RU2371154C1 - Method of chronic purulent medium otitis treatment in reconstruction of middle ear deformities - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly otolaryngology and treatment of chronic purulent medium otitis at reconstruction of middle ear deformities. It involves toilette and irrigation of newly formed acoustic meatus and tympanic cavity by Octenisept medicine solution at 1:5 ratio by attic cannula, followed byexposure to gas flow containing 0.1-0.3% of nitrogen monoxide at 18-20°C by Plazon device. Plazon handler nozzle is inserted to external acoustic meatus for 1.5-2 cm distance till physiological gorge. Afterwards the nozzle is exposed to both nasal cavity halves. Exposure is performed for 30 seconds once a day. Further Candibiotic medicine is applied onto tympanic cavity mucosa.

EFFECT: complete epithelisation of tympanic cavity, tympanic membrane coverage, reduced terms and enhanced efficiency of treatment due to improved drug absorption, normalised microcirculation, macrophage activation and fibroblast proliferation resulting from tympanic cavity mucosa preparation by Plazon device.

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Description

The invention relates to medicine, namely to otorhinolaryngology. There are many ways to treat chronic suppurative otitis media: 1. Introduction of drugs on turunda into the ear canal. 2. The introduction of candles that violate the outflow of secretions and hamper the natural aeration of the cavities. 3. Insufflation of finely divided powder into the external auditory meatus (V.T. Palchun, 2000). 4. The use of “Plazon” in combination with ultrasonic irrigation of miramistin (V.M. Zaitsev, 2004).

In this regard, an important factor is the selection of such a form of drugs and such a method of its introduction into the middle ear cavity, which would not depend on the perforation of the tympanic membrane and ensure their high concentration in the inflammation site for a long time, without complicating the outflow of the discharge and aeration of the cavity middle ear.

The purpose of the invention is to provide a high concentration of the drug substance in the focus of inflammation, regardless of the size of the perforation of the eardrum, preventing relapse of the disease and reducing treatment time.

This goal is achieved by the use of a comprehensive method for the treatment of purulent otitis media that occurs in children with congenital ear defects after reconstructive surgery, NO-therapy sessions using the Plazon apparatus in combination with drug irrigation of the newly created eardrum and through perforated opening in it , the mucous membrane of the tympanic cavity, followed by the administration of the drug “Kandibiotik”. "Plazon" is also used to affect the mucous membrane of the nasal cavity and pharyngeal mouth of the auditory tube.

The closest solutions are:

1. The invention proposed by G. Golubovsky et al .; 02/20/2004.

2. Device for ultrasonic irrigation with liquid solutions "Ultrahydrosan", patent RU 2066208 C1 A61M 35/00, A61N 7/00; 02/09/1993.

3. Patent No. 2227000, proposed by V. Zaitsev. et al .; 04/20/04.

This method under No. 3 (patent of the Russian Federation. No. 2227000 from 04/20/04) we take as a prototype.

All these methods have several disadvantages:

1. In the complex treatment of chronic otitis media, no attention was paid to restoring the microcirculation of the inflamed mucous membrane of the nasal cavity to reduce swelling and hyperemia of the nasal mucosa and pharyngeal mouth of the auditory tube, and regenerating the epithelium of the pharyngeal mouth of the auditory tube.

2. The drug, "dispersed" by an ultrasonic wave, is supplied without preliminary biostimulation of the soft tissues of the middle ear, as a result of which oxygenation of the mucous membrane of the tympanic cavity with nitric oxide does not occur.

To eliminate these shortcomings, we offer our method of treatment.

The method is based on the action of nitric oxide ions coming from the Plazon apparatus, developed by the MVTU im. N.E. Bauman in 1997. This device operates in three modes: destruction, coagulation and NO-therapy. The temperature of the cooled NO-containing gas stream was brought to room temperature (18-20 ° C). The content of NO molecules in the gas stream can be dosed from 0 to 2500 ppm by adjusting the gas flow in the stream and the distance from the outlet to the object. The intensity of NO exposure is also dosed by exposure time (exposure). In this case, we work with the device in the NO-therapy mode, thereby achieving the maximum effect.

Generated by a plasma-chemical method from atmospheric air, NO normalizes microcirculation, has an antibacterial effect, suppresses infection and inflammation, activates the function of macrophages and fibroblasts, and stimulates tissue regeneration.

