RU2110301C1 - Method to treat tonsillitis - Google Patents

Abstract

FIELD: medicine, otorhinolaryngology. SUBSTANCE: zinnate is additionally introduced at the quantity of 125-250 mg to take in twice a day for 5-7 days perorally at the background of laser and irrigation therapies, moreover, for irrigation therapy 2%-solution of ascorbic acid is applied, and at conducting laser therapy an additional impact upon submaxillary area is performed. EFFECT: higher efficiency of therapy. 8 dwg

Description

 The invention relates to medicine, more specifically to otorhinolaryngology, and may find application in the treatment of diseases of the upper respiratory tract.

 Tonsillitis is one of the most common diseases of ENT organs, in the treatment of which conservative and surgical methods are used. With the compensated form of tonsillitis, conservative debridement of the tonsils is effective, including washing, irrigation of the surface and lacunae of the tonsils under the conditions of the usual classic version, the use of antibiotics (mainly with paratonsillar blockade), physical methods (ultrasound, laser irradiation).

 With a decompensated form of tonsillitis, surgery is indicated - tonsillectomy.

 Often there is a variant of the structure of the palatine tonsils, in which there is an abnormal arrangement of their upper poles. Tonsils are in a position restrained between the arches, and the upper poles go towards the soft palate and the lateral pharyngeal wall. With hypertrophy of such an tonsil, an increase is observed, mainly of the upper pole, hidden in the soft tissues of the pharynx. The middle part of the tonsil remains, as a rule, small and with pharyngoscopy does not make an impression of hypertrophy. The lumen of the pharynx is free, and the respiratory and speech functions are impaired. Diagnosis of the pathological condition of the tonsil in these cases is difficult, which leads to untimely and inaccurate treatment. Due to breathing difficulties, these patients usually undergo an adenotomy, which does not give a positive dynamics of the disease. The most serious complication of tonsillitis with strangulated tonsils is hearing impairment, which concentrates all the attention of the doctor and patient, which again leads away from the correct course of treatment. And only the observed frequent acute respiratory infections, recurrent otitis media, tonsillitis give reason to think about the presence of a focus of infection in the upper pole. In such cases, with convincing history of a tendency to frequent diseases, adenotomy and tonsillectomy are recommended.

 However, widespread tonsillectomy in children of the first years of life, given the important immunological function of the tonsils, is unjustified. At the same time, ongoing relapses of otitis media and conductive hearing loss require the use of active measures. Given these features and with insufficiently clear information, a two-stage surgical intervention is performed, especially in young children.

 The first stage is an adenotomy and conservative debridement of the tonsils. In the absence of a positive effect from the treatment, tonsillectomy is performed.

 Of the conservative methods for the treatment of tonsillitis with strangulated tonsils, laser therapy was previously proposed. This method, taken as a prototype, consists of washing tonsils with furatsillin, followed by irradiation of the posterior pharyngeal mucosa with a helium-neon laser daily for 5 days for 20 s per session.

 The use of laser therapy for tonsillitis with the classic structure of tonsils is quite effective. According to reports, a positive therapeutic effect is observed in 86%. The clinical effect consists in the disappearance of unpleasant sensations in the throat, palatine tonsils are reduced in volume, congestive hyperemia of the front arches is reduced, purulent plugs are not detected in the gaps. Carrying out such treatment twice a year (in the autumn and spring season) provides a stable remission. Catamnesis - three years.

 However, with the strangulated position of the tonsils, accompanied by their hypertrophy, at the same time, there is a pronounced infiltration of the palatine arches, which exacerbates the condition of both the palatine tonsils and the middle ear.

 In this regard, one laser therapy is not effective enough, it gives a slight clinical improvement with remission of not more than one month. Even the monthly laser therapy does not always extend the remission, but makes the treatment very long.

 This indicates the lack of effectiveness of laser therapy for tonsillitis with strangulated tonsils, since the remission is short and does not exceed one month.

 The technical result of the invention is to reduce treatment time and lengthen remission.

 This result is achieved by the fact that in the known method for the treatment of tonsillitis by laser and irrigation therapy according to the invention, the patient is additionally administered zinnat in the amount of 125-250 mg twice a day for 5-7 days orally against the background of laser therapy and irrigation therapy, and for irrigation Therapies use a 2% solution of ascorbic acid, and when laser therapy is performed, an additional effect is made on the submandibular region.

 The introduction of a zinnat antibiotic to the patient, as shown in comparative studies (zinnat, augmentin) on equal groups of children with strangulated tonsils, helps to reduce the size of the tonsils and improve auditory function, and also reduces the treatment time to 5-7 days.

 Carrying out antibiotic therapy on the background of laser therapy helps to more quickly eliminate infiltration of the mucous membrane and parenchyma of the tonsils and accelerates the restoration of impaired auditory function. It should be noted that zinnat is recommended for otitis media, but augmentin is also recommended for such conditions. However, it was proved that only zinnat in this combination provides a quick positive clinical effect.

 Conducting irrigation therapy using a 2% solution of ascorbic acid also contributes significantly to the removal of inflammatory phenomena. As noted, it is ascorbic acid that quickly removes edema and hyperemia from the mucous membrane of the tonsils, improving trophism.

 And due to the whole range of proposed operations, not only a quick recovery is achieved, but also a stable remission.

 Laser therapy additionally on the submandibular region (simultaneously with the laser effect on the tissue of the tonsils) reduces the catarrhal phenomena of the mucous membrane and its infiltration.

 Thus, the proposed set of measures for tonsillitis with strangulated tonsils allows you to quickly (in 5-7 days) eliminate the pathological focus and achieve a stable and long-term remission. To date, treated patients are in remission for more than a year and continue to be observed.

