RU2391108C1 - Method of treating chronic adenoiditis and tonsillitis in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, otolaryngology, and can be used for treatment of chronic adenoiditis and tonsillitis in children. For this purpose sanation and immunocorrection are carried out. Sanation is carried out with sodium chloride solution at temperature 37-40°C one procedure daily during 7-10 days. After that additionally light therapy is performed by exposure of bridge of the nose and/or left and right sides of the neck to noncoherent polarised light with wavelength 400-2000 nm and density of light energy flow 2.4 J/cm², degree of polarisation at outlet 95-98%, for 5-10 minutes daily during 7-10 days. Immunocorrection is performed by medication tonsilotren sublingually 30-60 minutes before meal daily 3 times with 6-8 hour interval in amount 125-500 mg during 7-10 days.

EFFECT: method allows to increase efficiency of local and general immunisation, improve results of treatment of chronic adenoiditis and tonsillitis in children, reduce treatment terms.

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Description

The invention relates to medicine, namely to otorhinolaryngology, and can be used in the treatment of chronic adenoiditis and tonsillitis in children.

Chronic adenoiditis and tonsillitis occupy a leading place in the general structure of ENT diseases in children and make up from 20 to 56% of diseases of the upper respiratory tract. The main etiological factor in diseases is infectious agents. Most often, alteration of the tonsil tissue occurs under the influence of varieties of Streptococcus - β-haemolyticus, pneumonia, viridians; less commonly, Staphylococcus aureus.

According to modern concepts, the Waldeyer-Pirogov lymphoepithelial ring - a set of tonsils forms part of the MALT (mucosal-associated lymphoid tissue) system with a unique structural organization that allows lymphopoiesis and at the same time be a single mechanism for protecting the body from bacteria and viruses.

In chronic adenoiditis and tonsillitis, the occurrence and development of a local or systemic infectious and inflammatory process depends on the general reactivity of the body, consisting of the sum of exogenous and endogenous factors, among which the immune system occupies the main place.

Chronic adenoiditis and tonsillitis are multifactorial diseases with identical immunopathological pathogenesis.

The main methods of treatment of chronic adenoiditis and tonsillitis at the present stage are conservative and surgical. Among conservative treatments, the most common is antibiotic therapy.

The main methods of treatment include: tonsil sanitation - irrigation by irrigation, washing lacunae and / or nasopharynx, desensitization, immunocorrection, general metabolic therapy, physiotherapeutic effect. In the presence or threat of the formation of local and general complications in chronic adenoiditis and tonsillitis, surgical treatment is indicated - adenotomy or tonsillectomy, respectively. Taking into account the importance of the complex of tonsils of the Waldeyer-Pirogov lymphoepithelial ring as the main source of effector cells of the immune system, it seems important to develop new conservative integrated approaches to the treatment of chronic inflammation in the tonsils using pathogenetically based therapy.

The existing range of methods for conservative treatment is diverse and due to the lack of a lasting effect. In addition, the complexity of the conservative treatment of chronic adenoiditis is due to the inaccessibility of the pharyngeal tonsil, the proximity of important anatomical structures, the complexity of drug delivery and the implementation of rehabilitation measures.

Known is a combined method of treating chronic adenoiditis in children, including performing endoscopic irrigation of the pharyngeal tonsil with 10 ml of 0.01% miramistin solution diluted with distilled water in a 1: 2 ratio with simultaneous suction of the wash liquid and additional exposure to defocused coherent monochromatic red laser light λ = 6328 E , with a capacity of 10 mW / cm ² by introducing a fiber into each half of the nose to the nasopharynx for 5 minutes, one procedure per day for 5-7 days (RF Patent No. 2307686, M. to L. A61N 5/067, A61K 31/14, 2005).

The disadvantages of the method are:

1) the invasiveness of the treatment due to the discomfort of introducing both a rigid endoscope and an electric suction pump, and then a fiber into the nasopharynx of the child for 5-7 minutes;

2) miramistin, being a cationic detergent, increases the permeability of the cell wall of not only microorganisms, but also the mucous membrane of the nose and nasopharynx, thereby leading to cytolysis, hypersensitivity, inhibition of mucociliary clearance. This is manifested by a burning sensation;

3) the wide antimicrobial spectrum of miramistin does not help to reduce the destructive effect of free radicals and lipid peroxidation products;

4) it is generally accepted that laser systems are monochromatic, limited to a very narrow frequency range and transmit a large amount of energy. Moreover, the laser system is characterized by coherence - temporal and spatial synchronization of the movement of light waves, and, therefore, the intensity is summed. Thus, the laser acts on the field of application with a variable, unstable intensity. This does not allow the use of radiation of much lower intensity;

5) the biological effect that appears during laser exposure is identified exclusively as the activation of the lymphatic system - the effect of an immunostimulant. However, at the present stage of studying the characteristics of the immune-inflammatory process in chronic adenoiditis and tonsillitis, based on changes in the immune status, immunomodulation is preferable in treatment.

