RU2106854C1 - Method for treating patients suffering from neurosensory hypoacusis in acute and chronic phase - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves stimulating biologically active extrachannel and new acupuncture points by injecting into them pharmacological preparations selected by taking into account disease pathogenesis and etiology. Rectangular pulse current of negative polarity is applied next to it with 5-8 Hz frequency and current intensity of 8-12 mcA. EFFECT: enhanced effectiveness of diagnosis. 5 dwg

Description

 The invention relates to medicine, namely to reflexotherapy in the treatment of sensorineural hearing loss in the acute and chronic periods, and helps to lower hearing thresholds, improve speech intelligibility, decrease in intensity, and more often, the disappearance of ear sounds.

 A known method of treating patients with sensorineural hearing loss with reflexology methods ("Reflesotherapy in the complex treatment of neuron sensory hearing loss. Methodical recommendations. MH USSR, developed. Central Research Institute of Reflexotherapy, MMI M., 1989) includes the introduction of a variety of fairly active drugs according to generally accepted methods for the treatment of hearing loss depending on the etiology diseases followed by reflexology.

 The disadvantage of the described analogue is that the authors recommend the consistent use of a course of drug therapy using a large number of various drugs, which in combination do not always have a positive effect. Reflexotherapy on the background of such a powerful drug exposure becomes an additional component, helping to strengthen the achieved result.

 A known method of treatment requires a long stay of the patient in a hospital.

 The most similar in combination of essential features to the claimed invention is a method of treating patients with hearing loss and ear noise (M. A. Sakalinskas and D. I. Bartkevichine. Auth. St. N950383, class A 61 H 39/00, 1982), taken we follow the prototype, which includes the impact on acupuncture points around the auricle by the introduction of solutions of biological stimulants, into which lidase is preliminarily added, acting on 2-3 points daily, the treatment course is repeated after 3-6 months.

 The prototype and the claimed invention have the following essential features: 1) Microdoses of medicinal substances are introduced into biologically active points (BAP), which contribute to achieving a higher therapeutic effect at low doses of drugs than when pharmacological preparations are administered in the usual way.

 2) The prototype uses solutions of biological stimulants with the addition of lidase and 0.5% solution of novocaine. In the claimed invention, medicinal substances are selected depending on the etiology of the disease. In the treatment of sensorineural hearing loss (HCT) of influenza and intoxication etiology, lidase diluted with a 2% solution of novocaine is used.

 3) The prototype uses acupuncture points located near or directly on the auricle. In the claimed invention used extra-channel and "new" points located paraacuricular.

 The disadvantage of the prototype is that to obtain the desired treatment result, the simple introduction of a solution of a biological stimulant, into which lidase and a 0.5% solution of novocaine are added to the BAT without subsequent electric current passing through them, cannot simultaneously affect several links of pathogenesis. In addition, in the prototype, the introduction of drug substances at acupuncture points is not much different from simple point-wise subcutaneous injections and, as a result, HCT cannot be used in acute and chronic periods.

 The claimed invention is aimed at solving the problem of developing a method for the treatment of neuron-sensory hearing loss in acute and chronic periods using a minimum amount of drugs, provides a stable therapeutic effect.

 The solution to this problem helps to lower hearing thresholds in acute HCT from 15-20 to 35-45 dB, and sometimes (10.7%) and complete recovery, with chronic HCT-lowering hearing thresholds from 15 to 25-30 dB, and also increases speech intelligibility, the general condition improves, in the presence of ear noise, its intensity decreases or disappears completely. Electropuncture in combination with the introduction of pharmacological drugs to acupuncture points prolongs the exciting or inhibiting effect of electric current. The use of negative polarity currents helps to restore the mechanism of regeneration of bioelectric pulses. The use of weak pulsed currents, approaching in magnitude to the currents generated by the body, helps to achieve a therapeutic effect due to the normalization of homeostatic mechanisms of the body.

