Complementary and alternative medicine use by otolaryngology patients: a paradigm for practitioners in all surgical specialties


There is growing interest in complementary and alternative medicine (CAM) amongst the general population. Little information is available on CAM use in otolaryngology patients in the UK. Despite concerns over safety, efficacy and cost-effectiveness, CAM use is common amongst ENT patients. Patients perceive these medications as possible boosters to their immune system. It is becoming increasingly important that health care providers in all specialties ask their patients about CAM use and are aware of the implications it carries. The objective is to study the prevalence and pattern of CAM use among adult and paediatric ENT patients in a UK teaching hospital. A cross-sectional study was done by sending anonymous questionnaire to all outpatient and elective inpatients over a 3-month period. Response rate was 73% (1,789/2,440). Prominent demographics: female, married, over-50 s. Sixty percent had used CAM, 35% in last year. Most common herbs: cod liver oil (n = 481), garlic (n = 255), cranberry (n = 224); non-herbal: massage (n = 287), acupuncture (n = 233), aromatherapy (n = 170). Most commonly cited reasons for using CAM: general health, enhanced immunity and prevention/treatment of common illnesses like the common cold, asthma and bodily aches and pains.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2


  1. 1.

    Manheimer E, Berman B (2008) Cochrane Complementary Medicine Field. About The Cochrane Collaboration (Fields). Cochrane Collab (2):CE000052

  2. 2.

    Taylor N, Blackwell A (2008) Complementary and alternative medicine familiarization: what’s happening in medical schools in Wales? Evid Based Complement Altern Med, January 16 (Epub ahead of print)

  3. 3.

    Referrals to complementary therapists. The British Medical Association, 2006. Available at

  4. 4.

    Kleiner SM (1995) The true nature of herbs. Phys Sports Med 23:13

    Google Scholar 

  5. 5.

    House of Lords (2000) Complementary and alternative medicine. Select Committee on Sciences and Technology, 6th report. Science and Technology Committee Publications

  6. 6.

    Shakeel M, Bruce J, Jehan S, McAdam TK, Bruce DM (2008) Use of complementary and alternative medicine by patients admitted to a surgical unit in Scotland. Ann R Coll Surg Engl 90(7):571–576

    Article  PubMed  Google Scholar 

  7. 7.

    Ernst E, Cassileth BR (1998) The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer 83(4):777–782

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Shakeel M, Little SA, Bruce J, Ah-See KW (2007) Use of complementary and alternative medicine in pediatric otolaryngology patients attending a tertiary hospital in the UK. Int J Pediatr Otorhinolaryngol 71(11):1725–1730

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Jose VW, Bhalla A, Sharma N, Hota D, Sivaprasad S, Pandhi P (2007) Study of association between use of complementary and alternative medicine and the non-compliance with modern medicine in patients presenting to the emergency department. J Postgrad Med 53:96–101

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Ernest E (2007) Noncompliance with conventional medicine and the use of complementary/alternative medicine. J Postgrad Med 53:85

    Article  Google Scholar 

  11. 11.

    Eisenberg DM, Davis RB, Ettner SL (1998) Trends in alternative medicine use in the United States 1990–1997. JAMA 280:1569–1575

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Astin JA (1998) Why patients use alternative medicine: results of a national study. JAMA 279(19):1548–1553

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Woolf AD (2003) Herbal remedies and children: do they work? Are they harmful? Pediatrics 112:240–246

    PubMed  Google Scholar 

  14. 14.

    Hu Z, Yang X, Ho PC, Chan SY, Heng PW, Chan E, Duan W, Koh HL, Zhou S (2005) Herb–drug interactions: a literature review. Drugs 65(9):1239–1282

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Featherstone C, Godden D, Gault C, Emslie M, Took-Zozaya M (2003) Prevalence study of concurrent use of complementary and alternative medicine in patients attending primary care services in Scotland. Am J Public Health 93:1080–1082

    Article  PubMed  Google Scholar 

  16. 16.

    Bishop FL, Lewith GT (2008) Who uses CAM? A narrative review of demographic characteristics and health factors associated with CAM use. Evid Based Complement Altern Med, March 13 (Epub ahead of print)

  17. 17.

    Galarraga B, Ho M, Youssef HM, Hill A, McMahon H, Hall C et al (2008) Cod liver oil (n-3 fatty acids) as a non-steroidal anti-inflammatory drug sparing agent in rheumatoid arthritis. Rheumatology (Oxf) 47(5):665–669

    Article  CAS  Google Scholar 

  18. 18.

