Key Features

The use of complementary and alternative medicine (CAM) therapeutic modalities by patients is common in the United States and elsewhere. These may include traditional Chinese medicine including acupuncture, herbal medications, massage, chiropractic and osteopathic manipulations, Ayurvedic medicine, mind-body medicine, naturopathy, and homeopathy. As their use becomes more and more prevalent, more research on them is being performed. Otolaryngologic conditions for which patients may seek out CAM products include seasonal and perennial allergic rhinitis, acute and chronic rhinosinusitis, upper respiratory infections, head and neck cancer, tinnitus, and vertigo. Patients may be drawn to complements and alternatives to conventional medical therapies for various reasons, including (1) failure of the conventional medical therapy to treat a chronic medical condition, (2) perceived lack of potential side effects from a CAM modality, and (3) patient appreciation of the philosophy of the alternative practitioner regarding their treatment paradigm. Possible uses of CAM therapies are discussed here, organized by the otolaryngologic condition for which they have been advocated. As more high-quality research is done, there may be further evidence-based recommendations for novel therapies based on CAM practices.

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, standardized 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.”