RU2362592C1 - Way of treatment of diseases of paranasal of sinuses - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely to otorhinolaryngology and can be used at treatment of patients with diseases of paranasal sinuses. For this purpose inhalation of medical products in a kind of aerosols is carried out in a retrograde manner through a pharyngeal cavity. Thus aerosol supply is performed after end of inspiration, during breath holding and continued during exhalation.

EFFECT: rising of treatment efficiency of diseases of paranasal sinuses at the expense of improvement of delivery of medicinal preparations in paranasal sinuses and to their natural anastomosises, not entering lower respiratory tracts.

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Description

The invention relates to medicine, namely to otolaryngology, and can be used to treat diseases of the paranasal sinuses, in which inhalation therapy is used.

Diseases of the paranasal sinuses are one of the most pressing problems of otorhinolaryngology. Among patients with otolaryngological hospitals, patients with sinusitis account for 15-36% (NN Naumenko, GP Zakharova. Principles of etiopathogenetic therapy of acute sinusitis, guidelines, St. Petersburg, 2006). According to recent epidemiological studies, 5-10% of the adult and 5% of the child population suffer acute bacterial sinusitis annually (A.I. Kryukov et al. Treatment and diagnostic tactics for acute bacterial rhinosinusitis, guidelines No. 24, Moscow, 2002).

It is known that "in conditions of inflammation, the flow of drugs from the bloodstream to the mucous membrane decreases sharply" (cited by the book Piskunov GZ, Piskunov SZ Clinical rhinology, M .: Miklosh, 2002. In connection with local delivery of drugs to damaged mucous membranes of the paranasal sinuses in forms that do not inhibit the activity of mucociliary transport is of great importance.Inhalation therapy meets these conditions, however, the features of anatomy and aerodynamics in the nasal cavity do not allow the use of it is quite effective in its usual form due to the weak penetration of aerosol particles into the paranasal sinuses and to their anastomoses with the nasal cavity.

On inspiration, a reduced pressure is created in the nasal cavity, as a result of which air from the sinuses enters the nasal cavity. The elevation on the lateral wall of the nasal cavity before entering the middle nasal passage and the hook-shaped process close the path of the air stream into the middle nasal passage, where the anastomoses of the anterior group of the paranasal sinuses open. As a result, the inhaled air does not mix with the air entering the middle nasal passage from the anterior paranasal sinuses, and does not prevent its exit from them (SZ Piskunov. “Some questions of the physiology and pathophysiology of the nose and paranasal sinuses”, proceedings of the conference dedicated to the fifth anniversary Russian Society of Rhinologists, Moscow, 1997, p.14). T.O. the intake of aerosol particles to the anastomoses of the paranasal sinuses during inhalation, when aerosol is supplied during normal inhalation, prevents the flow of air from the sinuses.

A known method of treating respiratory diseases in the form of inhalation of an aerosol formed using ultrasound (see UIIP-1 individual ultrasonic inhaler inhaler, operating manual IEN, 9415827003 RE, NPO Elektropreobrazovatel Plant Inverter, Orenburg).

A known method of treating diseases of the respiratory tract using the supply of aerosols formed by the mechanical method (see. Aerosol inhaler AI-1 9G2. 933.001 PS).

A known method of treating respiratory diseases in the form of inhalation aerosols formed using compression

OMRON CX ^PRO nebulizer (NE-C18 / EN), registration certificate of the Ministry of Health of the Russian Federation No. 2003/544 of 04/10/03 (analog).

A known method of treating inflammatory diseases of the paranasal sinuses, including the flow of drugs into the nasal cavity in the form of an aerosol depending on the phase of the respiratory cycle (see RF patent No. 2141349, IPC6 A61M 11/00, A61N 2/04, 1995). Prototype (see also rhinolaryngological ultrasonic selective synchronous inhalation device in a magnetic field AUSI-MP-01-LOR, approved for industrial production by order of the Ministry of Health of the Russian Federation No. 219 of 07/20/1998, state registration number B9802842, scientific and production company "Pulse-M" , Rostov-on-Don.

A device for treating respiratory diseases is known - OMRON CX ^PRO compression nebulizer (NE-C 18 / EN), see the operating instructions.

A device for the treatment of inflammatory diseases of the paranasal sinuses, containing a mask connected to an ultrasonic nebulizer and a dispenser, a control system and a respiratory sensor (see RF patent No. 2141349, A61M 11/00, A61N 2/04, 1995).

The disadvantages of the known methods.

1. In the treatment of inflammatory diseases of the paranasal sinuses, the drug aerosol enters the nasal cavity by inspiration. In this phase of the respiratory cycle as a result of the above reasons, the penetration of aerosol particles into the paranasal sinuses and their natural fistula is difficult.

2. Most of the medicinal substances entering the nasal cavity with aerosols are absorbed by its mucous membranes, and when using inhalers in which the moments of aerosol delivery are not synchronized with the phases of the respiratory cycle, the mucous membrane of other parts of the respiratory tract.

3. The time of exposure to the pathological focus is limited by the time of spraying a therapeutic dose of the drug, which practically does not enter the paranasal sinuses and their anastomoses.

