Medication for equalization problems

[k374]

I found this link:
SCUBA Diving Health Problems

and it discusses using proteolytic enzyme tablets for equalization problems to promote ear equalization. Does this really work and has anyone here tried them?

[lmorin]

I found this link:
SCUBA Diving Health Problems

and it discusses using proteolytic enzyme tablets for equalization problems to promote ear equalization. Does this really work and has anyone here tried them?

I just did a search on PubMed and found essentially nothing in support of that idea. More important, there is evidence supporting different effects depending on which proteolytic enzyme is used. Not that one helps clear mucous, but rather the reverse--treatment with certain enzymes actually causes increased release of mucins. To quote a conclusion of the study, "We propose that mucin secretion in response to proteinases represents a useful defence mechanism but also forms the basis for hypersecretory states and airways obstruction in chronic endobronchial inflammatory states." In other words, they produce effects opposite to what is desired. Ciba Found Symp. 1984;109:72-88. Proteinases release mucin from airways goblet cells. Boat TF, Cheng PI, Klinger JD, Liedtke CM, Tandler B.(Note that the study in question used tissue culture methods to obtain the results)

I will not go so far as to say there is no evidence supporting the use of enzyme tablets, but it is hard to see how they would get from the mouth to the sinuses and inside the eustachian tube in any significant quantity and the evidence is hard to find in the scientific literature (and, such searching is part of my profession).

[ivobj]

I never had problems with equalization,so never needed any kind of "artificial" help. I am not an expert in the field, but seems rather strange to me that a medication based on an enzyme would help equalization, as enzymes have the function of dissolving proteins, basically in our body helping in digestion of proteins and because muscles are fed by proteins, it could have a role in functions depending on muscles, but as far as I know, there is no muscle involved in the equalization of ear or any air space.

Again, I am not an expert, so I may be wrong, it is just my opinion

[TSandM]

Since we already have someone who has searched to no avail, I didn't try to search again.

But I can largely dismiss the concept on the basis of physiology. Enzymes are proteins, and the digestive tract is designed to break down and absorb proteins. This is the reason why medications like insulin cannot be given orally; they are broken down from their active form. Digestive enzymes are given to patients with pancreatic insufficiency, but they work precisely because the pancreas in those patients does not make enough proteolytic enzymes itself to enable digestion. In someone with a normal digestive tract, a protein-based oral medication is extremely unlikely to be effective anywhere outside the intestinal lumen, if it survives long enough to have an effect there.

[vladimir]

But I can largely dismiss the concept on the basis of physiology. Enzymes are proteins, and the digestive tract is designed to break down and absorb proteins. This is the reason why medications like insulin cannot be given orally; they are broken down from their active form. Digestive enzymes are given to patients with pancreatic insufficiency, but they work precisely because the pancreas in those patients does not make enough proteolytic enzymes itself to enable digestion. In someone with a normal digestive tract, a protein-based oral medication is extremely unlikely to be effective anywhere outside the intestinal lumen, if it survives long enough to have an effect there.

With this in mind, the linked article is proposing proteolytic enzyme lozenges that you allow to dissolve between your cheek and gum. To my skeptical layman's eye it smacks of quackery, but the author seems to have legitimate medical credentials.

[lmorin]

With this in mind, the linked article is proposing proteolytic enzyme lozenges that you allow to dissolve between your cheek and gum. To my skeptical layman's eye it smacks of quackery, but the author seems to have legitimate medical credentials.

So, the proper conclusion is that at least some doctors are ducks. Not a particularly rare occurrence, unfortunately.

[TSandM]

Well, if the person proposing this is medically legitimate, a study will be done showing the efficacy of the approach. The fact that there is nothing in the literature suggests that either the enzymes in question are not patentable and therefore there isn't enough money in it to interest anybody in studying it, or that the people selling them don't care about objective information.

[Patient1]

The thing that makes the most sense to me is the use of a nasal steroid spray (Flonase, Nasonex, Nasacort AQ, Atrovent Nasal) daily. The key to getting any effectiveness as far as equalization is concerned is to use the spray and simply equalize your ears right after. Doing this twice daily whether diving or not allows some of the steroid to enter the eustacian tube and disperse in the mucous lining. This will prevent inflammation and hopefully easier clearing. I refuse to stop using it in order to see if I revert back to problematic equalization, so I guess I cannot prove its effectiveness.

When using nasal sprays, do not shoot them straight up towards your eyes. Stick the nozzle straight into the nostril so you're shooting toward the back of your head. Do not tip you head up or down. Do not inhale like a raging bull, this is a nasal spray not an inahler for the lungs. Nice easy breath in through the nose and squeeze an actuation off while you're inhaling gently.

[cutlass]

As for an oral route to the intestines, enteric-coated microspheres has been used to support delivery of pancreatin. But IIRC, there was some controversy concerning the reliability of this route for widespread applications; some of the problems being variable release rates or low penetration of intestinal wall or too rapid degradation upon arrival.

I know that bromelain, a proteolytic enzyme, has been used as a debriding agent in burn therapy. Using that as a keyword, I found this link which indicates bromelain may be an active sinus and nasal anti-inflammatory. After a few other spot checks, IMO, there seems to be a body of positive evidence but which tends to be of the lower quality case-study and expert opinion type; although there may be a better quality cohort study or two. Current standards for evidence-based medicine are typically higher.

Like TS&M mentioned above, my impression is that there's an economic factor at play here. High quality studies are expensive and I suspect that there's not much perceived return on investment for what could be an unpatentable herbal extract treatment for a relatively "unglamorous" condition (stuffy head) for which there already are treatments.

*A general discussion and bits of history about enzymatic meds is given here

**There seems to be increasing interest with the role of related MMP's (matrix metalloproteinase) with inflammation and mucoid production as related to asthma and COPD as mentioned in this article.