RU2213530C2 - Method and device for treating the cases of paranasal sinusitis - Google Patents

Abstract

FIELD: medicine; medical engineering. SUBSTANCE: method involves tightly sealing the nasal and rhinopharyngeal cavity with soft palatine that is pressed against the posterior pharyngeal wall by contracting respiratory muscles without performing exhalation at the first stage. Rarefaction to 60-85 kPa is created in nasal cavity and rhinopharynx that is equalized 5-15 s later by supplying air under atmospheric pressure. The second stage involves tightly sealing the nasal and rhinopharyngeal cavity for 10-15 s, sucking air and nasal cavity matter from one nose half off and supplying aerosol containing medicament into the other half under pressure higher than usual. The third stage involves tightly sealing the nasal cavity and rhinopharynx and reducing pressure to 60 kPa via the other half of the nose opposite to one in sinuses of which medicament is to be supplied. 1-2 s later, aerosol containing medicament is introduced into the injured half of nose under pressure of 140 kPa. The pressure is dropped to 80 kPa after having done sealing and quickly equalizing it with atmospheric pressure by supplying air or aerosol containing medicament into the other nose half under pressure of 120 kPa at the fourth stage. When needed, each stage is to be repeated using obturator. Pressure reduction or increase is carried out by the same value. Device has suction line having rarefaction source, reservoir for accumulating exudate, connection tube and delivery line having pressure source and connection tube. The suction line additionally has obturating olive, filter, vacuum manometer, distributor unit, receiver, vacuum-gage and rarefaction regulator. The obturating olive is connected to rarefaction source via the connection tube mounted in series, reservoir for accumulating exudate, filter, distributor unit, receiver and rarefaction regulator. The vacuum manometer is mounted between the receiver and rarefaction regulator. The delivery line additionally has pressure control unit, manometer, receiver, dosing unit, obturating olive and sprayer. Pressure source is connected to the obturating olive via pressure control unit, receiver, distributor unit, connection tube and sprayer connected in series. The manometer is mounted between the pressure control unit and receiver. The dosing unit is connected to the sprayer. EFFECT: improved quality of pathological content evacuation from nasal appendage sinuses; facilitated medicament delivery to the nasal appendage sinuses. 5 cl; 2 dwg

Description

 The invention relates to medicine and is used to treat rhinosinitis, adenoiditis, nasopharyngitis, salpingitis.

 A known method of treating sinusitis using a device for the treatment of sinusitis, which is used to distinguish the nasal cavity from the external environment using inflatable balloons. Negative pressure is created in the nasal cavity, due to which pathological contents are evacuated from the paranasal sinuses. At the next stage of treatment, a solution of the drug is injected into the nasal cavity, which enters the sinus with an increase in pressure in the nasal cavity (see AS 1768141, class A 61 B 17/12, 17/24, 1992).

 A known method of Politzer to determine patency and treatment of inflammatory diseases of the auditory tubes. In this case, the olive of the ear canal is introduced in the vestibule of one half of the nose, the second half of the vestibule of the nose is sealed by pressing the wing of the nose with a finger. At the moment of pronouncing the vowel sound to the patient (as a result, the soft palate deviates posteriorly, covering the exit from the nasopharynx), they compress the balloon. Positive pressure is created in the nasopharynx and air passes to the mouth of the auditory tubes (V.T. Palchun, N.A. Preobrazhensky, Diseases of the ear, throat, nose, M .: Medicine, 1980, p. 451 and 452).

 A known method of treating paranasal sinusitis and a device for its implementation, including sealing the nasal cavity, periodically changing the pressure in the nasal cavity with the creation of negative and positive pressure and introducing drugs into the nasal cavity at the time of creating negative pressure in it (A.S. 1768142, cells A 61 B 17/12, 17/24, 1992). Prototype.