The closest technical solution is a method for the treatment of chronic tonsillitis, including sanitation of the tonsils with activated celandine infusion with lubrication by spot application of the surface of the tonsils with Vitagmal solution once a day, for a course of 10 procedures followed by immunocorrective therapy with a biologically active food supplement " Vitagmal "once sublingually under the tongue, 10-12 drops 40-60 minutes before meals in the morning, daily for 14 days (RF Patent No. 2240132, M. class. A61K 35/78, 2 003 g.).

The disadvantages of this method are the form of release of the drug "Vitagmal" in the form of a water-alcohol solution, which limits its use in children by mouth, as well as in undiluted form on the mucous membranes.

The Vitagmal dietary supplement, which has an immunogenic effect, administered orally, is not effective enough and does not significantly affect local immunity in the treatment of chronic adenoiditis and tonsillitis. The systemic effect of Vitagmala is provided only by prolonged use. Researchers of the action of Vitagmal do not recommend using it in a state of high hypertension and with insomnia.

The use of an unofficial infusion of celandine for washing tonsil lacunae in children, taking into account the possibility of swallowing the solution, does not exclude the risk of systemic toxic effects and requires great care. All parts of the plant are poisonous, prolonged use causes nausea, vomiting, upset stool, depression of the respiratory center.

The organoleptic properties of the infusion of celandine - a bitter, astringent taste - also limits its use in children.

The objective of the invention is to increase the effectiveness of immunization and improve the treatment results of chronic adenoiditis and tonsillitis in children by reducing the duration of treatment. Reducing the duration of therapy and its optimization is possible due to the combined, consistent and justified effect of various types of therapy: the most physiological rehabilitation, the physiotherapeutic technique and the use of a non-synthetic drug of natural origin containing ultra-low concentrations of material substances.

The problem is achieved in that in a method of treating chronic adenoiditis and tonsillitis in children, including sanitizing and immunocorrecting therapy, the novelty is that sanitizing therapy is carried out with 0.9% sodium chloride solution at a temperature of 37-40 ° C every day according to one procedure for 7-10 days and then further carried phototherapy influence on the bridge and / or the left and right side of the neck incoherent polarized light with a wavelength of 400-2000 nm, a light energy flux density per minute of 2.4 J / cm ² and a degree of polarization and at the output of 95-98% for 5-10 minutes daily for 7-10 days, and immunocorrective therapy is carried out with the Tonsilotren drug sublingually 30-60 minutes before meals daily 3 times after 6-8 hours, 125-500 mg per within 7-10 days.

The use of 0.9% sodium chloride solution as a sanitizing therapy at a temperature of 37-40 ° C helps to remove the effects of irritation when using other solutions and inhibition of mucociliary clearance. It has the property of moisturizing the nasal mucosa, thinning thick mucus, softening dry crusts in the nose, and also contributing to their easy removal. The hydrogen index (pH) of the solution corresponds to the pH of the natural secretory fluid of the nasal mucosa. The solution of 0.9% sodium chloride solution is aqueous, has adaptive organoleptic properties, is safe, since it is physiological, sterile, pyrogen-free. Sodium chloride is found in the blood and in tissue fluids, its content provides to a large extent the constancy of the osmotic pressure of the blood. The use of mechanical irrigation of the nasopharynx and palatine tonsils at a temperature of 37-40 ° C is painless. An important factor is accessibility and profitability. Combined therapy helps to enhance the overall positive effect, which allows not to increase the concentration of the active substance and to obtain a therapeutic effect in up to 10 days.

Light therapy by exposure to incoherent polarized light with a wavelength of 400-2000 nm, with a light energy flux density per minute of 2.4 J / cm ² and a degree of polarization at the output of 95-98% has a pronounced biostimulating effect on the cells, which allows light to positively affect various biological processes in the body. Acting on the structure of cells, incoherent polarized light normalizes metabolic processes, increases the synthesis of enzymes by cells, strengthens the immune system, and stimulates reparative processes of the whole organism. The body's defense system modulates cellular and humoral mechanisms. For example, at the cellular level, phagocytosis intensifies, at the humoral level, the amount of immunoglobulins and plasma proteins increases. Extending the light therapy session by exposure to incoherent polarized light enhances the penetrating effect; a temperature of approximately 37 ° C is created at a distance of up to 10 cm from the skin surface. Skin temperature rises from a maximum of 1 ° to 3 ° C. Given that the surface temperature of the skin is 33-34 ° C, when using light therapy, there is no overheating of the skin and other tissues. The individual technical characteristics of light make it possible to penetrate not only the skin, but also into the underlying tissue.

