Successful treatment of long-COVID postural tachycardia syndrome with epipharyngeal abrasive therapy in an adolescent patient: A case report.

Publication date: Jul 11, 2025

Postural orthostatic tachycardia syndrome (POTS) is a type of autonomic dysfunction that can occur following coronavirus disease (COVID-19) infection, particularly in adolescents. Treatment options are limited and often ineffective. We report a case of long COVID-associated POTS that responded favorably to epipharyngeal abrasive therapy (EAT), a treatment targeting chronic inflammation in the epipharynx. A previously healthy adolescent developed persistent fatigue, headache, dizziness, insomnia, and orthostatic intolerance lasting over 3 months after a COVID-19 infection. The symptoms severely impaired daily functioning, rendering the patient bedridden. Based on clinical symptoms and a positive orthostatic test showing excessive postural tachycardia without hypotension, the patient was diagnosed with POTS associated with long COVID. Chronic epipharyngitis was also noted upon endoscopic examination. The patient underwent weekly sessions of EAT for a total of 120 days. No additional pharmacologic treatment was provided during this period. The patient showed marked improvement in symptoms, including increased tolerance to standing, reduced fatigue, and improved sleep quality. Objective improvement was confirmed through repeat orthostatic testing. The patient resumed school attendance and daily activities without limitation. This case highlights the potential effectiveness of EAT in treating long COVID-related POTS in adolescents. EAT may offer a nonpharmacological treatment option by addressing underlying chronic epipharyngeal inflammation, a possible contributor to autonomic dysfunction.

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