European Archives of Oto-Rhino-Laryngology

, Volume 269, Issue 2, pp 389–397 | Cite as

Phytotherapeutic and naturopathic adjuvant therapies in otorhinolaryngology

  • Raphael Richard CiumanEmail author
Open Access
Review Article


Phytotherapeutic pharmaceuticals and herbal medicinal products with its roots in classical phytotherapeutic medicine have a well-established role in otolaryngological therapy, especially for diseases of the upper airways and acute and chronic infections. A thorough selection and application could mean huge benefit for the patient, in particular in cases with contraindications, chemo- and antibiotic resistance or patient request. Besides, it might spare other medications. Phytotherapeutic pharmaceuticals must fulfil the same criteria of quality, effectiveness and harmlessness of evidence-based medicine like chemical pharmaceuticals, although they are often prescribed due to its well established or traditional based use. This review focuses on phytotherapeutic therapies well established within the European Community for otolaryngologic disease patterns by referring to clinical studies or meta-analysis.


Phytotherapy Naturopathy Essential oils Acute rhinosinusitis Acute otitis media 


Henri Leclerc (1870–1955) introduced the terminology of phytotherapy into medical science. Natural products were used in non-scientific manner before. People experienced natural products as being helpful for their health and learned to treat illnesses disease-specific. Therefore, it is appropriate to discuss phytotherapeutic and naturopathic adjuvant therapies in a disease oriented manner. Phytopharmaceuticals consist of a main ingredient that is responsible for the main mechanism of efficacy and of auxiliary agents, backing agents (effecting pharmacokinetics) and structure stabilizing agents. Often phytotherapeutic pharmaceuticals are composed of numerous herbal products or agents increasing medical effectiveness.

Generally speaking, phytopharmaceuticals are not used in emergency medicine and acute care medicine, but are indicated in diseases of mild to intermediate severity, in particular in cases of functional or chronic diseases. Adjuvant or co-therapy, relapse prevention, reconvalescence and unverified disorders are other indications for phytopharmaceuticals.

In contrast to chemical pharmaceuticals, phytotherapeutics possess a wider therapeutic range, lesser adverse reactions and less interactions with other pharmaceuticals. As well as in chemical pharmaceuticals, thoroughly underdosage, false applications and application duration have to be regarded and overestimation of effectiveness has to be avoided. Administration form and usage have to be tailored to the individual patient needs (Table 1). Consequently, adequate diagnostic means must proceed the administration of phytopharmaceuticals.
Table 1

Mode of preparation and administration form of phytotherapeutics

Mode of preparation

Administration form

Therapeutical application and characterization

Aqueous extracts

 Extracts with ethanol (tincture, fluid extracts)

Drops, inhalations, gargle solutions

Contain about 20–60% alcohol

 Extracts with wine

Tonics, medicated wines

Contain about 16% alcohol

 Spissum extracts

Baths, gels, soft gelatin capsules

Baths are in particular useful in early infections and should not be used when body temperature is increased

Alcoholic distillates

Contain essential oils, e.g. spirit of melissa

Contain 40–80% alcohol

Steam distillates

Essential oils

Most essential oils have to be diluted (e.g. in sunflower, peanut, almond oil 1/9) to avoid mucosal irritation or combined with a plant oil for skin preparations



For small plant parts, thermolabile and volatile ingredients



For not easily dissoluble plant parts and ingredients


Maceration (cold preparation)

Plant parts where hot preparation would damage or release damaging ingredients


Fresh-squeezed plant juices

Contain four times more active ingredients than tea

Creams, ointments, gels

Inunctions, fomentations

Selection and application according to skin moisture

Dry preparations (shredded, pulverized)

Tablets, dragees, pastilles, pellets, capsules

For systemic application

Evidence-based medicine has entered phytotherapeutic medicine as well and therefore its benefits and advantages have been established in clinical studies and meta-analysis in the last years. In addition, due to the long tradition of phytotherapy individual-based and experienced-based medicine provide the basis for consideration of off-label-use in cases where clinical studies are missing.

Acute and chronic rhinosinusitis

In otolaryngology, phytopharmaceuticals which combine secretolytic, mucolytic, mucous membrane detumescing, secretomotoric, antiphlogistic and antimicrobial properties are classically used in diseases of the upper airways. Nose douches or inhalations with Emser brine or chamomile flower solutions represent usually the basal treatment in banal or allergic rhinitis. In addition, applied nasal sprays with seawater and chamomile avoid privinism. Essential oils of eucalyptus leaf and branch (Eucalyptus globulus, E. polybractea or E. smithii, Myrtaceae), peppermint leaf (Mentha piperita, Lamiaceae), mugo pine (Pinus mugo, Pinaceae) have secretolytic and antimicrobial effects, but should not be applied in infants due to the danger of laryngo- or bronchospasm (Kratschmer reflex). Together with its ingredients, menthol, camphor and 1,8-cineol they depolarize the thermoreceptors by inhibition of the calcium influx (Table 2) and lead to a subjective improvement of airflow although the nasal resistance is not decreased [1]. Systemic administered phytopharmaceuticals containing essential oils like GeloMyrtol® gastro-resistant capsules (standardized to contain not less than 30 mg limonene, 30 mg cineol and 8 mg alpha-pinene, manufactured by G. Pohl-Boskamp GmbH & Co KG, Hohenlockstadt, Germany) have shown increase of the mucociliary secret transport velocity by 28% and of the secretolysis by 30% [2]. GeloMyrtol® is administered in acute and chronic rhinosinusitis and after operations of the paranasal sinuses as well (Table 3) [3]. The combination herbal medicine Sinupret® contains powdered herbal extracts of European elder flower (Sambucus nigra, Caprifoliaceae), garden sorrel herb (Rumex acetosa, Polygonaceae), cowslip flower (Primula veris, Primulaceae), European vervain herb (Verbena officinalis, Verbenaceae), gentian root (Gentiana lutea, Gentianaceae) and liquefies the nasal mucous and secretions and acts antiphlogistic as well. A meta-analysis has shown that alternate application of GeloMyrtol® and Sinupret® has best benefits in acute and chronic rhinosinusitis [4] and can be used in pregnancy, too [5]. Besides Sinupret® and GeloMyrtol® can be used in acute and chronic bronchitis [6] and it could be shown that the efficacy of Sinupret® is superior to ambroxol and n-acetylcysteine [7, 8, 9]. It could be shown that Tesalin N® film tablets (containing a CO2-extract, Ze 339, of purple butterbur leaf (Petasites hybridus, Asteraceae), manufactured by Zeller Medical AG, Romanshorn, Switzerland) are as effective as fexofenadin and cetirizin in allergic rhinitis [10, 11]. A meta-analysis showed equivalent effectiveness when compared with non-sedative antihistamines [12].
Table 2

