Mind-Body Therapies in the Management of Otolaryngologic Disease: A State-of-the-Art Review of Randomized Controlled Trials.

OBJECTIVE: To review and assess the peer-reviewed literature on the utility of mind-body therapy (MBT) as an adjunct treatment in the management of otolaryngologic disease. DATA SOURCES: PubMed, Embase, and Cochrane. REVIEW METHODS: Randomized control trials (RCTs) of MBTs in the management of otolaryngologic disease from 2002 to 2022 were identified and included according to predefined criteria. Interventions requiring expensive equipment were excluded because the goal of MBT is to be cost-conscious. All studies were subjected to a two-stage blinded screening, extraction, and appraisal process. The outcomes of the intervention and control groups were compared. CONCLUSION: RCTs of MBTs, including breathing exercises (4), aromatherapy (2), biofeedback (2), meditation, (2), and yoga (2), have been studied in several otolaryngologic conditions, including septoplasty/rhinoplasty (3), head and neck cancer (2), facial palsy (2), and tinnitus (2). Most studies were of moderate risk of bias on appraisal, and each MBT studied was found to significantly reduce subjective and objective distress associated with the otolaryngologic condition in question. IMPLICATIONS FOR PRACTICE: Despite a paucity of strong evidence supporting the universal use of MBTs, our review suggests that MBTs are cost-effective and easily deployable complementary tools in the management of otolaryngologic disease. Future large, methodologically rigorous RCTs are needed to address the limitations of the included studies, such as improper blinding and inappropriate statistical analysis. As MBTs are studied further, a case for their current use can be made because of their low cost and minimal risk to patients.

Acupuncture and the Otolaryngology-Head & Neck Surgery Patient.

The use of acupuncture among US adults was estimated at nearly 40% in 2012. A study from the United Kingdom in 2010 found 60% of otolaryngologic patients had used a form of complementary or integrative medicine, with greater than a third in the last year alone. Acupuncture, a therapeutic modality of traditional Chinese medicine, has been used for millennia in Asian countries. Within otolaryngology, acupuncture has been used for a variety of conditions encompassing otology, laryngology, rhinology, and pediatrics. Herein, we review the current literature on the applications of acupuncture for a range of ENT disorders.

Evaluation of Acupuncture's Efficacy Within Otolaryngology.

OBJECTIVES: Acupuncture is a form of Traditional Chinese Medicine that has minimal side effects, is cost-effective, can be easily administered, and may serve as a useful non-pharmaceutical therapy for certain conditions. However, studies and clinical practice guidelines are inconsistent in conclusions and recommendations about acupuncture. This qualitative review addresses the evidence available for acupuncture use in otolaryngology. METHODS: A literature review was completed using EMBASE, PubMed, and The Cochrane Collection for conditions within otolaryngology that have used and studied the comparative effects of acupuncture. Thirty studies ultimately fit the inclusion criteria and were used for this qualitative review. RESULTS: Studies included in this review contained a variety of conditions within otolaryngology, including allergic rhinitis, chronic rhinitis, tinnitus, sudden sensorineural hearing loss, post-viral olfactory dysfunction, dysphonia, and tonsillectomies. CONCLUSION: Given its safety profile, cost, and perceived benefit, recommendations and guidelines supporting acupuncture as an alternative or adjunctive therapy are surfacing for certain conditions such as allergic rhinitis. However, stronger conclusions with specific recommendations are limited by varied methodology between majority of the studies. Additional high-quality randomized control studies with low risk of bias are required to continue to assess the effects of acupuncture in the field of otolaryngology before stronger recommendations can be made on other conditions.

History of Cranial Nerve-Implanted Stimulators in Otolaryngology.

This article aims to clearly understand the historical development of cranial nerve-implanted stimulators in otolaryngology. The authors also discuss cranial nerve history; initial theory of the functional concept of animal spirit; electrical nerve impulse theory; first electrical otolaryngology cranial nerve stimulation devices; and the development of implanted stimulators.

Demonstrating the benefits of a multidisciplinary aerodigestive program.