 To achieve this technical result, the claimed method for the treatment of patients with sensorineural hearing loss in the acute and chronic periods contains the following significant similar signs: 1) microdoses of pharmacological preparations with insulin syringes are introduced into extra-channel and new BAT located paraauricularly, 2) in the claimed invention, treatment of HCT with infectious and intoxication etiology was carried out using lidase diluted with 2% novocaine solution. The prototype uses solutions of biological stimulants with the addition of lidase and 0.5% solution of novocaine.

 In contrast to the prototype, the claimed invention introduces microdoses of medicinal substances into the BAT, which are selected according to the etiology and pathogenesis of the disease. In vascular etiology, drugs that improve cerebral circulation (Cavinton) are used, in case of infectious and intoxication etiology, drugs containing hyaluronidase, in particular lidase, diluted with 2% novocaine solution are used, with HCT caused by stress, unexplained etiology and as a result of traumatic damage applied synthetic leu-enkephalin dalargin.

 The introduction of medicinal substances in the prototype in the BAT is carried out in the form of simple accurate subcutaneous injections. In the claimed invention, pharmacopuncture is produced by irritating methods, using toning in cases with acute HCT and dispersion in chronic HCT, with subsequent exposure to the used points of a rectangular pulse current of negative polarity with a frequency of electrical signals of 5-8 Hz, a current of 8-12 μA device for electropuncture ANELEK-5.

 Together, similar to the prototype and distinctive features are necessary to achieve a stable positive therapeutic effect.

Software in relation to the prototype of the claimed invention has the following distinctive features:
1. For pharmacopuncture, in combination with electro-puncture, extra-channel (RS 11 shan-lun, RS 13 i-min, RS 25 i-syue) and new points (PN 13 tin-syue, PN 14 tin-lin, PN 15 tin-zong , PN 16 tin-min, PN 18 hou-ting-gun, PN 21 hou-zong), located paraauricularly, which allows for therapeutic procedures at any time of the day and in a sitting position. For one procedure, 8-10 points are used, located symmetrically.

 2. Microdoses of medicinal substances are introduced into BAP according to two methods of irritating effect. Moreover, in cases with acute HCT, the method of toning (boo) - “adding energy” is used, which includes the rapid administration of the drug, rotating the syringe 3-7-9 times, after which the point is closed with a dry cotton ball or a soft massage of the point. In cases of chronic HCT, the dispersion (ce) method is used - “energy withdrawal”, in which the needle is slowly inserted and quickly removed. An injection is applied with a full deep exhalation. The drug substance is administered slowly, while the syringe is rotated up to 6 times.

 3. After the introduction of pharmacological preparations, the same points are affected by a rectangular pulse current of negative polarity with an electric signal frequency of 5–8 Hz and a current strength of 8–12 μA by ANELEK-5 electro-puncture apparatus. Pharmacopuncture is carried out every other day for 10 days, electropuncture - daily for 20 days. The course of treatment is 20 days.

Between the distinguishing features and the technical result, there is the following causal relationship:
1. The use of pharmacopuncture helps to achieve a higher therapeutic effect with small doses of drugs than with the introduction of pharmacological preparations in the usual way. Those. medicinal substances introduced into BAT in lower doses show their therapeutic properties stronger and with a longer duration of action.

 The introduction of drugs is carried out on the basis of the rules of traditional eastern medicine using irritant methods to restore lost balance: toning in the acute period of the disease and dispersion in the chronic period.

 2. A rectangular impulse current of negative polarity with a frequency of electric signals of 5-8 Hz and a current strength of 8-12 μA is supplied to the BAT, into which medicinal substances are preliminarily introduced, for 3-5 minutes.

 Weak effects on the BAP of electric current cause shifts in the physiological parameters of the whole organism, in particular, tissue blood flow, oxygen supply to tissues and their use change, cerebral blood circulation, blood and lymph microcirculation improve, cell and tissue metabolism, ion concentration in the intercellular space changes, mediator improves exchange, which leads to the generation of nerve impulses in the fibers and the formation of free radicals in their membranes.