With local exposure, the biopositive effect of light is transmitted through the blood to the entire body, delivering vital oxygen and energy to each cell. It is known that the number of capillaries per square centimeter of skin is from 1,600 to 6,500. Most slowly, blood flows in capillaries located close to the surface of the skin. This is precisely the ideal condition for photomodulation of blood, i.e. visible light stimulates the immune response of the blood.

The polarization of light, when all waves propagate in parallel planes, is one of the main factors regulating the activity of cell membranes, exerting a pronounced specific therapeutic effect. Acting as a trigger, polarized waves optimize cellular metabolism, which helps to modulate their own regeneration processes, accelerate the healing of the body.

Visible polarized light directly acts soothingly on the nerve endings, energy meridians, and the nervous system.

Light therapy by exposure to incoherent polarized light does not contain ultraviolet rays, does not cause redness of the skin or tanning, does not pose any danger to the eyes or skin.

Incoherent polarized light with a wavelength of 400-2000 nm, with a light energy flux density per minute of 2.4 J / cm ² and a degree of polarization at the output of 95-98% covers a wide frequency range, transfers less energy and is comparable to the spectrum emitted by the sun , which allows us to characterize it as the most physiological for recovery. Low energy intensity has a pronounced biostimulating effect. But unlike daylight, light therapy with visible polarized light is not subject to daily or seasonal fluctuations, so brightness and dosage can be precisely determined.

For the pharmacological correction of immuno-inflammatory disorders in chronic adenoiditis and tonsillitis, a course of therapy with the complex action drug Tonsilotren (German pharmaceutical company DHU, Germany) containing plant and mineral components was used. This drug is registered by the Ministry of Health and Social Development of the Russian Federation (Registration number 012166/01 of 07.28.2000). “Tonsilotren” as an active substance contains ultra-low concentrations of its material constituent substances. The drug quickly relieves sore throat, hyperemia and swelling of the tonsils, has an antipyretic effect, helps to reduce hypertrophic nasopharyngeal and palatine tonsils, and reduce swelling of the lymph nodes of the neck. “Tonsilotren” acts in case of recurrent inflammations occurring with suppuration and abscesses, it is effective in protracted processes with ulcerations, contributing to granulation and strengthening the protective properties of the body.

The use of "Tonsilotren" allows you to stop, despite a diverse etiology of inflammation, the main objective and subjective symptoms of chronic adenoiditis and tonsillitis - edema, hyperemia, pain, infiltration, lymphadenitis.

In a clinical study of immunotropic properties according to the principles of evidence-based medicine with the course use of "Tonsilotren" it is shown that the drug:

1) contributes to the eradication of pathogenic microflora while maintaining microbiocenosis;

2) increases the phagocytic activity of neutrophils and macrophages in biological material from the surface of the pharyngeal and palatine tonsils by reducing the total number of neutrophils to normal and increasing the percentage of active phagocytes;

3) reduces the content of lipid peroxidation product - malondialdehyde;

4) stabilizes the enzymatic link of the antioxidant system - increases the activity of glutathione-S-transferase, glutathione peroxidase, reduces the activity of catalase.

5) reduces the content of pro-inflammatory cytokines - interleukin-1β, tumor necrosis factor-α;

6) increases the concentration of anti-inflammatory cytokine - interleukin-4.

The shown versatile modulating effect of Tonsilotren on various parts of the immuno-inflammatory process in chronic adenoiditis and tonsillitis is due to the influence on the production of endogenous cytokines, which regulate mainly the cellular or humoral immune response, as well as the functional activity of macrophages. The ability of the drug to influence the ratio of Th1 and Th2 activities indicates the prospects of its use in conditions of insufficient function of the regulatory units of the immune system.

Thus, the combined use of sanitizing and immunocorrecting therapy with Tonsilotren additionally with light therapy includes the principles of prescribing pathogenetic, systemic and local immunomodulating and local antiseptic therapy for these nosologies and provides a long-term positive effect.

The method of combination therapy for chronic adenoiditis involves in the ENT office, nasopharynx sanitation by irrigation (justified by Arthur W. Proetz) with a 0.9% sodium chloride solution at a temperature of 37-40 ° C. To perform, it is necessary to have a rubber cylinder connected by a rubber tube to an olive. The patient lies on his back, his head hanging from the edge of the couch in a tilted state. This position of the head creates a condition for a lower location of the upper sections of the nasal cavity, which contributes to the retention of a solution of the drug substance in them. In one half of the nose, 6-8 ml of a drug solution is poured. Then the doctor squeezes the rubber balloon with his hand, removing air from it. With the other hand, inserts the olive into the nostril, where the solution of the drug substance is poured, completely covering half of the nose. The wing of the nose of the opposite side is fully pressed against the septum. Thus, in the nasal cavity there is a medicinal solution, the nose is closed from the outside. Then the patient is offered to say multiple “cuckoo” and slowly release the balloon in his hand. When pronouncing sounds, the soft palate adheres to the posterior pharyngeal wall and divides the nasopharynx from the oropharynx. As a result, a hermetically isolated space is formed, consisting of the nasopharynx, nasal cavity and paranasal sinuses, rubber tube and balloon. In this case, air from the nasal cavity is aspirated into the balloon, and negative pressure is created in the nasal cavity. The procedure is repeated with the other half of the nose.

