RU2294758C2 - Method for treating chronic adenoiditis in children - Google Patents

Abstract

FIELD: medicine, pediatrics, otorhinolaryngology.

SUBSTANCE: the present innovation deals with conservative treatment and rehabilitation in children in case of chronic adenoiditis (CA) and in ARVI-suffering ones. It is necessary to isolate the following groups of patients: with CA and purulent exudates, at CA at the background of allergic rhinitis and at CA at the background of intracellular infections. One should carry out conservative therapy along with washing a patient's nasopharynx and differentiated therapy for each group of patients. Therapy includes the intake of mucoregulating preparations, and differentiated therapy for patients with CA and purulent exudates additionally includes local antibacterial therapy with applying Bioparox for 7 d. For patients at CA at the background of allergic rhinitis - application of local antihistamine preparations or mast cells stabilizers. For patients at CA at the background of intracellular infections - two courses of systemic antibacterial therapy with macrolides and Bioparox locally followed by introducing interferonogens or interferon inductors. In about 7-8 d after the onset of therapy course all the patients should undergo 10 seances of quantum therapy with "Rikta" apparatus along with the intake of antioxidants, 4 times annually it is important to conduct rehabilitation with IRS-19, with biopreparation "Narine" endonasally for 10 d, inside - bifidumbacterin per 3 wk by alternating with "Narine". The innovation provides individual curative program for patients with CA of different groups at stable clinic effect of decreased hypertrophy of pharyngeal tonsil up to degree I and restoring microbiocenosis and values of local immunity in nasopharynx.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to pediatrics and otorhinolaryngology, and can be used in the conservative treatment and rehabilitation of children with chronic adenoiditis, especially often suffering from acute respiratory viral infections.

Known surgical method for the treatment of chronic adenoiditis, which consists in removing the hypertrophic pharyngeal tonsil under visual control, for example, using an endoscope (N. Eremin and others. Features of optical endoscopic surgery of the nasopharynx in children of different ages. Collection of articles of the All-Russian conference "Lymphatic epithelial upper respiratory education paths in normal and pathological conditions, "Ministry of Health of the Russian Federation, May 30 - June 1, 2002, Belokurikha, pp. 110-114).

Adenoid vegetations, even with the most careful removal, remain in the thickness of the nasopharyngeal arch, which is explained by the absence of a capsule. Relapses of adenoid vegetation after an adenotomy are up to 75%, especially in children of the lymphatic type of constitution.

Adenotomy can cause serious psychological trauma in children and leads to immunosuppression of local protective factors of the mucous membranes of the upper respiratory tract. There is evidence that with chronic adenoiditis, despite inflammation, the pharyngeal tonsil is actively involved in the formation of immunity, therefore a very careful approach to surgical methods of treatment is necessary.

The most rational should be considered a gentle approach with the widespread use of conservative methods of treating chronic adenoiditis in children. Surgical treatment of children with this pathology should be carried out only if the conservative treatment is ineffective or other organs are involved in the pathological process.

There is a conservative method for treating children with chronic adenoiditis with the release of various variants of it (allergic, hyperimmune, hypoimmune, immune dysfunction) and treatment with rinsing of the nasopharynx and the use of various oil-based preparations (Makkaev H.M. et al. A new approach to conservative treatment of adenoiditis in children. Russian Medical Journal. No. 1, 1998, p. 37-39).

Conservative treatment of specific variants of chronic adenoiditis by a known method gives the most pronounced result under the following conditions:

active anti-inflammatory effect on the mucous membrane of the nasopharynx with the use of herbal remedies;

ensuring proper nasal breathing, normalizing blood circulation and nutrition of the nasopharynx lymphadenoid tissue;

restorative therapy with the appointment of vitamins, physiotherapy and hardening.

A disadvantage of the known conservative method of treatment is that it is based on the traditional narrow approach, which takes into account only the narrow medical aspect of the problem, ignoring social and socio-psychological factors.

The method provides only relief of exacerbations, not taking into account the need for rehabilitation. The approach is differentiated taking into account only biological features - the state of local factors of nonspecific resistance.

A limited set of therapeutic measures affects the effectiveness of the method: only local treatment and traditional methods of restorative therapy, and some herbal remedies used, have side effects, for example, oil drops inhibit mucociliary clearance of the nasopharynx.

