Complementary and alternative medicine in rhinology

Abstract

Complementary and alternative medicine encompasses a wide range of practices. Eisenberg et al. defined this practice as "medical interventions not taught widely at U.S. medical schools or generally available at U.S. hospitals" [1]. Recently, a great interest has developed for the practice of complementary and alternative medicine (CAM), as evidenced by the number of publications on this subject. In 1999, the National Institutes of Health (NIH) established the National Center for Complementary and Alternative Medicine (NCCAM), which is funding research in this area. This is a further indication that "Western Medicine" is embracing certain aspects of the alternative practices and attempting to glean knowledge from these long-practiced remedies. Unfortunately, for practitioners in the U.S. many of the studies evaluating the efficacy of CAM have been published in languages other than English. In 1990, a survey reported that one third of the population of the United States used some form of CAM, and of those, nearly three-quarters did not inform their physicians of such practice [1]. In a subsequent study focusing on the changes in patients' practices between 1990 and 1997, the authors demonstrated that the use of CAM increased from 33.8% to 42.1%. Expenditure on CAM and CAM-related products was estimated to be $13.7 billion in 1990 and increased to approximately $21.2 billion in 1997 [2]. Moreover, this study estimated that the number of visits to practitioners of complementary medicine exceeded that of the number of visits to primary care physicians. The use of CAM in otorhinolaryngology permeates all the discipline's subspecialties, and thus the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) has established a Committee on Alternative Medicine to serve as a resource for information on this practice. The most common forms of CAM employed are herbal medicines, acupuncture, homeopathy, massage, mind-body medicine, and chiropractic manipulation [3]. In most of these arenas there is no evidence of safety or efficacy. In rhinology, there are several conditions for which CAM has been widely used, including the common cold/upper respiratory infections, allergic rhinitis, acute rhinosinusitis (ARS), and chronic rhinosinusitis (CRS). In 2001, a survey of 175 patients with rhinosinusitis in Northern California reported that 43% of patients used some form of CAM to alleviate their symptoms, with herbal medicine being utilized by 26% of subjects [4]. Krouse et al. in 1999 reported on the use of CAM by 120 patients and found that 35% of the cohort underwent chiropractic treatment, 29% herbal medicines, and 19% acupuncture for the treatment of their sinus conditions [5]. Thus, clinicians must be aware of these practices and actively query their patients on the use of CAM, not only for their potential benefits, but because they may have potential adverse effects, interact with traditional therapies, or complicate surgical intervention. © 2008 Springer Science+Business Media, LLC. All rights reserved.