RU2180605C1 - Method for applying intraaural ultrasonic therapy in the cases of chronic middle ear otites - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out low frequency ultrasonic cavitation of circulating antiseptic solution for washing the middle ear during 25-30 s with following OxyDANT solution phonophoresis. Middle otitis with no suppuration being treated, low frequency hydromassage of middle ear tissues is applied two times and concurrent phonophoresis of hyaluronidase proteolytic enzymes into them, each session being 20-30 s long. EFFECT: enhanced effectiveness of treatment.

Description

 The invention relates to medicine, in particular to otorhinolaryngology, to ultrasound therapy of chronic otitis media.

 The main diseases of the middle ear that require a long, complex, multi-stage treatment are chronic suppurative otitis media (including operated ear disease), cicatricial otitis media, tubootitis and tinnitus syndrome, which may be associated with these diseases.

 There is a method of treating chronic purulent otitis media by introducing antimicrobial agents: antibiotics, sulfonamides, antiseptic solutions, etc. into the pathological focus through a defect in the tympanic membrane (or into the cavity of the operated ear). taking into account the sensitivity of the microbial flora from the focus of inflammation. The method of drug administration is of great importance: the “wet” method - by instillation or washing of the middle ear with a rubber can or syringe, the “dry” method is the insufflation of powdered drugs or administration by electrophoresis (Soldatov IB, Preobrazhensky NA Patyakina OK Conservative treatment of hearing loss // Hearing loss. Edited by N. A. Preobrazhensky. - M .: Medicine, 1978. - S. 376-417) [1].

 However, all of the above treatment methods do not achieve a complete bactericidal effect due to the complexity of the selection of an antimicrobial preparation: as a rule, a limited set of test disks of antimicrobial preparations for bacteriological studies, the difference in the effect of the antimicrobial preparation "in vitro" and "in vivo". In recent years, many highly virulent, resistant to the vast majority of antimicrobial drugs, strains of pathogenic microorganisms have appeared. In addition, instillation, and with small perforations (up to 3 mm in diameter) and rinsing of the middle ear, do not provide complete mechanical removal of pathological secretions from the cavities of the middle ear due to the relatively weak flow of rinsing fluid.

 There is a method of treating cicatricial and exudative otitis media by pneumatic and vibration massage of the eardrum using an apparatus for pneumatic massage of the eardrum (passport AM. 000 PS). The work of the latter is based on the principle of an air mini-compressor, designed to create alternating cycles of "pressure - vacuum" in the enclosed space of the ear canal in order to exert a mechanical effect of air on the eardrum. The device using a hollow elastic tube connects to the ear canal of the affected ear. According to a certain methodology, a tympanic membrane massage is carried out daily for several minutes by jerky movements of a jet of air.

 However, the air pressure created during this is weak, insufficient to significantly improve the mobility of the eardrum and auditory ossicles, especially with pronounced cicatricial changes. Therefore, as shown by many years of clinical experience, this method of treatment is ineffective and is currently used only as an auxiliary.

 There is also a method of treating chronic otitis media by electrophoresis in the pathological focus of various drugs. With purulent otitis media, electrophoresis of antimicrobial agents is more often used, with scar-adhesive and exudative otitis media - enzymes of hyaluronidase and proteolytic action. For this purpose, a funnel with a carbon electrode can be used for endaural electrophoresis (Soldatov IB, Preobrazhensky N.A., Patyakina OK. Conservative treatment of hearing loss. // Hearing loss. Edited by N. A. Preobrazhensky - M .: Medicine, 1978.- S. 382; Fig. 79).

 However, the method of electrophoresis does not always ensure the penetration of the drug into the middle ear to the required depth and in sufficient concentration. In addition, electrophoresis of drugs does not affect all links of pathogenesis and therefore cannot be used as an independent method of treatment due to low efficiency, therefore, it is often combined with pneumomassage or has an auxiliary value (in combination with other therapeutic measures).

 The aim of the invention is the development of a new effective method for intraoral ultrasound therapy of chronic otitis media instead of all of the above methods.

 The specified goal is achieved as follows.

 For the treatment of chronic purulent otitis media, they affect the pathological focus in the middle ear with low-frequency ultrasound through various medicinal solutions. The main operating factors of low-frequency ultrasound are variable sound pressure, acoustic currents and cavitation of the voiced medicinal fluid, which allows thorough mechanical cleaning of purulent wounds and effective antimicrobial effect on the pathological focus. Ultrasound with a frequency of 25-27 kHz has a pronounced bactericidal effect, causing the destruction of the microbial bodies themselves. After just one minute of voicing the microbial fluid, 98-99% of the microbial cells die. In addition to the direct bactericidal action of low-frequency ultrasound during cavitation of solutions of medicinal substances, their "depot" is created in the walls of the voiced cavity and hydrodynamic massage of surrounding tissues is performed, which improves microcirculation processes.

