Dr. Edward Calabrese and G Dhawan have published an article titled Historical use of x-rays: Treatment of inner ear infections and prevention of deafness in Vol 33(5) of Human and Experimental Toxicology, May 2014.
Purpose: This article provides an historical assessment of the role of radiotherapy in the treatment of inner ear infections.
Materials and methods: The research utilized a literature-based evaluation of the use of x-rays during the first half of the 20th century on the treatment of otitis media (OM), mastoiditis, and cervical adenitis and their impact on the occurrence of deafness.
Results: X-Rays were consistently found to be effective as a treatment modality at relatively low doses, in the range of 10–20% of the skin erythema dose, rapidly reducing inflammation, and accelerating the healing process. The mechanistic basis of the clinical successes, while addressed by contemporary researchers, is evaluated in the present article in light of current molecular biology advances, which indicate that clinically effective low doses of ionizing radiation act via the creation of an anti-inflammatory phenotype in highly inflamed tissue.
Conclusions: X-Ray treatment of OM, mastoiditis, and cervical adenitis was widely accepted in the first half of the 20th century by clinicians as an effective treatment when administered within an appropriate dosage range.
The paper summarizes results from a number of medical papers published mostly during the period from 1920-1940, though there are some from as early as 1902 and as late as the mid 1960s.
In a related effort seeking effective treatments for lymphoid tissue-related hearing loss, Samuel J. Crowe at the Johns Hopkins University developed treatments using radium implants that showed impressive results.
Based on extensive clinical experience, they concluded that the most efficient treatment of hearing impairment due to excessive lymphoid tissue is irradiation with radium or x-rays. So striking were the findings of this clinical research that they claimed there was the potential to reduce the number of deaf adults in the next generation by 50%.
The success led to numerous discussions about the best treatment regimes, the most effective doses, and the relationship of patient ages to doses and results. Not surprisingly, critics also asked questions about the side effects of ionizing radiation.
There also emerged concern over whether there might be possible long-term effects related to the exposure to the ionizing radiation. This was especially the case for physicians and their assistants who were handling the radium on a daily basis while treating many patients. Further concerns were raised with respect to the long-term effects on patients, with particular concern for brain and thyroid. Table 3 summarizes the long-term studies conducted on patients irradiated with nasopharyngeal radium to treat ear dysfunctions. Such studies did not detect a definitive link between nasopharyngeal irradiation and any disease, including cancer, suggesting the capacity to estimate an upper bound risk for such procedures.
Here is an image version of the referenced Table 3 from the paper.
The paper authors note that treatments using therapeutic x-rays lost favor with the development of improved antibiotics and surgical procedure advances. When the treatments lost favor, there was no proposed theory to explain why they seemed to work so well; at that time, doctors were often satisfied to find effective treatments without needing to have a detailed understanding of exactly why they worked.
Recent findings have emerged, which may offer insight into this matter. In general, low doses of x-rays have been shown to affect the development of a highly integrated anti-inflammatory phenotype…This anti-inflammatory phenotype is a con- sistent feature when low doses of ionizing radiation are administered to tissues with substantial inflammation. Mechanistic studies with multiple animal and cell models have confirmed the consistency of these observations accounting for the protective effects of low-dose ionizing radiation in animal models with various types of inflammatory disease such as arthritis.
Calabrese and Dhawan did not specifically point out that the increasing fear of radiation and the imposition of the linear no threshold (LNT) dose response assumption in radiation protection regulations may have also played a role in discouraging doctors from administering radiation to cure infections and inflammation.
However, they did note that it might be time to reconsider using ionizing radiation treatments in an era with an increasing number of “antibiotic-resistant disease-causing microbial strains.”
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