RU2438614C1 - Method of treating chronic hypertrophic pharyngitis in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, otorhinolaryngology, and can be used for treating chronic hypertrophic pharyngitis in children. For this purpose, granules of a posterior oropharyngeal wall are exposed to a cryoapplicator cooled in liquid nitrogen. The exposure covers no more than 3-4 granules for no more than 5-7 seconds each without regard to hypertrophied tissue volume. Length of the treatment makes 1 session.

EFFECT: method allows providing higher clinical effectiveness in chronic hypertrophic pharyngitis in children ensured by cryoapplication stimulation of the cell immunity and improved response of protective properties of a patient's pharyngeal lymphoid ring.

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Description

The invention relates to medicine, namely to otorhinolaryngology, and is intended for the treatment of chronic hypertrophic pharyngitis in children.

There are various methods of treating chronic hypertrophic pharyngitis.

Inhalation therapy became widespread in the 20th century: warm inhalations in the form of a coarse aerosol decoction of chamomile flowers, sage leaves, eucalyptus, alkaline mineral water in various combinations with oil mixtures (for example, rosehip, sea buckthorn) [1].

There is a method of treating chronic hypertrophic pharyngitis in areas with a high content of airborne and hydroaerons: sea coasts, mountainous regions [1].

Known methods of treating chronic hypertrophic pharyngitis by cauterization of the granules of the pharynx medically or by physical action. After anesthesia, the granules are cauterized with silver nitrate or trichloroacetic acid, as a result of which the granules undergo superficial necrosis and their irritating effect is eliminated [1].

However, the above methods are ineffective and do not allow to achieve the healing effect of the patient. The patient receives massive “aggression” on the mucous membrane of the oropharynx, comfortably feels improvement for a short period (from practice, maximum 14-35 days), after which the symptoms of chronic pharyngitis resumes.

The closest analogue in technical essence and the achieved effect is a method of treating chronic hypertrophic pharyngitis by cryotherapy. The method is as follows. Cryoprobe or cryoapplicators are used as instruments, which are cooled immediately before manipulation in a vessel with liquid nitrogen. To remove the pharyngeal reflex, the mucous membrane of the pharynx, root of the tongue, soft palate is lubricated with a 3-5% cocaine solution once, only with an increased gag reflex, the lubrication is repeated. Under the control of vision, a cryoprobe is quickly inserted into the oropharynx cavity, pressing the tip against the granule or side roller. Exposure when using cryoprobes is 15-20 s, when using a cryo-applicator - 30-45 s when exposed to granules and 45-60 s when freezing side rollers. Depending on the age of the child, his behavior, the degree of prevalence of hypertrophic sections of lymphadenoid tissue in the throat, in a known manner, all or most granules are frozen in one session, and the application for one section is repeated up to 4-5 times in one session. The number of cryotherapy sessions per treatment cruise is 3-5 times. The interval between sessions is 6-7 days [2].

It is known that a cryoapplicator is cooled in a vessel with liquid nitrogen to a temperature of minus 80 degrees Celsius. The use of cold for a long time in pediatric otorhinolarynology can lead to adverse consequences.

Numerous studies confirm that prolonged application with cold leads to the following irreversible consequences:

1) significant dehydration of cells during the formation of ice extra- and intracellularly, leading to a sharp increase ("lethal concentration") of electrolytes in the cells;

2) mechanical damage to cell membranes with sharp ice crystals, squeezing of cell bodies with these crystals;

3) denaturation of phospholipids in cell membranes;

4) cessation of protoplasm mobility (the so-called "thermal shock");

5) the cessation of blood circulation in a frozen volume of tissue, leading to the development of a focus of ischemic necrosis.

Exposure to granules by cold for 15-45 s on each granule and lateral ridges for 45-60 s leads to deep damage to the tissues of the oropharynx and their necrosis. As a result, massive areas of sclerotic tissue appear on the oropharynx stacks, which cannot provide microcirculation (circulation) near the epithelium, which leads to subatrophic pharyngitis, the treatment of which does not give a positive result at any age.

The objective of the invention is to provide a more effective method of treating chronic hypertrophic pharyngitis using cryotherapy.

The technical result of the claimed invention is to increase the effectiveness of the treatment of chronic hypertrophic pharyngitis in children by stimulating by means of cryoapplication of cellular immunity and increasing the reactivity of the protective properties of the lymphadenopharyngeal ring of the patient.

