title: Benefits, pitfalls and risks of phytotherapy in clinical practice in otorhinolaryngology.
abstract: OBJECTIVE
  To elucidate the benefits, pitfalls and risks of phytotherapy in the clinical practice of otorhinolaryngology.
  
  
  METHODS
  The PubMed and Cochrane databases were searched using the following keywords: phytotherapy, phytomedicine, herbs, otology, rhinology, laryngology, otitis, rhinitis, laryngitis and otorhinolaryngology. Seventy-two articles (18 prospective randomized studies, 4 Cochrane analyses, 4 meta-analysis and 15 reviews of the literature) devoted to clinical studies were analyzed. Articles devoted to in vitro or animal studies, biochemical analyses or case reports (including fewer than 10 patients) and articles dealing with honey, aromatherapy or minerals were excluded.
  
  
  RESULTS
  Per os ginkgo biloba has no indications in tinnitus, presbycusis or anosmia following viral rhinitis. Traditional Asian medicine has no proven benefit in sudden deafness or laryngeal papillomatosis. Per os mistletoe extracts associated to conventional treatment for head and neck squamous cell carcinoma does not increase 5-year survival. Extracts of various herbs, notably echinacea, eucalyptus, petasites hybridus, pelargonium sidoides, rosemary, spirulina and thyme, show superiority over placebo for rhinosinusitis and allergic rhinitis, as does gingko biloba for selected vertigo. There have been encouraging preliminary results for intratumoral injection of mistletoe in head and neck carcinoma and acupoint herbal patching for allergic rhinitis. Herb intake should be screened for in case of certain unexplained symptoms such as epistaxis, headache or dizziness, or signs suggesting allergy. Phytotherapy should be interrupted ahead of surgery and/or chemotherapy.
  
  
  CONCLUSIONS
  Scientific proof of the benefit of phytotherapy in otorhinolaryngology remains to be established but, given its widespread use and the reported data, knowledge of this form of treatment needs to be developed.
authors.affiliation: Service d'otohinolaryngologie et de chirurgie cervico-faciale, HEGP, université Paris Descartes Sorbonne Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris cedex 15, France. Electronic address: ollivier.laccourreye@egp.aphp.fr.
authors.forename: O
authors.initials: O
authors.lastname: Laccourreye
authors.affiliation: Service d'otohinolaryngologie et de chirurgie cervico-faciale, HEGP, université Paris Descartes Sorbonne Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris cedex 15, France.
authors.forename: A
authors.initials: A
authors.lastname: Werner
authors.affiliation: Service d'otohinolaryngologie et de chirurgie cervico-faciale, HEGP, université Paris Descartes Sorbonne Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris cedex 15, France.
authors.forename: L
authors.initials: L
authors.lastname: Laccourreye
authors.affiliation: Service d'otohinolaryngologie et de chirurgie cervico-faciale, HEGP, université Paris Descartes Sorbonne Paris Cité, AP-HP, 20, rue Leblanc, 75015 Paris cedex 15, France.
authors.forename: P
authors.initials: P
authors.lastname: Bonfils
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D015201:Meta-Analysis as Topic; D010036:Otolaryngology; D010038:Otorhinolaryngologic Diseases / Q000188:drug therapy*; D008517:Phytotherapy / Q000379:methods; D010936:Plant Extracts / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D010936:Plant Extracts
keywords: Herbs; Otorhinolaryngology; Phytomedicine; Phytotherapy