4. The drug substance is consumed uneconomically, sprayed excessively.

As a result:

1. Inhalation has to be stopped after using a therapeutic dose of the drug, which acted mainly on the mucous membranes of the nasal cavity and other parts of the respiratory tract.

2. The interaction of the drug substance with the “target” occurs mostly according to an unfavorable scheme: drug - organism - pathological focus (favorable scheme: drug - pathological focus - organism - pathological focus).

3. Side effects of drugs (depending on the characteristics of the drugs used) develop on intact areas of the mucous membrane of the respiratory tract.

The disadvantages of the known methods are the low effectiveness of the treatment of inflammatory diseases of the paranasal sinuses, the insufficient penetration of medicinal aerosols into the paranasal sinuses and their anastomoses, as well as the adverse effect on the mucous membrane of the lower respiratory tract, depending on the characteristics of the drugs used.

The objective of the proposed method of treatment is to increase the effectiveness of inhalation therapy of inflammatory diseases of the paranasal sinuses, improve the flow of medicinal aerosols into the paranasal sinuses and their anastomoses, while reducing the side effects of the drugs contained in aerosols on the mucous membrane of the lower respiratory tract.

The task is achieved by the essential features of the method common with the prototype:

- the supply of drugs to the nasal cavity and paranasal sinuses in the form of aerosols;

- the supply of drugs, depending on the phase of the respiratory cycle, corresponding to the filling of certain sections of the respiratory tract;

new essential features:

- the supply of medicinal aerosols begins after the end of inspiration, during a short-term breath holding;

- and continue during forced expiration;

- the flow of drug aerosols into the nasal cavity is carried out retrograde through the pharyngeal cavity;

- the exhalation of the aerosol that filled the throat at the time of holding the breath on the inhale and continues to enter it during the exhalation is carried out through the nose.

The technical result is to improve the delivery of drugs to the paranasal sinuses and their natural fistulas.

This is achieved by the fact that according to the proposed method, aerosols of drugs enter the nasal cavity at the time of exhalation (see figure 1). In this phase of the respiratory cycle, excessive air pressure in the airways occurs, which occurs as a result of contraction of the muscles of the chest. Air pressure especially rises in the middle nasal passage, which is facilitated by the posterior end of the middle nasal concha, directing the air flow into the middle nasal passage and the hook-shaped process that blocks the exit from the middle nasal passage (SZ Piskunov. Some questions of physiology and pathophysiology of the nose and paranasal sinuses , materials of the conference dedicated to the fifth anniversary of the Russian Society of Rhinologists, Moscow, 1997, pp. 12-15). As a result of this, the medicinal aerosol, together with the exhaled air, enters the paranasal sinuses and their natural fistulas, and the medicine contained in the aerosol acts according to a favorable scheme: the drug - a pathological focus - the body - a pathological focus.

At the same time, according to some data (Proetz, 1953), the volume of gas exchange is up to 1/8 of the exhaled air volume (quoted by the book, Piskunov GZ, Piskunov SZ, et al., “Diseases of the nose and paranasal sinuses. Endomicrosurgery” , M.: “Top Secret”, 2003, p. 37). With a tidal volume of 500 ml, this will be 62.5 ml. Part of the first portion of exhaled air enters the sinuses, then gas exchange is reduced due to pressure equalization. Thus, for the delivery of drug aerosol to the paranasal sinuses, its presence in the first portion of air coming from the underlying respiratory tract into the nasal cavity when exhaling is necessary.

These conditions can be created by selective synchronous inhalation of the nose, pharynx and larynx through the nose, with aerosols entering the sinuses on the exhalation that have not settled on the walls of the respiratory tract (i.e., the initial preparatory cycle is the inhalation, in which the aerosol enters the specified section of the respiratory tract - nose pharynx larynx, secondary - working cycle - exhalation). However, there is a large loss of the drug due to its deposition on the walls of the listed sections of the respiratory tract, especially in the nasal cavity. After the aerosol passes through the area of the nasal valve, its flow becomes turbulent, which contributes to increased deposition of aerosol particles on the mucous membrane of the nasal cavity (Piskunov GZ, Piskunov SZ, et al. Diseases of the nose and paranasal sinuses. Endomicrosurgery ", M .:" Top Secret ", 2003, p. 36).

In the implementation of the proposed method, the moment of beginning and end of exposure, i.e. aerosol delivery duration is adjustable. Normal inhalation and forced exhalation are performed through the nose. The patient tightly covers the lips of the inhaler nozzle, which lies on the tongue to its posterior third, and performs a short-term breath-holding at the height of the inspiration through the nose. Medicinal aerosol is delivered directly to the throat. The aerosol supply begins after the end of inspiration, during breath holding (up to 0.5 s) and continues during exhalation. On exhalation, an aerosol that fills the throat and partially the larynx enters the nasal cavity with the first portion of exhaled air, which is most actively involved in gas exchange with the paranasal sinuses. In patients with a sharply reduced tone of the soft palate and poorly trained people, if necessary, the holder of a small tongue and soft palate can be installed. The holder is worn on the nozzle of the atomizer and winds up behind a small tongue and partially behind a soft palate, preventing them from sinking at the time of exhalation. The onset of exhalation is initiated by an inducing signal. The delay time is set in accordance with the capabilities of the patient and the performance of the inhaler to deliver up to 60 ml of aerosol into the throat.

