RU2191551C1 - Method for treatment of uncomplicated inflammations of frontal sinus - Google Patents

Abstract

FIELD: medicine, otorhinolaryngology. SUBSTANCE: as a naturally organic product one should daily inject an egg albumen diluted at room temperature at 1: 4 ratio at the volume of 2-4 ml for 3-5 d. At revealing a sterile washing liquid the procedure should be stopped. EFFECT: higher efficiency of therapy. 1 cl, 3 ex

Description

 The invention relates to medicine and will find application in otorhinolaryngology in the treatment of inflammatory diseases of the frontal and other paranasal sinuses.

 The spectrum of the microbial flora of the upper respiratory tract is very diverse. In recent years, representatives of opportunistic microorganisms - Haemophilus influenzae, Moraxella catarrhalis, Neisseria sp. and some others began to take an active part in the development of inflammatory processes in the respiratory tract with complications and adverse outcomes. Aggressive bacterial-bacterial and bacterial-viral associations of microorganisms are formed, significantly changing the clinical picture of diseases and creating difficulties in their treatment. The number of strains of microorganisms resistant to penicillin and ampicillin is constantly increasing, which is often associated with their formation of β-lactamase-resistant forms (SW Schwarzmann Novel cost-effective approaches to the treatment of community-acquired infections // Ann. Pharmacother. - 1998. - V. 32. - N 1. - S. 27-30) and makes you think about changing the spectrum of drugs used at the stage of pre-bacteriological diagnosis and empirical treatment.

 A number of studies have proved that the greatest therapeutic effect in paranasal sinusitis is achieved by administering drugs directly into the lumen of the affected paranasal sinuses and is orders of magnitude greater than the effect of parenteral exposure (Sergienko P.V. ... Candidate of medical science.- M., 1971, - 33 pp .; Razinkov S.P. Pathogenetic principles of treatment of inflammatory diseases of the paranasal sinuses // Abstract of diss .... Dr. med.science: St. Petersburg , 1998. - 40 p.).

 Conducted research on the medical-scientific and patent literature revealed various methods of drug treatment of frontal sinusitis.

 There is a method of introducing proteolytic enzymes of animal origin (trypsin, chymotrypsin) into the lumen of the sinuses in inflammatory diseases of the frontal sinuses, described by R. D. Karal-Ogly in the work "Treatment of acute and chronic frontal sinuses with proteolytic enzymes" (ZhUNGB. - 1968. - 3. - P. 51-54).

 The disadvantage of this method is the selectivity (lytic) action of the drugs and the need for their use in combination with antimicrobial drugs.

 A.I. Dayhes, Yu.P. Lipson (Experience in the treatment of purulent sinusitis with dioxin Mater. To the conference. Prob. Commission on the otorhinolar. Uch. Medical Council of the Ministry of Health of the RSFSR and rep. Scientific and practical conf. Otorinolar. - M., 1980. - P. 102-103) offer use for local exposure to the mucous membrane of the paranasal sinuses after washing them with an antiseptic - dioxidine albucide solution.

 The disadvantage of this method is also in the selectivity of the action of the drug mainly on coccal microflora.

 G.A. Georgiadi, A.B. Gobeev in the work "The effectiveness of treatment of purulent sinusitis with Dimexidum in combination with antibiotics" (Russian rhinology. - 1996. - 2-3. - P. 26-27) recommended the introduction of the drug Dimexidum into the sinus lumen. The authors believe that dimexide is a unique solvent and transporter of drugs, it penetrates perfectly into the mucous membranes along with the antibiotic dissolved in it, creating their high concentrations in the tissues, and changes the sensitivity of antibiotic-resistant microflora.

 The disadvantages of this method are the same as those of the above.