 For the implementation of pharmacopuncture, insulin syringes with thin needles are used, since injections of drugs at acupuncture points are more painful than conventional injections. Pharmacopuncture is performed every other day, electropuncture is performed daily. The course of treatment includes 10 sessions of pharmacopuncture and 20 sessions of electropuncture.

 Electropuncture is produced by the apparatus for electropuncture ANELEC-5. The choice of a rectangular pulsed current of negative polarity is due to the fact that electrodermal stimulation by a current of negative polarity promotes activation of the antinociceptive system, as a result of which endogenous oligopeptides of a morphine-like nature are released that promote the regeneration of nerve tissue.

 According to the information available to the authors, the set of essential features characterizing the essence of the claimed invention is not known from the prior art, which allows us to conclude that the criterion of "novelty" is met.

 According to the authors, the essence of the claimed invention does not follow explicitly from a known level of medicine for a specialist, since the above signs on the resulting therapeutic effect — the combination of the combined use of pharmaco-and electro-puncture using a rectangular pulse current of negative polarity with a frequency of electric signals — 5 -8 Hz, a current of 8-12 μA, helps to achieve a higher therapeutic effect with small doses of administered drugs in a biological and active points than with the introduction of pharmacological preparations in the usual way, as well as finding patients in the day hospital, which allows us to conclude that the criterion of "inventive step" is met.

 The set of essential features characterizing the essence of the invention, in principle, can be used repeatedly in medicine with obtaining a technical result consisting in a more complete restoration of the function of the auditory analyzer, which allows us to conclude that the invention meets the criterion of "industrial applicability".

 This method was carried out as follows.

 When a patient was admitted to the hospital, the diagnosis was established on the basis of complaints, anamnesis, objective examination of ENT organs, hearing tests with whispering and speaking, tuning forks, threshold tonal, suprathreshold, speech audiometry performed by an MA-31 audiometer.

 The degree of hearing loss was established on the basis of the classification given by prof. Hrappo N.S. (Guide to otorhinolaryngology. M: Medicine, 1994).

 The course of treatment consisted of 20 days while the patient was in the day hospital. Pharmacopuncture was performed in a day-10 procedures. Electropuncture - daily - 20 procedures. Pharmacopuncture was performed with insulin syringes, using 8-10 BATs arranged symmetrically. 0.1-0.2 ml of the drug substance was added to each BAT with the addition of a 2% solution of novocaine. The selection of pharmacological preparations was carried out depending on the etiology and pathogenesis of the disease. So, for infectious and intoxication etiology of HCT, enzyme preparations containing hyaluronidase, in particular lidase (1.2-2.4 units), diluted with 2% novocaine solution were used. In the vascular etiology of the disease, drugs used to improve cerebral circulation (Cavinton) were used; in case of HCT caused by stressful situations, an unknown etiology, and as a result of traumatic injuries, the opiate receptor ligand, synthetic leu-enkephalin dalargin, was used.

 For pharmacopuncture, extra-channel and new points were used, followed by exposure to them with a rectangular pulsed current of negative polarity with a frequency of electrical signals of 5-8 Hz and a current strength of 8-12 μA by ANELEK-5 electro-puncture apparatus.

 In cases with acute pathology, the toning method (bu) was used, with chronic HCT dispersion (ce). The toning method includes the quick insertion of the needle and its slow removal, while rotating the syringe 3-7-9 times, followed by slow removal of the needle, after which the point is closed with a dry cotton ball or a light massage of the point.

 When applying the dispersion method, the needle is slowly inserted and quickly removed. With the introduction of the needle produce a slow rotation of it up to 6 times.

 This method of treatment was used in 130 patients with sensorineural hearing loss, of which 89 people with acute pathology and 41 people with chronic pathology.

 According to the etiological factor, the patients were distributed as follows (see table. 1).

 In 91 patients, hearing loss was accompanied by subjective ear noise of 1-2 stages of severity. After the treatment, ear noise decreased in 40 patients and completely disappeared in 51 patients.