OBJECTIVES/HYPOTHESIS: The Aerodigestive Program (the Aero Program) at Children's Hospital Colorado is a multidisciplinary program focused on airway, digestive, and lung disorders in complex children, involving collaboration between gastroenterology, pulmonology, anesthesiology, and otolaryngology in clinic and operating room. These programs have proliferated as institutions focus on providing greater care coordination and family satisfaction. However, few cost, charge, and satisfaction data exist to support these resource-intensive programs. The goal of this study was to investigate the value of combined triple endoscopy delivered by the Aero Program through analysis of institutional charges, direct costs, operating room efficiency metrics, and parent satisfaction. STUDY DESIGN: Program evaluation. METHODS: Finance, satisfaction, efficiency, and quality-of-care metrics were evaluated within and outside of the Aero Program through retrospective queries of electronic health records, administrative databases, and parent surveys at our institution. RESULTS: Mean anesthesia time in the Aero Program was 54 minutes (49-60; 95% confidence interval), which was significantly less (P < .0001) than the estimated 89 minutes of having the three procedures done separately. Average charges and average direct costs for triple endoscopy were 38.8% and 41.9% less than the sum of the averages for separate procedures, respectively. Parent satisfaction was high for the Aero Program care. CONCLUSIONS: As organizations move toward greater coordination of care for complex patients, multidisciplinary programs must demonstrate their value by delivering cost-effective care. Aerodigestive programs have the potential to provide satisfying care that is less costly to the organization, insurer, and family. These programs represent a step in the evolution toward higher value care and value-based payment methodology. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:521-525, 2020.

Broncalt®, class II medical device, in patients with acute upper airways disease: a survey in clinical practice.

Inflammation is a common pathogenic mechanism involved in many otorhinolaryngological (ORL) disorders. Broncalt® is a class II Medical Device containing: thermal water (Medesano, PR, Italy), hyaluronic acid, and grapefruit seed extract. It has been reported that it exerted a safe and effective anti-inflammatory, washing, and antimicrobial activity by virtue of these components. Therefore, the aim of the current survey, conducted in clinical practice of 84 Italian ORL centers, was to evaluate its safety and efficacy in the treatment of patients with acute upper airways disease. The 3,533 (1,797 males, mean age 43.5 years) patients were evaluated at baseline (T0) and after a 2-week treatment (T1) with or without Broncalt®. Signs and symptoms severity were measured by visual analogue scale. Broncalt® significantly and safely diminished the clinical features in all sub-groups (p<0.001 for all). Interestingly, Broncalt® significantly induced a faster symptom relief already within 3 days after the start of the treatment. In conclusion, Broncalt® is a class II Medical Device able to exert a safe and effective activity in patients with acute ORL disorders.

Broncalt®, class II medical device, in patients with chronic upper airways disease: a survey in clinical practice.

Inflammation and infection are common pathogenic mechanisms involved in many otorhinolaryngological (ORL) chronic diseases. Broncalt® is a class II Medical Device containing: thermal water (Medesano, PR, Italy), hyaluronic acid, and grapefruit seed extract. It could exert a safe and effective anti-inflammatory, washing, and antimicrobial activity by virtue of these components. Therefore, the aim of the current survey, conducted in clinical practice of 84 Italian ORL centers, was to evaluate its safety and efficacy in the treatment of patients with chronic upper airways disease. The 1,817 (958 males, mean age 49 years) patients were evaluated at baseline (T0) and after one (T1) and two (T2) weeks of treatment, they were treated or not treated with Broncalt®. Signs and symptoms severity were measured by visual analogue scale. Broncalt® significantly, quickly, and safely diminished the clinical features in all sub-groups (p<0.001 for all). In conclusion, Broncalt® is a class II Medical Device able to exert a safe, quick, and effective activity in patients with chronic ORL disorders.

Broncalt®, class II medical device, in patients with chronic relapsed upper airways disease: a survey in clinical practice.

Inflammation and infection are common pathogenic mechanisms involved in many otorhinolaryngological (ORL) chronic diseases. Broncalt® is a class II Medical Device containing: thermal water (Medesano, PR, Italy), hyaluronic acid, and grapefruit seed extract. It could exert a safe and effective anti-inflammatory, washing, and antimicrobial activity by virtue of these components. Therefore, the aim of the current survey, conducted in clinical practice of 84 Italian ORL centers, was to evaluate its safety and efficacy in the treatment of patients with chronic upper airways disease. The 1,817 (958 males, mean age 49 years) patients were evaluated at baseline (T0) and after one (T1) and two (T2) weeks of treatment, they were treated or not treated with Broncalt®. Signs and symptoms severity were measured by visual analogue scale. Broncalt® significantly, quickly, and safely diminished the clinical features in all sub-groups (p<0.001 for all). In conclusion, Broncalt® is a class II Medical Device able to exert a safe, quick, and effective activity in patients with chronic ORL disorders.

Honey as a Treatment in Otorhinolaryngology: A Review by Subspecialty.