Phytotherapeutic therapy of upper airway and deglutition tract infections

Main mode of action




Chamomile flower, myrtle, thyme herb, sage leaf

α-Bisabolol and chamazulene in camomile inhibit the cyclooxygenase and lipoxygenase of arachidonic acid cascade

Antitussive-mucous releasing

Marshmallow leaf or root, ribwort plantain leaf, iceland moss thallus

Contain polysaccharides which swell with water

Antitussive-mucolytic (saponins)

Cowslip flower, thyme herb, english ivy leaf, mullein flower

Decrease mucous viscosity by decreasing the surface tension of water

Respiratory relieving, secretolytic

Mint oils (eucalyptus leaf and branch, peppermint leaf, mugo pine)

Central inhibitory effect by thermosensitive nerves

Cave: Kratschmer reflex in children

Menthol, camphor, 1,8-cineol

Depolarization of thermoreceptors by inhibition of calcium influx


Garden nasturtium haulm, horseradish root

Contains mustard oils


Lime flower, willow bark, european elder berry

The lacking acetyl group in salicin in elder avoids side effects of ASA


Echinacea root, chamomile flower

Stimulation of the unspecific cellular and humoral immune response

Cave: application duration, autoimmune and systemic diseases

Table 3

Discussed phytotherapeutic pharmaceuticals and their indication, administration form and dose

Phytotherapeutic pharmaceutical


Administration form


Angocin®, REPHA GmbH Biologische Arzneimittel, Langenhagen, Germany

Phytotherapeutic pharmaceutical with antibacterial properties against grampositive and gramnegative strains, virostatic and antimycotic effects

Film tablet

4–5 tablets 3–5 times per day, children (4–8 years) 2–3 tablets 3–5 times per day

Acute infections (e.g. acute pharyngotonsillitis, acute laryngitis, acute sinusitis)

Bronchipret®, Bionorica AG, Neumarkt, Germany

Acute and chronic bronchitis

Drops, syrup or film tablet

Drops: 40 drops 4 times per day, adolescents (12–18 years) 28 drops 4 times per day, children (6–11 years) 20 drops 4 times per day


Syrup: 5.4 ml 3 times per day, babies (−12 month) 1.1 ml 3 times per day, infants (−2 years) 2.2 ml 3 times per day, children (−6 years) 3.2 ml 3 times per day, children (−12 years) 4.3 ml 3 times per day

Tablets: 1 tablet 3 times per day

Contramutan® N, manufactured by A. Nettermann & Cie. GmbH, Cologne, Germany

Acute infectious of the upper airways (e.g. acute laryngopharyngitis)

Drops, syrup or tablet

Drops: 5–10 drops up to 12 times per day, children (6–12 years) 4–7 dops up to 12 times per day, children (1–6 years) 3-5 drops up to 12 times per day; after symptom relief intake is reduced to 3 times per day

Syrup: 15 ml every hour, children 5 ml every hour; after symptom relief intake is reduced to 3 times per day

Tablets: 1 tablet up to 12 times per day, children 1 tablet up to 6 times per day; after symptom relief intake is reduced to 1–3 times per day

Equisil® N, Dr. Gustav Klein GmbH & Co KG, Zell am Hamersbach, Germany

Intermediate cough state (productive and dry)


2.5 ml 3 times per day

Esberitox®, Schaper & Bruemmer GmbH & Co KG, Salzgitter, Germany

Acute infectious of the upper airways (e.g. acute laryngopharyngitis)

Drops, tablet

50 drops or 3 tablets 3 times per day, babies 10 drops or 1 tablet once per day, children (−6 years) 15 drops or 1–2 tablets twice per day, children (−12 years) 25 drops or 2 tablets twice per day

GeloMyrtol® forte, G. Pohl Boskamp GmbH & Co KG, Hohenlockstadt, Germany

Acute and chronic rhinosinusitis

Gastro-resistant capsule

1 capsule 3–4 times per day for acute infections, 1 capsule twice for chronic infections

Acute and chronic bronchitis

Postoperative convalescence


Imupret®, Bionorica AG, Neumarkt, Germany

Chronic tonsillitis, tracheitis, adenoid hyperplasia

Dragee or drops

2 dragees or 25 drops 5–6 times per day, children (−12 years) 1 dragee or 15 drops once per day, babies and infants 5–10 drops 5–6 times per day; after symptom relief intake is reduced to 3 times per day for 7 days

Lomaherpan®, Lomapharm Rudolf Lohmann GmbH KG, Emmerthal, Germany

Skin or mucosa infections with herpes simplex virus


10–20 mg per cm2 2–4 times per day

Otikon Otic® solution, Healthy-On Ltd., Petach-Tikva, Israel

Acute otitis media

Ear drops

5 drops 3 times per day

Prospan®, Engelhard Arzneimittel, Niederdorfelden, Germany

Productive cough

Drops, liquid, syrup, suppository, fizzy tablet or film tablet

Drops: 24 drops 3 times per day, children (4–10 years) 16 drops 3 times per day, children (1-year) 12 drops 3 times per day


Liquid: 5 ml 3 times per day

Syrup: 5–7.5 ml 3 times per day, children (6–9 years) 5 ml 3 times per day, children (1–5 years) 2.5 ml 3 times per day, children (−12 month) 1.5 ml twice per day

