Cannabis related side effects in otolaryngology: A scoping review

Abstract

Background Cannabis has been rapidly legalized in North America; however, limited evidence exists around its side effects. Health Canada defines side effect as a harmful and unintended response to a health product. Given drug safety concerns, this study’s purpose was to review the unintended side effects of cannabis in otolaryngology. Methods The Preferred Reporting Items For Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR) protocol was used to conduct a scoping review of the MEDLINE, EMBASE, CINAHL, and CENTRAL databases. (PROSPERO: CRD42020153022). English studies in adults were included from inception to the end of 2019. In-vitro, animal, and studies with n < 5 were excluded. Primary outcome was defined as unintended side effects (defined as any Otolaryngology symptom or diagnosis) following cannabis use. Oxford Centre for Evidence-Based Medicine: Levels of Evidence and risk of bias using the Risk of Bias in randomized trials (RoB 2) and Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tools were assessed.. Two authors independently reviewed all studies; the senior author settled any discrepancies. Results Five hundred and twenty-one studies were screened; 48 studies were analysed. Subspecialties comprised: Head and Neck (32), Otology (8), Rhinology (5), Airway (5), Laryngology (1). Cannabis use was associated with unintended tinnitus, vertigo, hearing loss, infection, malignancy, sinusitis, allergic rhinitis, thyroid dysfunction, and dyspnea. About half (54.1%) of studies showed increased side effects, or no change in symptoms following cannabis use. Oxford Levels of Evidence was 2–4 with substantial heterogeneity. Risk of bias assessment with RoB2 was low to high and ROBINS-1 was moderate to critical. Conclusion This was the first comprehensive scoping review of unintended side effects of cannabis in Otolaryngology. The current literature is limited and lacks high-quality research Future randomized studies are needed to focus on therapeutic effects of cannabis in otolaryngology. Substantial work remains to guide clinicians to suggest safe, evidence-based choices for cannabis use. Graphic abstract

Otolaryngologic Side Effects After COVID‐19 Vaccination

“…All AEs were manually categorized as otolaryngologic complaints if they pertained to the ear, nose, face, head, or neck/throat and/or are within the practice domain of an otolaryngologist, as performed by prior studies assessing otolaryngologic side effects. 16,17 AEs were then further substratified by different anatomic regions of the ear, nose, and throat including nasal cavity/sinuses, oropharynx/larynx, oral cavity, ears/vestibular system, and miscellaneous. For the purpose of organization, specific AEs were condensed into broader categories.…”

Cannabis use amongst tinnitus patients: Consumption patterns and attitudes

“…However, the literature is divided on the impact of cannabis on tinnitus as studies have found opposing results. Only two studies to date have found associations with tinnitus as a cannabis-related side effect [40]. In animal studies, cannabinoids were found to increase tinnitus in rat models, and although it was found to be otoprotective, but it was not effective in reducing tinnitus in guinea pigs [41,42].…”

Unintended Side Effects of Electronic Cigarettes in Otolaryngology: A Scoping Review

“…An otolaryngology‐related side effect was defined as a pathologic diagnosis or symptom affecting an anatomic region commonly treated by an otolaryngologist. This definition was adopted from a study by Phulka et al investigating the unintended otolaryngology‐related side effects following cannabis use 24 . Their list of otolaryngology‐related side effects was used as a reference for determining an appropriate list for the current study.…”

“…This definition was adopted from a study by Phulka et al investigating the unintended otolaryngology-related side effects following cannabis use. 24 Their list of otolaryngologyrelated side effects was used as a reference for determining an appropriate list for the current study. The side effects considered were not exclusive to the following: otalgia, tinnitus, vertigo, hearing loss, cancer, sinusitis, anosmia, sinus infections, oral infections, hoarseness, vocal cord dysfunction, vocal cord paralysis, dyspnea, respiratory arrest requiring intubation, sleep apnea, enlarged or diseased lymph nodes in the head and neck, oral lesions/ulcers, cough, mouth/throat irritation, allergic rhinitis, nasopharyngitis, dry mouth, epistaxis, and change or loss of taste.…”