The disadvantages of the known methods are:
1. The lack of effectiveness of the drainage of the sinuses, which is due to:
- evacuation at the time of the procedure only of the contents of the sinuses that are in the anastomosis or directly merges with the contents of the anastomosis, because when the jet breaks, the pressure in the nasal cavity and paranasal sinus equalizes and the drainage effect ceases. As a result, taking into account the relatively limited time of the procedure during the day, the exudate accumulating after the procedure is not evacuated (the duration of the procedure and their number depends not only on the capabilities of the medical staff, but also on the adverse mechanical effect on the mucous membrane of the sinuscatheter and the subjective ability to transfer the catheter);
- unregulated effect of negative pressure on the mucous membrane of the nasal cavity during the procedure leads to its edema, narrowing of the diameter of the natural anastomoses up to their complete closure and the difficulty of exudate secretion. The latter occurs due to the fact that the surface tension force, when the detachable sinuses are allocated through the anastomoses to the nasal cavity, is directed in the opposite direction from it and is inversely proportional to the radius of the anastomosis;
- with the defeat of several paranasal sinuses before the procedure, it is practically difficult (in terms of time) to consistently create the optimal position (facilitating the movement of exudate under the influence of gravity to natural anastomoses) for all sinuses. This cannot be effectively achieved even during the procedure, since it takes more time to move the viscous exudate under pathological conditions than the duration of the procedure.

 2. The need to use qualified medical staff.

 3. Adverse effect of the sinus of the catheter on the mucous membrane of the nasal cavity and nasopharynx due to mechanical pressure.

 4. A single injection of drugs during the day.

 5. Medicinal substances are delivered to the sinuses in the form of solutions that penetrate into them worse than, for example, aerosols.

 6. The therapeutic effect does not apply to the mucous membrane of the nasopharynx and auditory tubes, diseases of which are often associated with inflammatory diseases of the nose and sinuses.

 The objective of the proposed method of treatment is to increase the effectiveness of the treatment of paranasal rhinosinitis by improving the evacuation of pathological contents from the paranasal sinuses of the nose and its cavity, reducing the complexity and invasiveness of the procedure in combination with its availability for the patient and increasing the number of procedures during the day, using an adjustable short-term effect of reduced pressure, reducing the risk of infection in the unaffected sinuses, the possibility of simultaneous sanitation and nasopharynx and auditory tubes, as well as optimized sinus delivery of drugs in aerosol form.

 This is achieved using a device that allows you to create adjustable negative and positive (compared with atmospheric) pressure in the nasal cavity and nasopharynx, inject medicinal substances in the form of aerosols into the sinuses during equalization into the nasal cavity, nasopharynx, paranasal sinuses and auditory tubes. reduced pressure with the atmospheric, into the auditory tubes with a certain increase in pressure over the atmospheric and reception, allowing you to create a seal outlet from the nasopharynx due to the soft palate (or obturator ).

 Sealing the exit from the nasopharynx is carried out using the following technique: with a tightly closed oral cavity, without exhaling, the patient produces a moderate contraction of the respiratory muscles. At the same time, the air pressure in the oropharynx and the underlying respiratory tract increases, and the soft palate under its action reliably delimits the exit from the nasopharynx (PPMN - the method of raising the soft palate). In patients for whom admission is difficult for any reason, a nasopharyngeal exit obturator can be used, pressing the soft palate to the posterior pharyngeal wall. The second reference point in the latter case are the lower incisors.

General features of the proposed method with the prototype:
- sealing the nasal cavity;
- periodic changes in pressure in the nasal cavity with the creation of negative and positive pressure;
- the introduction of drugs into the nasal cavity at the time of creating negative pressure in it.

New features of the proposed method with the prototype:
- sealing of the nasal cavity and nasopharynx is simultaneously carried out with a soft palate - by raising it by increasing the pressure in the airways (which is achieved by reducing the respiratory muscles without exhaling) or by pressing it against the back of the throat with an obturator,
- a change in pressure in the nasal cavity and nasopharynx is carried out simultaneously in both halves of the nasal cavity and in the nasopharynx,
- additionally provide pressure reduction with subsequent equalization,
- and the disconnection of ways to create negative pressure and ways of supplying drugs.

 In addition, the negative pressure created in the nasal cavity and nasopharynx, act discretely and for a short time with the possibility of regulation, and the supply of drugs to the nasal cavity and nasopharynx is carried out in the form of aerosols.