OBJECTIVES: To provide an up-to-date review of honey's effectiveness and potential applications in otorhinolaryngology. METHODS: A literature search of the online databases PubMed, EMBASE, and Cochrane Central Register of Controlled Trials was conducted. RESULTS: Sixty-three studies were identified within head and neck surgery (n = 23, 36%); pediatric otolaryngology (n = 18, 29%); rhinology, sinus, and skull base surgery (n = 11, 17%); otology (n = 6, 10%), facial plastic and reconstructive surgery (n = 3, 5%); and laryngology (n = 2, 3%). Studies included 6 meta-analyses, 44 randomized control trials, 5 case reports, and 8 animal models or in vitro studies. Of 55 clinical studies, 50 reported Level 1 evidence (prospective randomized control trials), and 5 reported Level 4 evidence (case series). The evidence level by subspecialty was: head and neck surgery (Level 1 n = 23), pediatrics (Level 1 n = 18), rhinology (Level 1 n = 7, level 4 n = 1), otology (Level 1 n = 1, Level 4 n = 3), facial plastics and reconstructive surgery (Level 4 n = 1), and laryngology (Level 1 n = 2). CONCLUSIONS: Honey can be used for a variety of otolaryngology conditions. The highest quality meta-analyses support oral honey for prevention and treatment of oral mucositis in cancer patients, cough associated with upper respiratory infection in children, and pain control after tonsillectomy. Further research will likely justify broader applications.

[The use of propolis-based therapy in otorhionolaryngology]. / Propolisoterapiya v otorinolaringologii.

The authors analyze the literature publications and the results of their original investigations concerning the application of the propolis-based pharmacological products for the treatment of acute and chronic diseases of the upper respiratory tract and ears. The desirability of the more extensive application of the propolis-containing medicines in the routine otorhinolaryngological practice is emphasized bearing in mind their numerous biological effects including antibiotic, anti-inflammatory, immunostimulating, anti-oxidative, anesthetic, and cytostatic actions.

ENT indications for Hyperbaric Oxygen Therapy.

ENT indications for Hyperbaric Oxygen Therapy. Hyperbaric Oxygen (HBO) therapy is a treatment where patients breathe 100% oxygen while exposed to high environmental pressure in a hyperbaric chamber. This hyperoxygenation has several beneficial effects as an adjunctive treatment in a number of ENT-related conditions and diseases. These can be summarized as anti-ischaemic effects (delivery of oxygen to otherwise ischaemic tissues, reduction of ischaemia-reperfusion damage), anti-infectious effects (bacteriostasis, improved leucocyte phagocytosis bactericidal activity and optimization of antibiotic therapy) and wound-healing effects (stimulation of granulation tissue formation and stabilization). Since HBO therapy has a clear physiologic rationale, a demonstrated effect (although difficult to "prove" with placebo controlled randomized trials) in certain indications and certain side-effects, it is proposed that it should be considered an integral part of the (combined surgical and pharmacological) treatment of patients, and not simply as a supplementation of oxygen. Furthermore, the importance of a well-trained medical and technical staff to ensure proper selection and the correct follow-up of patients should not be underestimated.

Medically unexplained otorhinolaryngological symptoms: Towards integrated psychiatric care.

OBJECTIVE: To evaluate the presence of medically unexplained otorhinolaryngological symptoms in a patient cohort and propose an interdisciplinary approach for their care. STUDY DESIGN: Prospective cohort study. METHODS: The study describes the population of patients presenting consecutively at the Department of Otorhinolaryngology at the Maastricht University Medical Center. Patients with symptoms who did not meet clear "medical" criteria and were associated with psychological distress and high health care utilization were enrolled in the study by two experienced otorhinolaryngologists following informed consent. The aim of the study is 1) to specify the presence of medically unexplained otorhinolaryngological symptoms and 2) to evaluate the integration of otorhinolaryngological and psychiatric treatment in an interdisciplinary approach in order to help otorhinolaryngologists improve patient care. RESULTS: Of the 102 patients included, 41% (N = 42) did not have a proven somatic otorhinolaryngological diagnosis. For only 10.8% (N = 4) of the latter, no psychiatric diagnosis had been established. Overall, 78% of the study population (N = 80) was diagnosed with psychiatric morbidity/comorbidity, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. CONCLUSION: The preliminary data suggest that the majority of patients with these unexplained complaints may suffer from under- or undiagnosed psychiatric morbidity. Therefore, easy access to integrated interdisciplinary care (otorhinolaryngology and psychiatry) should be offered to patients with medically unexplained otorhinolaryngological symptoms after detailed information is made available to them about the pathogenesis of the complaints and the foreseen psychosomatic approach.