A method for the treatment of chronic adenoiditis is proposed, including the isolation of chronic adenoiditis with purulent exudate in separate groups of patients, as well as against the background of allergic rhinitis and intracellular infections and conservative treatment with rinsing of the nasopharynx and the use of various drugs taking into account the etiology of the lesion.

New in the proposed method of treatment is that a comprehensive examination of patients with a team of doctors consisting of an otorhinolaryngologist, pediatrician, allergist, psychologist, physiotherapist and immunologist is preliminarily carried out, and then with their participation they develop individual treatment and rehabilitation programs for each group of patients and conduct differential treatment, including taking mucoregulatory drugs, as well as quantum therapy with antioxidants in the amount of 10 sessions 7-8 days after the start of treatment, and rehabilitation yu spend 4 times a year immunoregulatory respiratory spray IRS-19 and endonasal biologic Narine for 10 days inside bifidumbacterin, alternating with Narine to 3 weeks.

Individual treatment programs for patients with chronic adenoiditis with purulent exudate additionally include antibiotic therapy with topical Bioparax for 7 days.

In individual treatment programs for patients with chronic adenoiditis on the background of allergic rhinitis, additionally include local antihistamines or mast cell membrane stabilizers and, if indicated, local glucocorticoid drugs.

Two individual courses of systemic antibiotic therapy with macrolides and topically Bioparox, and then interferogens or interferon inducers, are additionally included in individual treatment programs for patients with chronic adenoiditis with intracellular infections.

The staged, differentiated depending on the etiology of adenoiditis and the nature of the pathological process, the use of local antibacterial Bioparox, systemic antibiotics, local immunomodulating agents in combination with quantum therapy provides a persistent clinical effect with a decrease in pharyngeal tonsil hypertrophy to grade I, which is a normal variant. The use of individual, jointly developed treatment programs significantly (1.5-2 times) speeds up the implementation of the beneficial effects of modern therapy on the course of chronic inflammatory diseases of the pharyngeal tonsil.

The following is a description of the proposed method of treatment.

For the treatment and rehabilitation of patients, a team of doctors was appointed consisting of an otorhinolaryngologist, pediatrician, allergist, psychologist, pediatrician, allergist, psychologist, physiotherapist and immunologist. This allows you to comprehensively, taking into account the knowledge and opinions of all experts, consider the aspects of diagnosis and treatment of the disease, make adjustments and evaluate the results, given the effectiveness of treatment not only narrowly, at the biological level, but also on the state of the child's social and socio-psychological adaptation: type parental relationships, the state of the child’s psyche, level of anxiety, study opportunities, children's satisfaction with their position in the team, relationships with peers, etc. A team of doctors examined 196 frequently ill children with chronic nasopharyngeal infection. 76 children were diagnosed with hypertrophy of the pharyngeal tonsil I degree, in 122 children - II degree. Differentiated treatment taking into account the etiology of chronic adenoiditis and the nature of the pathological process was carried out in 98 children. As a result of a comprehensive examination, these children were divided into three groups:

Group 1 - chronic adenoiditis with purulent exudate;

Group 2 - chronic adenoiditis on the background of allergic rhinitis;

Group 3 - chronic adenoiditis on the background of intracellular infections (chlamydia, mycoplasma).

In addition, children who underwent undifferentiated therapy (4 groups of 67 children) and symptomatic treatment (control group) of 33 children were allocated.

To carry out differentiated therapy for 1-3 groups of children, a team of doctors developed individual treatment and rehabilitation programs (table 1).

Undifferentiated therapy was also carried out according to the proposed method of treatment, with the exception of the appointment of drugs intended for specific variants of chronic adenoiditis.

Symptomatic therapy included rinsing the nasopharynx and the use of vasoconstrictor drugs.