The specified result is achieved by the fact that in the method of treating chronic hypertrophic pharyngitis, including exposing the granules of the posterior wall of the oropharynx to a cryoapplicator cooled in liquid nitrogen, the effect is carried out regardless of the volume of the hypertrophic tissue by no more than 3-4 granules for no more than 5-7 seconds per each, while the duration of treatment is 1 session.

Short-term exposure to cryoapplicators creates aseptic inflammation with the least alteration phase at the site of exposure. Short cryoapplication creates all the conditions for the "launch" of immunological complexes, which is confirmed at the cellular level and the clinical improvement of patients with pathology of the nasopharynx and oropharynx. Analysis of cytological smear preparations (fingerprints of the site of inflammation of the oropharynx) performed by the applicant shows that after treatment the rate of neutrophilic leukocyte emigration to the surface of the oropharynx decreases by half, and the number of lymphocytes and fibroblates increases, which creates confidence in the immunological response to this method treatment. It was experimentally established that quantitative changes in the intensity of leukocytes on the surface of the mucous membrane of the oropharynx and changes in their qualitative composition, the appearance of a large number of unchanged cells also increase phagocytic activity, resulting in a decrease in the number of eosinophils and the dominant number of neutrophils and lymphocytes. This phenomenon can be regarded as an increase in the protective properties of the body as a result of short-term exposure to the cryoapplicator. Thus, the short-term exposure of the cryoapplicator to several granules stimulates cellular immunity, which makes it possible to judge the creation of “soil” to increase the reactivity of the protective properties of the lymphadenopharyngeal ring in a child.

It is known that the mucous membrane, in particular the posterior wall of the oropharynx, has a complex of factors of nonspecific and specific immune defense and serves as a reliable barrier to the penetration of pathogens. After a short-term exposure of the cryoapplicator to several granules of the posterior wall of the oropharynx, the cellular elements of nonspecific protection of the oropharynx (mainly polymorphonuclear neutrophils and macrophages) trigger a chain of redox reactions that lead to the death of a foreign cell captured by phagocytes. In this case, the local inflammatory process may be aggravated, caused by the aggressive influence of free radicals on the cell membranes of the posterior wall of the oropharynx. Specific immune defenses include derivatives of T-helophyte helper cells (SB4). They also stimulate non-specific immune defense of the posterior wall of the hypertrophic part of the oropharynx. Helper T-lymphocytes can both multiply the local response to the appearance of a foreign agent and directly destroy the foreign agent itself. The indicated process develops both in relation to the granules subjected to short-term cryoapplication, and to the granules not subjected to it. Thus, all areas of chronic inflammation of the oropharynx are localized.

This is confirmed by long-term monitoring of patients who were treated in this way. In children, relapses of upper respiratory tract diseases decreased: adeoiditis, acute tonsillitis, acute rhinopharyngitis and their complications. Short-term cryoapplication for no more than 5-7 seconds to the granules of the posterior pharyngeal wall does not allow reaching the moment of transition of the tissues to the state of crystallization (paranecrosis), conditions are created for the further reparative and eliminating process. The exposure time was selected experimentally. The criterion for the sufficiency of the impact of the cryoapplicator on the granules of the posterior wall of the oropharynx is the beginning of a change in the color of the tissue (the treated area begins to fade and becomes white).

A longer exposure time to the tissues leads to their paranecrosis, which is undesirable in this method of treatment.

The applicant experimentally established that, regardless of the degree of hypertrophy of the tissues of the oropharynx of the child, it is sufficient to act with a cryoapplicator on 3-4 granules of the posterior wall of the oropharynx. The course of treatment is one session. This is enough to force the body to “launch” immunological complexes, due to which, among other things, localized zones of chronic inflammation (granules, lateral ridges) that were not exposed to the cryoapplicator were localized. The advantages of the proposed method are physiological and ease of use, astressor in childhood.

The method is as follows.