 Washing the cavities of the middle ear with a solution of the proposed antiseptic provides an effective effect even on antibiotic-resistant strains of the microbial flora. To do this, after washing the cavities of the middle ear using a special ultrasound device (OTONUZ) with a solution of a traditional antiseptic and removing the main pathological discharge, ultrasonic cavitation and phonophoresis of the Oxidant solution are performed.

 Oxydant is an aqueous acid cathodic anolyte (ACC) or a neutral cathodic anolyte (ANC) with a redox potential of at least 1100-1200 mV at a pH of 2.5-3.7 and an oxidizing agent concentration of 100-150 mg / l. Oxydant provides guaranteed neutralization of purulent microbial cells remaining after preliminary washing in the cavities of the middle ear (or in the postoperative cavity).

 A close analogue of the proposed method for intra-ultrasound therapy of chronic otitis media in available sources of scientific, technical and patent information has not been established.

 The proposed method for intraoral ultrasound therapy of chronic otitis media is as follows.

 The treatment of patients consists in the washing of the middle ear with medicinal solutions through perforation of the eardrum (or postoperative cavity) using a special ultrasound device that ensures the effectiveness of the proposed method. The position of the patient - lying or sitting with a sick ear up.

 This device is inserted into the ear canal and, using low-frequency ultrasound, the first stage is washed with a circulating antiseptic solution for 25-30 seconds from the ear cavity: it can be a 3% solution of boric acid, a 3% solution of hydrogen peroxide, a solution of furacilin 1: 5000 and etc.). In this case, the spent solution by suction is collected in a separate container.

 Under the influence of low-frequency ultrasound from the end end of the waveguide, a vortex flow of washing liquid occurs inside the apparatus, which is directed through the holes in the nozzle funnel towards the perforation of the tympanic membrane or postoperative cavity. In this case, thorough mechanical cleaning of all sections of the tympanic and trepan cavities from pathological exudate occurs. The circulation and suction of the washing liquid is ensured by suction.

 The second stage of treatment is to fill the ear canal with a solution of OxyDANT - an aqueous acid cathode anolyte (ACC) or a neutral cathode anolyte (ANK) with a redox potential of at least 1100-1200 mV at a pH of 2.5-3.7 and an oxidizing agent concentration of 100-150 mg / l This antiseptic is obtained on STEL devices intended for the electrochemical synthesis of activated detergents, disinfectants and sterilizing solutions, which are authorized by the Ministry of Health of the Russian Federation for use on the territory of the Russian Federation.

 Ultrasonic cavitation of the OxyDANT drug solution with the aim of introducing it into all departments of the middle ear and creating its “depot” in the tissues during one treatment session is carried out twice for 25-30 seconds with a short break for 20-30 seconds between treatments.

 The apparatus, by means of which the proposed method of treatment is carried out, consists of a hollow body, inside of which there is a miniature ultrasonic waveguide instrument, which has the form of a blunt needle with a diameter of the working part, for example, 2 mm with a straight beveled, beveled at a certain angle or hemispherical end surface .

 An ultrasonic waveguide is installed in the hollow body of the device, and replaceable tips in the form of ear funnels of various diameters and purposes are screwed onto the threaded part of the device body. Inside the hollow body of the device, one solution and an elastic tube are used to deliver a drug solution and at the same time it is dubbed with an ultrasonic waveguide, and the spent drug solution is removed from the body cavity and treatment area using a medical suction. The course of treatment consists in daily treatment procedures for 6-10 days.

 When a dry ear is reached already from the 3-4th ultrasound treatment session, only phonophoresis of antimicrobial agents can be performed (taking into account the sensitivity of the microbial flora), i.e. only the second stage of treatment, and from the 4-5th session - phonophoresis of a standard hydrocortisone emulsion to normalize reparative processes, for example, in the operated ear.

 After a course of ultrasound therapy according to the proposed method, by the 10-12th day of the clinically “dry” ear we observed in 129 of 146 patients who underwent conservative treatment of chronic purulent otitis media. Using the proposed method, 136 patients with chronic purulent otitis media were also treated in terms of preparing for a debridement operation on the middle ear using a closed method.

 In all patients, already after the second treatment session, complete removal of the pathological secretion from the middle ear was achieved, exudation decreased sharply, which allowed the vast majority to operate - 124 of 136 patients under optimal conditions, no later than three days after the patient was admitted to the hospital, and only 12 patients needed in a longer (up to 5-7 days) preparation for surgery.

 Clinical example 1.

 Patient I., 43 years old, resident of the Omsk district of the Omsk region, went to the regional clinical hospital and was hospitalized as planned in the ENT department (case history 16841) on 10/23/1999. with complaints of pain in the left ear, purulent discharge and hearing loss in this ear.

 From the anamnesis: the left ear hurts from childhood, periodically noted purulent discharge, sometimes for several weeks. It was treated on an outpatient basis, but the result was short-lived and suppuration resumed. The last exacerbation was associated with a cold.