 The closest in its technical essence is the method of treatment of paranasal sinusitis, proposed by V.T. Zholobov in the work "Experimental justification and results of the use of sea water in the Amur Bay of the Sea of Japan in the treatment of sinusitis and frontal sinusitis" (ZhUNGB. - 1973. - 2. - P. 37-41), used for local introduction into the paranasal sinuses (including - and frontal) seawater. The author believes that sea water contains almost all trace elements, as well as biologically active substances, which are products of the metabolism of marine plants and animals.

 This method of treatment of inflammatory diseases of the frontal sinuses is taken by us as a prototype.

 The disadvantages of this method are: 1) stimulation of only metabolic processes in the mucous membrane (osmosis, diffusion and surface tension); 2) the impossibility of the direct action of sea water on the microbial and fungal flora of the sinus cavity; 3) the absence of indirect anti-inflammatory action - stimulation of phagocytosis; 4) mandatory preliminary sterilization of sea water.

 From our point of view, for the treatment of paranasal sinusitis (including frontal sinusitis), it is necessary to use agents that have a wide spectrum of action, in some ways - "universal". These include with certainty some natural organic compounds - propolis, aloe juice, chicken egg white and others. Chicken egg white has many unusual properties by acting directly on the microorganism and indirectly, enhancing the protective functions of the nasal cavity. It accelerates the vibrations of the cilia of the ciliated epithelium, preventing the adhesion of hemophilic rods on the mucous membrane (Geme JW, Cutter D. Evidence that surface fibrils expressed by Haemophilus influenzae type b promote attachment to human epithelial cells // Molecular Microbiology. - 1995.- V. 15. - N 1. - P. 77-85), stimulates phagocytosis (Reynolds D. The antimiorobial spectrum of crystalline egg white lysozyme // Bac. Proc. - 1950. - V. 82. - P. 66-67), interrupts growth pathogenic fungi (Sushkevich L.P. Microbiological and physicochemical processes in chicken eggs depending on their storage methods // Scientific notes of Belotserkovsk Agricultural Institute. - Bila Tserkva, 1967. - T. XIV. - S. 77-78), enhances the perception of antimicrobial agents by microorganisms (A. Kolman A.E. Lysozyme // Antibiotics. - 1967. - T. 12. - 8. - S. 741-745), both due to the splitting of complex sugars of the outer shell of many species bacteria, and the formation of factors that inactivate or inhibit certain enzymes or vitamins of chicken egg protein, turning them into formations that inhibit the growth of bacteria (Board R., Fuller R. Non specific antimicrobial defences of the avian egg, embryo and neonatal // Biol. Rev. - 1974. - V. 49. - P. 15-49).

The aim of the invention is to reduce the treatment time and achieve a persistent clinical effect.
The goal is achieved by introducing into the lumen of the frontal sinuses a natural organic product - chicken egg protein, diluted with saline in a ratio of 1: 4.

 The proposed method is as follows.

After introducing into the lumen of the inflamed frontal sinus, it is washed with warm (temperature 36-37 ^o C) physiological saline. Wash fluid is examined for the presence of an inflammatory pathogen. Then, protein is removed from the chicken egg using a disposable syringe. In a sterile dish, chicken egg white is mixed with physiological saline at room temperature in a ratio of 1: 4. The resulting natural-organic product is introduced into the lumen of the frontal sinus through a cannula in a volume of 2-4 ml, after which the patient is in a supine position for 20 minutes . During this time, the maximum absorption of the drug by the sinus mucosa occurs. The procedure is repeated daily. After the washing liquid becomes sterile, the introduction of a natural organic agent into the frontal sinus is stopped. As experience has shown, such procedures can be carried out within 3-5 days.

