RU2164159C2 - Method of laser therapy of postoperative tympanum cavities in patients with chronic purulent inflammation of middle ear - Google Patents

Abstract

FIELD: otolaryngology. SUBSTANCE: trepanation cavities preliminarily filled with 2-3 ml of Shostakovsky balsam are irradiated by low-energy laser with wavelength 0.63 mcm and power on light guide end through external acoustic passage. Irradiation is performed first on the 5-7th day after operation and continued daily (duration 5 min and single irradiation dose 20 J/sq. cm. EFFECT: accelerated epithelization of postoperative tympanum cavities and increased percentage of positive treatment results to 92% at lower summary irradiation dose of 120 J/sq.cm. 2 ex

Description

 The invention relates to medicine, namely to otorhinolaryngology, and relates to methods for treating postoperative ear cavities in chronic suppurative otitis media.

 Chronic purulent otitis media is a consequence of acute otitis media and is characterized by constant or periodically recurring suppuration of the ear, persistent perforation of the eardrum, progressive hearing loss, leading to disability, and occurs in 22% of the population [1].

 The social significance of chronic purulent otitis media is due to the development of hearing loss, which complicates communication between people, restricts the patient's professional activity, and also contributes to impaired speech development in children [1].

 Quite often, the only way to sanitize a purulent-inflammatory focus in the cavities of the middle ear is surgical treatment.

 In 40% of patients undergoing surgical treatment, the bone trepanation cavity is not completely epithelized - a sluggish purulent-inflammatory process continues in the ear, accompanied by otorrhea [1] [2].

There is a method of treating middle ear cavities in the early postoperative period (from 5-7 days after surgery) with low-energy laser radiation (wavelength 0.63 μm, radiation power at the end of the fiber 6 · 10 ^-3 W, exposure 5 minutes), brought to the attic , aditus, antrum along a quartz fiber up to 5 mm thick through shunts formed surgically in the behind-the-ear region, passing through the thickness of soft tissues and the temporal bone.

 The use of a helium-neon emitter with a wavelength of 0.63 μm is justified by the widespread prevalence of these devices in medical institutions, the convenience of bringing the laser beam through a flexible fiber to any irradiated surface, and the ability to modulate the total radiation dose by changing the exposure.

 Previously, the attic, aditus, and antrum cavities are filled with a solution of 0.02% furatsilina or 3% aqueous solution of boric acid or 0.9-10% sodium chloride solution in an amount of 2-3 ml.

 These solutions, having the property of scattering, contribute to a more uniform distribution of laser light along the walls of the cavities of the middle ear and increase the depth of penetration of laser energy into the underlying tissue.

A positive effect in the form of complete cessation of suppuration ("dry ear") is observed in 88.8% of cases after 6 laser therapy sessions (total dose of 150 J / cm ² ) [3] [4].

 In order to increase the effectiveness of treatment, reduce the total dose of radiation and speed up the regeneration processes, it is proposed to fill the trepanation cavity, purified from the pathological discharge, through the auditory canal with immersion medium — 2-3 ml of Shostakovsky balsam - polyvinyl butyl ether in 20% oil solution before starting the sessions [5]. Shostakovsky balm is not only an immersion medium, but also enhances wound cleansing, accelerates tissue regeneration and epithelization.

 For the first time, Shostakovsky balm was used as an immersion medium. Its use made it possible to reduce the radiation dose, which was probably the result of increased penetration of laser radiation into tissues.

The authors used laser therapy with Shostakovsky balsam in a group of 3 people. As a result, the effect of dry ear in this group was obtained already when the total radiation dose of 120 J / cm ² was reached.

In this case, irradiation is carried out with a helium-neon laser with a wavelength of 0.63 μm and a radiation power at the end of the fiber of 4 · 10 ^-3 W. The laser beam is led to the irradiated cavities of the middle ear using a polymer fiber with a diameter of 0.2 mm through the external auditory canal.

The course of treatment consists of 5-6 sessions conducted from 5-6 days after surgery, daily, once, with an exposure of 5 minutes. In this case, a single dose is not more than 20 J / cm ² . The use of a single dose above 20 J / cm ² is impractical, because, in this case, there is an increase in radiation load on the patient's body without changing the clinical effect.

