"Experience of hemp (Cannabis sativa L.) oil application in treatment of ent disorders" (Dr. Oleg Grigoriev, State District Hospital, St. Petersburg, Russland)

The present-day development of pharmaceutical industry and the continuing introduction into treatment practice of new chemical preparations add vitality to such issues as complications in the course of antibiotic treatment, development of resistance to medicinal preparations by the pathogenic microflora, additional allergic load on the organism, drug disease and many other complications. All this served as an impetus to start a search for new safe, highly effective and, at the same time, ecologically pure and relatively cheap medicinal preparations. We paid attention to a means which once has been widely used in folk medicine, that is hemp oil (Cannabis sativa L.).

Metabolism of oil components and potential application in medicine
The question of medicinal application of different vegetable oils, including essential ones has been sufficiently covered in literature (Shevrygin, 1999). However, in the available Russian literature sources we failed to find any comprehensive information on the clinical experience of hemp oil application despite the fact that both hemp oil (hemp milk), as well as fibre, have been known since olden days both in Russia and other countries (Fleming, Clarke, 1998).Thus, the feature of hemp oil which makes it attractive for medical application is the combination of a large amount of polyunsaturated fatty acids and tocopherols (table 1).

These components are very important for human : they are necessary for cell membranes buildup, prostaglandins (local hormones) production, nervous tissue structure formation, energy generation and in lipids regeneration It is important to underline , that these components are antioxidant protection of cell. Tocopherols and fatty acids protect from oxidation important compounds in the organism. The best as antioxidant is delta- tocopherol. Tocopherols blockade of lipids peroxidation in cells membranes by means of formation the complex selenium- polyunsaturated fatty acids. Besides this occurrence of gamma-linolenic and stearidonic asids, makes the henp oil unique among others wegetable oils.

We believe, special attention should be paid to hemp oil unsaturated fatty acids as antioxidants applied in treatment of different surgical cases. Biochemical and morphological investigations (Bezshapochny et al , 1991) have shown an intensification of lipids peroxidate (LP) in the case of traumatic lesions, it being caused by a series of factors like psychogenic pain shock, loss of blood, hypoxia, inflammatory response in the traumatized zone. Intermediate and end products of LP, that is aggressive agents like aldehydes, hydroperoxides, epoxides cause inactivation and transformation of enzymes, and accumulation of inert biopolymers thus disturbing the process of tissue cells restoration in the lesion zone. In such a case, the necessity in antioxidants (AO) capable of inhibiting LP is increasing, and the lack of their additional supply to the organism leads to the LP growth.

After these conclusions we desided to use hemp oil in ENT disorders. Hemp oil was experimentally used in an open clinical trial on in- and outpatients treated for various ENT disorders. For this purpose, pure hemp oil was used.

All in all, 117 patients were under observation. Of these, there were

 7 cases of chronic laryngitis - long disorder of laryng and vocal folds;
 11 of chronic pharyngitis - disorder of the larynx posterior wall. According to degree of disorder process it is possible to determine surface degree (subatrophic form) and deep one ( atrophic form);
 10 of acute external otitis - inflammation of skin of external auditory meatus;
 8 of chronic external otitis;
 66 of chronic tonsillitis - prolonged disorder of tonsils;
 14 of chronic sinusitis - prolonged inflammation of maxillary sinuitis .
 one case of face wound

Prior to treatment, all patients underwent allergy test. Positive cases of allergic reactions to oil have not been observed.

Below are presented several case histories, detailing treatment schemes which were individualized, depending on the disease.

Patient T., 54 years old, a teacher, complained of discomfort, dry scratchy feeling in the throat, undue fatiguability, hoarseness. He has been suffering from symptoms for over 7 years with periodical exacerbations during autumn, winter and sprind due to an increased vocal load at school. Examination showed the mucous membrane of the larynx to be moderately hyperemic, edematic; vocal folds thickened, closing of vocal folds in phonation incomplete. Diagnosis: aggravation of chronic laryngitis. Intralaryngeal vocal folds have been sprinkled with suspension of 1.0 ml hemp oil with some drops of 1% adrenaline.This treatment, combined with vocal regimen and vocal exercises, yielded improvements after the 3rd daily application: laryngeal hyperemia disappeared, edema of vocal folds reduced and phonation improved significantly. Recovery was achieved after the 7th procedure and no aggravations were observed within a year after the treatment.