 In the ENT clinic of the Russian State Medical University, 45 patients with isolated uncomplicated frontal sinusitis were treated with natural-organic means - chicken egg white, 8 of them with acute, 37 with chronic processes. To achieve the most optimal treatment results, patients were divided into three groups of 15 people each. In all groups, for the treatment of patients, only the introduction of a natural organic agent — chicken egg protein (CNS), diluted in the groups 1: 2, 1: 4, 1: 8, respectively, into the frontal sinuses was used. Dilution of CNS was carried out to reduce its viscosity, and consequently, improve absorption and maximize the manifestation of its antimicrobial properties. CNS was obtained from eggs from chickens that had previously undergone bacteriological examination. The CNS was diluted with physiological saline at room temperature and introduced into the lumen of the frontal sinus after washing through the cannula once a day daily. The flushing fluid obtained during daily washing of the frontal sinuses was examined for the presence of a pathogen. Mostly microbial flora was isolated, but fungi and some opportunistic microorganisms were found. The cannula from the frontal sinus was removed the next day after receiving a clean wash fluid.

 I group. Of the 15 patients, purulent exudate was removed in 8 of the frontal sinuses, in 4 - mucopurulent exudate, in 1 - mucopurulent clots, in 2, the rinsing fluid turned out to be clean. Pathological contents from the washout disappeared on the second day in 7 patients (out of 13), in 5 on the third and in 1 on the fourth. In 13 out of 15 patients (86.7%), the washing fluid became sterile on the fourth day of the cannula’s stay in the frontal sinus, in 2 - on the fifth. The average hospital stay for patients was 7.67 bed days, and the cannulation time was 3.2.

 II group. Purulent exudate was found in the frontal sinuses in 6 (out of 15) patients, in 5 - mucopurulent, in 1 - mucopurulent clots, in 3 - the washing fluid turned out to be clean. Pathological contents from the washout disappeared on the second day in 9 patients (out of 12), in 3 on the third. In 12 out of 15 patients (86.7%), on the third day of the cannula’s stay in the frontal sinus, microflora did not stand out from the washing liquid, in 3 - on the fourth. The average hospital stay for patients was 6.27 bed days, and the cannulation time was 2.8.

 III group. Purulent discharge from the frontal sinuses was obtained in 7 patients, mucopurulent in 3, mucopurulent clots in 3. Patients were washed with clean fluid. The disappearance of pathological contents from the wash fluid was observed on the third day in 5 patients (out of 13), in 2 on the fourth, in 3 on the fifth, in 2 on the sixth, in 1 on the eighth. In 2 patients, the wash fluid became sterile on the fourth day after surgery, in 9 - on the fifth, in 2 - on the sixth. The average hospital stay for patients was 6.53 bed days, and the cannulation time was 4.9.

 As a control, we took the data obtained in the treatment of patients in the ENT clinic of diseases of the Russian State Medical University (Frontal sinuses / Phoenix: Rostov n / D, 2000. - S. 239). In case of acute frontal sinus, the cannulation time was 3.96 bed days, and the hospital stay was 10.47; with chronic frontitis, respectively - 3.53 and 11.81. Since the inflammatory processes in the frontal sinuses were not distinguished in the observations by the time of their development, we averaged these data: the hospital stay was considered equal to 11.14 bed days, and the cannulation was 3.75. According to the compared indicators, and most importantly - according to the earliest time of the disappearance of microbial flora from the washing fluid of the frontal sinuses, the best results were obtained in the second group of patients. Therefore, when diluting chicken egg white with physiological saline at room temperature in a ratio of 1: 4, the best therapeutic effect was obtained.

 Compared with the prototype, the inventive method has the following advantages: the treatment time is reduced, its quality improves; natural-organic remedy - chicken egg white, diluted with physiological saline 1: 4 inhibits the microbial flora, boosts the processes of phagocytosis, improves reparative processes in the mucous membrane of the affected sinuses; affordable and easy to use.

Claims (1)

 A method for the treatment of uncomplicated frontal sinusitis, involving the introduction into the lumen of the inflamed frontal sinus through a cannula of a natural-organic agent, characterized in that chicken egg white diluted at a room temperature in a ratio of 1: 4 in a volume of 2-4 ml is administered daily as a natural-organic agent within 3-5 days, if a sterile wash liquid is detected, the procedure is stopped.