Epipharyngeal Abrasive Therapy (EAT) Has Potential as a Novel Method for Long COVID Treatment, 2022, Imai et al

Hmm.

Only one month treatment and no longer term follow up. No control group, subjective outcome measures apart from degree of epipharyngeal inflammation after treatment, and that measure didn't correlate with symptoms after treatment.

If this were a psychological treatment we would dismiss the trial as useless. We need to apply the same standards here.

 

Yeah, lots of problems.

Still, it's interesting to read about this for a range of reasons.

These Japanese researchers are recognising that ME/CFS is 'a frequently mentioned symptom of long Covid'. They recognise that no standardised treatment has been developed for ME/CFS. They suggest that immune activation is 'one of the pathologies of ME/CFS'.

They suggest that a relationship has been established between chronic epipharyngitis and ME/CFS. In a forum poll here, nearly half of the participants did report sore throats are a feature of their illness, even if only sometimes during PEM. I sometimes also experience an aching roof of my mouth when PEM is setting in.

Just to be clear on the anatomy, I'm not too sure how well recognised the term 'epipharynx' is. Given these researchers are going in through the nose, I think we are talking about the upper part of the pharynx.



The authors suggest that this epipharyngeal abrasive therapy is a treatment for chronic epipharanyngitis in Japan and 'is reported to be effective against ME/CFS'. It is ringing a bell - I'm sure we have talked about this before. It seems to involve sticking a cotton swab dipped in ZnCl solution through the nose, and scrubbing the tissue, in some cases to the point of making the tissue bleed. The bleeding is referred to as 'impure bleeding'.

The mean period that participants in the trial had had long Covid symptoms for was 81 days - so definitely most were at the stage where natural recovery is likely.

I've long wondered whether a biopsy of an ME/CFS sore throat would tell us anything and why no researcher has ever been interested enough to look, so it was interesting to see the pictures of the Long Covid pharyngeal tissue.

It's not clear what the numbers relate to - there was a rating of inflammation from 0 to 6, but then the results were grouped into absent (0), mild(1-2), moderate (3-4) and severe (5-6). So the pictures there might relate to absent, mild, moderate and severe.

They say that all of the Long Covid patients (suffering from fatigue, headache and what I'm assuming is cognitive issues) had epipharyngitis, even though half of them reported no throat symptoms. It would be interesting to compare pharynx's from people who have recovered from Covid-19 and don't have ME/CFS-like symptoms in a blinded analysis.

https://www.japantimes.co.jp/news/2022/02/20/national/science-health/kyodo-reporter-long-covid/
The article at the link gives an account of a journalist who had Long Covid and underwent the treatment with Osamu Hotta of the Japanese Focal Inflammation-related Disease Research Group. Although she improved over time, it sounds as though she has relapsed when trying to return to work and is not yet cured. I think the reporter stopped the treatment.

The theory of the treatment, according to the article, is:

The reporter in the article said she underwent the procedure 70 times and that initially it was very painful.

I don't think there's much to suggest that the treatment is of any use, and it sounds thoroughly unpleasant. But I do wonder about whether there is something happening with the pharyngeal tissue. It would be great to have that investigated by people who are not wanting to promote a treatment.

 

Before they go on using the treatment, if they are serious about evidence, they should do a double blind trial with long term follow up, and also compare the existence of the condition between people with long covid, ME, fully recovered from covid, and healthy controls.