Longitudinal treatment of cleft lip and palate in developing countries: dentistry as part of a multidisciplinary endeavor.

Cleft lip and palate affects roughly 1 in 600 children and predisposes patients to a lifetime of functional and esthetic discrepancies. Disparities in access as well as quality of care exist worldwide, with many children in developing countries unable to receive treatment. In the late 20th century, humanitarian medical missions emerged as a means of delivering surgical expertise to patients in resource-limited settings. These early missions took on a patient-centered approach focused solely on cleft repair, with little emphasis on treating the dental abnormalities that arose after the initial surgery. However, modern cleft care is characterized by a multidisciplinary, team-based approach with significant dental involvement. Recent cleft lip and palate endeavors have shifted from a mission-based approach to a developmental approach facilitating growth of an independent care center. This strategy focuses on creating an institution with expanded access to dental services, thus facilitating the long-term treatment inherent in modern cleft care. One clinic in a developing country that has experienced successful transitioning from a mission site to an independent craniofacial clinic is Operation Smile's Cleft Comprehensive Care Clinic in Guwahati, India. This article will summarize the rationale and planning of the clinic, underscore the team-based approach required in longitudinal treatment of cleft lip and palate, and demonstrate how treatment methodology may differ in resource-limited settings by outlining the therapeutic considerations of each provider in the Guwahati Clinic.

[Treatment of otorhinolaryngologic diseases of deficient heat type with Professor XIE Qiang's Tihu Guanding needling method].

Professor XIE Qiang's Tihu Guanding needling method, a kind of acupuncture method which takes acupoints of the Conception Vessel as the primary and acupoints of the Governor Vessel as the secondary. Acupoints Lianquan (CV 23), Tiantu (CV 22), Qihai (CV 6), Zhongwan (CV 12), Baihui (GV 20) and Dazhui (GV 14) are adopted as the basic ones. Other points can be added according to various symptoms, for instance, Yingxiang (LI 20) and Yintang (GV 29) for rhinopathy, Tinggong (SI 19) and Yifeng (TE 17) for otopathy, Yan'an (Professor XIE's experience) and Shanglianquan (EX-HN 21) for pharyngopathy and Kaiyin 1 (Professor XIE's experience) and Kaiyin 2 (Professor XIE's experience) for laryngopathy. During the needle retention, rotation manipulation should be done every 5 min at Lianquan (CV 23). And the patient should be told to put the tip of one's tongue at the the palate as well as to do deep breathing to communicate the Conception Vessel and the Governor Vessel. Moxibustion is adopted at Yongquan (KI 1) to induce the up floating fire to mingmen (where the primary yang is stored). The therapeutic effect on treatment of persistent otorhinolaryngologic diseases with the above mentioned method is approve to be good.

[Chinese medicine as vegetative systems biology. Part I: therapeutic methods]. / Chinesische Medizin als vegetative Systembiologi. Teil I: Therapeutische Verfahren.

Chinese medicine (CM) enjoys increasing popularity in Germany despite doubts about whether the measures taken make sense and whether they are safe and effective. In quantitative terms, CM de facto has already established itself, but very often it is reduced to the level of Asian philosophy in the form of mystical philosophical remnants. In this bipartite article we present a short overview of CM as a traditional approach to stringent and complex systems biology. Only if the internal logic of CM can clearly be appreciated by the Western doctor will its increasing integration be successful.

[Forty years of acupuncture experience in an ENT practice]. / 40 Jahre Akupunkturerfahrung in der HNO-Praxis.

Acupuncture as a complementary method provides optimal conditions for ENT specialists, particularly when somatotopic microsystems are used, e.g., ear, skull, and oral acupuncture. Via points of these systems, pain conditions and functional disorders as well as specific ENT indications (e.g., rhinitis pollinosa, sinusitis, pharyngitis) can be treated successfully. Therapy is performed quickly and without side effects.

[Professor XIE Qiang's unique acupuncture therapy in otorhinolaryngologic department].

The detailed operating methods and the clinical application of the unique acupuncture therapy established by professor XIE Qiang and applied specially in otorhinolaryngologic department are introduced, ie. acupuncture and moxibustion methods for regulating channels and contacting qi, transferring focus of excitation, needling movement and needling ying combined with minimally invasive needle scalpel. Meanwhile, the position of the experience acupoints named Kaiyin 1 (ease-up the voice 1) and Kaiyin 2 (ease-up the voice 2) and their manipulation are recommended, and the clinical application of these acupuncture methods and acupoints for inflammation and pain in otorhinolaryngologic department are explained.