasal discharge in adults when taken for an extended time period.”
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CAM for Upper Respiratory Infections
In several double-blind placebo controlled trials, North American ginseng ( Panax quinquefolius ) has been found to be efficacious for influenza and common cold prevention.
Imu-Max (Ortho Molecular Products, Woodstock, IL), a proprietary blend of propolis, echinacea ( E. angustifolia and E. purpurea ), and vitamin C, is reported to be effective for cold prevention in children. Also, the use of milk fortified with probiotics was found to reduce the incidence of upper respira- tory infections in children.
However, the Cochrane Database reviewed the use of echinacea and vitamin C for both cold prevention and treatment and found them both to be ineffective.
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CAM for Tinnitus and Vertigo
Coenzyme Q 10 supplementation in individuals with coenzyme Q 10 deficiency and tinnitus has been reported to result in an improvement in tinnitus.
Ginkgo biloba and acupuncture are ineffective in all studies for tinnitus treatment. Biofeedback is helpful in some patients.
A homeopathic remedy, Vertigoheel (Heel, Inc., Albuquerque, NM), is sug- gested to be as effective as betahistine hydrochloride for moderate vertigo.
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Acupuncture
As with the rest of traditional Chinese medicine, acupuncture has been prac- ticed for thousands of years. Its efficacy has been established for multiple medi- cal conditions. The National Institutes of Health position paper on acupuncture supports its efficacy and use for seasonal allergic rhinitis and asthma.
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Herbal and Nutritional Supplements and Surgery
Many herbal and nutritional supplements interact with general anesthet- ics and with the coagulation system; therefore, all supplements and herbs should be avoided 2 weeks preoperatively.
Homeopathic Arnica montana has not been found to be effective for he- matoma prevention postoperatively.
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Dangerous CAM Practices
Ear candling is ineffective for cerumen removal and can cause severe burns.
Ephedra (from the plant Ephedra sinica , known in traditional Chinese medi- cine as “ma huang”) may cause arrhythmias and was removed from the market by the FDA in 2004. High doses of licorice may elevate blood pres- sure and cause potassium depletion (deglycyrrhizinated licorice, or DGL, does not cause these side effects).
Further Reading
Aung SKH, Chen WPD. Clinical Introduction to Medical Acupuncture. Stuttgart/New York: Thieme; 2007
Björkstén B. Evidence of probiotics in prevention of allergy and asthma. Curr Drug Tar- gets Inflamm Allergy 2005;4(5):599–604
Cohen HA, Varsano I, Kahan E, Sarrell EM, Uziel Y. Effectiveness of an herbal prepara- tion containing echinacea, propolis, and vitamin C in preventing respiratory tract infections in children: a randomized, double-blind, placebo-controlled, multicenter study. Arch Pediatr Adolesc Med 2004;158(3):217–221
Higdon J. An Evidence-Based Approach to Dietary Phytochemicals. Stuttgart/New York: Thieme; 2007
Khan M, Gross J, Haupt H, et al. A pilot clinical trial of the effects of coenzyme Q10 on chronic tinnitus aurium. Otolaryngol Head Neck Surg 2007;136(1):72–77 McElhaney JE, Gravenstein S, Cole SK, et al. A placebo-controlled trial of a proprietary
extract of North American ginseng (CVT-E002) to prevent acute respiratory illness in institutionalized older adults. J Am Geriatr Soc 2004;52(1):13–19
Predy GN, Goel V, Lovlin R, Donner A, Stitt L, Basu TK. Efficacy of an extract of North American ginseng containing poly-furanosyl-pyranosyl-saccharides for pre- venting upper respiratory tract infections: a randomized controlled trial. CMAJ 2005;173(9):1043–1048
Quirico PE. Teaching Atlas of Acupuncture, Vols. 1 and 2. Stuttgart/New York: Thieme;
2007, 2008
Ramelet AA, Buchheim G, Lorenz P, Imfeld M. Homeopathic Arnica in postoperative haematomas: a double-blind study. Dermatology 2000;201(4):347–348
Schapowal A; Petasites Study Group. Butterbur Ze339 for the treatment of intermit- tent allergic rhinitis: dose-dependent efficacy in a prospective, randomized, double-blind, placebo-controlled study. Arch Otolaryngol Head Neck Surg 2004;
130(12):1381–1386
Schram S. Traditional Chinese medicine: its approach to facial beauty. In: Bosniak S, Cantisano-Zilkha M, eds. Minimally Invasive Techniques of Oculofacial Rejuvena- tion. Stuttgart/New York: Thieme; 2005:158–164
Smit A, O’Byrne A, Van Brandt B, Bianchi I, Kuestermann K. Introduction to Bioregula- tory Medicine. Stuttgart/New York: Thieme; 2010
Weiser M, Strösser W, Klein P. Homeopathic vs conventional treatment of vertigo: a randomized double-blind controlled clinical study. Arch Otolaryngol Head Neck Surg 1998;124(8):879–885
Wen MC, Wei CH, Hu ZQ, et al. Efficacy and tolerability of anti-asthma herbal medicine intervention in adult patients with moderate-severe allergic asthma. J Allergy Clin Immunol 2005;116(3):517–524