Suppositories: school children 1 supp. 3 times per day, babies and infants 1 supp. twice per day

Brausetabletten: 1 tablet twice per day, children (4–12 years) ½ tablet 3 times per day

Film tablets: 2 tablets 3 times per day

Sinupret®, Bionorica AG, Neumarkt, Germany

Acute and chronic rhinosinusitis,

Drops, liquitab®, dragee

50 drops, 2 dragees or 2 liquitabs three times per day, children (6–12 years) 25 drops, 1 dragee or 1 liquitab per day, children (2–6 years) 15 drops per day

Acute and chronic bronchitis

Postoperative convalescence


Tesalin® N, Zeller Medical AG, Romanshorn, Switzerland

Allergic rhinitis

Film tablets

1 tablet 2–3 times per day

Acute and chronic laryngopharyngitis

About 50–70% of acute infections of the pharyngolaryngeal spaces are of viral pathogenesis [13, 14, 15]. Therapeutic considerations of antibiotics with regards to microbial etiology starting point and duration of application or cost-effectiveness have been discussed extensively. Generally speaking, antibiotics have to be applied, whenever complications occur. Typically, gurgle solutions with sage leaf (Salvia officinalis, Lamiaceae), thyme herb (Thymus vulgaris, Lamiaceae) or chamomile flower (Matricaria recutita, Asteraceae) are applied in acute laryngopharyngitis. Imupret® dragees or drops (a combination herbal medicine manufactured by Bionorica AG, Neumarkt, Germany) can be used in chronic tonsillitis, tracheitis or in adenoid hyperplasia and acts antiphlogistic, astringent and immunomodulating. It contains aqueous-alcoholic extracts of marshmallow roots (Althaea officinalis, Malvaceae), chamomile flower, oak bark (Quercus robur, Q. Petraea, Q. pubescens, Fagaceae), English walnut leaves (Juglans regia, Juglandaceae), dandelion herb (Taraxacum officinale, Asteraceae), horsetail herb (Equisetum arvense, Equisetaceae) and yarrow flower (Achillea millefolium, Asteraceae) [16]. Two important phytotherapeutics with antimicrobial qualities are garden nasturtium haulm (Tropaeolum majus, Tropaeolaceae) and horseradish root (Armoracia rusticana, Brassicaceae) which contain mustard oils that have antibacterial properties against grampositive and gramnegative strains, virostatic and antimycotic effects and can be used when antibiotics should be avoided. The combination herbal medicine Angocin® (film tablets, manufactured by REPHA GmbH Biologische Arzneimittel, Langenhagen, Germany) uses synergistic effects of these two herbs. In particular, efficacy against Pseudomonas species has been proven and studies showed equivalent efficacy compared with standard antibiotics [17, 18, 19]. Willow bark (Salix purpurea, S. daphnoides, S. fragilis, Salicaceae) decreases the body temperature directly due to its main ingredient salicin which in contrast to acetylsalicylic acid (ASA) lacks the acetyl-group and therefore has no adverse reactions in regards with stomach mucosa and platelet aggregation. Standardized willow bark extracts has comparable antiinflammatory activities as higher doses of ASA and shows antinociceptive and antipyretic effects [20]. Besides European elder berry (Sambucus nigra, Caprifoliaceae) and lime flower tea (Tilia platyphyllos, T. cordata, T. vulgaris, Tiliaceae) are often used to reduce body temperature and it could be shown that elder berry preparations reduce symptoms and illness duration 4 days faster when compared with placebo syrup in influenza A and B infections [21]. Marigold (Calendula officinalis, Asteraceae) and pelargonium root (Pelargonium sidoides, Geraniaceae) are successfully used in the treatment of upper infections of the respiratory tract and for acute and chronic tonsillitis as well [22, 23]. They have antibacterial, antiviral and secretolytic functions, but have to be applied in tonsillitis off-label as clinical data are not sufficient [24, 25].


Acute and chronic cough impair the general condition and should often be avoided after chirurgical interventions. Suppressing the need to cough can be achieved by physical and pharmacological measures. Main physical supporting measures include intake of fluids by drinking, inhalation and air humidification. A productive cough is often preceded by a dry and painful cough. Different phytotherapeutics have to be used in these disease stadiums. Opium alkaloids like codeine or noscapine have a direct antitussive effect on the CNS cough center in the medulla oblongata and the sensory nerves in the lower airways. They are applied in the phase of dry cough and mainly administered at night and only for a short time. Alternatively, phytopharmaceuticals that possess an antitussive and abirritative effect by contain polysaccharides that swell with water and produce a mucous layer inhibiting the hyperactive ciliary activity can be applied in dry cough. These phytopharmaceuticals usually contain marshmallow leaf or root (Althaea officinalis, Malvaceae), ribwort plantain leaf (Plantago lanceolota, Plantaginaceae) or iceland moss thallus (Cetraria islandica, Parmeliaceae). A productive cough should be treated with expectorations like cowslip flower (Primula veris, Primulaceae), thyme herb, English ivy leaf (Hedera helix, Araliaceae) or mullein flower (Verbascum densiflorum, V. phlomoides, V. thapsus) [26]. Syrup can be used for children [27]. These plants contain saponins which decrease mucous viscosity by decreasing the surface tension of water, increase ciliary activity and possess an antiphlogistic and bronchospasmolytic effect [28]. A combination of both mucous-releasing and secretolytic acting ingredients can be used in an intermediate cough state, e.g. Equisil® N Syrup (containing extracts of cowslip flower, mullein flower, thyme herb and ribwort plantain leaf, manufactured by Dr. Gustav Klein GmbH & Co KG, Zell am Hamersbach, Germany). Various studies have shown similar or superior effects of phytopharmaceutical expectorations compared to acetylcysteine or ambroxol. Prospan®, a dried ivy leaf extract (drops, liquid, syrup or tablets, manufactured by Engelhard Arzneimittel, Niederdorfelden, Germany), showed superiority to acetylcysteine [29] and Bronchipret® film tablets (dried alcoholic extracts of primula root and thyme herb, manufactured by Bionorica AG, Neumarkt, Germany) showed equivalency to ambroxol and n-acetylcysteine [30, 31]. In addition, essential mint oils due to its secretolytic effects can be inuncted or inhaled. They are well reabsorbed by the skin, e.g. as warm thorax compresses in pseudocroup. Menthol, camphor, 1,8-cineol activate the cold receptors in the larynx and have an antitussive and negative inspiratory effect [32].

