RU2464054C1 - Method of complex regional lymphothropic therapy of acute othelcosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely otorhinolaryngology, and may be used in complex therapy of acute othelcosis. Low-frequency ultrasound is used to introduce ceftriaxone phonophoresis through an eardrum into a tympanic cavity for 10 seconds. Then 5 minutes later, it is followed by the phonophoretic introduction of ceftriaxone and lidase in equal proportions into mastoid, preauricular and submandibular lymph nodes for 15 seconds. The therapeutic course is 5 daily procedures.

EFFECT: method provides higher conservative clinical effectiveness in the patients with acute othelcosis ensured by additional pathogenetic lymphotropic exposure on the region of middle ear.

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Description

The invention relates to medicine, in particular otorhinolaryngology, and may find application in the conservative treatment of patients with acute otitis media.

There is a method of local treatment of acute otitis media at the preperforative stage of inflammation by bringing osmotically active drugs (furatsilinovy, boric alcohol, otinum, otipax) to the eardrum, which make its epidermis more loose, cause osmotic currents from the tympanic cavity to the ear canal, thereby reducing exudate pressure on the walls of the tympanic cavity [Temkin Ya.S. Acute otitis media and its complications. - M: MEDGIZ, 1955-200 p .; Grigoryan K.I. Otipax in the treatment of acute otitis media in children / K.I. Grigoryev, A.K. Grigoryan, A.M. Zaprudov // Russian Bulletin of Perinatology and Pediatrics. - 2000. - No. 2. - S. 45-48]. Some authors, as a means of enhancing the penetration of substances through the eardrum, use a solution of dimethyl sulfoxide, filling them with the auditory meatus [Diskalenko, V.V. Our experience in the use of dimethyl sulfoxide in the treatment of acute otitis media / V.V.Diskalenko, I.V. Vinogradova // Russian otorhinolaryngology. - 2005. - No. 2 (15). - S. 44-47].

The disadvantage of these methods is that they cannot be attributed to etiotropic, as they do not directly affect the pathological lesion in the tympanic cavity, as a result, there is no local bactericidal and bacteriostatic effect.

In the perforated stage of acute otitis media, a method of local treatment is known by introducing antibiotics, antiseptic solutions into the tympanic cavity through a point or slit-like opening of the tympanic membrane by instillation or washing of the external auditory canal. To better get the drug into the tympanic cavity using a special device (an obturator, a rubber balloon with a manometer), the drug solution is pumped under high pressure [Ageenko I.V. Treatment of perforated purulent otitis media with the introduction of medicinal solutions in a controlled mode / I.V. Ageenko, V.A. Chaukina, M.A. Rymsha // Russian otorhinolaryngology. - 2004 - No. 6. - S.3-5].

The disadvantage of this method is that only instillation and washing of the auditory canal with point and slit-like perforations, which are characteristic of acute otitis media, do not provide sufficient resorption of exudate from the tympanic cavity due to the low concentration of antibiotic due to the relatively weak flow of washing liquid. The injection of drugs under high pressure can lead to an additional rupture of the eardrum, an increase in the perforation area and the transition of the acute process to a chronic course.

A common drawback inherent in all of the above methods of local treatment of acute otitis media is the lack of medication with them on the lymphatic region of the middle ear (lymph nodes, blood vessels, tissue interstitium), where there is drainage and detoxification of tissue fluid and lymph.

The objective of the invention is to increase the effectiveness of conservative treatment of patients with acute otitis media by using the principles of regional lymphotropic therapy using low-frequency ultrasound.

The problem is solved in that by means of low-frequency ultrasound, ceftriaxone ultraphonophoresis is carried out through the tympanic membrane in the tympanic cavity for 10 seconds, after 5 minutes, a mixture of ceftriaxone and lidase is administered in equal volumes into the mastoid, pre and submandibular lymph nodes within 15 minutes; the course of treatment is 5 daily procedures.

The method is as follows.

To create an antibiotic depot in the tympanic cavity, endourally, ceftriaxone ultraphonophoresis is performed through the tympanic membrane. For this patient, they are brought to a horizontal position on the back with the head turned to a healthy ear. Before contact with the eardrum, a 3 cm gauze swab moistened with a solution of ceftriaxone is introduced into the external auditory canal of the affected ear. The ultrasonic generator is tuned to a resonant frequency of 25-26 kHz. The end of the waveguide with a diameter of 4 mm is tightly brought to the gauze swab, after which the sound of the eardrum through the swab with the drug is made for 10 seconds for the latter to penetrate into the tympanic cavity.

After 5 minutes, a mixture of lidase with ceftriaxone in equal volumes is successively ultraphonophoretically injected into the lymph nodes of three points of the mastoid process (below the temporal line, projection of the cave, apex), from the front wall of the auditory meatus (tragus region), in the projection of the angle of the lower jaw and, departing from it is 5 cm in the submandibular region. Only 6 points. Sounding of each zone of the regional lymph nodes is carried out for 15 seconds using a special waveguide with a flattened end face with a diameter of 1 cm through a gauze cloth, abundantly moistened with a mixture of medicinal substances and laid in the appropriate areas. The course of treatment is 5 daily procedures.