 On examination, the behind-the-ear area is not changed on both sides. When otoscopy: in the ear canal of the right ear there is no pathological discharge, the eardrum is whole, gray, the identification points are well differentiated. In the auditory meatus of the left ear there is purulent mucus, the eardrum is pink, thickened, in the central part anterior to the handle of the malleus, non-edge perforation up to 2 mm in diameter is determined. Other ENT organs unchanged.

 Hearing: I heard whispering speech with my left ear near the auricle, with my right one at a distance of 6 m, I heard conversational speech with my left ear at a distance of 6 m. With tonal threshold audiometry, a conductive form of hearing loss was detected with an increase in EP thresholds to 37 dB in the area of speech frequencies to the left an ear.

 The treatment was carried out: general - according to the generally accepted scheme, including anti-inflammatory, hyposensitizing therapy, vasoconstrictor drops in the nose and local - 7 sessions of OTONUZ therapy with 1% solution of dioxidine and a solution of OxyDANT.

 As a result of the treatment, after 3 weeks the patient had inflammation in the ear stopped, suppuration ceased, the hearing improved to the perception of whispering speech of 5 m on the left ear, tonal hearing thresholds on the left ear by air conduction increased to 10 dB in the area of speech frequencies. When otoscopy: the eardrum of the left ear is gray, cloudy, thickened, a scar is formed in the projection of the defect. Patient I. was discharged from the hospital with recovery. During follow-up examinations 1 and 3 months after discharge, the achieved results (morphological and functional) were preserved.

 In case of non-purulent otitis media (scar-adhesive, exudative, tubootitis), the treatment consists in endaural cavitation and phonophoresis of a standard solution of lidase in a dilution of 1: 5 or 1:10 (in children) or another drug.

 NUZ - cavitation of a medicinal solution in the ear canal allows macromassage of the eardrum to improve the mobility of the sound-conducting apparatus of the middle ear and micromassage to improve microcirculation in the tissues of the middle ear. At the same time, phonophoresis of lidase is performed to “soften” scars.

 The method of intrauterine ultrasound therapy of non-purulent otitis media consists in double within one session of 20-30 with endaural scoring of medicinal solutions without a washing step.

 In this group, 58 patients were treated and 43 of them had positive results, which consisted in a significant improvement in hearing or a decrease or disappearance of tinnitus.

 Clinical example 2.

 Child E. (Omsk), 6 years old, turned to the Omsk Regional Audiological Center (outpatient card of the Audiological Center) 26.04. 2000 with complaints of hearing loss in both ears.

 From the anamnesis: 2 months ago, the boy suffered bilateral acute otitis media, there was no suppuration. After some time, the mother noticed that the child did not hear, often asked again.

 Upon examination by the audiologist, the behind-the-ear area is not changed on both sides. There is no pathological discharge in the auditory canals. The tympanic membrane of the right ear is pink, infiltrated, thickened, and the light cone is shortened. The tympanic membrane of the left ear is infiltrated and injected in the area of the handle of the malleus. Other ENT organs unchanged.

 Hearing: I heard whispering speech with both ears at a distance of up to 0.5 m, colloquial speech at a distance of 6 m.With a tonal threshold audiometry, a conductive form of hearing loss was detected with an increase in EP thresholds to 20 dB in the area of speech frequencies in both ears. With acoustic impedance measurement, the peak of compliance is not expressed on both sides - tympanogram type "B".

 The treatment was carried out: 10 sessions of OTONUZ therapy with 1% solution of dibazole, alternating with 25% solution of magnesium sulfate, antihistamines inside (pipolfen 0.006 twice a day) for 2 weeks, otipax drops in the ear - 5 days and vasoconstrictive drops in the nose.

 As a result of the treatment, after 2 weeks, the patient’s hearing restored to the perception of a whisper of 6 m in both ears, the tonal hearing thresholds for air conduction reached normal levels. With otoscopy, both eardrums are gray, dull, somewhat retracted. As a result, child E. completed a course of outpatient treatment with recovery.

Literature
1. Soldatov IB, Preobrazhensky NA, Patyakina OK Conservative treatment of hearing loss // Hearing loss. Ed. ON THE. Preobrazhensky. -M.: Medicine, 1978.- S. 376-417.

Claims (1)

 The method of intra-ultrasonic therapy of chronic middle otitis media, which consists in washing the middle ear with antiseptic agents, characterized in that in the treatment of purulent otitis media for washing the cavities of the middle ear, low-frequency ultrasonic cavitation of the circulating antiseptic solution is carried out for 25-30 seconds using an OTONUZ ultrasonic device followed by phonophoresis of the solution Oxydant, and in the treatment of non-purulent otitis media, a low-frequency ultrasound is performed twice for 20-30 s in one session dromassage of middle ear tissues and simultaneous phonophoresis of hyaluronidase proteolytic enzymes in them.