Common features of the claimed device with a prototype:
- suction line, including a vacuum source, a vessel for exudate, a connecting pipe,
- discharge line, including a pressure source, connecting pipe.

New features of the claimed device with a prototype:
the suction line additionally contains olive obturating, filter, distributor, receiver, rarefaction regulator,
- obturating olive is connected to the source of rarefaction through a series-connected connecting pipe, exudate vessel, filter, distributor, receiver and rarefaction regulator,
the discharge line further comprises a pressure regulator, a receiver, a distributor, an olive blocking, a spray;
- the pressure source is connected to the olive obturating through successively located pressure regulator, receiver, distributor, connecting pipe, sprayer,
- the suction line contains a pressure gauge connected to the line between the filter and the distributor, a vacuum gauge connected to the line between the receiver and the vacuum regulator,
- the discharge line contains a pressure gauge connected to the line between the receiver and the pressure regulator, and a dispenser connected to the sprayer.

 According to the proposed method, the vestibule of both halves of the nose is blocked by olives, in one of which there is a through hole for aspirating air from the nasal cavity, and in the other there is a device for spraying aerosols.

 1. Sinus drainage.

 The goal of this stage is to sparingly evacuate the contents of the sinuses. Before the first procedure begins, anemization of the middle nasal passages is done with a cotton pad or by instillation of vasoconstrictive drops (2-3 times a day, with intermediate instillation procedures they are not performed). After instillation of vasoconstrictive drops, the patient for 15-20 minutes is in one of the known positions, ensuring the movement of exudate to the mouth of the affected sinus. Then, without changing the position of the head, he performs the procedure for raising the soft palate (MPS), in this position holds his breath for 5-10-15 seconds (or inserts an obturator) and creates a vacuum in the nasal cavity and nasopharynx through the olive to suck air from the nasal cavity. Depression can be performed in several modes, and the reduction of the negative effect of depression on the mucous membrane is achieved due to the short action of reduced pressure. With 1 mode, a vacuum of up to 60 kPA is created in the nasal cavity and nasopharynx for 5 seconds, with 2 mode, a vacuum of up to 75 kPa for 10 seconds is created and in 3 mode, a vacuum of up to 85 kPa for 15 seconds. After this period of time, the pressure in the nasal cavity and nasopharynx equalizes with atmospheric by supplying air under atmospheric pressure through an olive inserted into the other half of the nose or lowering the soft palate (by removing the obturator). With a large amount of detachable, mode 1 is used, then, as it decreases, they switch to more gentle modes. Drainage is repeated several times.

 After each drainage, a break is carried out until the breathing rhythm is restored. Olives at this time can be removed from the vestibule of the nasal cavity.

 After drainage of one group of sinuses, the patient takes, for a while, the position necessary for drainage of the other group of sinuses, and the procedure is repeated.

 When using an obturator, the patient breathes through the mouth.

 As a result, with repeated drains, the exudate that appears to the anastomosis during the day is gradually evacuated. To evacuate the contents of the anastomoses, a large and long-acting negative pressure in the nasal cavity is not required. To overcome the surface tension forces that arise when a drop of exudate is released into the nasal cavity, p = 2σ / R, where p is the pressure that is directed towards the sinus, σ is the viscosity of the discharge, R is the radius of the drop (anastomosis). Calculations using this formula show that, with an optimal head position, a 10-20 kPA reduction in atmospheric pressure in the nasal cavity is sufficient to isolate exudate from the anastomosis.

 2. Kavum lavash.

 The purpose of the stage is the cleaning of the nasal cavity and nasopharynx, the destruction of pathogenic microflora in these cavities. To do this, after performing the PMN for 10-15 seconds, air and the contents of the nasal cavity are aspirated from one half of the nasal cavity and aerosols of medicinal substances are injected into the other half of the nose under high pressure. In this case, the vacuum corresponds to an increase in pressure above atmospheric with the opposite sign, for example, a vacuum of 60 kPA is created in one half of the nose, and an aerosol under a pressure of 140 kPa is supplied to the other half. As a result, positive pressure is not created in the nasopharynx, and the mouths of the auditory tubes do not open. After several procedures, the olives in the vestibule of the nasal cavity change places. The procedure is performed with interruptions necessary to restore the rhythm of breathing.

