Japanese Treatment EAT for Long COVID

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This treatment known as Epipharyngeal Abrasive Therapy, or EAT,

involves rubbing the back of the nose with a cotton swab.

It is only available in Japan, where it originated.

In April 2022, a Japanese research group reported that this simple procedure

had significantly improved long COVID symptoms such as fatigue, headaches, and poor concentration.

The scientific journal, Nature, also mentioned EAT in an article on long COVID.

The World Health Organization estimates that 10 to 20 percent of COVID-19 patients experience mid- or long-term effects

after they recover from their initial illness, in what's known as long COVID.

The Japanese therapy EAT has emerged as a possible solution.

Today, we are going to report on the latest findings on EAT

and its potential and also the challenges associated with it.

At the back of the nose is a section called the epipharynx.

This is endoscopic footage of the inside of the nose.

The epipharynx is at the very end.

This is the area that is targeted by EAT.

The epipharynx serves as the immune system's initial defense against foreign substances, such as dust and pathogens.

Such substances trigger the immune system, causing inflammation.

Once they are removed, the inflammation subsides.

Doctors in Japan have continued their studies based on the belief that chronic epipharyngitis,

or long-term inflammation of the epipharynx,

causes symptoms not just in the throat but also throughout the body,

including headaches, dizziness and fatigue.

EAT was developed to ease chronic epipharyngitis.

Doctors insert a cotton swab through the nose or the mouth.

They rub it against the epipharynx to scrape out blood and pus that has accumulated as a result of the inflammation.

In Japan, EAT is covered by public health insurance.

It is currently offered at over 500 hospitals and clinics.

In 2019, a committee was launched within an academic society to examine the treatment's efficacy in detail.

Ear, nose and throat doctor Nishi Kensuke is a member of the EAT review committee.

He has been administering EAT for a decade.

Nishi says that in recent years, he has seen a surge in inquiries from people with long COVID.

I'm not sure how prevalent chronic epipharyngitis
is among long COVID patients.

But I believe treating it helps to ease
their symptoms. That's why I use EAT.

Hello.

How are you feeling?

I haven't had any symptoms
since my last treatment.

This patient in his 20s was infected with the coronavirus in April 2022.

He visited Nishi complaining of persistent coughs and phlegm that he has had ever since.

When it was really bad, I couldn't even
speak without clearing my throat.

The phlegm was that thick.

I took over-the-counter drugs
for months, but they didn't help.

I came to Dr. Nishi, desperate for help.

This is endoscopic footage of the patient's epipharynx during his first visit.

It is badly swollen, looks reddish and has large amounts of sticky mucus attached to it.

The difference between this and the normal epipharynx is clear.

To diagnose chronic epipharyngitis, doctors check for swelling, redness, and the state and levels of mucus.

They may also rub the area to check for bleeding caused by inflammation and congestion.

We use a diagnostic scale of
1 to 8 for chronic epipharyngitis.

We gave him an 8, the most severe stage.

EAT involves the use of cotton swabs soaked in a zinc chloride solution,

which has a sterilizing and anti-inflammatory effect.

I'm going in through your left nostril.

It's a simple procedure that takes only a minute or two.

But there's a drawback.

It was extremely painful at first.

When the doctor told me I had to do it
every week, the prospect was daunting.

That's how painful it was.

The more severe the inflammation, the more pain the treatment causes.

The patient continued with EAT once a week.

After six or seven sessions, I noticed
no phlegm sticking to my throat.

Three months later, the swelling and redness in his epipharynx faded.

The sticky mucus and the bleeding subsided, as did the coughing and the phlegm.

Once the treatment was over, I felt that its
benefits outweighed the pain that it caused.

I'm glad that I went through with it.

Nishi and his team examined the epipharynges of 58 people with long COVID and confirmed inflammation in all of them.

The group gave them EAT to see whether it could improve their symptoms.

They had the patients rate the intensities of their fatigue, headaches, and poor concentration on a scale of 0 to 100

and compared the figures before and after the treatment.

The median for fatigue dropped from 65 to 23.

The numbers for headache and poor concentration also fell dramatically.

Nishi decided to analyze tissue from the epipharynx with a pathologist to determine how it is affected by EAT.

These micrographs show the surface of a long COVID patient's epipharynx before EAT.

The brown particles are substances that trigger inflammation.

Nishi speculated that the accumulation of such substances contributes to chronic inflammation, leading to symptoms.

He administered EAT once a week for three months and viewed the tissue again.

The inflammatory substances had almost disappeared.