Herpese simplex infection and stomatitis

It could be shown that lomaherpan® cream (manufactured by Rudolf Lohmann GmbH KG, Emmerthal, Germany) which contains dried extract of lemon balm leaf (Melissa officinalis, Lamiaceae) can be used for prophylaxis and is as effective as acyclovir when administered in the first 8 h in herpes simplex infections [33]. Besides, healing is faster and recurrences are reduced [34, 35]. Another study showed that rhubarb-sage cream is as effective as acyclovir [36]. Other therapeutics and preparations that have been effective in herpes simplex infections are propolis [37], ozonated olive oil or essential oils with thyme herb, chamomile flower, ginger root, peppermint leaf, eucalyptus leaf and tea tree foliage (Melaleuca alternifolia, M. dissitiflora, M. linariifolia, Myrtaceae) [38, 39, 40]. Topical medications, such as mouth-washes and topical corticosteroids can achieve the primary goal to reduce pain and to improve healing time but do not improve recurrence or remission rate in recurrent aphthous stomatitis. It could be shown that myrtle (Myrtus communis, Myrtaceae) reduces ulcer size, pain severity, erythema and exudation level **in recurrent aphthous stomatitis [41], and a daily intake of 500 mg bee propolis could reduce the outbreaks in recurrent aphthous stomatitis [42]. Candidiasis or thrush can be effectively treated with solutions or tinctures of chamomile flower, myrtle, sage leaf, or thyme herb [43]. Besides, essential oil of thyme herb potentiates the antifungal effect of amphotericin B in culture [44]. In addition, maloudor in cancer patients improves significantly and ulcer healing benefits after essential oil application (in this study an essential oil mix based on eucalyptus was applied twice daily) [45]. Besides, astringencies who have antiinflammatory, weak antiseptic effects and increase tissue repair like arnica flower (Arnica montana, Asteraceae), mulberry leaves (Morus alba, Moraceae) and silverweed (Argentina anserina, Rosaceae) are used in stomatitis, as well as aromatica (essential oil drugs) with its antiphlogistic and antimicrobial effects like clove flower bud (Syzygium aromaticum, Myrtaceae), calendula flower or rose blossom (Rosa spp., Rosaceae) [46].

Acute otitis media

About 50% of all acute middle ear infections are of viral pathogenesis [47]. Antibiotic usage in uncomplicated acute otitis media in children has been discussed controversial recently [48, 49]. It has been advocated that a watchful waiting period of 2–3 days is adequate before administering antibiotics [50]. However, antibiotics have to be applied whenever complications occur. To reduce the pain, a hot chamber that can be simple made by hot washcloth and a bathing cap is often very helpful. The American Academy of Otolaryngology-Head and Neck Surgery guidelines recommend topical medications as the first line of treatment for ear pain in the absence of systemic infection or serious underlying disease. There is some evidence that in the management of ear pain topical combination herbal medicines (e.g. Otikon otic solution containing extracts of garlic bulb, mullein flower, calendula flower and St. John’s wort herb in olive oil, manufactured by Healthy-On Ltd., Petach-Tikva, Israel) are as effective as oral amoxicillin and topical anaesthetics due to its antimicrobial, antiinflammatory, immunostimulating effects and good penetration through the tympanic membrane [51, 52]. Generally speaking, the dosage for phytotherapeutic drugs in children can be estimated for children under 4 years of age with 1/3 of the dosage for adults, children to 10 years take 1/2 and children to 16 years take 2/3 of the adult dosage.

Otitis externa diffusa

Infections of the outer ear canal are often only controlled when systemically and locally treated with longer application duration at the same time. First, cerumen and detritus have to be sucked from the outer ear canal to avoid a growing medium. Phytopharmaceuticals can be of adjuvant benefit for these patients often suffering from systemic diseases as well. Above-mentioned antiviral, antimycotic and antibacterial tinctures, drops or solutions are very useful in otitis externa as well, e.g. otikon ear drops, essential oil drugs, melissae or myrtle tinctures (Lomaherpan®, lomastatin®).

Reflux disease

The importance of gastroesophageal reflux in the aetiopathogenesis for various diseases of the upper airways and deglutition pathways, including cancerogenesis, is well known in otolaryngology. Reflux disease with a prevalence of up to 20% is a common symptom in western civilizations and can be the reason for other symptoms as globus pharyngis, postnasal drip, cough or halitosis [53]. Besides gastroesophageal reflux affects wound healing negatively. A tea spoon of healing earth (e.g. Luvos®, Heilerde-Gesellschaft Luvos Just GmbH & Co KG) equating 6.5 g has an acid-binding capacity of 25 mVal that is recommended for an antacidum from the German Federal Institute for Drugs and Medical Devices (BfArM). Asian ginseng root (Panax ginseng, Araliaceae) can be used in chronic erosive esophagitis [54] and possesses anticancerogenic effects [55].

Wound care

Acute and chronic wounds benefit from adjuvant phytotherapeutic and naturopathic care, although further research has to be done in this field. In vitro studies have shown the stimulation of keratinocytes cell proliferation of bee propolis in wound healing [56]. Meta-analyses have shown that medical grade honey (Medihoney, standardized antibacterial honey) is suitable as alternative for wound healing, burns, oral and external surgical wounds, various skin conditions and in the cancer setting, e.g. applied for radiation-induced mucositis, radiotherapy-induced skin reactions, hand and foot skin reactions in chemotherapy [57, 58, 59]. Ozone or ozonated olive oil application has been used for many years as a method ancillary to basic treatment in acute or chronic wounds, especially in those cases in which traditional treatment methods do not give satisfactory results, e.g. skin loss in non-healing wounds, ulcers, pressure sores, fistulae, etc. [60, 61, 62, 63]. Besides, essential oils represent a cheap and antiseptic effective treatment option for antibiotic-resistant strains of MRSA and antimycotic-resistant Candida species [64]. Calendula flower has antiphlogistic, immunostimulating, cytotoxic, antimicrobial, antiedematous, lymphagogue, phagocytosis and granulocytosis increasing effects and is successfully applied topically and systemic in the prevention and treatment of radiation dermatitis, venous ulcers and postoperative wounds [65, 66, 67, 68, 69].

