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Proteolytic Enzymes for Ear, Nose, & Throat Problems

Since the 50's proteolytic enzymes such as bromelain, papain, protease, and chymoral have been used as anti-inflammatory agents. They have been used at least as long ago as during the Mayan civilization, when papaya leaves were wrapped around wounds. Today proteolytic enzymes are used for a variety of problems of the ear, nose, and throat, administered in a buccal tablet with measured enzyme activity. Look for over-the-counter preparations which contains one million enzyme units of bromelain and 1/2 million enzyme units of papain.

Originally there were Streptodornase and Streptokinase which were administered via the buccal pouch. Later, papain was also available in buccal form. Buccal tablets, that is, tablets made to dissolve in the buccal pouch (between cheek and gum) are used instead of tablets which are swallowed because stomach acid will digest the protein and inactivate the enzyme. As an odd result of competition among the various enzyme formulas, oral tablets were later marketed to be swallowed, even though it was known that minimal systemic effect would result. It should be noted, however, that oral enzymes are still excellent as an aid to digestion when swallowed.

In the 60's I was using the buccal form of the enzymes to reduce swelling, reduce inflammation, thin mucus. This was most dramatic for scuba divers and pilots when used to reduce congestion around the eustachian tube opening and to thin mucus to aid the movement of the cilia that drain the middle ear and the sinuses. This was especially useful since divers and pilots can't take medications that might make them drowsy. Then the companies stopped making enzymes which had calibrated activity! They stopped making buccal tablets!

Fortunately for my patients, chewable papain or bromelain tablets were still available. Many people could dissolve these in the buccal pouch, despite irritation from the sugar. Unfortunately, because there was no calibration as to enzyme activity, sometimes these were not effective - no enzyme activity, no benefit. Patients often had to try many brands until they found one that worked. Unfortunately because there was no calibration, products from the same company would vary dramatically as to potency!

A wide variety of published research suggests many benefits from proteolytic enzymes for ear, nose, and throat problems. I get good results, realizing the benefits described in the research literature, with calibrated combinations of papain and bromelain.


Use in Sinusitis: Seltzer, Taub and others reported an improvement of sinusitis symptoms due to the anti-inflammatory action, the thinning of the mucus, the shrinkage of tissue. This helps to open the natural drainage of the sinuses.

Sinus Pain: Sinus pain occurs when there is edema of the membranes of the sinus wall. When the sinus is completely blocked, this forms a vacuum that pulls on the membrane; this is the worst pain of all. The proteolytic enzymes reduce this swelling rapidly, whether due to infection or vacuum. They thin the mucus which helps the cilia to clear the sinus and the ear.

Throat Pain: The more swollen the throat tissue the more the pain. Certain areas like the uvula - the guy that hangs down in the back in the middle, have more pain fibers and are cause severe pain. Proteolytic enzymes reduce this swelling.

Foreign Bodies: Friday and Saturday have always been busy days in the emergency room for fish bones But we regularly see patients later who have been examined, had X rays, have been assured there is no fish bone in the throat but feel the bone there! I don't see the bone, but I may see a tiny scratch where the bone scratched the skin of the throat. This is just like a paper cut of the eye; don't see much but there is intense muscle contraction as the body tries to "get rid of it". In the eye it is easy to see the cut and anesthetize it. In the throat we use the proteolytic enzymes to reduce the swelling, which allows the cut to heal and gets rid of the muscle spasm.

Joint Pain: because they are anti-inflammatory and reduces swelling, these enzymes are useful for joint swelling conditions that are inflammatory or due to trauma. The temperomandibular joint is frequently painful from stress or poor muscle balance or dental origin. By reducing swelling at the joint, symptoms can be improved.

Trauma: many authors recommend enzymes to reduce hematoma and swelling associated with soft tissue trauma. These enzymes affect primarily the undesirable swelling factors.

Salivary Gland Inflammation: Here, inflammation has caused a blockage of the drainage duct on the salivary gland. Or saliva has become sluggish and thickened and blocks the drainage. The old buccal tablets used to take a long time to dissolve.These proteolytic enzyme combinations of papain and bromelain are usually absorbed in about 5 minutes from the buccal pouch (the area between cheek and gums). Since these are natural fruit enzymes and not from meat products they taste like fruit and there is significantly less chance of an allergic reaction.

The papain is from papaya fruits and the bromelain is extracted from pineapples. Note that persons who observe Kosher laws appreciate that these enzymes are fruit and don't contain any meat products.

©2000 Dr. Murray Grossan

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Partial list of References:

Blonstein, J.L. Control of swellng in boxing injuries. Practitioner 1969;203-206 Buccal or sublingual delivery. Use of buccal papaya resulted in less swelling, less hematoma.

Blonstein, J.L. The use of buccal Varidase in boxing injuries. Practitioner 1967;198:547 Cuts took 1/2 time to heal.

Cohen A, Goldman J. Bromelains therapy in rheumatoid arthritis. Pennsylvania Med J 1964;67:27&endash;30. Antiinflammatory properties of bromelain for arthritis

Cirelli MG Bromelain use in Arthritis . Clinical Medicine With bromelain arthritis, muscle and back pain was improved Craig RP. The quantitative evaluation of the use of oral proteolytic enzymes in the treatment of sprained ankles. Injury 1975; 6:313 Ankles healed faster and with less pain on enzymes.