 In the treatment of Eustacheitis, aerosol pressure is increased by another 2-20 kPa compared to the described conditions. As a result, drug aerosol enters the auditory tubes.

 When using an obturator, the patient breathes through the mouth, and the procedure continues for the necessary time in accordance with the task and tolerance of the obturator.

 3. Sinus injection.

 After the kavum - pita procedure, aerosol is introduced into the nasal cavity with the aim of penetrating it into the sinuses. Through the opposite half of the nose, from the one into the sinuses of which it is necessary to administer the medicine, after PMNP (administration of the obturator), the pressure in the nasal cavity and nasopharynx is previously reduced to 60 kPa, and after 1-2 seconds an aerosol is injected into the affected half of the nose under pressure up to 140 kPa until the pressure in the nasal cavity is restored to the original. In this case, the principle of reducing and increasing the pressure by the same value with respect to atmospheric pressure is maintained. The procedure is repeated several times with interruptions necessary to restore the rhythm of breathing.

 In the treatment of Eustacheitis, aerosol delivery is stopped when the pressure in the nasal cavity becomes 2-20 kPa higher than atmospheric. The latter value is regulated depending on the nature of the damage to the auditory tubes. As a result, the drug aerosol is portioned into the auditory tubes and massages their mouths.

 When using an obturator, the patient breathes through the mouth and the procedure is carried out continuously.

 4. Sinus aeration (pneumomassage).

 The purpose of the procedure is to improve blood circulation of the mucosa in the anastomosis and the entire nasal cavity, to reduce its swelling. For this, after performing an MPS (installation of the obturator) in the nasal cavity and nasopharynx for 1-2 seconds, the pressure decreases to 80 kPa, which quickly equalizes to atmospheric (in the treatment of salpingitis, it is 2-20 kPa higher than atmospheric) by supplying air to the other half of the nose or medicinal aerosols under pressure up to 120 kPa. The procedure is carried out several times for 10-15 seconds with interruptions to restore the rhythm of breathing. When using an obturator, the procedure is carried out continuously.

 The invention is illustrated in the drawings, where not Fig. 1 shows a method of installing a special obturator in the oral cavity for sealing the nasal cavity and nasopharynx; figure 2 is a block diagram of the proposed device.

A device for the treatment of paranasal sinusitis, inflammatory diseases of the nasopharynx (figure 2) contains the functional lines of suction and discharge
The suction line contains an olive blocking 1, a connecting pipe 2, a vessel for exudate 3, a filter 4, a vacuum gauge 5, a distributor 6, a receiver 7, a vacuum gauge 8, a rarefaction regulator 9, a rarefaction source 10. In this case, the olive blocking 1 is connected to a rarefaction source 10 through consecutively arranged connecting pipe 2, exudate vessel 3, filter 4, dispenser 6, receiver 7 and rarefaction regulator 9, vacuum gauge 5 connected to the line between the filter 4 and distributor 6, vacuum gauge 8 connected to the line between the receiver 7 and regulator p zrezheniya 9.

 The discharge line contains a pressure source 11, a pressure regulator 12, a pressure gauge 13, a receiver 14, a distributor 15, a connecting pipe 16, a sprayer 17, an olive obturating 18, a dispenser 19. At the same time, a pressure source 11 is connected to an olive obturating 18 through successive pressure regulators 12 , receiver 14, distributor 15, connecting pipe 16, atomizer 17, pressure gauge 13 is connected to the line between the pressure regulator 12 and receiver 14, and the dispenser 19 is connected to the atomizer 17.

 Filter 4 with an antiseptic is designed to disinfect the evacuated air.

 As valves 6 and 15, known two-position and three-position pneumatic valves can be used.

 As a rarefaction regulator 9 and a pressure regulator 12, known regulating elements of pneumatic systems containing a throttle with a rarefaction (pressure) regulator and safety valves can be used. Designed to reduce the vacuum (pressure) of the air created by the source of vacuum (pressure), and automatically maintain at a given level.