Then, light therapy is additionally performed by exposing the bridge of the nose to incoherent polarized light with a wavelength of 400-2000 nm, with a light energy flux density per minute of 2.4 J / cm ² and a degree of polarization at the output of 95-98% for 5-10 minutes.

At the same time, immunocorrecting therapy with Tonsilotren is carried out sublingually 30-60 minutes before meals every day 3 times after 6-8 hours, 125-500 mg for 7-10 days.

The course of combination therapy includes 7-10 rinses of the nasopharynx, light therapy sessions, daily according to one procedure against the background of immunocorrective therapy.

By the end of the course of therapy, patients noted improvement in general condition, increased appetite. Sanitation therapy contributed to the rapid cleansing of the nasopharynx from the pathological discharge, the persistent relief of edema, hyperemia of the pharyngeal tonsil, and the indirect improvement of the lymphatic drainage function of regional lymph nodes. A clinical positive result correlated with an improvement in laboratory parameters: normalization of leukocytosis, ESR, inhibition of lipid peroxidation processes, increased activity of antioxidant defense enzymes, decreased general bacterial contamination with eradication of pathogenic microflora, increased phagocytosis.

When confirming the diagnosis of chronic tonsillitis as a sanitizing therapy, the method of intra-lacunar administration of a 0.9% sodium chloride solution at a temperature of 37-40 ° C in a volume of 15-20 ml for each amygdala using a syringe and a curved cannula with a diameter of 1.2 mm, immersed in the mouth of the crypt of the palatine tonsil. At the end of the procedure, light therapy is additionally carried out by exposure to the left and right sides of the neck with incoherent polarized light with a wavelength of 400-2000 nm, with a light energy flux density per minute of 2.4 J / cm ² and a degree of polarization at the output of 95-98% in 5- 10 minutes. At the same time, immunocorrecting therapy with Tonsilotren is carried out sublingually 30-60 minutes before meals every day 3 times after 6-8 hours, 125-500 mg for 7-10 days.

The combination therapy course included 7-10 washings of tonsil lacunae, light therapy sessions, daily according to one procedure against the background of immunocorrective therapy.

By the end of the course of therapy, patients noted relief of complaints of sore throat, increased salivation. Well-being improved, temperature returned to normal. Efficiency and appetite increased. Objectively, positive dynamics was observed during mesopharyngoscopy: hyperemia was thickened and swelling of the anterior palatine arches, palatine tonsils, lymphoid hyperplasia of the lateral ridges on the posterior pharyngeal wall regressed, the tonsils cleared of pathological contents, and the lymphatic drainage function of regional lymph nodes improved. Achieved positive clinical effect was accompanied by an improvement in laboratory parameters: in the clinical analysis of blood - normalization of leukocytosis, ESR; in immunological analysis - a decrease in the concentration of pro-inflammatory cytokines; in biochemical, the content of primary and secondary products of lipid peroxidation was normalized with an increase in the activity of antioxidant defense enzymes, the immunological activity of palatine tonsils increased, the total bacterial contamination decreased until the pathogenic microflora in the gaps disappeared.

Thus, it is the combined use of sanitizing therapy, light therapy and immunocorrecting therapy with the Tonsilotren drug according to a certain scheme established experimentally that allows to obtain a lasting effect in the treatment of chronic adenoiditis and tonsillitis in children.

The effect of different doses of Tonsilotren for the effect was studied. We prescribed doses of the drug Tonsilotren 125-750 mg sublingually 3 times a day. The most effective doses, taking into account compliance, were 125-500 mg. The sublingual method of taking the drug provides the best absorption from the oral cavity. Reception of "Tonsilotren" 30-60 minutes before meals, disconnected from food intake, ensures the activity of ultra-low concentrations of the material constituent substances of the drug, the necessary exposure to the mucous membrane and effective absorption. Studied the timing of the appointment of “Tonsilotren” to achieve immunocorrective action: 5-20 days. The drug was found to be optimal for 7-10 days.

