Hip
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In the 2016 Japanese study (full paper here), Dr Osamu Hotta et al looked at 41 patients who developed a chronic fatigue syndrome-like condition after receiving the human papillomavirus (HPV) vaccine (Gardasil or Cervarix).
All 41 patients were found to have severe chronic nasopharyngitis (also called epipharyngitis), which is an inflammation in the nasopharynx (also called the epipharynx), the area just above the pharynx.
The Nasopharynx
When the chronic inflammation in the nasopharynx area of 16 of these CFS patients was treated with 0.5% zinc chloride solution (ZnCI2) topically applied with cotton swabs, 25% of the 16 patients were completely cured of their CFS-like illness, and another 56% of the 16 patients significantly improved as a result of the treatment (they only treated 16 out of the 41 patients, because only these 16 were willing to regularly attend hospital for the zinc chloride treatment).
In the 19% of the 16 patients who did not respond to treatment, the study authors observed that the zinc chloride unfortunately did not reduce their nasopharygeal inflammation; whereas in the responders, they observed that the application of zinc chloride helped resolve the nasopharyngitis. So this is more evidence that the nasopharygeal inflammation is actually playing a causal role in these cases of CFS.
This study is very interesting, as it perhaps reignites the old idea of a chronic focal infection playing a role in ME/CFS (a focal infection is one that is localized to a specific site in the body). Several people on this forum had ME/CFS symptoms as a result of a chronic focal infection within the jaw bone (osteomyelitis). location
The Hotta 2016 study authors propose that the cures and symptomatic improvements in the CFS patients treated with zinc chloride could be related to hypothalamic pituitary adrenal (HPA) axis normalization, and propose that these improvement may arise from restoration of the immune neuroendocrine system.
The authors think that this nasopharyngitis treatment may also be effective for various other types of functional somatic syndrome, regardless of the initial cause, as well as for some autoimmune diseases. Functional somatic syndromes include: chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivity, the Gulf War syndrome and irritable bowel syndrome.
This video shows the red appearance of a severely inflamed nasopharynx: an endoscope camera is passed through nose to reach the nasopharynx located just beyond the end of the nasal cavity:
Zinc Chloride Solution Treatment Applied to the Nasopharynx
The image below shows how the 0.5% zinc chloride solution is applied to the entire nasopharynx surface, by inserting a cotton swab through the nasal cavity, and by inserting a cotton swab via the back of the throat. The treatment procedure is shown at timecode 6:46 in this video.
Applying 0.5% Zinc Chloride Solution to the Inflamed Nasopharynx Using Swabs
This treatment is named epipharyngeal abrasive therapy (EAT). In one paper, Dr Hotta suggests the mechanism of action of EAT may involve a combination of the anti-inflammatory effects of zinc chloride solution, plus a mechanical abrasion from prodding the cotton swab into the nasopharynx, which promotes blood flow and local bleeding to clean out the nasopharynx.
You can buy the extra long cotton swabs required for this test online, see here.
Testing for Nasopharynx Inflammation
Chronic nasopharynx inflammation is diagnosed by observing the amount of blood collected on the cotton swab, and by observing if there is any pain while rubbing the cotton swabs on the nasopharynx area.
The authors used the amount of blood found on the cotton swab as a rough gauge of the degree of nasopharyngeal inflammation (the more blood, the worse the inflammation).
Blood on the Cotton Swabs Used to Apply Zinc Chloride Solution to the Inflamed Nasopharynx
In the Hotta 2016 study, they found that all 41 patients with HPV vaccine-induced CFS had the 2+ severe level of bleeding on the cotton swab applicator, as shown at the far left of the above image. This indicates they have severe chronic nasopharyngitis.
By contrast, in 39 female healthy controls, 39% had no bleeding, 56% had 1+ moderate to mild level bleeding, and 5% had the 2+ severe level bleeding, as determined by the amount of blood on the cotton swab. Ref: 1
As treatment continues over the weeks, the severity of the pain and the amount of blood on the swab is found to gradually reduce in response to treatment with zinc chloride.
More details about how to test for chronic nasopharyngitis given in this post below.
Chronic Nasopharyngitis May Be Linked to Autoimmunity, HPA-Axis Dysfunction, Autonomic Nervous System Dysfunction, and Various Diseases
The authors think chronic nasopharyngitis (epipharyngitis) may play an important role in the development of autoimmune diseases. They say that because of its anatomical location, chronic inflammation in the nasopharynx could have systemic effects through autoimmunity, and also via the autonomic nervous system. More info can be found at timecode 13:27 of this video.
The Hotta 2016 study authors point out that:
- Chronic nasopharyngitis is present in a significant proportion of the population.
- Although it may cause significant symptoms, nasopharyngitis is rarely observed on routine otolaryngologic observation by ENT specialists.
