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

Another large-scale review of the existing literature of CAM in rhinitis and asthma, conducted by the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative concluded that the therapeutic efficacy of CAM treatments is not supported by currently available evidence (J Allergy Clin Immunol. 2006;117(5):1054-1062). Other systematic literature reviews, conducted by the Department of Complementary Medicine headed by Edzard Ernst, MD, PhD, FRCP, FRCPEd, at the University of Exeter in the U.K., have come to similar conclusions. One review found that although there were “promising” results for herbal products such as butterbur extract and several Chinese herbal medicines, the results were limited due to paucity of data, small sample size and lack of confirmatory rigorously designed randomized controlled trials (RCTs) (Ann Allergy Asthma Immunol. 2007;99(6):483-495). Another review noted limited evidence for the efficacy of herbal products, although it cited “encouraging” evidence for the use of bromelain (pineapple extract) as an adjunctive in acute rhinosinusitis (Otolaryngol Head Neck Surg. 2006;135(4):496-506).

Pros and Cons

Patients’ choices to explore complementary therapies draw varying opinions from otolaryngologists. “I’m very happy for my patients to explore complementary medicines, as long as I believe that the complementary therapy isn’t at great time or financial expense for them,” Dr. Harvey said. Although he is extremely cautious about the use of herbals prior to surgery, Dr. Harvey gives patients handouts about selected herbal products and vitamins, such as grape seed extract and vitamin C, that can help ease their rhinitis symptoms.

click for large version

Source: Richard J. Harvey, FRACS

Table 1: CAM and Endoscopic Sinus Surgery

Richard F. Lockey, MD, president of the World Allergy Organization and professor of medicine, pediatrics and public health and the Joy McCann Culverhouse Chair in Allergy and Immunology at the University of South Florida College of Medicine in Tampa, gives unequivocal advice to his patients: “I am a scientist first and everything else second,” he said. “Except for nasal lavage, I’m not open to any of that. I just tell patients like it is: ‘We used to call it quackery, but now we call it alternative medicine.”

“I think skepticism is appropriate,” said Dr. Seidman, who holds a degree in human nutrition and is also director of the Henry Ford Health System’s Center for Integrative Medicine and has studied nutraceuticals since 1981. “To those who say, ‘There are no studies to verify that,’ the answer is, you have to know where to look for those studies.” He cites, for instance, work done by the German Commission E (http://cms.herbalgram.org/commissione.index.html), which publishes monographs on herbal medicines, showing that Echinacea purpurea is effective in up-regulating T-cell phagocytosis.

Dialogue Is Essential

Whether or not physicians agree with their patients’ choices to explore complementary therapies, one thing is certain: Careful communication with patients is essential. In the Aberdeen study, only 43 percent of patients who used CAM had informed their physicians of this fact. A 2006 survey conducted by the National Center for Complementary and Alternative Medicine (NCCAM) and the American Association of Retired Persons (AARP) found that almost 70 percent of respondents had not told their physicians about CAM approaches they had tried.