An example of the method

Example 1

Patient I., age - 3 years 2 months (study protocol No. 2), applied for outpatient treatment at the Municipal Health Institution “City Children's Hospital No. 8, Children's Clinic No. 2” in Krasnoyarsk on March 22, 2007 complaining of severe difficulty nasal breathing due to nasal congestion and nasal discharge, periodic morning coughing, snoring during night sleep, frequent acute respiratory viral infections every 2 months, loss of appetite, rapid fatigue and general weakness, restless sleep with night fears, etc. itelny to 2 weeks subfebrilitet. Complaints within 6 months. Associates with admission to a kindergarten. Acute respiratory viral diseases monthly, lasting more than 7 days. Their course is complicated by a purulent runny nose. I received outpatient treatment twice with a pediatrician and ENT specialist, according to the generally accepted method, the last time a month ago: systemic antibiotics of a wide spectrum of action, on which transient digestive disorders began to appear in the form of unstable stools and abdominal pains, vasoconstrictor drops in the nose, protargol solution intranasally, alternating with topical antibiotics, antihistamines inside, immune preparations, and also laser therapy. As a result of the treatment, there was a slight improvement over 10 days: the discharge from the nose and the severity of congestion decreased. The reason for applying for a second outpatient appointment was persistent nasal discharge, snoring, nasal congestion, bad breath, with general weakness and loss of appetite, intermittent sleep with prolonged falling asleep and nightly fears.

With endoscopy of the nasal cavity and nasopharynx, mild mucous membrane edema was noted, mainly in the region of the lower nasal concha, their cyanosis, as well as profuse mucopurulent discharge in the general nasal passage, pharyngeal tonsil hyperplasia of the II degree with a predominant location in the choanus with non-differentiation of the furrows, the presence of scarce caseous detritus in them against the background of hyperemia. From other ENT organs - signs of pathology were not detected. Lymph nodes of the antero-cervical, posterior-cervical groups are enlarged to 0.7 × 0.7 cm in diameter, with a densely elastic consistency, unsoldered, painless.

A clinical blood test revealed a mild absolute leukocytosis without changes in the leukocyte formula (9.2 × 10 ⁹ / L), slightly accelerated ESR (15 mm / h), which are laboratory indicators of endogenous intoxication and indicate an inflammatory process.

In the patient’s biochemical blood analysis, activation of the lipid peroxidation process and a decrease in the activity of antioxidant defense enzymes with the development of adaptive stress syndrome and the predominantly peroxidase destruction pathway of hydrogen peroxide generated by mitochondria were detected: malondialdehyde - 3.8 nmol / ml (control - 2.73 nmol / ml), diene conjugates - 2.52 μmol / ml (control - 1.96 μmol / ml), glutathione-S-transferase - 0.96 mmol / min × ml cells (control - 1.43 mmol / min × ml cells ), glutathione peroxidase - 2.94 μmol / min ml cells (control - 3.97 pmol / ml cells × min), superoxide dismutase - 1.7 standard units / ml (control - 1.79 standard units / mL), catalase - 14.89 × 10 ³ mol / min × ml cells (control - 15.12 μmol · 10 ³ / min × ml cells).

An immunological study of blood serum: the concentration of interleukin-1β - 211.4 pg / ml (control - 65.43 pg / ml), interleukin-4 - 141.2 pg / ml (control - 58.68 pg / ml), factor tumor necrosis-α - 201.2 pg / ml (control - 58.84 pg / ml). Interleukin-1β, tumor necrosis factor-α are the main pro-inflammatory cytokines that determine the severity of the process, an increase in their concentration is associated with the activation of the immune response along the type 1 T helper pathway and is associated with the development of inflammation. A highly significant increase in the concentration of these cytokines before therapy compared to similar indicators in healthy children is 3.1 times, which indicates inflammation activity and massive antigen delivery (p <0.001), the development of a systemic inflammatory response. The initial level of interleukin-4 is also significantly higher than that in healthy children (p <0.001) by 1.7 times, due to the existing inactivation of type 2 T-helpers by antigens in vivo. Thus, in a patient with chronic adenoiditis with a prolonged absence of pathogen elimination, the immune-inflammatory process is expressed, since the regulation mechanisms of both the cellular and the humoral immune response are equally activated with a certain degree of competition for switching to the T-type helper pathway or T-helper path 2 types.

During bacteriological examination of biological material from the surface of the pharyngeal tonsil, an increase in the degree of contamination was revealed mainly due to the polyculture of pathogenic microflora - green streptococcus and Staphylococcus aureus. The quantitative content of microorganisms per 1 g (ml) of the test material amounted to 1 · 10 ⁷ CFU / g (ml). Staphylococcus aureus strains were distinguished by an increased degree of virulence according to 5–6 signs: they gave hemolysis, cleaved beckon, coagulated plasma, secreted lecithinase, and had antilysocyme activity.

In the nasocytogram, the patient recorded an increase in the number of neutrophils 66.85% with a decrease in the number of phagocytic neutrophils 9.56%, which corresponds to the logic of purulent inflammation with signs of inhibition of the phagocytic system of local immunity.

Taking into account complaints, anamnesis, objective examination data and a comprehensive clinical, laboratory and instrumental study, the diagnosis of chronic adenoiditis was verified by an allergist and an otorhinolaryngologist.