 As a nebulizer 17, a jet nebulizer that converts liquid medicinal substances into an aerosol can be used.

 The dispenser 19 is a volumetric piston fluid dispenser with a drive.

 The device operates as follows.

 1. Sinus drainage.

 Preparatory operations: the patient after instillation of vasoconstrictor drops for 15-20 minutes is in a known optimal position.

 The rarefaction regulator 9 sets and monitors, according to the readings of the vacuum gauge 8, a certain rarefaction in the receiver 7 - 60-85 kPa. The patient performs an MRP or establishes an obturator. According to the control command, the distributor 6 is transferred to position B and a vacuum is created in the nasal cavity for 5, 10 or 15 seconds, depending on the selected mode and patient capabilities. After removing the control action, the distributor 6 returns to its original position A. By the control command, the distributor 15 is transferred to position B and the rarefaction in the nasal cavity is equalized with atmospheric pressure. The latter result can also be achieved by lowering the soft palate or by removing the obturator.

 2. Kavum lavash.

 The patient performs a method of raising the soft palate for 15 seconds or installs an obturator.

 The vacuum regulator 9 sets the vacuum in the receiver 7 to 60 kPa and the pressure regulator 12 sets the pressure in the receiver 14 140 kPa. In the treatment of auditory tubes, the pressure regulator 12 sets the pressure in the receiver 14 another 2-20 kPa higher.

 According to the control command, the distributor 6 is transferred to position B, in which, under the action of the vacuum created in the vessel for exudate 3, the contents are sucked out, at the same time, the distributor 15 is transferred to position D, at which air is pumped into the other half of the nose and sprayed with a portion 17 sprayer drug supplied by the dispenser 19. After some time, olives 1, 18 in the vestibule of the nasal cavity are interchanged.

 3. Sinus injection.

 The vacuum regulator 9 sets the vacuum in the receiver 7 up to 60 kPa.

 The pressure regulator 12 sets the pressure in the receiver 14 to 140 kPa. Olive 18 of the injection line is introduced into the affected half of the nose, and olive 1 of the suction line is introduced into the other half of the nose.

 The patient performs an MRP or establishes an obturator.

 According to the control command, the distributor 6 is transferred to position B, in which a predetermined depression is created in the nasal cavity. After 1-2 seconds, a command is issued to transfer the dispenser 6 to position A, and the distributor 15 to position D, at which air is injected into the affected half of the nose and a dose of the drug is sprayed. When equalizing the pressure on the manovacuum meter 5 with the atmospheric cycle ends. If necessary, the patient takes a break (lowering the soft palate or taking out the obturator), and after restoring the rhythm of breathing, the procedure is repeated several times.

 In the treatment of diseases of the auditory tubes, the cycle ends when the manovacuum gauge 5 reaches a pressure of 2-20 kPa above atmospheric.

 4. Sinus aeration (pneumomassage).

 The rarefaction regulator 9 is set to a pressure of up to 80 kPa, the pressure regulator 12 to a pressure of up to 120 kPa.

 Olives 1, 18 are introduced on the eve of the nasal cavity. The patient performs an MRP or pre-enters the obturator.

 By a controlled command, the distributor 6 is transferred to position B, in which a vacuum is created in the nasal cavity (working position). After 1-2 seconds, by a controlled command, the distributor 15 is transferred to position D, at which air is pumped into the nasal cavity and nasopharynx, and the distributor 6 is returned to its original position A. Upon reaching the atmospheric pressure in the nasal cavity, the distributor 15 is translated into position G, and distributor 6 to position B. When treating diseases of the auditory tubes, the distributor 15 is moved to position G when the pressure on the manovacuum meter 5 is 2-20 kPa higher than atmospheric. If necessary, take a break, the patient lowers the soft palate or removes the obturator. After restoring the rhythm of breathing, the procedure is repeated.

 The device can perform all the procedures sequentially in the set mode.

 Example 1. Patient K., 37 years old, turned to the ENT department with bilateral acute purulent maxillitis. When puncture of both maxillary sinuses received purulent discharge in the amount of 3-4 ml. Sinus drainage, kavum-pita with a solution of dioxidine and sinus injection of a solution of gentamicin are prescribed. After 4 days: no complaints, nasal breathing is good, with a control puncture of the maxillary sinuses, the washings are clean.