 To confirm the objectivity of the proposed method, the authors conducted tests.

 Laser treatment with Shostakovsky balm was carried out in 25 patients who underwent a sanitizing operation for chronic purulent otitis media aged 35 to 43 years with an assessment of clinical indicators.

 At the same time, in 23 patients (92%), by the 4-5th session of laser therapy, cessation of the purulent-purulent discharge from the ear was observed. After the 6th session, an active growth of tender granulations was observed in the ear. In 2 patients (8%), the clinical effect of laser therapy was absent - after completion of the course of treatment, the blood-purulent discharge was preserved in the ear.

The proposed method of treatment made it possible to achieve the clinical effect of "dry ear" by the 5-6 session in 92% of cases, with a total radiation dose of up to 120 J / cm ² .

 Thus, the signs that distinguish the proposed method from the known one are necessary, and in combination with the features common to both methods, sufficient to achieve a new result - to increase the effectiveness of treatment while reducing the radiation dose.

 Analysis of the generally available literature showed that the invention is not known from the prior art, i.e. meets the requirement of novelty. Without explicitly flowing from the prior art, the invention has an inventive step.

Example 1: Patient D., 38 years old, I / B N 2518/136, was operated on for right-sided chronic purulent mesoepitympanitis. On the 5th day after the operation, the patient started irradiating the postoperative cavities of the middle ear on the right with a helium-neon laser, with a power of 4 mW at the end of the fiber, daily, once, with an exposure of 5 minutes in Shostakovsky balm. At the beginning of irradiation, an abundant purulent-purulent discharge was observed in the ear. After 3 sessions of laser therapy, a sharp decrease in the amount of discharge was observed, after 5 sessions, the ear was dry, rapid growth of delicate granulation tissue was noted in the cavities. A positive clinical effect was achieved with a total radiation dose of 100 J / cm ² .

 Example 2: Patient T., 41 years old, I / B N 1383/275, was operated on for left-side chronic suppurative mesoepitympanitis. On the 6th day after the operation, irradiation of the cavities of the operated ear with a helium-neon laser was started, with a power of 4 mW at the end of the fiber, once daily, in Shostakovsky balm, with an exposure of 5 minutes. At the beginning of irradiation, an abundant suppurative-purulent discharge was observed in the ear. After 4 sessions of irradiation in the ear, no pathological departments were observed. After the 6th session, rapid growth of gentle granulations was noted. Treatment extended to 8 sessions. There were no significant differences in the state of postoperative cavities of the middle ear at the time of the end of 6 and 8 laser therapy sessions.

Thus, the proposed method for the treatment of postoperative ear cavities with chronic exudative otitis media, which differs from the prototype by the use of Shostakovsky balm as an immersion medium, which accelerates regeneration and epithelization, allows to achieve the clinical effect of "dry ear" with a total radiation dose of up to 120 J / cm ² in 92% of cases versus 88.8% with a total dose of 150 J / cm ² in the prototype.

LITERATURE
1. Soldatov I. B. Lectures on otorhinolaryngology - M .: Medicine, 1990. - 286 p.

 2. Mishenkin N. Century. Clinic, diagnosis and treatment of chronic otitis media - Omsk, 1979. - 88 p.

 3. Mishenkin N.V., Tikhomirov V.V. and other Laser therapy in the early postoperative period after sanitizing ear surgery according to the "closed method" (experimental study) // Bulletin of Otorhinolaryngology, 1988. - N 6 - P. 75-76.

 4. Mishenkin N. V., Tikhomirov VV et al. Low-energy lasers in otiatrics - Novosibirsk: Novosib publishing house. University, 1991 .-- 136.

 5. Mashkovsky M. D. Drugs: in 2 volumes. - M.: Medicine, 1993. - T. 2. - S. 482-483.

Claims (1)

A method of laser therapy of postoperative ear cavities in chronic suppurative otitis media with a low-energy laser with a wavelength of 0.63 μm, including 5, 6 daily, single sessions, characterized in that before the start of the laser therapy session, the irradiated cavity is filled through the auditory meatus with 2 - 3 ml of immersion medium - Shostakovsky balm and irradiation is carried out with a single dose of not more than 20 J / cm ² .