The patient is offered conservative combination therapy. Sanitizing therapy was carried out by irrigation according to Proetz A. with a 0.9% sodium chloride solution at a temperature of 37-40 ° C daily according to one procedure for 7 days, then additional light therapy with exposure to the nose with incoherent polarized light with a wavelength of 400-2000 nm, s the density of the flow of light energy per minute 2.4 J / cm ^{2 the} degree of polarization at the output of 95% for 7 minutes daily for 7 days. At the same time, the patient received immunocorrective therapy with the Tonsilotren drug sublingually 30-60 minutes before meals every day 3 times after 6 hours, 250 mg for 7 days.

At the visit to the end of the course of therapy on the 8th day, a significant clinical improvement was established: general complaints were not bothered, my state of health and emotional tone are good, the child is active. The appetite is satisfactory, the sleep returned to normal. Positive dynamics was objectively observed: nasal breathing was restored, snoring, nasal congestion and bad breath were stopped. With video endoscopy, the mucous membrane of the nasal cavity and nasopharynx is pink, clean, swelling and mucous discharge in the area of the choanas and nasal cavity are stopped, pharyngeal tonsil I-II degree due to hyperplasia, with a clear relief of the tissue due to differentiation of the furrows, narrowing of the furrows, cleansing them of caseous detritus against the background of normalization of tissue trophism. Regional lymph nodes along the sternocleidomastoid muscle 0.5 × 0.5 cm in diameter, elastic consistency, painless.

In the clinical blood test, the number of leukocytes (7.3 × 10 ⁹ / l), ESR (6 mm / h) was normalized, which indicates a decrease in the level of endogenous intoxication and a decrease in the severity of inflammatory and destructive processes.

In the biochemical analysis of blood, the primary and secondary products of lipid peroxidation normalized with an increase in enzyme activity, which indicates the reversibility and compensation of processes in the system of initiation of peroxide compounds and their inactivation: malondialdehyde - 2.9 nmol / ml, diene conjugates - 1.44 μmol / ml, glutathione-S-transferase - 1.22 mmol / min × ml cells, glutathione peroxidase - 3.76 μmol / min × ml cells, superoxide dismutase - 1.8 conventional units / ml, catalase - 16.92 μmol · 10 ³ / min × ml cells.

An immunological study of blood serum showed a decrease in the severity of the systemic inflammatory response and the initial stage of development of a specific immune response: a decrease in the concentration of interleukin-1β - 94.5 pg / ml, interleukin-4 - 81.7 pg / ml, tumor necrosis factor-α - 120 5 pg / ml.

Bacterial seeding was reduced due to the eradication of pathogenic microflora - green streptococcus and a decrease in Staphylococcus aureus in biological material from the surface of the pharyngeal tonsil. The quantitative content of microorganisms per 1 g (ml) of the test material amounted to 1 · 10 ³ CFU / g (ml). Staphylococcus aureus, represented by monoculture, is differentiated in terms of virulence as a low virulent strain.

In the patient’s nasocytogram, a highly significant decrease of 1.55 times in neutrophils to 43.15% with an increase in the number of phagocytic neutrophils by 1.89 times to 17.05% was recorded, which reflects the restoration of the phagocytic function of neutrophils.

At the end of the course of treatment, the patient did not need additional therapy. A routine follow-up examination was recommended after 3 and 6 months.

When analyzing the results of combination therapy after 3 and 6 months, the patient was diagnosed with persistent remission: no exacerbations were observed, ARVI did not tolerate. Laboratory indicators without negative dynamics.

The patient rehabilitation plan included repeated courses of therapy once every six months.

To date, the duration of remission is one and a half years. During the observation period, there were no complications: from the ears, the formation of tubotitis, exudative otitis media, violation of the maxillofacial skeleton, autonomic dysfunctions. The incidence of ARVI decreased by 5.2 times. ARVI is typical: recovery within 7 days without the use of antibiotic therapy and in the absence of complications of acute inflammatory diseases from the ENT organs.

Example 2

Patient X., age 12 years (study protocol No. 50), applied for outpatient treatment at the Municipal Health Institution “City Children's Hospital No. 8, Children's Clinic No. 2” in Krasnoyarsk on November 29, 2005 complaining of difficulty in swallowing, sore throat, increased salivation, fever up to 37.1 ° C, malaise. Sick for 4 years. In the anamnesis: 4 years ago she suffered a severe sore throat, after a course of ampicillin a complete recovery did not occur. Repeated tonsillitis annually up to 4 times a year. Repeatedly treated on an outpatient basis by an otorhinolaryngologist. She received systemic antibacterial therapy with Augmentin in the usual dose, a second course of antibiotic macrolide series, as well as sanitation of the tonsils with antiseptic solutions (dioxidine, octenisept, miramistin), physiotherapeutic methods. But the effectiveness of therapy was low, since it did not provide a prolonged remission and complete relief of all symptoms. Discomfort in the throat, periodic formation in the palatine tonsils of purulent plugs with a smell, perspiration, fast fatigue persisted.