After this, the second stage is the irrigation of the tympanic cavity with a solution of the drug octenisept.

This drug belongs to the class of surfactants, has a pronounced spectrum of antimicrobial activity, is effective against aerobic-anaerobic, gram-positive and gram-negative bacteria, chlamydia, mycoplasmas, fungi, as well as viruses, has a disinfectant effect, enhances local protective reactions, regenerative processes , including does not cause allergies.

The method is as follows. An ear toilet is carried out, at first drainage of the external auditory canal, it is cleaned of mucopurulent discharge, then it is washed with an attic cannula with a syringe with an octenisept solution (diluted 1: 5). Next, a session of NO-therapy in stimulation mode with an exposure of 30 seconds.

Then, using the Plazon apparatus (full name: scalpel - coagulator - air-plasma stimulator SKSVP / NO-01 Plazon), a NO-therapy session is conducted in a stimulation mode with an exposure of 30 seconds.

Regarding acute and chronic rhinitis accompanying inflammation of the operated ear, NO-therapy was performed (exogenous nitric oxide in stimulation mode, Plazon apparatus) with exposure from 30 seconds to 2 minutes in both halves of the nose daily. The number of sessions ranged from 3 to 5.

The stimulator manipulator is a DC electrical device, which is a plasma-chemical source of nitrogen monoxide, with an output channel diameter of 2.0 mm (Certificate of Conformity No. РОСС RU. UM02.В 100042), Registration Certificate of the Ministry of Health of the Russian Federation No. 29/01040400 / 2722-01 of November 28, 2001. When the manipulator is operated with the recommended air flow rate in the “max.” Mode, a gas jet is formed with a temperature at the channel exit of not more than 100 ° C, of which NO is a specific component. The stimulator is a therapeutic manipulator and is intended to obtain a therapeutic effect by exposing the tissue to a gas stream with a temperature of 18-20 ° C with a content of 0.1 ... 0.3% of nitrogen monoxide.

When using a manipulator-stimulator for intracavitary exposure to tissue with nitric oxide, install it in the bracket socket, the handle of the device with a rubber connection to the front panel and attach a gas pipe to it with a metal tip installed at its end with an outlet of 0.7 mm in length 100 mm or 200 mm.

The patient sits in front of the doctor, turning his head to the right or left so that the affected ear is opposite the doctor. In the doctor’s right hand is a metal tip 100 or 200 mm long with an outlet of 0.7 mm. The tip is inserted into the external auditory canal of the affected ear to a physiological narrowing of approximately 1.5-2 cm, the distance to the eardrum to the end of the tip varies from 0.5 to 1 cm.

Depending on the location and size of the perforation, the doctor independently evaluates the depth at which the tip is inserted, resulting in the maximum effect of the procedure.

NO-therapy of the mucous membrane of the nasal cavity and pharyngeal mouth of the auditory tube is carried out by the Plazon apparatus with a plastic conductor nozzle.

This procedure has an antibacterial effect, suppresses infection and inflammation, activates macrophage function and fibroblast proliferation. In this case, the penetration of NO molecules is carried out not only through perforation in the eardrum, but also through intact skin, mucous membranes, providing a powerful biostimulating effect on body tissues, and is the best way to prepare for a medicinal irrigation of the tympanic cavity.

After this, the next stage is the drug irrigation of the tympanic cavity with a candibiotic (the official drug containing antibiotics - chloramphenicol and clotrimazole; hormone - beclamethasone dipropionate; anesthetic - lignocaine hydrochloride).

To do this, through the funnel introduced into the ear canal, endoural transtimpanal injection of the drug is carried out. The mucous membrane before the start of the irrigation procedure has already been prepared due to the normalization of microcirculation, as well as the activation of macrophages and the proliferation of fibroblasts, which contributes to better absorption of the drug and reduce the duration of treatment.

The proposed method allows to achieve complete epithelization of the tympanic cavity, closing the perforation of the tympanic membrane, reducing edema and hyperemia of the mucous membrane of the nasal cavity and pharyngeal mouth of the auditory tube in terms of 4-5 days without the use of antibiotics. It was possible to achieve a recovery of 100% of patients. In all patients treated with the proposed method, relapse was not observed, and the period of remission lasts 3-6 months.

Concrete example

Patient Kalugina Anastasia Mikhailovna, and / b No. 34362.

