title: 'Complementary ENT': a systematic review of commonly used supplements.
abstract: OBJECTIVE
  To assess the evidence surrounding the use of certain complementary supplements in otolaryngology. We specifically focussed on four commonly used supplements: spirulina, Ginkgo biloba, Vertigoheel and nutritional supplements (cod liver oil, multivitamins and pineapple enzyme).
  
  
  METHODS
  A systematic review of the English and foreign language literature.
  
  
  METHODS
  in vivo human studies.
  
  
  METHODS
  animal trials, in vitro studies and case reports. We also excluded other forms of 'alternative medicine' such as reflexology, acupuncture and other homeopathic remedies.
  
  
  RESULTS
  Lack of common outcome measures prevented a formal meta-analysis. Three studies on the effects of spirulina in allergy, rhinitis and immunomodulation were found. One was a double-blind, placebo, randomised, controlled trial (RCT) of patients with allergic rhinitis, demonstrating positive effects in patients fed spirulina for 12 weeks. The other two studies, although non-randomised, also reported a positive role for spirulina in mucosal immunity. Regarding the use of Ginkgo biloba in tinnitus, a Cochrane review published in 2004 showed no evidence for this. The one double-blind, placebo-controlled trial that followed confirmed this finding. Regarding the use of Vertigoheel in vertigo, two double-blind RCTs and a meta-analysis were identified. The first RCT suggested that Vertigoheel was equally effective in reducing the severity, duration and frequency of vertigo compared with betahistine. The second RCT suggested that Vertigoheel was a suitable alternative to G. biloba in the treatment of atherosclerosis-related vertigo. A meta-analysis of only four clinical trials confirms that Vertigoheel was equally effective compared with betahistine, G. biloba and dimenhydrinate. Regarding multivitamins and sinusitis, two small paediatric pilot studies reported a positive response for chronic sinusitis and otitis media following a course of multivitamins and cod liver oil. Regarding bromelain (pineapple enzyme) and sinusitis, one randomised, multicentre trial including 116 children compared bromelain monotherapy to bromelain with standard therapy and standard therapy alone, for the treatment of acute sinusitis. The bromelain monotherapy group showed a faster recovery compared with the other groups.
  
  
  CONCLUSIONS
  The positive effects of spirulina in allergic rhinitis and of Vertigoheel in vertigo are based on good levels of evidence, but larger trials are required. There is overwhelming evidence that G. biloba may play no role in tinnitus. There is limited evidence for the use of multivitamins in sinus symptoms, and larger randomised trials are required.
authors.affiliation: Department of Otolaryngology, University Hospital Aintree, Liverpool, UK. pkarkos@aol.com
authors.forename: P D
authors.initials: PD
authors.lastname: Karkos
authors.forename: S C
authors.initials: SC
authors.lastname: Leong
authors.forename: A K
authors.initials: AK
authors.lastname: Arya
authors.forename: S M
authors.initials: SM
authors.lastname: Papouliakos
authors.forename: M T
authors.initials: MT
authors.lastname: Apostolidou
authors.forename: W J
authors.initials: WJ
authors.lastname: Issing
mesh_terms: D001963:Bromelains / Q000627:therapeutic use; D002648:Child; D003060:Cod Liver Oil / Q000627:therapeutic use; D000529:Complementary Therapies / Q000379:methods*; D019587:Dietary Supplements; D004338:Drug Combinations; D020441:Ginkgo biloba; D006801:Humans; D006967:Hypersensitivity / Q000188:drug therapy; D008903:Minerals / Q000627:therapeutic use; D010038:Otorhinolaryngologic Diseases / Q000188:drug therapy*; D008517:Phytotherapy; D010852:Picrotoxin / Q000627:therapeutic use; D010936:Plant Extracts / Q000627:therapeutic use; D028321:Plant Preparations; D012220:Rhinitis / Q000188:drug therapy; D012852:Sinusitis / Q000188:drug therapy; D053545:Spirulina; D014012:Tinnitus / Q000188:drug therapy; D014717:Vertigo / Q000188:drug therapy; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D001963:Bromelains; D003060:Cod Liver Oil; D004338:Drug Combinations; D008903:Minerals; D010852:Picrotoxin; D010936:Plant Extracts; D028321:Plant Preparations; D014815:Vitamins; C044596:Vertigoheel