E3 PreliminaryWeak / uncertainPEM not requiredReview-NarrativePeer-reviewedMachine draft
Retracted: Chronic Epipharyngitis Treated with Epipharyngeal Abrasion Therapy: Symptoms, Diagnosis, Pathogenesis, and Treatment Outcomes.
Harabuchi, Yasuaki, Kumai, Takumi, Nishi, Kensuke et al. · JMA journal · 2025 · DOI
Quick Summary
This article discusses chronic epipharyngitis—long-term inflammation in the upper throat—and describes a treatment called epipharyngeal abrasion therapy (EAT) that aims to reduce this inflammation. The authors note that this throat inflammation may cause various symptoms including fatigue, brain fog, dizziness, and cough, and they review evidence that EAT might help some patients, including those with long COVID. However, this paper has been retracted and should not be relied upon for clinical decisions.
Why It Matters
For ME/CFS patients, this work proposes a potential peripheral inflammatory mechanism (chronic epipharyngitis) that could explain central nervous system symptoms such as brain fog, fatigue, and dysautonomia through vagal and cerebrospinal fluid pathways. If valid, it might point toward a testable biological mechanism and treatment option; however, the retraction status severely limits its credibility and applicability.
Observed Findings
- Chronic epipharyngitis was proposed to present with both local throat symptoms (postnasal drip, sore throat, cough) and systemic functional symptoms (chronic fatigue, brain fog, dizziness, insomnia, depression)
- - Endoscopic visualization of epipharyngeal inflammation is now technically feasible for diagnosis
- - EAT mechanisms were categorized into anti-inflammatory/antiviral, bloodletting, and vagus nerve stimulation effects
- - A Japan Society of Stomato-pharyngology Review Committee was established in 2019 to accumulate evidence on EAT efficacy
Inferred Conclusions
- The authors concluded that chronic epipharyngitis may generate systemic symptoms through hypothalamic-limbic dysfunction via vagal and cerebrospinal fluid disturbances
- - EAT, particularly endoscopic EAT, was inferred to be a potentially viable treatment with multiple proposed mechanisms of action
- - The authors suggested that EAT effectiveness for long COVID warrants investigation through prospective multicenter studies
Remaining Questions
- Does chronic epipharyngitis causally contribute to ME/CFS symptoms, or is the association coincidental or correlative?
- - What is the actual clinical efficacy and safety profile of endoscopic EAT in rigorous randomized controlled trials?
What This Study Does Not Prove
This retracted review does not prove that chronic epipharyngitis is a causative factor in ME/CFS or long COVID, nor does it establish the safety or efficacy of EAT for any condition. The retraction indicates serious concerns about the article's reliability, and readers should not regard it as established evidence. Reviews present secondary synthesis rather than primary evidence, and mechanistic proposals remain unproven without controlled trials.
Tags
Symptom:Cognitive DysfunctionFatigueSensory Sensitivity
Phenotype:Long COVID Overlap
Method Flag:PEM Not DefinedWeak Case DefinitionExploratory Only
Metadata
- DOI
- 10.31662/jmaj.2024-0437
- PMID
- 40416015
- Review status
- Machine draft
- Evidence level
- Early hypothesis, preprint, editorial, or weak support
- Last updated
- 10 April 2026
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
Spotted an error in this entry? Report it →