Age 22 g. She was hospitalized in 2 ENT departments. City Clinical Hospital No. 67 from February 14 to February 22, 2008

Diagnosis at admission: Congenital malformation of the right ear. Condition after auriculoplasty. Condition after auriculomeatotympanoplasty. Exacerbation of right purulent otitis media. Exacerbation of chronic rhinitis. The diagnosis at discharge: the same.

Complaints: hearing loss in the right ear, microotia of the right auricle. Anamnesis: congenital malformation of the outer and middle ear. In 2002-2007 a number of plastic and reconstructive operations on the external ear and external auditory meatus to restore the shape and function of the organ of hearing. Last hospitalization in June 2007, auriculoplasty was performed with the formation of the posterior surface of the auricle with grafting of the skin flap from the abdomen and excision of the keloid scar on the abdomen.

Status at admission: In local status - AD - there is a formed auricle, cicatricially altered (constricted by a keloid) in the region of the upper pole of the auricle, the cartilage implant is consistent, insufficient in volume. There is an external auditory meatus, blindly ending, discharge from the ear of a mucopurulent nature. Hearing - ШР AS 6 m, AD - ШР - ad conchae. SpNy abs. In the Romberg position is stable. The nose is of the correct form, the nasal septum is in the midline, the mucous membrane of the nasal cavity is edematous, there are mucopurulent discharge in moderate amounts. Difficult nasal breathing

Ear toilet, irrigation of the tympanic cavity with octenisept solution, NO-therapy sessions of the tympanic cavity and the mucous membrane of the nasal cavity and pharyngeal mouth of the auditory tube were conducted daily in a stimulation mode with an exposure of 30 seconds, for 10 days, followed by transtimpanic injection of the drug “Candibiotic”. The effect of treatment occurred on the 8th day from the start of treatment. When admitted to the bacteriological analysis of February 14, 08, Staphylococcus aureus, in the control smear of February 22, 08, there is no flora growth.

State at discharge: After further examination, on February 15, 2008, auriculoplasty was performed under m / a with implantation of a titanium nickelide mesh into the upper pole of the right auricle of the upper auricular keloid deformity with the formation of a sufficient upper pole. In the postoperative period she received antibacterial therapy, daily dressings with the Plazon treatment. As a result of the treatment, the upper pole of the auricle was enlarged, the wound healed by primary intention. Moderate reactive phenomena in the area of the implant persist, discharge from the right ear ceased. The nose, mucous membrane and pharyngeal mouth of the auditory tube are not edematous, there are no discharge. On admission to the bacteriological analysis of 07/10/07 - Staphylococcus aureus, in the control smear of 07/25/07 there is no flora growth.

Used Books

1. Grachev SV. NO-therapy // M., 2001.

2. Golubovsky G.A. A method for the treatment of acute stenosing laryngotrachebronchitis in children патент 2223769, 02.20.2004.

3. Kozlov A.Yu., Lisovoy M.N. "Device for ultrasonic irrigation with medicinal substances." Patent RU No. 2119804 C1 of 08.27.97.

4. Palchun V.T. Diseases of the ear, nose and throat. - M., "Medicine", 2000.

5. Clerk B.C., Danusevich I.N. Ultrasound - as a physical catalyst for physico-chemical, biophysical and biochemical processes. 1975.

6. Device for ultrasonic irrigation with liquid solutions "ultrahydrosan". Patent RU No. 2066208 of 02/09/93. (3)

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Claims (1)

A method of treating chronic purulent otitis media during reconstruction of middle ear abnormalities by introducing drugs into the external auditory canal, characterized in that at the beginning they irrigate and toilet the newly formed auditory canal and tympanic cavity with an octenisept drug solution using an attic cannula at a dilution of 1: 5, then act with a gas stream containing nitrogen monoxide 0.1-0.3% at a temperature of 18-20 ° C with an exposure of 30 s once a day, using the tip of the manipulator-stimulator of the Plazo apparatus n "for intracavitary impact on the tissue, which is introduced into the external auditory canal by 1.5-2 cm before physiological constriction, then the tip is exposed in both halves of the nasal cavity to affect the mucous membrane of the nasal cavity and pharyngeal mouth of the auditory tube, then the introduction Candibiotic preparation for an already prepared mucous membrane of the tympanic cavity.