In children suffering from chronic adenoiditis with purulent exudate (neutrophilic-macrophatal variant), nasocytograms were accompanied by a significant change in cell composition with a large amount of coccal flora, neutrophilic leukocytes with a high level of destruction of the cells of the cylindrical epithelium. A small functional reaction of neutrophils favors the chronization of the process in the nasopharynx. In patients, β-hemolytic streptococcus was sown in large numbers from the nose and pharynx, which helps to maintain the inflammatory process in the nasopharynx. Local antibiotic therapy with an aerosol antibiotic Bioparox reduces the development of pathogenic flora and reduces edema and local inflammatory response. Taking into account local immunodeficiency of the mucous membranes of the upper respiratory tract, mucoregulatory therapy (fluifort, erespal), immunoregulatory therapy with respiratory spray IRS-19, quantum therapy with the Rikta apparatus and antioxidants are prescribed. The unity of the mucosal immune system involves the appointment of biological products - endonasally Narine (10 days) after cleansing the nasal mucosa from pus and inside bifidumbacterin, alternating with Narine for 3 weeks.

In case of chronic adenoiditis due to allergic rhinitis, in addition to the main regimen, patients received topically antihistamines (allergodil etc.) or mast cell membrane stabilizers (intal and others), and local glucocorticoid drugs (flixonase, etc.) were indicated as indicated. The rest of the treatment corresponded to the main scheme.

In addition, the treatment of chronic adenoiditis with intracellular infections (chlamydia, mycoplasma) included the combined use of the local antibiotic Bioparox and macrolides (rovamycin). At the rehabilitation stage, interferonogens — viferon in suppositories — 2 weeks 2 times a day were connected: at the age of up to 3 years - 150 thousand ME, at the age of 3-14 years - 500 thousand ME and interferon inducers - ridostin endonasally 7 days, and then intramuscularly No. 3 every other day. Therapy for children with chronic adenoiditis lasted from 1 to 1.5 months. The results of treatment in comparison are shown in table 2.

table 2 The dynamics of the clinical picture of the treatment of chronic adenoiditis Indicators Types of treatment Differentiated therapy Undifferentiated therapy Symptomatic treatment before treatment after treatment before treatment after treatment before treatment after treatment Difficult nasal breathing,% 97.93 2.04 97.01 50.73 96.97 93.94 Hypertrophy of the pharyngeal tonsil of the II degree 72.45 19.39 51.48 48.52 51.51 54.55 Hypertrophy of the pharyngeal tonsil I degree 27.55 80.61 48.52 51.88 48.49 45.45 Signs of Adenoiditis 98.98 2.04 98.51 47.76 96.97 one hundred

Against the background of the use of individual treatment programs in patients with chronic adenoiditis, favorable dynamics of the clinical symptoms of the disease were noted: pharyngeal tonsil edema subsided, adequate nasal breathing recovered, the number of children with pharyngeal tonsil hypertrophy of the second degree decreased, microbial biocenosis of the nasopharynx was restored with a significant decrease in the number of pathogenic flora. The use of treatment and rehabilitation programs developed and implemented by a team of different profiles fundamentally changes the course of diseases of the nasopharyngeal region in comparison with traditional symptomatic therapy and is characterized by a more favorable dynamics compared to undifferentiated therapy. Prospective observation for 6 months showed a more persistent effect in the differentiated management of patients, a decrease in the number of exacerbations and a persistent high level of local immunity.

The proposed organ-preserving method of staged treatment of tonsillar disease corresponds to modern ideas about the important functions of the lymphadenoid ring.

Claims (1)

A method for the treatment of chronic adenoiditis in children, including the allocation of the following groups of patients: with chronic adenoiditis with purulent exudate, with chronic adenoiditis against allergic rhinitis, and with chronic adenoiditis against intracellular infections; conservative treatment with rinse of the nasopharynx and differentiated therapy for each group of patients, characterized in that the treatment includes the use of muco-regulating drugs, and differentiated therapy for patients with chronic adenoiditis with purulent exudate additionally includes local antibiotic therapy with Bioparox for 7 days, for patients with chronic adenoiditis on the background of allergic rhinitis - the use of local antihistamines or mast cell stabilizers for patients with chronic nical adenoiditis against the backdrop of intracellular infections - two courses of systemic antibiotic therapy and topical macrolides bioparoks followed by administration interferonogenic or interferon inducers; 7-8 days after the start of treatment, patients of all groups are given quantum therapy with the Rikta apparatus in the amount of 10 sessions with antioxidants, then they are rehabilitated with immunoregulatory respiratory spray IRS-19 and endonasally with Narine biological product for 10 days and taken orally bifidumbacterin for 3 weeks, alternating with Narine.