Immunomodulation and immunostimulation

The terminology of immunomodulation should be preferred to immunostimulation as many phytotherapeutics used for a longer time or used in systemic and autoimmune diseases can lead to immunodepression. Therefore, coneflower root (Echinacea spec., Asteraceae) should not be applied longer than 8 weeks in adults and 2 weeks in children at a stretch. Echinacea and combination medicines (e.g. Esberitox®, manufactured by Schaper & Bruemmer GmbH & Co KG, Salzgitter, Germany or Contramutan®N, manufactured by A. Nettermann & Cie. GmbH, Cologne, Germany) can be used in all acute infections and is helpful in acute laryngopharyngitis, in particular [70, 71]. It enhances cell-mediated immunity by stimulation of macrophages, natural killer cells and granulocytes as well as humoral immunity through monokines, interferons and the complement system. Further herbs used for immunomodulating combination herbal medicines or single preparations are thuja herb (Thuja occidentalis, Cupressaceae), hemp agrimony (Eupatorium cannabinum, Asteraceae), boneset (Eupatorium perfoliatum, Asteraceae), wild indigo root (Baptisia tintoria, Fabaceae), lime flower, European elder berry, chamomile flower, meadowsweet herb (Filipendula ulmaria, Rosaceae) and pelargonium root (Pelargonium sidoides, Geraniaceae). Besides, it could be shown that Asian ginseng root (Panax ginseng, Araliaceae) accelerates reconvalescence, body weight, leukocytes and serum protein after operations and radiotherapy [72].

Vertigo and kinetosis

Scopoderm is a transdermal patch contain pure scopolamine, an alkaloid of belladonna leaves. It should be administered 4–6 h before the start of a journey. Equivalent effects for motion sickness (kinetosis) have been shown for ginger rhizome (zingiber officinale, Zingiberaceae) [73, 74]. Besides, ginger is well known for nausea and vomiting in pregnancy and postoperative care. Numerous trials, reviews and meta-analyses have shown equivalent efficacy when compared with hydrochloride (vitamin B6) and metoclopramide [75, 76, 77, 78, 79, 80]. Extracts of Gingko leaves (Gingko biloba, Gingkoaceae) have positive effects on the microcirculation and can be effectively used in long-time therapy for vestibular vertigo [81, 82].


Phytotherapeutic pharmaceuticals and herbal medicinal products with its roots in classical phytotherapeutic medicine have a well-established role in otolaryngological therapy within the European Community. A thorough selection and application can mean huge benefit for the patient, in particular in cases with contraindications, chemo- and antibiotic resistance or patient request. In complicated cases of upper airway or ear infections chemical antibiotics are indicated, but phytopharmaceuticals can be of additive value. In cases, where clinical studies and meta-analysis are missing, the long tradition of individual-based and experienced-based medicine provide the basis for therapeutical consideration.