These results made it histologically clear that

EAT suppresses inflammation
in chronic epipharyngitis.

I was stunned at the huge difference it made.

He also found that the treatment changes the structure and properties of the epipharynx.

A close look before EAT reveals numerous cilia on the surface of the epipharynx.

The cilia transport foreign materials to
the back of the throat, then the stomach.

This helps to prevent infectious diseases.

But at the same time, many viruses and
other substances can stick to the cilia.

Post-EAT, I noticed the membrane of the swollen
epipharynx became smooth to the naked eye.

After EAT, Nishi confirmed under a microscope that the cilia had disappeared and the surface was smooth.

He believes this makes it difficult for foreign substances such as viruses to stick -

thus increasing barrier function.

In April 2023, Nishi's study received a grant from the Japanese government.

He plans to do more detailed research into EAT's benefits

and the mechanisms behind how it improves symptoms of long COVID.

First and foremost, I want people to
take an interest in chronic epipharyngitis.

Many patients are visiting
doctors in search of help.

My mission as a researcher is to
collect evidence of EAT's efficacy.

EAT is usually performed at nose, ear and throat clinics.

It's very nice to meet you.

However, Hotta Osamu, who has led efforts to promote EAT, is an internist.

He spent many years working on a curative treatment for a kidney disease called IgA nephropathy.

It was during this work that he came across EAT in 2005.

One characteristic of IgA nephropathy is
macroscopic hematuria, or bloody urine,

after catching a cold, especially a sore throat.

Since it occurs after a sore throat, I assumed
the cause was throat-related, and focused there.

To find the cause, he searched various past materials and finally arrived at the epipharynx.

As he had suspected, many patients of the kidney disease had inflammation in their epipharynges.

After finding EAT effective on them, he decided to incorporate it to his treatments.

I introduced it as a remedy for IgA nephropathy,
but patients reported various other benefits.

Some said their headaches disappeared,
and their stiff neck and shoulders improved.

Others said their fatigue decreased
or their chronic diarrhea stopped.

I was convinced that I should expand its
use to people with other diseases.

Hotta has performed EAT on about 4,000 people.

Patients with various symptoms travel to his clinic from all over the country.

17-year-old Kumazawa Riko receives EAT regularly.

In August 2021, after getting the HPV vaccine, her memory began to decline,

and she would feel sluggish and easily tired.

She felt worse as the days went by.

I couldn't get out of bed in the morning.

My body felt heavy, as if I were
trapped in a swamp.

I'd try very hard to get up, but my body
would seem to sink deeper and deeper.

I worried about what was happening to my body.

I was also surprised because
I'd never had such an experience.

It was really sad.

She visited a local hospital, where she was told she may have depression.

Despite visiting many other hospitals, her symptoms did not improve.

She had no choice but to take a leave of absence from high school.

Let's start.

About 6 months after her sudden decline in health, she happened to learn about EAT.

In May 2022, she visited Hotta, who confirmed severe inflammation in her epipharynx.

This footage was taken shortly after she began receiving EAT.

Hotta is instructing Riko to raise her leg, but she is struggling.

She finds it difficult to even stand up without assistance.

Let go slowly.

Yes, that's it.

You're doing great.

Just one month after she began EAT...

Wow!

You stood up on your own.

This is a day to remember.

I was left speechless. It was a miracle.
I thought I was dreaming.

Near the epipharynx is a part of the brain called the hypothalamus.

It plays a key role in regulating the autonomic nervous system,

which controls the movement of the body.

Hotta believes that chronic inflammation in the epipharynx negatively affects hypothalamic function,

disrupting the balance of the autonomic nervous system and causing various abnormalities.

He speculates that EAT restores the functions of the hypothalamus,

resetting the autonomic nervous system and improving the symptoms.

Riko's mother Kanako has always stood by her daughter's side and offered support.

She's come a long way.

We'd see tiny improvements and be overjoyed.

You just took a step!

Keep it up, Riko! Well done!

We lived in the hope that since
she was able to achieve one thing today,

she should be able to do more tomorrow.
I just remembered those days.

See you later.

In April 2023, Riko returned to high school for the first time in a year.

I had given up on everything -
my dreams, walking on my own.

But after discovering EAT and meeting
Dr. Hotta, I was able to become positive.

I believe that if I don't give up and keep going,
many good things will happen.

Hotta performed EAT on 16 other females who developed health problems

after receiving the HPV vaccine, just like Riko.

Thirteen of them showed clear improvement.

Is there any potential side effects with EAT?