As a result, medicinal substances do not come into contact with the mucous membrane of the lower respiratory tract, and are already contained in the first portion of exhaled air, which enters the paranasal sinuses and their anastomoses. The conditions are created to achieve a therapeutic dose of the drug directly in the pathological focus. The drug contained in the aerosol, to a greater extent, acts according to the favorable scheme: pathological focus - body - pathological focus.

The drug is consumed more economically, conditions are created for prolonged exposure (several times a day) before using a therapeutic dose of the drug, i.e. the contact time of the drug and the affected mucosa is prolonged, a higher concentration of the drug is achieved on its surface.

The invention is illustrated in the drawings, where Fig. 1 shows a spirogram, predetermined moments of the beginning and end of the supply of drug aerosol; figure 2 is a block diagram of a device for implementing the method.

A device for implementing the method comprises a respiratory sensor 1, a control unit 2, a nebulizer compressor 3, a pneumatic distributor 4, an atomizer 5, a nozzle 6 and a soft palate holder 7.

A method for the treatment of inflammatory diseases of the paranasal sinuses is as follows.

Preparatory operations are carried out:

- the nebulizer of the compression nebulizer 5 is filled with a medicinal substance;

- a respiratory sensor 1 is installed on the nose or chest of the patient;

- the nozzle 6 of the sprayer is inserted into the mouth to the rear third of the tongue;

- if necessary, a holder 7 of a soft palate and a small tongue is mounted on the nozzle 6 and inserted behind the soft palate.

It is set and controlled according to the indications of the indicator (not shown in the drawing)

- duration of the procedure;

- breath holding time.

By the signal of readiness of the control system, the inhalation procedure begins.

The signal from the respiratory sensor 1 is fed to the input of the control unit 2. The control unit 2 captures the moment of the end of the inspiratory phase and sends a signal to transfer the air distributor 4 to the operating position, in which the air from the compressor enters the atomizer. Aerosol through nozzle 6 enters the throat. At the same time, a signal is sent to the patient, prompting him to hold a short-term breath hold, after a specified time, the patient is given a second signal, prompting him to exhale. After the end of inspiration, the pneumatic distributor is put into an inoperative position, in which the air coming from the compressor is discharged into the external environment. Aerosol formation stops.

Example 1. Patient M., 43 years old, was admitted to the department complaining of a runny nose with mucous discharge from the nose and headaches. Sick for 10 days after acute respiratory viral infections. Diagnosis: acute rhinosinusitis. On the radiograph of the paranasal sinuses, parietal “dimming” of the maxillary and frontal sinuses is determined. In the treatment complex, inhalations of the proposed method with a 0.005% miramistin solution 3 times a day for 20 minutes were performed. On day 3, headaches subsided, nasal discharge decreased. On day 6 - recovery. On the control x-ray pathology from the paranasal sinuses is not. The usual treatment period for this pathology is 10-12 days.

Example 2. Patient D., 28 years old, suffers from chronic infectious and allergic polyposis rhinosinusitis for 10 years. Due to the ineffectiveness of conservative treatment, the patient underwent an endoscopic revision of the middle nasal passages and maxillary sinuses, removed polyps and restored patency of natural anastomoses. In the postoperative period, purulent-mucous discharge from the maxillary sinuses persistently continued, and swelling of the middle nasal concha, difficulty in nasal breathing, and moderate headaches persisted. In the treatment complex, inhalations of the proposed method with a 0.005% miramistin solution 3 times a day for 20 minutes were performed. Nasal discharge stopped on the 3rd day, headaches subsided, nasal breathing recovered. Discharged in satisfactory condition on the 5th day of inhalation therapy.

Example 3. Patient P., 24 years old, was admitted with complaints of a runny nose, with profuse light mucous secretions, frequent sneezing, itching in the nose, headache. Suffers from chronic allergic infectious-dependent rhinosinusitis for 6 years. The real exacerbation is 8 days. The mucous membranes of the nose are pale in color, marked swelling of the middle nasal concha, profuse mucous discharge. Nasal breathing is difficult. In the treatment complex, inhalations of the proposed method with a mixture of E.A. Evdoshchenko and V.P. Melnik were performed. After 2 days, improvement came, after 4 days the discharge stopped, nasal breathing recovered, headaches subsided, swelling of the nasal concha decreased. Discharged in satisfactory condition on the 7th day of treatment (the usual treatment time for this pathology is 12 days).

Claims (1)

A method for the treatment of inflammatory diseases of the paranasal sinuses, comprising administering drugs to the nasal cavity in the form of an aerosol depending on the phase of the respiratory cycle, characterized in that the drug is administered after the end of the inhalation act, while holding the breath and continues during exhalation, while medicines into the nasal cavity are carried out retrograde through the pharyngeal cavity, and the final delivery to the paranasal sinuses is carried out due to the peculiarities of the aerodynamics of the nose and the force of the force vannogo exhalation.

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