- Diagnosis of nasopharyngeal inflammation can only be made by direct surface abrasion of the nasopharyngeal mucous membrane (with a swab); pain during and after the abrasion of the nasopharyngeal mucosa with local hemorrhage confirms the presence of nasopharyngitis. In other words, if it hurts and it bleeds when a cotton swab is rubbed on your nasopharyngeal mucous membranes, then that indicates nasopharyngitis.
- In the nasopharynx, there is an abundance of lymphocytes in the submucosal area, with a large number of lymphocytes colocating with the nasopharyngeal epithelial cells; there are more B-lymphocytes (B-cells) than T-lymphocytes (T-cells).
- In the nasopharynx, both the T-lymphocytes and B-lymphocytes are highly activated, even in normal healthy individuals. So the nasopharynx site seems to be of immunological significance.
- It is conceivable that latent, pre-existing inflammation of the nasopharynx may be prone to exacerbation by the immune stimulating effects of the adjuvants found in most vaccinations.
(1) Direct or radiated symptoms caused by nasopharyngitis, including: headache, shoulder stiffness, neck stiffness, sore throat, throat discomfort including globus sensation (feeling of a lump in the throat that is not actually there), tinnitus, post-nasal drip, persistent cough, and low-grade fever are included in this category.
(2) The second category is symptoms that arise because of dysfunction of the hypothalamic-pituitary-adrenal axis (HPA axis) and alterations in the limbic system. Symptoms associated with dysfunction of the autonomic nervous system include: orthostatic dysregulation, dizziness, gastrointestinal symptoms, general fatigue, and generalized pain.
(3) The third category is an associated immune-mediated mechanism caused by focal inflammation of the nasopharynx, and symptoms or conditions associated with this include: glomerulonephritis / inflammation of the kidneys (such as immunoglobulin A nephropathy), dermatitis (such as chronic urticaria and pustulosis palmoplantaris), arthritis (such as reactive arthritis and sternocostoclavicular hyperostosis), and some other autoimmune diseases.
In Japan, the discovery of chronic nasopharyngitis, and the proposal that chronic nasopharyngitis could be linked to autoimmunity, originates with Professor Shinsaku Horiguchi 50 years ago (ref: 1). However, unfortunately the concept of chronic nasopharyngitis got lost in medicine, and was forgotten. Until now.
Further Info
An editorial commentary of the Dr Osamu Hotta 2016 study is found here: Is the immune neuroendocrine system the connection between epipharyngitis and chronic fatigue syndrome induced by HPV vaccine?
The Dr Osamu Hotta et al 2016 study is here (full paper here).
A good article about this study is found on the ME research UK website here.
Dr Osamu Hotta details his findings in this video presentation.
Another paper by Osamu Hotta: Chronic epipharyngitis: A missing trigger in chronic fatigue syndrome
Dr Hotta's paper examining the possible mechanisms of epipharyngeal abrasive therapy (EAT) with zinc chloride as a treatment for nasopharyngitis: Possible Mechanisms Underlying Epipharyngeal Abrasive Therapy (EAT) with ZnCl2 Solution for the Treatment of Autoimmune Diseases and Functional Somatic Syndrome.
- In this paper Dr Hotta points out that one possible mechanism of EAT is the anti-inflammatory affect of zinc chloride: the epithelial cells in the nasopharynx have MHC class II receptors, as do a large number of lymphocytes which are located directly adjacent to these epithelial cells. So it is hypothesized the zinc chloride may quell inflammation in these cells.
- A second possible mechanism is based on a hypothesized blood-letting effect of EAT: the bleeding in the nasopharynx caused by abrasive rubbing may drain excessive interstitial fluid, which contains the tissue’s waste products, harmful antigens, immune cells, and inflammatory cytokines and mediators.
- A third possible mechanism is a hypothesized stimulation of the vagus nerve via EAT. This stimulation might occur chemically, or via the mechanical prodding of the cotton swab.
Possible Connection to Dr Shoemaker's Nasopharyngeal Infection With MARCoNS?
Dr Ritchie Shoemaker found infections of MARCoNS (multiple antibiotic-resistant coagulase-negative staphylococcus) on the nasopharyngeal mucous membranes of patients with mold-induced illness (an illness Dr Shoemaker calls CIRS, or chronic inflammatory response syndrome).
Dr Shoemaker explains MARCoN infection of the nasopharynx is a major factor behind the pathogenesis of mold and biotoxin-induced illness:
When MARCoN bacteria are detected in a nasopharyngeal swab, Dr Shoemaker treats MARCoNS using the BEG nasal spray (two sprays 2 to 3 times a day, for 30 days). Ref: 1 The BEG nasal spray consists of Bactroban, EDTA and gentamicin.
Another possible parallel to the idea that chronic nasopharyngitis may be a causal factor in autoimmune disease is the link between jawbone cavitation osteonecrosis / infection and ME/CFS.
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