So far, I have performed EAT
about 50,000 times on 4,000 patients.

There have never been any serious problems.

EAT is becoming more widespread nationally,
but no issues have been reported.

What do you think is needed in order to make EAT more widespread,

both domestically here in Japan and also internationally?

I believe we need to conduct more
research and publish more papers.

There are many diseases with unknown causes.

It's important to accumulate evidence
that inflammation of the epipharynx is

closely associated with such pathologies.

I hope that someday, checking the back of
the throat will become routine, just like

listening to the heartbeat with a stethoscope.

EAT is also attracting attention as a voice therapy.

Freelance announcer Koide Akira is among those who have received the treatment.

I'm freelance announcer Koide Akira, and
I'll be your commentator again this week.

Koide mainly provides live commentary for sports such as baseball and martial arts.

He uses his voice heavily, talking continuously for an average of two to three hours.

In the summer of 2021, he began to feel discomfort when speaking.

It became kind of difficult to speak.
My throat didn't feel moist.

My throat had always retained
moisture, a key to my stamina,

even after two to three hours of talking non-stop.
The dryness left me anxious and bewildered.

Koide was recommended EAT by Kusuyama Toshiyuki, a doctor specializing in voice therapy.

A look at Koide's epipharynx showed redness, swelling and bleeding.

He had chronic epipharyngitis, so I told him
that the tightness in his throat was probably

caused by dryness in the vocal cords.

The vocal cords are located behind the Adam's apple.

This is footage of Koide's throat.

The two white bands are the vocal cords.

Kusuyama determined that their dryness was the cause of Koide's voice problems.

The vocal cords are normally covered with a thin fluid.

However, chronic inflammation in the epipharynx can disrupt the autonomic nervous system,

which can lead to a thickening and drop in the amount of fluid.

As a result, the vocal cords become dry and stiff.

Chronic epipharyngitis can make the
vocal cords dry and stiff.

This stops them from vibrating properly, but if
treated, they should be able to vibrate again,

enabling him to continue talking like before.

The inflammation in Koide's epipharynx disappeared after three months of weekly EAT sessions.

Before EAT, Koide's maximum phonation time was 29 seconds.

But it increased by five seconds after the treatment.

My throat has been feeling more moist.

It felt great when my voice started to come out
smoothly, and I wanted to vocalize more and more.

I'm able to talk for longer, and it feels like
my voice is getting stronger than before.

Kusuyama performed EAT on 53 singers with voice problems believed to have been caused by chronic epipharyngitis.

He confirmed significant improvements in about 80 percent of them.

Kusuyama has continued with his study with a wide range of patients to collect more evidence.

He plans to publish the results abroad soon.

Chronic epipharyngitis can happen without your knowledge.

Hotta says answering the following questions may reveal whether you have the condition.

First: Does mucus from your nose drip down the back of your throat,

where it feels like it's stuck?

Second: Do the muscles below your ears feel stiff or painful when you press down on them?

It's tight.

When you have chronic epipharyngitis,
the muscles in this area become stiffer.

Third: Do you breathe through your mouth?

Because the mouth has no filtering system,

foreign substances can reach the epipharynx directly, triggering inflammation.

Close your mouth and check where the tip of your
tongue is. If it's on the upper jaw,

you breathe through your nose.

If it's on the back of the teeth, especially the
lower teeth, you're very inclined to mouth-breathe.

If your tongue gets lazy, then you are more likely to breath through the mouth.

If you answered yes to all three, then it's very
likely you have chronic epipharyngitis.

Having even one symptom suggests the possibility.

Let's do an exercise that can improve mouth breathing and help to maintain a healthy epipharynx.

Move your mouth to produce the four sounds "ka," "ni," "yu" and "de."

To correct mouth breathing, it's important to
raise the tongue and move it forward.

"Ka." Put the tip of your tongue
on your upper jaw. "Ka."

"Ni." Press your tongue against your upper gums. "Ni."

"Yu." Purse your lips and say "yu."

"De." Raise your tongue and say "de."

Do 30 sets of the four sounds per day.

Hotta says this will correct the position of your tongue and strengthen the muscles around your mouth.

I would imagine... because our tongue,

I mean it's a muscle, but it gets very lazy, I think for most people.

This is great workout also for tongue as well, for the muscles.

I was impressed to learn that EAT, a therapy which is unique to Japan,

can help improve conditions for which other treatments have proved elusive.

I very much hope that research will progress so that EAT will become an evidence-based treatment

that can help many people with a wide range of conditions.