A clinical study of the effectiveness of an integrated method of regional lymphotropic therapy was carried out in 36 patients with acute otitis media who were treated in the ENT department of the regional clinical hospital in Omsk. In all cases, there was unilateral otitis media. In 20 patients, it proceeded in the first preperforative stage, in 16 - in the perforation stage. Using simple randomization, patients are divided into 2 groups (main and control) of 18 people. In both groups, the ratio between males and females was the same, the age of the patients ranged from 6 to 24 years, the duration of the disease before treatment was no more than 3-5 days. In the structure of complaints prevailed: pain, noise in the ear, feeling of stuffiness, hearing loss. The general condition of the patients was satisfactory, however, all had a temperature reaction from sub- to febrile numbers. The main clinical sign characterizing the state of the tympanic cavity in acute inflammation was the presence of hyperemia, vascular injection, swelling, swelling of the tympanic membrane, lack of differentiation of the identification signs of the eardrum, mucopurulent discharge in the ear canal, slit-like or punctate perforation of the tympanic membrane. In 4 patients mild pain was observed during palpation of the mastoid process and smoothness of the posterior superior angle, which is regarded as a phenomenon of periostitis. There were no differences in the structure of complaints and clinical manifestations in the compared groups.

During treatment, patients of both groups were prescribed general antibacterial therapy, vasoconstrictor drops in the nose, and a half-alcohol compress on the sore ear. Local treatment in the control group was carried out in the traditional way, in the main group by the method of complex ultrasound regional lymphotropic therapy. The effectiveness of treatment of patients was determined by assessing their general condition, data from clinical and laboratory research methods, the condition of the eardrum (color, visual consistency, identification marks), the state of the hearing function and airiness of the tympanic cavity (live speech examination, tonal threshold audiometry, impedance measurement). The examination phase included three periods: on the day of admission, after the end of the course of treatment (on the 8-10th day of hospital stay), and 1.5-2.0 months after discharge from the hospital (long-term period). The results obtained during the dynamic inspection are confirmed by a set of nonparametric methods of comparative statistical analysis.

When studying the immediate results of treatment of patients, greater efficiency of the method of complex ultrasound regional lymphotropic therapy, carried out in the main study group, was clinically expressed, which was clinically expressed in earlier relief of the main symptoms of inflammation, restoration of airiness of the tympanic cavity, hearing function, and reduction of treatment time. On the 4th day, cessation of pain in the ear was observed in 15 patients (83.3%) of the main group, in 11 patients (61.1%) of the control group. On the 6th day of treatment, the eardrum acquired normal color with distinct contours in the main group in 15 patients (83.3%), in the control group in 10 patients (55.5%). The cessation of suppuration with scarring of the slit-like perforation in the main group occurred from 6 to 8 days, in the control group from 9 to 14 days. The restoration of hearing function in the main group was from 5 to 10 days, in the control group from 7 to 12. The duration of treatment in the main group was 10 ± 0.6 f / d, in the control - 12 ± 0.7 k / d. The differences are statistically significant.

Long-term results of treatment were studied in 14 patients of the main group, where in all cases there was a complete restoration of hearing and airiness of the tympanic cavity. In the control group of 14 patients examined, in 1 case there was a relapse of otitis media, 4 had deviations in the peak of compliance, indicating tubular dysfunction.

Clinical example: Patient S., 12 years old, medical history No. 1801168, was hospitalized in the ENT department of the Omsk Regional Clinical Hospital with a diagnosis of Left-sided acute otitis media, stage 1. Upon admission, he complained of intense growing pains in his left ear, which bothered for the past 3 days. He became acutely ill after suffering an acute respiratory viral infection. On examination, the general condition of the patient is closer to satisfactory, temperature 36.8 ° C, clear consciousness, active. The ear region of the right ear is not changed, there is no discharge in the auditory canal, the eardrum is sharply hyperemic, infiltrated, the identification marks do not differentiate, the smoothness of the upper back corner. Hearing: whispering speech is perceived from a distance of 1 meter, conversational - from 3 meters. With tonal threshold audiometry, a conductive form of hearing loss was revealed with an increase in EP thresholds to 20 dB in the area of speech frequencies. With acoustic impedanometry, the compliance peak is not expressed on the side of inflammation - tympanogram type “B”.

Against the background of general treatment, 5 sessions of complex ultrasound regional lymphotropic therapy in the right ear and regional lymph nodes were performed according to the method described above. As a result of treatment on the 8th day, the patient's hearing restored to the perception of whispering speech from a distance of 6 meters. The tonal thresholds of hearing in air conduction came to a normal level. Otoscopically eardrum of gray color with identification marks. With acoustic impedance measurement, the peak of compliance was clearly identified. As a result, the child completed the course of treatment of complex ultrasound regional lymphotropic therapy with complete recovery.

Claims (1)

A method for complex regional lymphotropic therapy of acute otitis media, including the effect of drugs on the tympanic cavity, characterized in that, using low-frequency ultrasound, ceftriaxone is carried out through the tympanic membrane for 10 seconds, after 5 minutes, a mixture of ceftriaxone and lidase is introduced into the phonophoresis in equal amounts volumes in the mastoid, aortic and submandibular lymph nodes for 15 s; the course of treatment is 5 daily procedures.