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).
MATERIALS AND METHODS: A systematic review of the English and foreign language literature.
INCLUSION CRITERIA: in vivo human studies.
EXCLUSION CRITERIA: 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.
CONCLUSION: 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.