    Saremi A, Arora R (2008) The utility of omega-3 fatty acids in cardiovascular disease. Am J Ther, December 15 (Epub ahead of print)

  19. 19.

    Sanders TAB, Oakley FR, Miller GJ, Mitropoulos KA, Crook D, Oliver MF (1997) Influence of n-6 versus n-3 polyunsaturated fatty acids in diets low in saturated fatty acids on plasma lipoproteins and hemostatic factors. Arterioscler Thromb Vasc Biol 17(12):3449–3460

    CAS  PubMed  Google Scholar 

  20. 20.

    Larson MK, Ashmore JH, Harris KA, Vogelaar JL, Pottala JV, Sprehe M et al (2008) Effects of omega-3 acid ethyl esters and aspirin, alone and in combination, on platelet function in healthy subjects. Thromb Haemost 100(4):634–641

    CAS  PubMed  Google Scholar 

  21. 21.

    O’Brien D (2002) Notes from the 2001 American Society of Anesthesiologists annual meeting. J Perianesth Nurs 17(2):130–141

    Article  PubMed  Google Scholar 

  22. 22.

    Gardner CD, Lawson LD, Block E, Chatterjee LM, Kiazand A, Balise RR et al (2007) Effect of raw garlic vs. commercial garlic supplements on plasma lipid concentrations in adults with moderate hypercholesterolemia: a randomized clinical trial. Arch Intern Med 167(4):346–353

    Article  CAS  PubMed  Google Scholar 

  23. 23.

    Ang-Lee MK, Moss J, Yuan C (2001) Herbal medicines and perioperative care. JAMA 286:208

    Article  CAS  PubMed  Google Scholar 

  24. 24.

    Apitz-Castro R, Escalante J, Vargas R, Jain MK (1986) Ajoene, the antiplatelet principle of garlic, synergistically potentiates the antiaggregatory action of prostacyclin, forskolin, indomethacin and dypiridamole on human platelets. Thromb Res 42:303–311

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Jepson RG, Craig JC (2008) Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev (1):CD001321. doi:10.1002/14651858.CD001321.pub4

  26. 26.

    Pham DQ, Pham AQ (2007) Interaction potential between cranberry juice and warfarin. Am J Health Syst Pharm 64(5):490–494

    Article  CAS  PubMed  Google Scholar 

  27. 27.

    Mohammed Abdul MI, Jiang X, Williams KM, Day RO, Roufogalis BD, Liauw WS et al (2008) Pharmacodynamic interaction of warfarin with cranberry but not with garlic in healthy subjects. Br J Pharmacol 154(8):1691–1700

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Shah SA, Sander S, White CM, Rinaldi M, Coleman CI (2007) Evaluation of Echinacea for the prevention and treatment of the common cold: a meta-analysis. Lancet Infect Dis 7(7):473–480

    Article  PubMed  Google Scholar 

  29. 29.

    Kreft S (2008) Assessment report on Echinacea purpura (L.) Moench, Herba Recens. EMEA 2008, March 6. ref:EMEA/HMPC/104918/2006

  30. 30.

    Schoneberger D (1992) The influence of immune stimulating effects of pressed juices from Echinacea purpurea on the course and intensity of the common cold: results of a double-blind clinical trial. Forum Immunol 2:18

    Google Scholar 

  31. 31.

    Boullata JI, Nace AM (2000) Safety issues with herbal medicine. Pharmacotherapy 20:257–269

    Article  CAS  PubMed  Google Scholar 

  32. 32.

    Mullins RJ (1998) Echinacea-associated anaphylaxis. Med J Aust 168:170–171

    CAS  PubMed  Google Scholar 

  33. 33.

    Butterweck V (2003) Mechanism of action of St John’s wort in depression: what is known? CNS Drugs 17(8):539–562

    Article  CAS  PubMed  Google Scholar 

  34. 34.

    Linde K, Berner MM, Kriston L (2008) St John’s wort for major depression. Cochrane Database Syst Rev (4):CD000448. doi:10.1002/14651858.CD000448.pub3

  35. 35.

    Ernst E, Rand JI, Barnes J, Stevinson C (1998) Adverse effects profile of the herbal antidepressant St. John’s wort (Hypericum perforatum L.). Eur J Clin Pharmacol 54:589

    Article  CAS  PubMed  Google Scholar 

  36. 36.

