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

Discussion in 'Long Covid research' started by Andy, May 30, 2022.

  1. Andy

    Andy Committee Member

    Hampshire, UK

    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
  2. hinterland

    hinterland Senior Member (Voting Rights)

    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

    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?
    Peter Trewhitt likes this.
  3. Trish

    Trish Moderator Staff Member


    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.
  4. butter.

    butter. Senior Member (Voting Rights)

    Bunch of bullshit.
  5. alex3619

    alex3619 Senior Member (Voting Rights)

    Couldn't have said it better myself.
    oldtimer, Hutan, alktipping and 2 others like this.
  6. Hutan

    Hutan Moderator Staff Member

    Aotearoa New Zealand
    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.

    Screen Shot 2022-05-31 at 6.14.23 pm.png

    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.

    Screen Shot 2022-05-31 at 6.17.21 pm.png

    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.

    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.
    Last edited: May 31, 2022
    cfsandmore, hinterland and Trish like this.
  7. Trish

    Trish Moderator Staff Member

    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.
  8. Wonko

    Wonko Senior Member (Voting Rights)

    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.
    Sean, oldtimer, alex3619 and 2 others like this.
  9. Sly Saint

    Sly Saint Senior Member (Voting Rights)

    paper from 2017

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

    NelliePledge likes this.

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