Objectively with mesopharyngoscopy: the mouth opens freely. Mucous of the oropharynx with delimited severe hyperemia of the anterior palatine arches, palatine tonsils. Lymphoid hyperplasia of the lateral ridges on the posterior pharyngeal wall. Thickening and infiltration of the anterior arch. Palatine tonsils of the II degree due to hypertrophy, the relief is smoothed, in the gaps there is a plentiful purulent-caseous content, the presence of adhesions between the palatine tonsils and palatine arches. From the rest of the ENT organs, pathology was not detected. Regional lymph nodes, tonsillar and submandibular, are enlarged to 1 × 1 cm in diameter, elastic, unsoldered, painless.

At this time, a mild absolute leukocytosis due to lymphocytes (9.4 × 10 ⁹ / L and 58%, respectively), accelerated ESR (17 mm / h) was revealed in the clinical blood test, which indicates the presence of an inflammatory process in the body.

A biochemical blood test demonstrates the activation of lipid peroxidation: malondialdehyde - 5.8 nmol / ml (control - 2.73 nmol / ml), diene conjugates - 0.36 μmol / ml (control - 1.96 μmol / ml), glutathione S-transferase - 1.21 mmol / min × ml cells (control - 1.43 mmol / min × ml cells), glutathione peroxidase - 1.97 mmol / min × ml cells (control - 3.97 μmol / min × ml of cells), superoxide dismutase - 1.8 conventional units / ml (control - 1.79 conventional units / ml), catalase - 15.31 micromol · 10 ³ / min × ml cells (control - 15.12 micromol 10 ³ / min × ml cells).

In an immunological study of blood serum, a significant increase in anti-inflammatory cytokines indicates the development of a systemic inflammatory response: the concentration of interleukin-1β - 315.4 pg / ml (control - 65.43 pg / ml), tumor necrosis factor-α - 189.5 pg / ml (control - 58.84 pg / ml). At the same time, a significant increase in the anti-inflammatory cytokine indicates a violation of the humoral immune response, leading to an increase in inflammatory and destructive processes in the palatine tonsil: the concentration of interleukin-4 is 155.4 pg / ml (control - 58.68 pg / ml).

A bacterial study of biological material from crypts of palatine tonsils revealed a high degree of bacterial contamination (the quantitative content of microorganisms per 1 g (ml) of the test material amounted to 1 · 10 ⁷ CFU / g (ml) with the presence of an association of pathogenic microflora of group A β-hemolytic streptococcus and Staphylococcus aureus.

The functional activity of the tonsils was sharply reduced (the content of lymphocytes in the contents of the gaps of the tonsils was 10 cells on the right; 12 cells on the left in one large square of Goryaev’s cell).

Taking into account complaints, medical history, objective examination data and a comprehensive clinical and laboratory study, the otorhinolaryngologist verified the diagnosis of chronic tonsillitis, decompensated form - recurrent tonsillitis, subfebrile condition.

The patient was offered conservative combination therapy, including sanitizing and immunocorrective therapy. Palatine tonsils were sanitized with 0.9% sodium chloride solution at a temperature of 37-40 ° C in a volume of 15-20 ml for each tonsil daily, according to one procedure for 10 days, then additional light therapy was applied to the left and right sides of the neck with incoherent polarized light with a wavelength of 400-2000 nm, with a light energy flux density per minute of 2.4 J / cm ² , a degree of polarization at the output of 95% for 8 minutes for 10 days. As an immunocorrective therapy, the patient received the drug “Tonsilotren” sublingually 30-60 minutes before meals every day 3 times after 8 hours, 375 mg for 10 days.

After completing the course of therapy, the patient complained of sore throat, increased salivation, malaise did not show. Swallowing is painless. The general state of health is good, the temperature returned to normal. Efficiency and appetite increased. Objectively, positive dynamics was observed during mesopharyngoscopy: hyperemia of the anterior palatine arches, palatine tonsils disappeared, lymphoid hyperplasia of the lateral ridges on the posterior pharyngeal wall regressed, thickening and infiltration of the anterior arches, the palatine tonsils were reduced in size and cleared of pathological limb, were redundantly tonsillar and submaxillary up to 0.5 × 0.5 cm in diameter.

In the clinical blood test, the absolute number of leukocytes and the percentage of lymphocytes (5.3 × 10% and 32%, respectively), ESR (7 mm / h) were normalized, which indicates a significant decrease in the level of endogenous intoxication and the severity of inflammatory and destructive processes.

