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

[Andy]

Abstract

COVID-19 often causes sequelae after initial recovery, referred to collectively as long COVID. Long COVID is considered to be caused by the persistence of chronic inflammation after acute COVID-19 infection. We found that all long COVID patients had residual inflammation in the epipharynx, an important site of coronavirus replication, and some long COVID symptoms are similar to those associated with chronic epipharyngitis. Epipharyngeal abrasive therapy (EAT) is a treatment for chronic epipharyngitis in Japan that involves applying zinc chloride as an anti-inflammatory agent to the epipharyngeal mucosa.

In this study, we evaluated the efficacy of EAT for the treatment of long COVID. The subjects in this study were 58 patients with long COVID who were treated with EAT in the outpatient department once a week for one month (mean age = 38.4 ± 12.9 years). The intensities of fatigue, headache, and attention disorder, which are reported as frequent symptoms of long COVID, were assessed before and after EAT using the visual analog scale (VAS). EAT reduced inflammation in the epipharynx and significantly improved the intensity of fatigue, headache, and attention disorder, which may be related to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). These results suggest that EAT has potential as a novel method for long COVID treatment.

Open access, https://www.mdpi.com/1999-4915/14/5/907/htm

 

[hinterland]

Epipharyngeal abrasive therapy (EAT) is a treatment for chronic epipharyngitis in Japan that involves applying zinc chloride as an anti-inflammatory agent to the epipharyngeal mucosa.

Very interesting, this has also been proposed as a valid approach to CFS/ME.

Chronic epipharyngitis: A missing trigger in chronic fatigue syndrome

Does anyone know if there is a risk of loss of sense of smell (anosmia) with this procedure, as has been reported with zinc containing nasal sprays? As otherwise this looks like a relatively safe treatment to try, other than the inconvenience and discomfort of someone poking around up your nose.

Intranasal zinc and anosmia: the zinc-induced anosmia syndrome

Conclusions: The zinc-induced anosmia syndrome, characterized by squirt, sniff, burn, and anosmia, occurs after the exposure of olfactory epithelium to zinc cation. It can be distinguished from postviral anosmia based on history.

Otherwise, if safe enough, this YouTube vid explains what chronic epipharyngitis is and how it can be treated with epipharyngeal abrasive therapy (EAT).

This diagnosis and treatment appears to be a uniquely Japanese phenomenon. Does anyone know any ENT clinics in the UK familiar with this approach?

If zinc is contraindicated, I think Lugol's iodine solution may be an alternative disinfectant/ anti-inflammatory agent that could be applied?

 

[Trish]

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.

 

[butter.]

Bunch of bullshit.

 

[alex3619]

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.

Couldn't have said it better myself.

 

[Hutan]

Yeah, lots of problems.

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

Long COVID refers to a series of health consequences that are present four or more weeks after infection with SARS-CoV-2 [1,2]. A systematic review and meta-analysis revealed that 80% of patients developed one or more long-term symptoms, including fatigue, headache, attention disorder, hair loss, sore throat, and dyspnea [3]. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a frequently mentioned symptom of long COVID [4]. Hyperinflammation due to COVID-19 can cause ME/CFS, but the causal organs associated with ME/CFS have not been identified and no standardized treatment has been developed [4,5,6,7,8]. The epipharynx is a primary target for SARS-CoV-2 replication in the early stages of COVID-19 [9]. The activated lymphoid tissue of the epipharynx produces various inflammatory cytokines for the clearance of pathogens and this immune activation is considered to be one of the pathologies of ME/CFS [10,11,12].

A relationship has already been established between chronic epipharyngitis and ME/CFS, and epipharyngeal abrasive therapy (EAT), a treatment for chronic epipharyngitis in Japan, is reported to be effective against ME/CFS [9,13,14,15]. In this study, we endoscopically confirmed that all patients with long COVID had residual inflammation of the epipharynx. To examine whether EAT is an effective treatment for long COVID, which has symptoms similar to those of ME/CFS, we evaluated the intensity of symptoms, including fatigue, headache, and attention disorder, before and after EAT using the visual analog scale. We found that continuous EAT significantly improved the intensity of the symptoms of long COVID via the reduction of chronic epipharyngitis and neuromodulation by stimulation of the vagus nerve ending in the epipharynx. It was reported that about 70% of patients had sequelae even after half a year of acute infection but EAT relieved the symptoms of long COVID in one month [16]. Our results suggest that EAT may be an effective treatment for long COVID.

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.

The inflammation grade of chronic epipharyngitis. (a) The endoscopic findings of chronic epipharyngitis. The upper panels show the endoscopic characteristics before epipharyngeal abrasive therapy (EAT). The score of inflammation was assessed using endoscopic characteristics. The black arrow indicates redness of the mucosa. The white arrow indicates cobblestone-like granular changes. The black triangle indicates submucosal bleeding. The white triangle indicates severe mucosal swelling.

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:

that chronic inflammation occurring at the boundary between the nose and throat due to viral infection causes blood congestion, triggering a decline in brain function and autonomic neuropathy in which the nerves that control involuntary bodily functions are damaged.

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.

 

[Trish]

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.

 

[Wonko]

If patients report symptoms that are inconvenient, in terms of treatment options or belief, then torture them until they no longer report troubling symptoms, and then pronouce them cured.

 

[Sly Saint]

paper from 2017

Possible Mechanisms Underlying Epipharyngeal Abrasive Therapy (EAT)
with ZnCl2
Solution for the Treatment of Autoimmune Diseases and
Functional Somatic Syndrome

Abstract
Chronic epipharyngitis is a common latent but serious condition that may contribute to a wide range of diseases
in humans, including collagen diseases, glomerulonephritis and autonomic nervous disorders. In a previous study,
we presented a putative causal role of chronic epipharyngitis in the development of functional somatic symptoms
and syndromes following human papillomavirus vaccination by demonstrating a significant improvement in
symptoms following abrasive therapy using ZnCl
2
on the epipharynx. Since this initial study, we have expanded our
clinical experience, providing epipharyngeal abrasive therapy to 988 patients with confirmed chronic epipharyngitis
associated with a wide variety of clinical symptoms. These symptoms could be classified into three broad categories,
namely local inflammation-referred, autoimmune-related, and neuroendocrine symptoms. Symptom alleviation was
achieved in the majority of patients with repeated epipharyngeal abrasive therapy.
Through an in-depth review of the literature on epipharyngeal abrasive therapy, combined with our clinical experience, we propose three mechanisms underlying the therapeutic effects of epipharyngeal abrasive therapy: the astringent anti-inflammatory effect of ZnCl2
, a blood-letting effect that promotes removal of epipharyngeal activated
lymphocytes and drainage of excess inflammatory fluids containing various antigens, cytokines or noxious
substances, and a neuromodulation effect achieved through stimulation of the vagus nerve. These effects can be
explained within the context of current understanding of immunology, lymphology and neuroscience.
Our hypothesis-driven review provides a theoretical basis for the observed therapeutic effects of epipharyngeal
abrasive therapy in ameliorating various diseases, including functional somatic symptoms and syndromes following
human papillomavirus vaccination

https://www.longdom.org/open-access...utoimmune-diseases-andf-1948-5964-1000168.pdf

 

[Mij]

https://www3.nhk.or.jp/nhkworld/en/shows/2050141/