    Crowe S, Keating K (2002) Delayed emergence and St. John’s Wort. Anesthesiology 96:1025

    Article  PubMed  Google Scholar 

  37. 37.

    Birks J, Grimley Evans J (2007) Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev (2):CD003120. doi:10.1002/14651858.CD003120.pub2

  38. 38.

    Hilton M, Stuart E (2004) Ginkgo biloba for tinnitus. Cochrane Database Syst Rev (2):CD003852. doi:10.1002/14651858.CD003852.pub2

  39. 39.

    Vuksan V, Sievenpiper JL, Koo VY et al (2000) American ginseng (Panax quinquefolius L) reduces postprandial glycemia in nondiabetic subjects and subjects with type 2 diabetes mellitus. Arch Intern Med 160:1009–1013

    Article  CAS  PubMed  Google Scholar 

  40. 40.

    Kuo SC, Teng CM, Lee JC, Ko FN, Chen SC, Wu TS (1990) Antiplatelet components in Panax ginseng. Planta Med 56:164–167

    Article  CAS  PubMed  Google Scholar 

  41. 41.

    Teng CM, Kuo SC, Ko FN et al (1989) Antiplatelet actions of panaxynol and ginsenosides isolated from ginseng. Biochim Biophys Acta 990:315–320

    CAS  PubMed  Google Scholar 

  42. 42.

    Janetzky K, Morreale AP (1997) Probable interaction between warfarin and ginseng. Am J Health Syst Pharm 54:692–693

    CAS  PubMed  Google Scholar 

  43. 43.

    Santos MS, Ferreira F, Cunha AP, Carvalho AP, Ribeiro CF, Macedo T (1994) Synaptosomal GABA release as influenced by valerian root extract-involvement of the GABA carrier. Arch Int Pharmacodyn Ther 327:220–231

    CAS  PubMed  Google Scholar 

  44. 44.

    Garges HP, Varia I, Doraiswamy PM (1998) Cardiac complications and delirium associated with valerian root withdrawal. JAMA 280:1566–1567

    Article  CAS  PubMed  Google Scholar 

  45. 45.

    Pittler MH, Ernst E (2003) Kava extract versus placebo for treating anxiety. Cochrane Database Syst Rev (1):CD003383. doi:10.1002/14651858.CD003383

  46. 46.

    Meyer HJ (1967) Pharmacology of kava. 1. Psychopharmacol Bull 4:10–11

    CAS  PubMed  Google Scholar 

  47. 47.

    Norton SA, Ruze P (1994) Kava dermopathy. J Am Acad Dermatol 31:89–97

    Article  CAS  PubMed  Google Scholar 

  48. 48.

    Russman S, Barguil Y, Cabalion P, Kritsanida M, Duhet D, Lauterburg BH (2003) Hepatic injury due to traditional aqueous extracts of kava root in New Caledonia. Eur J Gastroenterol Hepatol 15:1033

    Article  Google Scholar 

  49. 49.

    Almeida JC, Grimsley EW (1996) Coma from the health food store: interaction between kava and alprazolam. Ann Intern Med 125:940–941

    CAS  PubMed  Google Scholar 

  50. 50.

    Gurley BJ, Gardner SF, Hubbard MA (2000) Content versus label claims in ephedra-containing dietary supplements. Am J Health Syst Pharm 57:963–969

    CAS  PubMed  Google Scholar 

  51. 51.

    Nightingale SL (1997) From the Food and Drug Administration. JAMA 278:15

    Article  CAS  PubMed  Google Scholar 

  52. 52.

    Roizen MF (1994) Anesthetic implications of concurrent diseases. In: Miller RD (ed) Anesthesia, 4th edn. Churchill Livingstone, New York, pp 903–1014

    Google Scholar 

  53. 53.

    Haller C, Benowitz N (2000) Adverse cardiovascular and central nervous system events associated with dietary supplements containing ephedra alkaloids. N Engl J Med 343(25):1833–1838

    Article  CAS  PubMed  Google Scholar 

  54. 54.

    Tamayo C, Diamond S (2007) Review of clinical trials evaluating safety and efficacy of milk thistle (Silybum marianum [L.] Gaertn.). Integr Cancer Ther 6(2):146–157

    Article  CAS  PubMed  Google Scholar 

  55. 55.