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  1. 1.
    Fox N (1927) Effect of camphor, eucalyptol, and menthol on the vascular state of the mucous membrane. Arch Otolaryngol Head Neck Surg 6:112–122CrossRefGoogle Scholar
  2. 2.
    Behrbohm H, Kaschke O, Sydow K (1995) Effect of phytogenic secretolytic drug Gelomyrtol forte on mucociliary clearance of the maxillary sinus. Laryngorhinootologie 74:733–737PubMedCrossRefGoogle Scholar
  3. 3.
    Federspil P, Wulkow R, Zimmermann T (1997) Effects of standardized myrtol in therapy of acute sinusitis-results of a double-blind, randomized multicenter study compared with placebo. Laryngorhinootologie 76:23–27PubMedCrossRefGoogle Scholar
  4. 4.
    Melzer J, Saller R, Schapowal A, Brignoli R (2006) Systematic review of clinical data with BNO-101 (Sinupret) in the treatment of sinusitis. Forschende Komplementärmedizin 13:78–87 (German)PubMedCrossRefGoogle Scholar
  5. 5.
    Ismail C, Wiesel A, März RW, Queisser-Luft A (2002) Surveillance study of Sinupret in comparison with data of the Mainz birth registry. Arch Gynecol Obstet 267:196–201PubMedGoogle Scholar
  6. 6.
    Meister R, Wittig T, Beuscher N, deMey C (1999) Efficacy and tolerability of myrtol standardized in long term treatment of chronic bronchitis. A double-blind, placebo-controlled study. Study group investigators. Arzneimittelforschung 49:351–358 (German)PubMedGoogle Scholar
  7. 7.
    Ernst E, März RW, Sieder C (1997) Acute bronchitis: effectiveness of Sinupret. Comparative study with common expectorants in 3187 patients. Fortschr Med 115:52–53 (German)PubMedGoogle Scholar
  8. 8.
    März RW, Ismail C, Popp MA (1999) Profile and effectiveness of a phytogenic combination preparation for treatment of sinusitis. Wien Med Wochenschr 149:202–208 (German)PubMedGoogle Scholar
  9. 9.
    Matthys H, deMey C, Carls C, Geib A, Wittig T (2000) Efficacy and tolerability of myrtol standardized in acute bronchitis. A multi-centre, randomised, double-blind, placebo-controlled parallel group clinical trial vs. cefuroxime and ambroxol. Arzneimittelforschung 50:700–711 (German)PubMedGoogle Scholar
  10. 10.
    Schapowal A (2002) Randomised controlled trial of butterbur and cetirizine for treating seasonal allergic rhinitis. BMJ 324:144–146PubMedCrossRefGoogle Scholar
  11. 11.
    Schapowal A (2004) Butterbur Ze339 for the treatment of intermittent allergic rhinitis: dose-dependent efficacy in a prospective, randomized, double-blind, placebo-controlled study. Arch Otolaryngol Head Neck Surg 130:1381–1386PubMedCrossRefGoogle Scholar
  12. 12.
    Guo R, Pittler MH, Ernst E (2007) Herbal medicines tor the treatment of allergic rhinitis: a systematic review. Ann Asthma Allergy Immunol 99:483–495CrossRefGoogle Scholar
  13. 13.
    Chi H, Chiu NC, Li WC, Huang FY (2003) Etiology of acute pharyngitis in children: is antibiotic therapy needed. J Microbiol Immunol Infect 36:26–30PubMedGoogle Scholar
  14. 14.
    Eposito S, Blasi F, Bosis S (2004) Aetiology of acute pharyngitis: the role of atypical bacteria. J Med Microbiol 53:645–651CrossRefGoogle Scholar
  15. 15.
    Gerber MA (2005) Diagnosis and treatment of pharyngitis in children. Pediatr Clin North Am 52:729–747PubMedCrossRefGoogle Scholar
  16. 16.
    Berger T (2008) Tolerability and efficacy of a herbal combination preparation in children and adolescents with recurrent infections of the upper respiratory tract. MMW Fortschr Med 150:85–90 (German)PubMedGoogle Scholar
  17. 17.
    Conrad A, Kolberg T, Engels I, Frank U (2006) In vitro study to evaluate the antibacterial activity of a combination of the haulm of nasturtium (Tropaeoli majoris herba) and of the roots of horseradish (Armoraciae rusticanae radix). Arzneimittelforschung 56:842–849 (German)PubMedGoogle Scholar
  18. 18.
    Goos KH, Albrecht U, Schneider B (2006) Efficacy and safety profile of a herbal drug containing nasturtium herb and horseradish root in acute sinusitis, acute bronchitis and acute urinary tract infection in comparison with other treatments in the daily practice/results of a prospective cohort study. Arzneimittelforschung 56:249–257 (German)PubMedGoogle Scholar
  19. 19.
    Goos KH, Albrecht U, Schneider B (2007) On-going investigations on efficacy and safety profile of a herbal drug containing nasturtium herb and horseradish root in acute sinusitis, acute bronchitis and acute urinary tract infection in children in comparison with other antibiotic treatments. Arzneimittelforschung 57:238–246 (German)PubMedGoogle Scholar
  20. 20.
    März RW, Kemper F (2002) Willow bark extract-effects and effectiveness. Status of current knowledge regarding pharmacology, toxicology and clinical aspects. Wien Med Wochenschr 152:354–359 (German)PubMedCrossRefGoogle Scholar
  21. 21.
    Zakay-Rones Z, Thom E, Wollan T, Wadstein J (2004) Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res 32:132–140PubMedGoogle Scholar
  22. 22.
    Matthys H, Eisebitt R, Seith B, Heger M (2003) Efficacy and safety of an extract of Pelargonium sidoides (EPs 7630) in adults with acute bronchitis. A randomised, double-blind, placebo-controlled trial. Phytomedicine 10:7–17PubMedCrossRefGoogle Scholar
  23. 23.
    Matthys H, Kamin W, Funk P, Heger M (2007) Pelargonium sidoides preparation (EPs 7630) in the treatment of acute bronchitis in adults and children. Phytomedicine 14(Suppl 6):69–73PubMedCrossRefGoogle Scholar
  24. 24.
    Conrad A, Kolodziej H, Schulz V (2007) Pelargonium sidoides-extract (EPs 7630): registration confirms efficacy and safety. Wien Med Wochenschr 157:331–336 (German)PubMedCrossRefGoogle Scholar
  25. 25.
    Kolodziej H, Schulz V (2003) Umckaloabo. Deutsche Apotheker Zeitung 143:55–64 (German)Google Scholar
  26. 26.
    Beer AM, Loew D (2008) Medical plants for infections of the upper and lower airway tract: practical recommendations. MMW Fortschr Med 150:29–33 (German)PubMedGoogle Scholar
  27. 27.