 Example 1. Patient N., 5 years old, and / b N 615. Was admitted to the children's clinic of the Research Institute of ENT SPECIALIST on 11.03.1996 with a diagnosis of chronic adenoiditis, hypertrophy of the tonsils, bilateral tubootitis.

 On admission, complaints of difficulty in nasal breathing, decreased hearing acuity, and apnea were noted.

Sick for six months. In September 1995, the girl suffered from SARS, which was manifested by stuffy nose, runny nose, sore throat, general malaise, body temperature up to 38.5 ^o C, decreased hearing acuity. According to impedanometry (Fig. 1, 3), the tympanogram at the patient’s admission is flattened both to the right (line I in figure 3) and to the left (line I in figure 3). According to tonal audiometry (Fig. 2,4), there was a decrease in hearing acuity to 55 dB (line I in figure 2) on the right and to 65 dB (line I in figure 4) on the left.

 ENT status upon admission: nasal breathing is difficult symmetrically on both sides. The mucous membrane of the nose is swollen. In the nasal passages mucus in a small amount. In the nasopharynx adenoid lesions of the II degree. The mucous membrane of the pharynx with the phenomena of congestive hyperemia. Palatine tonsils of the III degree are restrained between the arches, the upper and lower poles go deep into the soft tissues. On the back wall of the pharynx is a granule. AD / AS - b / n cloudy, retracted, fuzzy contours.

 Treatment: Zinnat suspension of 125 mg 2 times a day, washing the lacunae of the tonsils with a 2% solution of ascorbic acid daily, then 20 s with a helium-neon laser on the back of the pharynx and 5 minutes on the submandibular region. It was carried out for 5 days.

 Inspection after treatment showed: nasal breathing free. The mucous membrane of the nose is pink, moist. Adenoids contracted, signs of inflammation subsided. The mucous membrane of the pharynx is pink. Palatine tonsils decreased in size and appeared in the lumen of the pharynx. AD / AS - eardrums are gray, the contours are clear.

 According to tonal audiometry and impedance barometry, a week after the start of treatment, an improvement in hearing acuity is observed up to 20 dB on the right (line II in Fig. 2) and up to 25 dB on the left (line II in figure 4); the tympanogram shows an increase in the mobility of the eardrum from two sides (line II in Fig. 1.3).

 A week later, hearing acuity and tubular function reached normal limits (line III in figures 1 to 4), which indicates normalization of hearing.

 Discharged in satisfactory condition. At the follow-up examination after a month no complaints were presented, the achieved result was saved.

 To date (11 months), the child is in remission.

 Example 2. Patient H., 5 years old, and / b 1712.

 He was admitted to the children's clinic of the NII ENT 14.XII.95 with a diagnosis of acute tonsillitis, tonsil hypertrophy, bilateral acute catarrhal otitis media, bilateral acute sinusitis.

 On admission, complaints of difficulty in nasal breathing, decreased hearing acuity, purulent discharge from the nose, and sore throat were noted.

 Sick for a week.

 Received symptomatic treatment.

 ENT status upon admission: nasal breathing is difficult on both sides. In the nasal passages purulent discharge. The mucous membrane of the pharynx is hyperemic. The front arches are hyperemic, infiltrated. Palatine tonsils are enlarged, pinched between the palatine arches and go deep into the soft tissue of the lateral pharynx and soft palate. AD / AS- eardrums are pink, thickened, the contours are blurred.

 Treatment: Zinnat suspension of 250 mg 2 times a day, irrigation of the nasopharynx and washing of the lacunae of the tonsils with 2% solution of ascorbic acid, a helium-neon laser on the back wall of the pharynx for 20 s and for the submandibular region for 5 minutes. Such treatment was carried out for 7 days.

 Inspection after treatment. Nasal breathing is free. The mucous membrane of the pharynx is pink, moist. The infiltration of the front arches disappeared. Palatine tonsils decreased in volume and entered the lumen of the pharynx. AD / DS- eardrums are gray, contours are visible.

 On the pre-treatment tonal audiogram, there was a decrease in hearing acuity to 25 dB on the right and left ear (lines IV in Fig. 6.8), tympanograms are also flattened on both sides (lines IV in Fig. 5.7). After 10 days from the start of treatment, the auditory function normalized according to tonal audiometry and tubular function according to impedancemetry (line V in FIGS. 5-8).

 Discharged in satisfactory condition. During the follow-up examination after a month there were no complaints, the achieved result was saved. To date (more than one year), the child is in remission.

 The proposed method conducted the treatment of a group of children of 25 people with tonsillitis with strangulated tonsils, and 22 achieved a stable result. It is shown that the proposed regimes ensure the recovery of children in 5-7 days, and to date, remission for more than 1 year, the children are in satisfactory condition and continue to be observed.

The proposed method in comparison with the known has several significant advantages:
the method for the first time in tonsillitis with strangulated tonsils provides conservative treatment with complete recovery, and previously such patients underwent surgery - tonsillectomy;
the method provides a stable and long-term remission, currently up to more than 1 year, and the children continue to be observed, being in a satisfactory condition;
The method ensures the achievement of a positive therapeutic effect in 5-7 days.

 The method was developed in the children's surgical clinic of the Research Institute of ENT SPb and was tested in 25 children with the achievement of a positive therapeutic effect.

Claims (1)

 A method of treating tonsillitis, mainly with pinched tonsils, by means of laser and irrigation therapy, characterized in that the patient is additionally injected with zinnat in an amount of 125 - 250 mg per dose 2 times a day for 5 to 7 days orally against a background of laser and irrigation therapy moreover, for irrigation therapy, a 2% solution of ascorbic acid is used, and when laser therapy is performed, an additional effect is made on the submandibular region.

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