Alternative Remedies for Chronic Rhinosinusitis: Are complementary and alternative treatments harmful or advisable?

Laurie McCombs, 53, has dealt with sinus problems nearly all of her adult life. Clogged sino-nasal passages made it difficult for her to breathe at night, and the congestion caused morning pressure headaches. Over-the-counter and prescription antihistamines muted her symptoms but did not address their cause. At the age of 40, she decided to take the advice of friends who had experienced relief with acupuncture. Now McCombs follows the advice of the acupuncturist, who diagnosed her with allergies to dairy products and yeast, by limiting her intake of breads and milk products. She also continues to take loratadine and has found saline irrigation with the neti pot helpful in clearing her sinuses.

Studies of complementary and alternative medicine (CAM) use in the specific setting of chronic rhinosinusitis (CRS) have been modest to date. Jon Newton, MD, and colleagues from the department of otolaryngology, head and neck surgery at the Aberdeen Royal Infirmary in Scotland surveyed patients admitted to their tertiary care center for elective otolaryngologic surgery and found that 63 percent of patients had used some form of complementary or alternative therapy (J Otolaryngol Head Neck Surg. 2009; 38(3): 355-361). What do these trends mean for otolaryngologists and their patients? Do any of these remedies show efficacy, and how should physicians solicit disclosure and provide patients with guidance regarding their use? Experts interviewed by ENT Today weighed in.

Garlic

St. John’s wort

Ginkgo

Turning to Other Solutions

It’s the chronic nature of rhinosinusitis that makes complementary therapies appealing, said Richard J. Harvey, FRACS, associate professor of rhinology/skull base surgery at St. Vincent’s Hospital in Sydney, Australia. “When conditions are chronic—and rhinology is full of them—the concept of control of a chronic inflammatory airway condition, rather than cure, is very challenging for patients,” he said.

Michael D. Seidman, MD, FACS, director of the division of otologic/neurotologic surgery and medical director of wellness for Henry Ford Health System in Detroit, Mich., said physicians are much more adept at healing acute conditions. “But for patients with chronic sinusitis who keep trying different treatments—antibiotics, surgery—and nothing’s working, it’s reasonable to consider some of the integrative medicine strategies,” he said.

But Do They Work?

Since David Eisenberg’s landmark studies in the 1990s (JAMA. 1998;280(18):1569-1575), physicians have become increasingly aware of their patients’ use of remedies outside of the allopathic armamentarium. CAM encompasses a broad range of techniques, from acupuncture, massage and yoga, to herbal products and aromatherapy. Dr. Harvey applies a scale of “plausible to preposterous” when educating his patients about CAM. Among the most plausible of late: saline irrigation, delivered by a variety of means, including the neti pot, which comes from a yogic/Ayurvedic healing tradition. Dr. Harvey is principal author of The Cochrane Collaboration review of nasal saline irrigations for symptoms of CRS (Cochrane Database of Systematic Reviews. 2007;3;CD006394). He and co-authors found reliable evidence that nasal irrigation as an adjunctive treatment “is likely to improve symptom control in patients with persistent sino-nasal disease.”