    Marzian O (2007) Treatment of acute bronchitis in children and adolescents. Non interventional postmarketing surveillance study confirms the benefit and safety of a syrup made of extracts from thyme and ivy leaves. MMW Fortschr Med 149:69–74 (German)PubMedGoogle Scholar
  28. 28.
    Schilcher H, Kammerer S, Wegener T (2007) Praxisleitfaden phytotherapie. Urban und Fischer, München (German)Google Scholar
  29. 29.
    Bolbot Y, Prokhorov E, Mokia S, Yurtseva A (2004) Comparing the efficacy and safety of high-concentrate ivy leaves extract and acetylcysteine for treatment of children with acute bronchitis. Drugs of Ukraine 11Google Scholar
  30. 30.
    Ernst E, März R, Sieder C (1997) A controlled multi-centre study of herbal versus synthetic secretolytic drugs for acute bronchitis. Phytomedicine 1:287–293CrossRefGoogle Scholar
  31. 31.
    Ismail C, Willer G, Steindl H (2003) Bronchipret in acute bronchitis. Schweizerische Zeitschrift für Ganzheitsmedizin 15:171–175 (German)Google Scholar
  32. 32.
    Abe J, Hosokawa H, Sawada Y, Matsumura K, Kobayashi S (2006) Ca2+-dependent PKC activation mediates menthol-induced desensitization of transient receptor potential M8. Neurosci Lett 397:140–144PubMedCrossRefGoogle Scholar
  33. 33.
    Mohrig A, Alken RG (1996) Melissa extract in comparison to acyclovir. Pharmazeutische Rundschau 38:25–26 (German)Google Scholar
  34. 34.
    Wölbling RH, Leonhardt K (1994) Local therapy of herpes simplex with dried extract from Melissa officinalis. Phytomedicine 1:25–31CrossRefGoogle Scholar
  35. 35.
    Köhler K (1997) Extract from Melissa officinalis in herpes simplex. Effectivity against placebo proofed again. Allgemeinarzt 19:1853–1854 (German)Google Scholar
  36. 36.
    Buechi S (2005) Sage leaves and pieplant roots vs acyclovir in herbes labialis. Zeitschrift für Phytotherapie 26:275–277 (German)CrossRefGoogle Scholar
  37. 37.
    Vynograd N, Vynograd I, Sosnowski Z (2000) A comparative multi-centre study of the efficacy of propolis, acyclovir and placebo in the treatment of genital herpes (HSV). Phytomedicine 7:1–6PubMedCrossRefGoogle Scholar
  38. 38.
    Koch C, Reiching J, Schneele J, Schnitzler P (2008) Inhibitory effect of essential oils against herpes simplex virus type 2. Phytomedicine 15:71–78PubMedCrossRefGoogle Scholar
  39. 39.
    Nolkemper S, Reichling J, Stintzing FC (2006) Antiviral effect of aqueous extracts from species of the Lamiaceae family against herpes simplex virus type 1 and type 2 in vitro. Plant Med 72:1378–1382CrossRefGoogle Scholar
  40. 40.
    Schnitzler P, Schön K, Reichling J (2001) Antiviral activity of Australian tea tree oil and eucalyptus oil against herpes simplex virus in cell culture. Die Pharmazie 56:343–347 (German)PubMedGoogle Scholar
  41. 41.
    Babaee N, Mansourian A, Momen-Haravi F, Moghadamnia A, Momen-Beitollahi J (2010) The efficacy of paste containing Myrtus communis (Myrtle) in the management in recurrent aphthous stomatitis: a randomized controlled trial. Clin Oral Investig 14:65–70PubMedCrossRefGoogle Scholar
  42. 42.
    Samet N, Laurent C, Susarla SM, Samet-Rubinsteen N (2007) The effect of bee propolis in recurrent aphthous stomatitis. Clin Oral Investig 11:143–147PubMedCrossRefGoogle Scholar
  43. 43.
    Braga PC, Alfieri M, Culici M, Dalsasso M (2007) Inhibitory activity of thymol against the formation and viability of Candida albicans hyphae. Mycoses 50:502–506PubMedCrossRefGoogle Scholar
  44. 44.
    Giordani R, Regli P, Kaloustian J, Mikail C, Abou L, Portugal H (2004) Antifungal effect of various essential oils against Candida albicans. Potentiation of antifungal action of amphotericin B by essential oils from thymus vulgaris. Phytother Res 18:990–995PubMedCrossRefGoogle Scholar
  45. 45.
    Warnke PH, Sherry E, Russo PA, Acil Y, Wiltfang J, Sivananthan S, Sprengel M, Roldan JC, Schubert S, Bredee JP, Springer IN (2006) Antibacterial essential oils in malodorous cancer patients: clinical observations in 30 patients. Phytomedicine 13:463–467PubMedCrossRefGoogle Scholar
  46. 46.
    Braga PC, Sasso MD, Culici M, Alfieri M (2007) Eugenol and thymol alone or in combination induce alterations in the envelope of Candida albicans. Fitoterapia 78:396–400PubMedCrossRefGoogle Scholar
  47. 47.
    Bulut Y, Güven M, Otlu B, yenisehirli G, Aladag I, Eyibilen A, Dogru S (2007) Acute otitis media and respiratory viruses. Eur J Pediatr 166:223–228PubMedCrossRefGoogle Scholar
  48. 48.
    Damoiseaux RA, Van Balen FA, Hoes AW, deMelker RA (1998) Antibiotic treatment of acute otitis media in children under two years of age: evidence based? Br J Gen Pract 48:1861–1864PubMedGoogle Scholar
  49. 49.
    Glasziou PP, DelMar CB, Sanders SL, Hayem M (2004) Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 1:CD000219PubMedGoogle Scholar
  50. 50.
    McCormick DP, Chonmaitree T, Pittman C, Saeed K, Friedman NR, Uchida T, Baldwin CD (2005) Nonsevere acute otitis media: a clinical trial comparing outcomes of watchful waiting versus immediate antibiotic treatment. Pediatrics 115:1455–1465PubMedCrossRefGoogle Scholar
  51. 51.
    Sarrell EM, Mandelberg A, Cohen HA (2001) Efficacy of naturopathic extracts in the management of ear pain associated with acute otitis media. Arch Pediatr Adolesc Med 155:796–799PubMedGoogle Scholar
  52. 52.
    Sarrell EM, Cohen HA, Kahan E (2003) Naturopathic treatment for ear pain in children. Pediatrics 111:574–579CrossRefGoogle Scholar
  53. 53.
    Locke GR, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ (1997) Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology 112:1448–1456PubMedCrossRefGoogle Scholar
  54. 54.
    Bespalov VG, Alexandrov VA, Limarenko AY (2001) Chemoprevention of mammary, cervix and nervous system carcinogenesis in animals using cultured Panax ginseng drugs and preliminary clinical trials in patients with precancerous lesions of the esophagus and endometrium. J Korean Med Sci 16:42–53Google Scholar
  55. 55.
