RU2216347C1 - Method for treating chronic inflammation of trepanation cavity after radical operation upon middle ear - Google Patents

Abstract

FIELD: medicine, otorhinolaryngology. SUBSTANCE: it is suggested to apply papain for cleaning cavity against necrotic masses trice daily for 5 d at exposure of 15-20 min at concentration being 20 mg/ml physiological solution. Then, to improve cavitary tissue regeneration it is necessary to apply Curiosin preparation per 1-2 ml/twice daily at exposure of 15-20 min. Treatment is carried out under bacteriological and cytological control and according to the values obtained therapeutic stages should be repeated. EFFECT: higher efficiency and shortened terms of therapy. 2 ex

Description

 The present invention relates to medicine, namely to otorhinolaryngology, and can be used to increase the effectiveness of treatment of patients undergoing radical surgery on the middle ear.

 The relevance is due to the significant prevalence of chronic purulent otitis media, as well as a large number of unsatisfactory morphological and functional results in the complex treatment of patients with this pathology. New advances in biology, medicine and medical technology, changing the reactivity of the body and the properties of bacteria, the accumulation of practical experience in using the currently accepted principles for the diagnosis and treatment of patients with chronic purulent otitis media, make us reconsider some of the established principles, as well as develop all new research areas designed to improve the treatment of patients with this pathology.

 A known method (Guide to otorhinolaryngology / Ed. By I. B. Soldatov. - M .: Medicine. - 1994. - 608 p.) Conservative treatment of chronic inflammation in the middle ear. At the first stage, they conduct toilet of the tympanic cavity and auditory tube with antiseptic solutions, as a result of which the severity of the inflammatory process in the middle ear decreases and the microflora is deprived of the nutrient medium. The second stage of treatment is a direct effect on the mucous membrane of the middle ear with various medicinal substances. In this case, antibacterial drugs acting on gram-negative bacteria (1% solution of dioxidine, etc.) are used. Antibiotic treatment is carried out taking into account the sensitivity of microflora to them. In the presence of allergic manifestations in the ear, glucocorticosteroid preparations are prescribed. The disadvantages of this method of treatment, in our opinion, are the lack of clear recommendations on the use of drugs, depending on their properties and the nature of the pathological process in the middle ear, and the lack of effectiveness of treatment.

 For the prototype, we have adopted a treatment regimen for non-healing trepanation wounds of the mastoid process (DI Tarasov, O.K. Fedorova, V.P. Bykova. Diseases of the middle ear. Guide for doctors. M .: Medicine, 1988. - 288 p.) , including daily washing of the postoperative cavity with antiseptic solutions (furatsillin, 3% aqueous solution of boric acid), followed by instillation of 1% dioxidine. Often observed inflammation and accumulation of crusts allow the widespread use of drugs based on alcohol, oil and ointment, proteolytic enzymes. Small granulations can be quenched with a cauterizing liquid or removed with a curette, and the parts of the edematous mucous membrane can be quenched with a 1-10% silver nitrate solution. It is possible to supplement the treatment with physiotherapeutic procedures and general strengthening therapy, antihistamines. The disadvantages of this method, in our opinion, are the same as in the above analogue.

 The objectives of the new method are to increase efficiency, achieve a stable result in the treatment of patients who are concerned about the ongoing otorrhea from the operated ear.

 The essence of the method is the use of papain in order to cleanse the trepanation cavity from pus, desquamated epidermis and crusts during the first 5 days of treatment by instilling 1-2 ml of solution (20 mg in 1 ml of physiological solution) for 15-20 minutes in the ear canal, 3 times per day. Then they switch to kuriosin 1-2 ml, 2 times a day for 10 days, the exposure is also 15-20 minutes. At the same time, patients are rinsed with solutions of furatsillin or boric acid, instilled 1% solution of dioxidine.

 When applied locally, the proteolytic enzyme of plant origin papain exhibits high lytic activity against non-viable tissues and blood clots, practically without affecting living tissues. Along with the necrolytic effect, it has a mucolytic effect, i.e., the ability to break down various exudates and purulent masses, which leads to improved drainage function in the area of the inflammation focus and the creation of conditions for accelerating tissue regeneration. Due to the active destruction and removal of necrotic masses and exudate, unfavorable conditions for microorganisms are created, and the contact of antibacterial drugs with the microbial cell is improved.

