EPIPHARYNGEAL ABRASIVE THERAPY
When nasal medication never
cleared the post-nasal drip
some patients change with EAT
EAT is a local treatment applied deep behind the nose when inflammation is found there. It is not for everyone. We examine first, then decide whether it applies to you.
- EAT
- Epipharyngeal Abrasive Therapy
- B-spot therapy
- 上咽頭擦過療法
- Chronic epipharyngitis
- Nasopharyngitis
Symptoms that may be
worth a closer look
These are not diagnostic criteria. They are situations in which endoscopic examination of the epipharynx may be reasonable. The same symptom can come from very different causes.
Persistent post-nasal drip
Mucus keeps running down the back of the throat despite nasal sprays and rinsing.
Globus sensation
A stuck, phlegmy feeling that makes you clear your throat over and over.
Deep throat discomfort
Not a cold, but the area high behind the palate stays raw and irritated.
Symptoms after infection
Throat discomfort and fatigue that stayed on after COVID-19 or another infection.
Chronic cough
A cough lasting more than two weeks that several treatments have not settled.
Headache, stiff neck
Throat symptoms arriving together with neck and shoulder tightness or headache.
Dizziness on standing
Autonomic symptoms alongside, which need to be assessed on their own terms.
No cause found
Tests at several hospitals came back normal and no explanation was offered.
Treating post-COVID and ME/CFS patients,
we kept meeting the same finding
Some people have normal test results yet live with fatigue, brain fog, headache and dizziness on standing — the picture described as long COVID or ME/CFS (myalgic encephalomyelitis / chronic fatigue syndrome). Seeing these patients, one thing became hard to ignore: whenever we looked at the epipharynx endoscopically, inflammation was there again and again.
The same observation has been reported in Japan. In a study of long COVID patients, residual inflammation of the epipharynx was found in every participant (Imai K, et al. Viruses 2022). The epipharynx is known as an early site of coronavirus replication, which has been offered as one explanation for local inflammation persisting after the infection itself has passed.
For these patients an ENT clinic is rarely the first stop. Many say their symptoms began after catching COVID-19, or after a vaccination. We record that timing as stated and draw no conclusion about causation. Most have already been through internal medicine, neurology and psychiatry, collected normal results, and been told nothing is wrong — and quite a few have been treated as if they were exaggerating. We listen to that history first, then check whether any area remains that nobody has actually looked at.
Post-nasal drip that medication does not fix
has more than one cause
The same drip and throat discomfort can arise from several sources. The epipharynx is one of them. We rule the others out first and see what is left.
- 1Allergic rhinitis · sinusitis
Simply too much secretion draining backwards. We check whether nasal treatment reduces the throat symptom in step.
- 2Laryngopharyngeal reflux
Acid irritating the larynx produces globus and throat clearing. Timing around meals and lying down is informative.
- 3Chronic epipharyngitis
Nasal treatment is adequate but the throat symptom alone persists. Only endoscopic inspection of the epipharyngeal mucosa can settle this.
- 4Airway hypersensitivity
A sensitised cough reflex, where the drip can feel like the cause when it is closer to a consequence.
- 5Pharyngeal dysaesthesia · thyroid disease
When globus dominates, thyroid and neck ultrasound may belong in the workup.
We do not decide the treatment first.
We look, then judge
A first visit takes roughly 20–30 minutes. If endoscopy shows no inflammation, we do not perform EAT.
History
When symptoms began, what has already been tried, current medication, associated symptoms.
Endoscopy
A thin endoscope examines the nasal cavity and epipharynx: redness, swelling, secretion, contact bleeding.
Decision
Whether EAT fits, or another treatment comes first. If it is better not to proceed, we say so.
Reassessment
After several sessions we review symptoms and findings again to set the interval, or to stop.
What actually happens
A cotton swab carrying the solution is brought into direct contact with the epipharyngeal mucosa. The application itself takes well under a minute.
- 1Route
Through the nose, through the mouth, or both, depending on your anatomy and findings.
- 2Endoscopic technique (E-EAT)
Where useful, the procedure is performed under direct endoscopic view so inflamed areas can be treated precisely.
- 3Pain and bleeding
Discomfort during the procedure is normal and blood on the swab is common. Inflamed mucosa bleeds on contact, so the amount of bleeding is read as one indicator of how inflamed the tissue is.