    Boerth J, Strong KM (2002) The clinical utility of milk thistle (Silybum marianum) in cirrhosis of the liver. J Herb Pharmacother 2(2):11–17

    Article  PubMed  Google Scholar 

  56. 56.

    Zuber R, Modriansky M, Dvorak Z, Rohovzky P, Ulrichova J, Simanek V et al (2002) Effect of silybin and its congeners on human liver microsomal cytochrome P450 activities. Phytother Res 16:632–638

    Article  CAS  PubMed  Google Scholar 

  57. 57.

    Bleakley CM, McDonough SM, MacAuley DC (2008) Some conservative strategies are effective when added to controlled mobilisation with external support after acute ankle sprain: a systematic review. Aust J Physiother 54(1):7–20

    PubMed  Google Scholar 

  58. 58.

    Barna M, Kucera A, Hladícova M, Kucera M (2007) Wound healing effects of a Symphytum herb extract cream (Symphytum × uplandicum NYMAN:): results of a randomized, controlled double-blind study. Wien Med Wochenschr 157(21–22):569–574

    Article  PubMed  Google Scholar 

  59. 59.

    Grube B, Grünwald J, Krug L, Staiger C (2007) Efficacy of a comfrey root (Symphyti offic. radix) extract ointment in the treatment of patients with painful osteoarthritis of the knee: results of a double-blind, randomised, bicenter, placebo-controlled trial. Phytomedicine 14(1):2–10

    Article  CAS  PubMed  Google Scholar 

  60. 60.

    Stickel F, Seitz HK (2000) The efficacy and safety of comfrey. Public Health Nutr 3(4A):501–508

    Article  CAS  PubMed  Google Scholar 

  61. 61.

    Williams L, Chou MW, Yan J, Young JF, Chan PC, Doerge DR (2002) Toxicokinetics of riddelliine, a carcinogenic pyrrolizidine alkaloid, and metabolites in rats and mice. Toxicol Appl Pharmacol 182(2):98–104

    Article  CAS  PubMed  Google Scholar 

  62. 62.

    Wilt T, Ishani A, MacDonald R (2002) Serenoa repens for benign prostatic hyperplasia. Cochrane Database Syst Rev (3):CD001423. doi:10.1002/14651858.CD001423

  63. 63.

    Scholtysek C, Krukiewicz AA, Alonso JL, Sharma KP, Sharma PC, Goldmann WH (2009) Characterizing components of the saw palmetto berry extract (SPBE) on prostate cancer cell growth and traction. Biochem Biophys Res Commun 379:795–798

    Article  CAS  PubMed  Google Scholar 

  64. 64.

    Avins AL, Bent S, Staccone S, Badua E, Padula A, Goldberg H et al (2008) A detailed safety assessment of a saw palmetto extract. Complement Ther Med 16(3):147–154

    Article  PubMed  Google Scholar 

  65. 65.

    Cheema P, El-Mefty O, Jazieh AR (2001) Intraoperative haemorrhage associated with the use of extract of saw palmetto herb: a case report and review of literature. J Intern Med 250(2):167–169

    Article  CAS  PubMed  Google Scholar 

  66. 66.

    Clement Y (2009) Can green tea do that? A literature review of the clinical evidence. Prev Med, May 22 (Epub ahead of print)

  67. 67.

    Mazzanti G, Menniti-Ippolito F, Moro PA, Cassetti F, Raschetti R, Santuccio C et al (2009) Hepatotoxicity from green tea: a review of the literature and two unpublished cases. Eur J Clin Pharmacol 65(4):331–341

    Article  PubMed  Google Scholar 

  68. 68.

    Taylor JR, Wilt VM (1999) Probable antagonism of warfarin by green tea. Ann Pharmacother 33(4):426–428

    Article  CAS  PubMed  Google Scholar 

  69. 69.

    Nishikawa M, Ariyoshi N, Kotani A, Ishii I, Nakamura H, Nakasa H et al (2004) Effects of continuous ingestion of green tea or grape seed extracts on the pharmacokinetics of midazolam. Drug Metab Pharmacokinet 19(4):280–289

    Article  CAS  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Muhammad Shakeel.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Shakeel, M., Trinidade, A. & Ah-See, K.W. Complementary and alternative medicine use by otolaryngology patients: a paradigm for practitioners in all surgical specialties. Eur Arch Otorhinolaryngol 267, 961–971 (2010).

Download citation


  • Complementary
  • Alternative
  • Anaesthesia
  • Risks
  • Otolaryngology