 "Curiosin" manufactured by the Hungarian company Gideon Richter is an associate of hyaluronic acid and zinc. Local increase in the concentration of hyaluronic acid during tissue regeneration creates optimal conditions for activation, migration and proliferation of cells involved in tissue repair. A consequence of increased angiogenesis is an improvement in local microcirculation. Zinc hyaluronate, which is part of curiosin, has an antiseptic effect.

 We have conducted studies on the use of papain and curiosin in the early postoperative period after sanitizing and hearing-improving operations on the middle ear. Based on the results of these studies, we noted that kuriosin, compared with papain, somewhat more actively reduces bacterial contamination and causes epithelization of the wound surface more quickly, while papain earlier than kuriosin cleanses the wound of necrotic tissues.

Examples: 1. Patient S., 19 years old, was treated in the Krasnodar Regional ENT Center - from May 31, 2000 to June 15, 2000. Diagnosis: Left-sided chronic purulent epithympanitis. Condition after radical surgery on the left ear. Received complaints of purulent discharge with a smell from the left ear. From the anamnesis it is known that in 1998 he underwent a radical operation on the left middle ear. A year after surgery, against the background of acute respiratory viral infections, suppuration of the ear resumed. Treated conservatively at the place of residence, the effect is negligible. He entered the ENT - center for a course of conservative treatment. Objectively: the cavity after RO is of the correct form, not completely epithelized, filled with epidermal masses, pus, crusts. Other ENT - organs without visible changes. In bacteriological examination, the value of CFU / ml is higher than 1 • 10 ⁵ . Papain and curiosin were used according to the scheme: during the first 5 days of treatment, papain was prescribed by instillation of 20 ml of the solution in the ear canal for 20 minutes, 3 times a day. Then they switched to kuriosin 2 ml, 2 times a day for 10 days, the exposure was also 20 minutes. At the same time, the cavity was washed with furatsillin solution, instillation of 1% dioxidine solution. Against the background of treatment, the trepanation cavity was cleansed of necrotic masses, microbial contamination did not exceed the critical value. At discharge: the cavity after radical surgery of the correct form, there is no detachable, epithelialized over 2/3 of the surface of the cavity. At the control examination after 3 months, 6 months and 1 year, no complaints, the cavity is epithelized, without pathological discharge.

Example 2: Patient S., 33 years old, was treated at the ENT center from 12/12/2000 to 12/27/2000. Diagnosis: Bilateral chronic purulent epithympanitis. Condition after radical surgery on both ears. From the anamnesis: in 1987 he underwent RO on the right, in 2000 - a radical operation with tympanoplasty type III on the left middle ear. Received complaints of periodic purulent discharge from the right ear, the last exacerbation began more than a month ago after SARS. Objectively: the cavity after RO of the correct form, is not completely epithelized, a large number of purulent and necrotic masses. Papain was prescribed during the first 5 days of treatment. For 15 minutes, 2 ml of the solution was instilled into the ear canal, 3 times a day. Then they switched to kuriosin: 1 ml, 2 times a day for 10 days, the exposure was also 15 minutes. The patient was washed the cavity with a solution of furatsillina, instillation of a 1% solution of dioxidine. Against the background of the therapy, the cavity after the operation was cleaned of the discharge, during sowing, the value of CFU / ml did not exceed the critical value of 1 • 10 ⁵ in 1 ml. Epithelized about 2/3 of the surface of the cavity. After 2 months, the patient was hospitalized with complaints of newly appeared suppuration from the ear. A second course of treatment was carried out according to the above scheme. Discharged in satisfactory condition: no complaints, no discharge, more than 2/3 of the cavity surface epithelized. During the control examination after 6 months, the cavity after the operation of the correct form, there is no detachable, epithelized.

 The use of papain and curiosin for the treatment of trepanation cavity disease can increase the efficiency and reduce the treatment time for patients with this pathology.

Claims (1)

 A method for the treatment of chronic inflammation of the trephine cavity after radical surgery on the middle ear, including daily cavity toilet with rinsing and instillation of antiseptic solutions, characterized in that for 5 days at a concentration of 20 mg in 1 ml of saline, 3 times a day with an exposure of 15- Papain is used for 20 minutes to cleanse the cavity of necrotic masses, then, to improve the regeneration of the tissues of the cavity, curiosin is instilled 1-2 ml 2 times a day, also with an exposure of 15-20 minutes, and the treatment is carried out under the bacterium biological and cytological control and, according to indications, the treatment steps are repeated.