 Example 2. Patient M., 17 years old, was admitted to the ENT department with a diagnosis of acute rhinosinitis. During puncture of the maxillary sinuses, washing water through natural anastomoses practically does not enter, the second needles are inserted into both maxillary sinuses, there is a little mucus in the washing waters. Appointed pneumatic massage. After 2 days, during the control puncture of the jaw sinuses, the anastomoses are freely passable, kavum lavash and sinus injection with a solution of dioxidine are connected. On the fifth day: no complaints, inflammation in the nose subsided, nasal breathing recovered.

 Example 3. Patient B. Age 53 years. He was in the ENT department from 9/12 to 21/12-99 due to acute purulent rhinosinitis. On the radiograph, a decrease in pneumatization of the right maxillary and frontal sinuses.

 Conducted combined conservative treatment (anti-inflammatory, desensitizing, restorative, displacement treatment, FTL, etc.).

 With a puncture of the right maxillary sinus in the washings, pus. In total, 7 punctures were required on the right for rehabilitation. After 6 punctures, due to difficult rehabilitation, sinus drainage and sinus injection of a dioxidine solution are connected. Control 7 puncture: wash water clean. Sinus drainage and sinus injection from 16 to 20 / 12-99. The inflammation subsided. Nasal breathing restored.

 The method allows to improve the evacuation of pathological contents from the paranasal sinuses, reduce the complexity and invasiveness of the procedure, reduce the risk of introducing the infection into the healthy sinuses, simultaneously sanitize the nasopharynx and auditory tubes, facilitate the delivery of drugs to the paranasal sinuses and auditory tubes.

Claims (5)

 1. A method of treating paranasal sinusitis, which consists in the fact that at the first stage, the nasal cavity and nasopharynx are sealed with a soft palate, which is pressed against the posterior pharyngeal wall by contracting the respiratory muscles without exhaling and creating a vacuum of up to 60-85 kPa in the nasal cavity and in the nasopharynx, which after 5-15 s is leveled by supplying air under atmospheric pressure, at the second stage, the nasal cavity and nasopharynx are sealed for 10-15 s, air and contents are aspirated, but an owl cavity from one half of the nose, and the other half is supplied with an aerosol with a medicinal substance under increased pressure, at the third stage, the nasal cavity and nasopharynx are sealed and through the opposite half of the nose, from the one into the sinuses of which it is necessary to introduce a medicinal substance, reduce the pressure to 60 kPa, and after 1-2 s, an aerosol with a medicinal substance is injected into the affected half of the nose under pressure up to 140 kPa, at the fourth stage after sealing, reduce the pressure to 80 kPa, which is quickly equalized through atmospheric Uteem supplying air to the other half of the nasal aerosol or with the drug substance under pressure to 120 kPa.  2. The method according to claim 1, characterized in that, if necessary, each step is repeated several times.  3. The method according to claim 1, characterized in that the sealing of the nasal cavity and nasopharynx is carried out using an obturator.  4. The method according to claim 1, characterized in that the decrease and increase in pressure at each stage is carried out by the same amount.  5. The device for implementing the method according to claim 1, containing a suction line including a vacuum source, an exudate vessel, a connecting pipe, and a discharge line including a pressure source, a connecting pipe, characterized in that the suction line further comprises an obturating olive, a filter, pressure gauge, dispenser, receiver, vacuum gauge and rarefaction regulator, while the obturating olive is connected to the rarefaction source through a consecutively located connecting pipe, exudate vessel, filter, distribution a separator, a receiver and a discharge regulator, and a vacuum gauge is installed between the filter and the distributor, and a vacuum gauge is installed between the receiver and the rarefaction regulator, the discharge line additionally contains a pressure regulator, pressure gauge, receiver, distributor, dispenser, obturating olive, sprayer, while the pressure source is connected to an olive blocking through a sequentially located pressure regulator, receiver, distributor, connecting pipe, sprayer, and a manometer is connected between the pressure regulator and receiver m, and the dispenser is connected to the sprayer.

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