Dietrich RE. Oral proteolytic enzymes in the treatment of athletic injuries. Penn. Med J. 1965;68:35 Use of protease enzymes reduced injury time for acute sprains, contousions and strains.

Felton G.E. Does kinin released by pineapple stem of bromelain stimulate production of prostagalandin like compounds? Hawaii Journal of Medicine 36(2):39 1977 Bromelain use reduces coughs and bronchitis and relieves sinus symptoms.

Gaby AR. The story of bromelain. Nutr Healing May 1995:3,4,11. Use for sinus pain, blocked bronchial passages, asthma and allergy.

Grossan, M. Help your Patients Have a Healthy Vacation. Consultant Magazine.April 1982, 22:4 pp256-258 papaya enzyme can be used to insure a trouble free dive trip.

Grossan M. Care of the Scuba Diver. Osteopathic Annals October 1976 The use of papaya enzyme taken via buccal route for blocked ears.

Grossan M. Enhancing the Mucociliary System. Advance for Respiratory Care Practitioners. April 17, 1995. 8:12-13 For chest congestion due to thick mucus, the proteolytic enzyme can aid significantly.

Grossan M. Office Measurement of Nasal Mucociliary Clearance. English: Otolaryngology 1994, Vol 2 Chapter 7 Because the mucus is thinned by the enzyjes, nasal and sinus mucociliary movement is enhanced.

Holt HT. Carica papaya as ancillary therapy for athletic injuries. Curr Ther Res 1969;11:621 Papain tablets showed a significantly better than expected recovery in sprains, strains, contusions. Best results when started immediately after injury.

Howatt RCL. The effect of bromelain therapy on episiotomy wounds. J. Ostet, Gynaecol. Br. Common. 1972;79:951 Reduction of post operative pain and swelling occured in 1,788 patients.

Ito C, Yamaguchi K. Anti -inflammatory actions of proteases, bromelain, trypsin, and their mixed preparation. Nippon Yakurigaku Zasshi 1979 April 20; 75(3).227 - 37 Mixed preparations showed anti-inflammatory actions indicating synergism. Inhibition against edema. Inhibition against histamine induced vascular permeability. Anti-inflammatory action seems best against acute exudative inflammation.

Kelly GS. Bromelain: a literature review and discussion of its therapeutic applications. Alt Med Rev 1996;1:243&endash;57 Use for sinusitis, joint and muscle swelling and to aid in effectiveness of antibiotics.

Lotz-Winter H On the pharmacologiy of bromelain. Planta Medica.56 (3):249 1970 Bromelain lowers inflammation quickly.

Majima Y, Inagaki M. The effect of an orally administered proteolytic enzyme on the elasticity and viscosity of nasal mucus. Archives of Oto-Rhino-Layngology 1988 244:335-359

Martin GJ. Bromelain pineapple proteases with anti-edema activivity. Exper Med Surg 1962;20:228-48. Reduction of extra cellular edema.

Masson M. Bromelain in the treatment of blunt injuries to the musculoskeletal system. Fortschr Med 1995;113(19):303&endash;6. Treatment for injuries to muscles and joints

Metzig C. Bromelain proteases reduce human platelet aggregation in vitro, adhesion to bovine endothelial cells and thrombus formation. In Vivo, 13(1):7-12 1999 Jan-Feb Proteases are shown to have antithrombolytic activity and is helpful for thrombosis and inflammation.

Ryan RE. Evaluation of bromelains in the treatment of acute sinusitis. Headache 1967;7:13-7 When used for sinus pain, enzymes were effective in relieving sinus pain.

Schafer A, Adelman B. Plasma inhibition of platelet function and of arachidonic acid metabolism. J Clin Invest 1985;75:456&endash;61. Action on platelet aggregation is one of the antiinflammatory actions of bromelain/papain

Seltzer AP. Minimizing post-operative edema and ecchymosis by the use of an oral enzyme preparaton bromelain. EENT Monthly 1962;41:813-7 Reduction of hematoma, swelling and pain post op.

SeltzerAP. Adjunctive use of bromelains in sinusitis. EENT Monthly 1967;46:1281-8. Less pain and faster recovery when enzymes were used combined with other sinusitis treatment

Taub SJ. The use of Ananase in sinusitis-a study of 60 patients. EENT Monthly 1966;45: 96-8 Less post operative swelling in patients given enzymes pre op.

Taussig,SJ. The mechanism of the physiological action of Bromelain . Med Hypoth 1980;6:99-104 Bromelain acts to reduce inflammation.

Taussig SJ. Bromelain: a proteolytic enzyme and its clinical application. Hiroshima J Med Sci, 24:185 1975 Sep Use of bromelain in postoperative care, wounds and thromaboplebitis

Tsomides J. Controlled evaluation of oral chymotrypsin-trypsin treatment of injuries to the head and face. Clin. Med 1969;76:40 Protease administration was effective in reducing signs of swellng and bruising in traumatic facial injuries

Walker JA. Attenuation of contraction-induced skeletal muscle injury by bromelain. Med Sci Sports Exerc, 24(1):20-5 1992 Jan Experiments showed bromelain reduced muscle injury.

White RR Bioavailability of 125I bromelain after oral administration to rats. Biopharm Drug Dispos, 9(4):397-403 1988 Jul-Aug There is less than 40 percent of product available from oral administration

©2000 Dr. Murray Grossan

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Last Update 2003 October 20
Murray Grossan M.D.