    Shin HR, Kim JY, Yun TK, Morgan G, Vainio H (2000) The cancer preventive potential of Panax ginseng: a review of human and experimental evidence. Cancer Causes Control 11:565–576PubMedCrossRefGoogle Scholar
  56. 56.
    Sehn E, Hernandes L, Franco SL, Goncalves CC, Baesso ML (2009) Dynamics of reepithelialisation and penetration rate of a bee propolis formulation during cutaneous wound healing. Anal Chim Acta 635:115–120PubMedCrossRefGoogle Scholar
  57. 57.
    Bardy J, Slevin NJ, Mais KL, Molasiottis A (2008) A systematic review of honey uses and its potential value with oncologic care. J Clin Nurs 17:2661–2664CrossRefGoogle Scholar
  58. 58.
    Jull AB, Rodgers A, Walker N (2008) Honey as a topical treatment for wounds. Cochrane Database Syst Rev 4:CD005083PubMedGoogle Scholar
  59. 59.
    Robson V, Dodd S, Thomas S (2009) Standardized antibacterial honey (Medihoney) with standard therapy in wound care: randomized clinical trial. J Adv Nurs 65:565–575PubMedCrossRefGoogle Scholar
  60. 60.
    Bialoszewski D, Kowalewski M (2003) Superficially, longer, intermittent ozone therapy in the treatment of the chronic, infected wounds. Ortop Traumatol Rehabil 5:652–658 (Polish)PubMedGoogle Scholar
  61. 61.
    Kim HS, Noh SU, Han YW, Kim KM, Kang H, Kim HO, Park YM (2009) Therapeutic effects of topical application of ozone on acute cutaneous wound healing. J Korean Med Sci 24:368–374PubMedCrossRefGoogle Scholar
  62. 62.
    Skomro P, Opalko K, Gadomska-Krasny J, Lietz-Kijak D, Perzanowska-Stefanska M (2005) Ozone therapy with the Ozonytrone apparatus. Ann Acad Med Stetin 52:39–42 (Polish)Google Scholar
  63. 63.
    Valacchi G, Fortino V, Bocci V (2005) The dual action of ozone on the skin. Br J Dermatol 153:1096–1100PubMedCrossRefGoogle Scholar
  64. 64.
    Warnke PH, Becker ST, Podschun R, Sivananthan S, Springer IN, Russo PA, Wiltfang J, Fickenscher H, Sherry E (2009) The battle against multi-resistant strains: renaissance of antimicrobial essential oils as a promising force to fight hospital-acquired infections. J Cranio-maxillo-fac Surg 37:392–397Google Scholar
  65. 65.
    Chandran PK, Kuttan R (2008) Effect of Calendula officinalis flower extract on acute phase proteins, antioxidant defense mechanisms, and granuloma formation during thermal burns. J Clin Biochem Nutr 43:58–64PubMedCrossRefGoogle Scholar
  66. 66.
    Duran V, Matic M, Jovanovc M, Mimica N, Gajinov Z, Poljacki M, Boza P (2005) Results of the clinical examination of an ointment with marigold (Calendula officinalis) extract in the treatment of venous leg ulcers. Int J Tissue React 27:101–106PubMedGoogle Scholar
  67. 67.
    Grimme H, Augustin M (1999) Phytotherapy in chronic dermatoses and wounds: what is evidence? Forschende Komplementärmedizin 5(Suppl 2):5–8 (German)CrossRefGoogle Scholar
  68. 68.
    McQuestion M (2006) Evidence-based skin care management in radiation therapy. Semin Oncol Nurs 22:163–173PubMedCrossRefGoogle Scholar
  69. 69.
    Pommier P, Gomez F, Sunyach MP, D’Hombres A, Carries C, Montbarbon X (2004) Phase III randomized trial of Calendula officinalis compared with trolamine for the prevention of acute dermatitis during irradiation for breast cancer. J Clin Oncol 22:1447–1453PubMedCrossRefGoogle Scholar
  70. 70.
    Melchart D, Linde K, Fischer P, Kaesmayr J (2000) Echinacea for preventing and treating the common cold. Cochrane Database Syst Rev 2:CD000530PubMedGoogle Scholar
  71. 71.
    Schoop R, Klein P, Suter A, Johnston SL (2006) Echinacea in the prevention of induced rhinovirus colds: a meta-analysis. Clin Ther 28:174–183PubMedCrossRefGoogle Scholar
  72. 72.
    Chang YS, Lee JY, Kim CW (1978) The effect of ginsenoide-triol on the postoperative recovery in gynecological patients. In: Proceedings of the second international Ginseng symposium, pp 79–84Google Scholar
  73. 73.
    Careddu P (1999) Motion sickness in children: results of a double-blind study with ginger (Zintona) and dimenhydrinate. Healthnotes Rev Complement Integr Med 6:102–107Google Scholar
  74. 74.
    Ribenfeld D, Borzone L (1999) Randomized double-blind study comparing ginger (Zintona) with dimenhydrinate in motion sickness. Healthnotes Rev Complement Integr Med 6:98–101Google Scholar
  75. 75.
    Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, Leeprakobboon K, Leelasettagool C (2006) The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis. Am J Obstet Gynecol 194:95–99PubMedCrossRefGoogle Scholar
  76. 76.
    Chittumma P, Kaewkiattikun K, Wiriyasiriwach B (2007) Comparison of the effectiveness of ginger and vitamin B6 for the treatment of nausea and vomiting in early pregnancy: a randomized double-blind controlled trial. J Med Assoc Thailand 90:15–20Google Scholar
  77. 77.
    Ernst E, Pittler MH (2000) Efficacy for ginger for nausea and vomiting: a systematic review of randomized clinical trials. Br J Anesth 84:367–371Google Scholar
  78. 78.
    Ozgoli G, Goli M, Simbar M (2009) Effects on ginger capsules on pregnancy, nausea, and vomiting. J Altern Complement Med 15:243–246PubMedCrossRefGoogle Scholar
  79. 79.
    Smith C, Crowther C, Willson K, Hotham N, McMillian V (2004) A randomized controlled trial of ginger to treat nausea and vomiting in pregnancy. Obstet Gynecol 103:639–645PubMedCrossRefGoogle Scholar
  80. 80.
    White B (2007) Ginger: an overview. Am Fam Phys 75:1689–1691Google Scholar
  81. 81.
    Clostre F (1999) Ginkgo biloba extract (EGb 761) State of knowledge in the dawn of the year 2000. Ann Parma Francaises 57(Suppl 1):8–88 (French)Google Scholar
  82. 82.
    Hamann K (2007) Special Gingko extract in cases of vertigo: a systematic review of randomised, double-blind, placebo-controlled clinical examinations. HNO 55:258–263 (German)PubMedCrossRefGoogle Scholar

Copyright information

© The Author(s) 2011

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of BochumBochumGermany

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