The biochemical analysis of blood normalized the content of primary and secondary lipid peroxidation products with an increase in enzyme activity: malondialdehyde - 3.2 nmol / ml, diene conjugates - 0.324 mmol / ml, glutathione-S-transferase - 1.21 mmol / min × ml cells, glutathione peroxidase - 1.6 μmol / min × ml cells, superoxide dismutase - 1.72 conventional units / ml, catalase - 14.44 μmol · 10 ³ / min × ml cells.

An immunological study of blood serum showed a decrease in the concentration of pro-inflammatory and anti-inflammatory cytokines: the concentration of interleukin-1β - 112.4 pg / ml, interleukin-4 - 89.3 pg / ml, tumor necrosis factor-α - 102.4 pg / ml.

In a bacterial study of biological material from the crypts of the tonsils, the total bacterial contamination was reduced (the quantitative content of microorganisms per 1 g (ml) of the test material was up to 1 · 10 ⁴ CFU / g (ml) with the presence of microflora, characteristic of normal oral microbiocenosis. , presented before therapy with β-hemolytic group A streptococcus and Staphylococcus aureus, was not found in the secret of both palatine tonsils.

The immunological function of the tonsils increased (the lymphocyte content in the contents of the lacunae of the tonsils was 30 in one large square of Goryaev’s cell).

Given the satisfactory condition of the patient, a routine follow-up examination was recommended after 3 and 6 months. Upon repeated examination after 3 and 6 months, the patient was diagnosed with remission: exacerbations of chronic tonsillitis were not observed, ARVI did not tolerate. Laboratory indicators are within normal limits.

Repeated courses of therapy were carried out once every six months.

Currently, the patient continues to be observed. During the observation period, no further decompensation was noted: local (paratonsillar abscesses) and metatonsillar complications (heart, kidney, joint damage). The duration of remission is more than two years.

The dynamics of laboratory parameters in children with chronic adenoiditis after combination therapy (table).

Indicator, units Patient group (n = 39) Group of healthy children (n = 16) before therapy after therapy White blood cells (× 10 ⁹ / L) 9.20 ± 0.31 7.30 ± 0.14 6.18 ± 0.17 ESR (mm / h) 14.92 ± 0.88 6.18 ± 0.44 6.06 ± 0.43 MDA (nmol / ml) 3.8 ± 0.12 2.90 ± 0.11 2.73 ± 0.2 DC (μmol / ml) 2.52 ± 0.10 1.44 ± 0.11 1.96 ± 0.21 GST (mol / min × ml) 0.96 ± 0.02 1.45 ± 0.04 1.43 ± 0.05 GPO (μmol / min × ml) 2.94 ± 0.19 3.76 ± 0.21 3.97 ± 0.05 SOD (conventional units / ml) 1.70 ± 0.01 1.80 ± 0.02 1.79 ± 0.04 Catalase (μmol · 10 ³ / min × ml) 14.89 ± 0.12 15.92 ± 0.18 15.12 ± 0.10 Interleukin-1β (pg / ml) 211.39 ± 8.20 94.51 ± 5.29 65.43 ± 1.21 Interleukin-4 (pg / ml) 141.24 ± 3.76 81.7 ± 4.74 58.68 ± 1.74 Tumor Necrosis Factor-α (pg / ml) 201.21 ± 6.13 120.45 ± 3.91 58.84 ± 1.43

Combination therapy helps to reduce the inflammatory process in children with chronic adenoiditis.

The technical result of the present invention is to increase local and general immunization and improve the treatment results of chronic adenoiditis and tonsillitis in children by reducing treatment time. A universal approach to understanding the mechanisms of the functioning of the immune system and antioxidant defense in the development of chronic inflammation has allowed the development of therapy for chronic adenoiditis and tonsillitis. Integrative development and implementation of a combination therapy method using, according to a certain scheme, established experimentally, adequate sanitation, physiotherapy and the use of a non-toxic, harmless drug obtained from environmentally friendly natural raw materials, minimizing the risk of adverse and allergic reactions and having immunomodulating, metabolic, eradication effects provides local and systemic immunocorrection, combined with a high prolonged clinical effect vnostyu.

Claims (1)

A method for the treatment of chronic adenoiditis and tonsillitis in children, including sanitizing and immunocorrecting therapy, characterized in that sanitizing therapy is carried out with 0.9% sodium chloride solution at a temperature of 37-40 ° C daily according to one procedure for 7-10 days, then additionally, light therapy is performed by exposing the bridge of the nose and / or the left and right sides of the neck to incoherent polarized light with a wavelength of 400-2000 nm, with a light energy flux density per minute of 2.4 J / cm ² and a degree of polarization at the output of 95-98% of 5 -10 min daily for of 7-10 days, and drug therapy is immunotherapy "Tonsilotren" Sublingual 30-60 minutes before meals 3 times daily in 6-8 hours at 125-500 mg for 7-10 days.