Of special interest is the case of chronic laryngitis observed in patient P, 35 years old, who has been smoking 2 packs of cigarettes a day for the last 10 years. He has never been treated for his disease. Antibiotic therapy and hydrocortisone suspension inhalations were accompanied by infusions of 1.0 ml oil with adrenaline and vocal exercises. Voice sounding improved already after the 4th daily sprinkling. After the 7th application, hyperemia and laryngeal edema disappeared, complete closing of vocal folds and clear phonation were registered. No aggravation has been observed within 7 months after the treatment, and the patient’s condition remains stable despite excessive smoking.

In the case of chronic atrophic pharyngitis (patient K, 40 years old), oil application to the larynx posterior wall was practiced once a day for 8 days. No other drugs were prescribed. As soon as after the 3rd application the mucous membrane moistened. Such subjective sensations as the dry scratchy feeling and pain in the throat disappeared. After the 8th application, the pale mucous membrane became more pink and moist. During the following 7 months no aggravations have been observed.

When treating the subatrophic form of the same disease, complete recovery could be achieved in 2 individual cases. In both cases the disease started no more than 1.5 years ago.

In the case of acute external otitis, an oil-impregnated gauze trailer was inserted with tweezers into the auditory meatus for 2 to 3 hours daily. As soon as after 5 to 6 hours after beginning of the treatment, patients reported easing of pain. After the 2nd or 3rd daily application, edema and hyperemia of the external auditory meatus practically disappeared and hearing restored. As a rule, recovery took place after the 4th or 5th day of treatment.

The treatment of chronic forms of external otitis was preceded by taking a smear from the external auditory meatus and determining composition of the microflora. Then, the oil was applied in combination with the antibiotic to which the microflora was sensitive. Gauze trailers were inserted for 24 hours. Easing of pain and reduction of itching were noticed by patients after the first application. After the 3rd application reduction of edema, peeling and hyperemia of the external auditory meatus, and improvement of hearing were observed. Significant improvement was observed after 7 to 9 applications.

When treating all patients with chronic compensated tonsillitis ( i.e. without attendant aggravations in cardiovascular system, nephropathy and rheumatism), along with vitamin and immunity stimulating therapy, washing of lacunas of faucial tonsils with aseptic solutions and LF ultrasound (25-27 KHz with "Tonsillor-2" apparatus) was practiced (Mishenkin, Drachuk, 1992). The oil was applied to each tonsil with ultrasound during 1 min. For example, the following case may be described:
Patient P, 8 years old, has been suffering from the disease since early childhood. She was susceptible to catarrhal diseases (e.g. Acute Respiratory Virus Disease, angina) 5 to 6 times a year and previously has never been treated for chronic compensated tonsillitis. After a 10-day treatment condition of the patient improved considerably: appetite restored and weight increment was recorded. The child became more active, happy, and school results improved. No aggravations have been recorded during the year after the treatment.

Treatment of maxillary sinuitis involves application of drug depots, i.e. drug mixtures with an ointment as a binder, which remains in sinuses for several days and thus prolongs healing effect of the applied drugs (Lopatin, Piskunov, 1995).
We attempted to use hemp oil as a drug depot. For example, is the case of patient P, 36 years old. She has been suffering from the chronic form of the disease for about 20 years. Aggravations occurred twice a year and the patient had been subjected to repeated treatment.
A mixture of oil and antibiotics (1:2) was infused into sinuses meatus once in 2 days after washing with aseptic solutions. 3.0 ml of the mixture was infused at the beginning of treatment and 10.0 ml in the end. No other drugs have been prescribed. The amount of puss reduced considerably after the 5th application. Stable improvement was achieved after the 10th application and confirmed by X-ray and microbiological tests. Nasal breathing restored and the patient regained the sense of smell that she’s been lacking for many years. Sense of taste and capacity for work improved. Within the year condition of the patient remained stable and she never applied for medical assistance.

Patient T, 45 years old, was admitted to the in-patient department with a diagnosis of infected avulsive-bite wound in the right buccal-temporal region as a result of a pet attack. Examination showed wound 8 x 10 cm, with uneven edges, signs of suppuration and naked fascia of muscles. After the wound has been treated, the patient was prescribed intramuscular antibiotic injections and daily dressings with hemp oil. Since the used oil was non-sterile, it was alternated with 1% sol. dioxidini (antibacterial solution) on the suppurating wound. After 3 dressings an intensive tissues regeneration and appearance of granulate islands were noted. After 9 dressings the wound absolutely healed with recovery of all skin layers. Tissues growth rate was about 3 to 5 mm daily. Thus, such a complicated surgery as skin transplantation could be avoided.

Results of observations are summarized in the table 2 which also shows average duration required for treatment the given diseases in the Belgorod Province of Russia (Standards of medical help..., 1994). The use of hemp oil made it possible to cut down the period of treatment by a mean of eight days (9%) in comparison with the required standard (see the total line in table below).