- 4Immediately after
We look at the swab together and explain the current state. After a short rest you can leave.
- 5Interval
Usually once or twice a week at the start, then adjusted. Japanese clinical reports and patient accounts mention around 10–20 sessions for relapse prevention, but that is not a standard we transfer unchanged. We do not promise a total number in advance.
- 6Stopping or changing course
If findings and symptoms do not move, if pain or bleeding becomes a burden, or if another cause looks more likely, we change direction.
When we take extra care,
or do not proceed
None of these rules you out automatically. We check medication and history and judge individually, so please tell us everything you are taking.
Bleeding tendency
Anticoagulants, antiplatelet agents, or a bleeding disorder
Structural findings
Previous nasal or epipharyngeal surgery, or anatomical variation
Acute infection
Fever or an upper respiratory infection in progress
Pregnancy
Pregnant, or possibly pregnant
Drug hypersensitivity
A history of hypersensitivity to the agent used
Severe anxiety
When anxiety makes a stable procedure difficult
Reported reactions include pain during the procedure, minor bleeding, temporary sore throat or nasal irritation afterwards, and rarely headache or dizziness. Most are transient, but please contact us if anything persists. The degree and timing of benefit also vary widely, and in some patients it is not clear at all.
Symptoms overlap with
patulous eustachian tube
Globus, aural fullness and hearing your own voice echo can arise from chronic epipharyngitis and from patulous eustachian tube (PET) alike. The epipharynx sits immediately beside the eustachian tube opening, and the two conditions are not rarely present together.
Autophony
Hearing your own voice or breathing resonate in the ear. Typical of PET, but often reported alongside epipharyngeal discomfort.
Aural fullness
Eustachian tube dysfunction, epipharyngeal inflammation and middle ear problems must be told apart. Whether posture changes it is an important clue.
Weight change · autonomic factors
Rapid weight loss, dehydration or autonomic symptoms can aggravate PET, so we check these together.
What is known, and
where the knowing stops
Research on the mechanism of EAT has come largely from Japan. Reduction of local epipharyngeal inflammation, changes in the mucosal epithelium, and autonomic modulation through a trigeminal–vagal reflex are described as proposed mechanisms.
Selected literature indexed in PubMed.
Bibliographic data from PubMed (National Library of Medicine). The conclusions of these papers do not guarantee any individual outcome.
Questions patients
ask most often
Is B-spot therapy different from EAT?
They are different names for the same treatment. In Japan it is called 上咽頭擦過療法 (EAT); B-spot therapy is another common name. When performed under direct endoscopic view it is sometimes distinguished as E-EAT.
Does it hurt?
The swab contacts the mucosa directly, so there is pain and minor bleeding is common. Pain usually subsides within minutes to tens of minutes. Many people find pain and bleeding decrease over successive sessions, but individual variation is considerable.
How many sessions will I need?
Usually once or twice a week to begin with, adjusted as symptoms and findings are reassessed. Japanese sources mention around 10–20 sessions, but we do not transfer that figure directly. Rather than promising a total in advance, we review after several sessions and decide.
Is it covered by Korean national health insurance?
Consultation and endoscopy may fall under covered items; coverage for the procedure itself depends on the diagnosis and what is performed. We will explain at the visit.
Can it be done on the same day?
Often yes, if endoscopy confirms inflammation and there are no contraindications. If another cause is suspected or further assessment is needed, we address that first.
Any restrictions afterwards?
No particular restrictions. Avoid blowing your nose forcefully or vigorous nasal irrigation for a short while after the procedure.
Do you see patients who do not speak Korean?
Yes. Consultations are available in Korean, English and Japanese. Please mention your preferred language when booking.
Find out first
why it is not clearing up
We do not decide the treatment first. We look, and tell you whether it is needed at all.
Visiting us
Location
3F Lemeilleur Jongno Town,
19 Jongno, Jongno-gu, Seoul
Jonggak Stn (Line 1) Exit 1 — 2 min walk
Gwanghwamun Stn (Line 5) Exit 4 — 2 min walk
Hours
Mon–Fri 09:00 – 18:00
Saturday by prior appointment
Registration closes 12:30 / 17:30
Closed Sundays and public holidays
Care
ENT specialist · certified in functional medicine
One of the few clinics in Korea performing EAT. Autonomic (HRV) and gut (SIBO) assessment can be considered where relevant.