 According to the degree of hearing loss, the distribution of patients was as follows (see table. 2).

 Patients were treated according to the method described above. Audiological research of hearing was carried out in dynamics before and after treatment.

 A comparison of the effectiveness of treatment of patients with the degree of hearing loss is given in table. 3.

 Patients in the control group comprised 60 people in acute and chronic periods of sensorineural hearing loss. Of these, 30 people were treated with reflexology using medical treatment for HCT and 30 people were treated with the introduction of solutions of biological stimulants with the addition of lidase and a 0.5% solution of novocaine at acupuncture points.

 Based on the results presented in table. 4, in tonal audiograms of patients with acute sensorineural hearing loss, who were treated by the combined use of pharmaco- and electro-puncture, a decrease in hearing thresholds from 15-20 to 25-3o-35-40 dB was noted. Complete recovery was observed in 14 patients who received in the acute period of the disease within one week from the moment of hearing loss.

 All patients noted an increase in speech intelligibility and an improvement in general condition.

 In the treatment by other methods, lowering of hearing thresholds occurs mainly in the acute period of the disease from 15-20 to 25-30 dB, the use of these methods of treatment in the chronic period of HCT has a low percentage of effectiveness.

 An analysis of the results shows that the method of combined use of pharmaco- and electro-puncture contributes to a more complete restoration of auditory function, has a stable therapeutic effect, its use is possible both in acute and in chronic periods of sensorineural hearing loss.

 Example 1. Patient H., 28 years old, was in an outpatient department of the ENT department of the ROD, Vladikavkaz, from November 20, 1995 to December 12, 1995, with a diagnosis of right-sided acute sensorineural hearing loss. Bilateral tubootitis.

 4 days before admission to the hospital, the patient's hearing decreased after stress, there was a constant noise in the ear, low tonality, grade I. The noise increased in the evening. Objective inspection data without features. With endoxopia of ENT, pathology organs were not detected.

 The data of the auditory passport are given in table. 5.

 On a tonal audiogram - hearing loss II Art. on right. Bilateral tubootitis. The data above the threshold audiometry FUNG, SiSi-test positive. General blood tests, urine tests are within normal limits. A biochemical blood test is normal. Radiographs of the cervical spine revealed no pathology.

 For 20 days, the patient was treated with pharmacopuncture with the introduction of dalargin 0.1-0.2 ml in each BAT, then they were exposed to the same points with a rectangular pulse current with a frequency of electric signals of 5-8 Hz, a current of 8-12 μA with an apparatus for electric points ANELEC-5.

 Pharmacopuncture was performed every other day for 10 days. Electropuncture - daily for 20 days. When conducting pharmacopuncture used the method of toning (bu).

 In addition, catheterization of the auditory tubes was carried out with the introduction of lidase with hydrocartisone intratubally, as well as blowing and pneumomassage (treatment of tubootitis).

 Discharged from the clinic after 20 days with a complete clinical recovery. Tonal audiograms before (figure 1) after treatment (figure 2) are attached.

Claims (1)

 A method of treating patients with sensorineural hearing loss in the acute and chronic periods by exposure to biologically active points of pharmacological preparations and electric current, characterized in that in off-channel and "new" biologically active points by irritating methods in the form of toning (bu) in the acute period of the disease and dispersion (se) in the chronic period, insulin syringes are injected with infectious and intoxication etiology lidase, diluted with 2% novocaine solution in 0.1 - 0.2 ml, with vascular etiolo Cavinton 0.1 - 0.2 ml, with sensorineural hearing loss of an unknown etiology resulting from traumatic injuries and stress - lei - enkephalin dalargin - 0.1 - 0.2 ml, and then they act on the same points with a rectangular pulse a negative polarity current, a current strength of 8 - 12 μA, a frequency of electrical signals of 5 - 8 Hz for 3 to 5 minutes, 8-10 points located symmetrically are used for one procedure, pharmacopuncture is carried out every other day for 10 days, electro-puncture is performed every day within 20 days.

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