Prior to the procedure, the patient is given antihistamines in an age dose for three days. To remove the pharyngeal reflex, the mucous membrane of the posterior pharyngeal wall, root of the tongue, soft palate is smeared with 3% solution of dicain or another similar drug once, with an increased gag reflex, the lubrication is repeated. After anesthesia, dry cotton swabs drain the cavity of the oropharynx from saliva. The tongue is squeezed with a spatula from front to bottom, under the control of vision, the cryoapplicator cooled in liquid nitrogen is quickly inserted into the oropharynx cavity, pressing the tip against the granule of the posterior wall of the oropharynx. The impact is carried out for no more than 5-7 seconds per granule. Immediately after the cryoapplicator is removed, the tissue site, subjected to a short exposure, becomes white and compacts, after 10 seconds the white color disappears. On the first day after cryoexposure, hyperemia of the mucous membrane of the oropharynx intensifies, the granules become yellowish. On the second day, hyperemia of the mucous membrane increases, a slight swelling appears around the focus of local exposure. On the third day in these places a delicate whitish-yellow plaque is clearly detected, which lasts, as a rule, for 6-7 days. On the fourth day, hyperemia and edema decrease, on the fifth day, edema disappears, hyperemia is insignificant. On 6-7 days, plaque is rejected, after which there is a significant decrease in the size of the granules. In places of local exposure by cryoapplicator, delicate scars are formed, which are distinguished by a lighter color in comparison with the surrounding tissues. Irregularities in the mucous membrane of the posterior pharyngeal wall are sometimes noted. Patients tolerate the intervention easily. In the first two days, complaints of slight sore throat when swallowing are possible. Sometimes in the first three days subfebrile body temperature is possible. Observation and examination for six months allow us to conclude that, objectively, normalization of the mucous membrane of the oropharynx is observed in all patients, hyperemia decreases or granules are absent, and granules are absent.

The effectiveness of the proposed method of treatment is confirmed by the following examples.

Example 1

Patient M., 12 years old, turned to the ENT office complaining of a prolonged cough at night. During the day I experienced a feeling of coma and sore throat, fatigue. It has long been treated with affordable drugs. During the examination, the diagnosis of hypertrophic pharyngitis was established. The treatment was carried out according to the above method: one cryoapplication session for 3 granules of the posterior oropharynx for 3-4 seconds each. After treatment, the patient disappeared symptom complex of chronic hypertrophic pharyngitis, a long-term somatic recovery.

Example 2

The mother of the child P., aged 5 years old, complained. Complaints of a prolonged cough, accompanied by attacks at night and in the daytime, as well as prolonged subfebrile condition for three months. The child underwent prolonged antibiotic therapy, physiotherapy, and spa treatment. The effect was minimal. On the second day after treatment by the claimed method: one cryoapplication session for 3 granules of the posterior oropharynx for 4-5 seconds each, coughing stopped, the temperature returned to the sixth day, laboratory data returned to normal within fifteen days. Diagnosed with somatically healthy.

Example 3

Parents of patient V., age 4.5 years, complained of coughing the child during the day. The child for a long time experienced a feeling of "sand" in the throat. Examined by a pediatric neurologist, psychiatrist. The examination was diagnosed with hypertrophic pharyngitis. In this way, a single cryoapplication was performed on 3 granules of the posterior wall of the oropharynx for 2 seconds each. On the sixth day after treatment by the claimed method, the child’s foreign body sensation passed, coughing stopped.

Example 4

Patient A., 14 years old, for a long time (for five years) could not afford to consume spices in food. This was accompanied by prolonged coughing and vomiting. It has been treated for a long time with a pediatrician, neurologist, allergist. There were no results. At an appointment with an otorhinolaryngologist, he was diagnosed with chronic hypertrophic pharyngitis. A single cryoapplication was performed on 4 granules of the posterior wall of the oropharynx for 5-7 seconds each. On the 15th day after treatment, the patient was able to eat spicy food.

Example 5

Parents of patient P., 3 years old, complained of a prolonged paroxysmal cough of the child at night. The child was examined by an infectious disease specialist, a pulmonologist, an immunologist. When contacting an otorhinolaryngologist, he was diagnosed with hypertrophic pharyngitis. The treatment was carried out according to the claimed method: one cryoapplication session for 3 granules of the posterior oropharynx for 1-2 seconds each. On the second day, the child did not have a paroxysmal cough. Observation of the child for two months, paroxysmal cough did not resume.

Information sources

1. "Guide to otorhinolagology", edited by I. B. Soldatov, 2nd ed., Revised. and add. - M .: “Medicine”. - 1997.

2. I.I. Potapov, P.G. Rudnya, L.S. Tarlycheva, B.V. Shevrygin "Cryosurgery in otorhinolaryngology." - M .: “Medicine”. - 1975.

Claims (1)

A method for the treatment of chronic hypertrophic pharyngitis, comprising exposing the granules of the posterior wall of the oropharynx to a cryoapplicator cooled in liquid nitrogen, characterized in that the effect is carried out regardless of the volume of the hypertrophic tissue by no more than 3-4 granules for no more than 5-7 s each , while the duration of treatment is 1 session.