RU2510757C2 - Method of treating aggravated chronic laryngitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely otorhinolaryngology, phoniatrics and physiotherapy and may be used for the integrated treatment of aggravated chronic laryngitis. Starting from the 4-5th day from the aggravation, a standard drug therapy is additionally combined with an endolaryngeal injection of specific pyobacteriophague 1 ml and further exposure to low-frequency vibration covering 3 fields of the larynx and phonopaedic breathing exercises. The low-frequency vibration starts at a first filed comprising side neck surfaces at frequency 20 Hz per 1 filed with a vibratode advanced smoothly upward at 2-3 mm/sec with undisplaced skin and rectangularly up to a mandibular angle, and then downwards to a posterior triangle of neck for 1-2 minutes from each side; the patient does the phonopaedic breathing exercises and pronounces expiratory 'M'; that is followed by the vibrational exposure covering a projection of intersection of a thyroid cartilage plate and a border of sternocleidomastoid muscle (m.sternocleidomastoideus) at a thyroid cartilage notch at frequency 40 Hz and 60 Hz for 1-2 minutes from both sides according to the stable technique; the patient does the phonopaedic breathing exercises and pronounces expiratory vowels 'U', 'O', 'A'; that is followed by vibration of a collar at frequency 30-40 Hz with the vibratode advanced from a paravertebral line to a shoulder joint for 2-3 minutes from each side; the technique is labile. The course performs 8-10 combined daily procedures.

EFFECT: method enables higher clinical effectiveness ensured by the integrated effect on the patient's immune system in a combination with the drainage, anti-inflammatory, and trophic stimulating effects.

11 tbl, 2 ex

Description

The invention relates to medicine, namely to otorhinolaryngology, phoniatrics and physiotherapy and can be used in the complex treatment of exacerbation of chronic laryngitis

The treatment of inflammatory diseases of the larynx in people with voice and speech professions in the last decade is becoming increasingly important [1, 6, 9].

There has been a tendency to increase this category of patients, due to an increase in the number of viral respiratory diseases and other causes. About 80-90% of patients suffering from this pathology are people of working age. With this pathology, such vital functions as the voice-forming and respiratory are disrupted, which often leads to prolonged disability of patients - voice professionals, which in general is a very difficult medical and social problem [1, 5, 9].

A known method of treating chronic hyperplastic laryngitis by directly introducing into the vocal folds or subglottic space of the intralaryngeal inducers of interferon - poludan or cycloferron [3].

The disadvantage of this method are:

1. Injection into the under-storage space is allowed only in stationary conditions, and not on an outpatient basis;

2. Injections into the vocal folds or the subclavian space are dangerous for the development of complications, such as hemorrhage, abscesses, which is unacceptable for people with voice and speech professions.

There is also a method of treating chronic hyperplastic laryngitis by the method of removing altered sections of the mucous membrane of the larynx within its own plate and the appointment of an interferon inducer - amixin [4].

The disadvantage of this method are:

1. The need for these procedures in stationary conditions;

2. The development of post-injection complications;

3. A significant increase in the cost of treatment.

There is a method of complex treatment of exacerbations of chronic laryngitis using acupuncture and phonopedic breathing exercises [2].

The disadvantage of this method are:

1. The duration of treatment;

2. The need for appropriate conditions for acupuncture;

3. The need for a special qualification of a doctor, acquisition of a license to master this method.

Closest to the claimed, selected for the prototype, is a method of treating laryngitis using ultrasound (phonophoresis). The action of ultrasound is based on mechanical (micromassage of tissue and cells) and thermal factors [8].

The disadvantage of this method are:

1. The inability to use in the acute stage of the disease or exacerbation of chronic;

2. The effect of treatment in the long term is more pronounced than after the end of the course of treatment (after 1.5-2 months).

3. Sufficiently long periods of disability.

The objective of the invention is the availability, ease of use, increasing the effectiveness of treatment with a significant reduction in the period of disability of patients - persons of voice and speech professions.

To solve the problem in a method of treating exacerbation of chronic laryngitis by exposure to a physical factor on the larynx area against the background of traditional drug therapy, from 4-5 days of the onset of an exacerbation of the disease, endolaryngial infusion of a specific pyobacteriophage in the amount of 1 ml is performed, and the effect is performed by low-frequency vibration massage of the larynx region with simultaneous phonopedic breathing exercises, while the low-frequency vibration massage begins with exposure to the 1st field, including its lateral surfaces of the neck with a frequency of 20 Hz in 1 field, smoothly moving vibrato up at a speed of 2-3 mm / s without displacement of the skin, in straightforward movements to the angle of the lower jaw, then down to the supraclavicular region for 1-2 minutes on each side, while the patient performs phonopedic breathing exercises with the pronouncing of the sound “M” during each exhalation, then vibro massage is performed on the second field, including the projection area of the intersection of the plate of the thyroid cartilage and the edge of the sternocleidomastoid muscle (m.sternocleidomast oideus) at the level of excision of the thyroid cartilage with a frequency of 40 Hz and 60 Hz for 1-2 minutes on both sides according to a stable method, while the patient performs breathing phonopedic exercises on the exhale with the pronunciation of vowels “U”, “O”, “A” , at the third stage they are exposed to vibro massage on the third field, including the collar area at a frequency of 30-40 Hz, while the vibratodes are moved from the paravertebral line to the shoulder joints for 2-3 minutes on each side, the procedure is labile. In total, the course performs 8-10 combined procedures received daily.

The method is as follows

Against the background of drug anti-inflammatory treatment in accordance with the standards, starting from 4-5 days of exacerbation of the disease, 1 ml of specific pyobacteriophage is additionally administered, followed by exposure to low-frequency vibration massage on 3 fields of the larynx and simultaneous phonopedic breathing exercises, while low-frequency vibration massage starts from the first field, including the lateral surfaces of the neck with a frequency of 20 Hz per 1 field, smoothly moving vibrato up at a speed of 2-3 mm / s without shifting the skin, directly by linear movements to the angle of the lower jaw, then down to the supraclavicular region for 1-2 minutes on each side, while the patient performs phonopedic breathing exercises with the uttering sound “M” during each exhalation, then vibromassage the area of the projection of the intersection of the plate of the thyroid cartilage and the edges of the sternocleidomastoid muscle (m.sternocleidomastoideus) at the incision level of the thyroid cartilage with a frequency of 40 Hz and 60 Hz for 1-2 minutes on both sides according to a stable technique, while the patient performs a phonopedic breathing on exhalation with pronouncing vowels "U", "O", "A", in the third stage, vibromassage of the area including the collar zone at a frequency of 30-40 Hz is performed, while the vibratodes are moved from the paravertebral line to the shoulder joints for 2- 3 minutes on each side, the procedure is labile; in total, 8-10 combined procedures received daily are performed on the course.

It is known that exacerbation of chronic laryngitis begins most often either with hypothermia of the patient, or with a viral infection. However, as shown by numerous data [6, 10, 11, 12], a bacterial infection that begins to play an important role very quickly in this process.

An increase in the resistance of microorganisms and a change in the etiological structure of laryngeal infections indicate the need for a review of therapeutic approaches, in particular, it is relatively advisable to prescribe antibacterial drugs in this situation [7, 14]. Both in our country and abroad, interest in therapeutic bacteriophages reappears. One of these drugs is a purified polyvalent liquid pyobacteriophage, approved by the Chief State Sanitary Doctor of the Russian Federation G.G. Onishchenko on December 16, 2005 as a broad-spectrum antibacterial agent. The antibacterial effect of the drug is due to the specific lysis of pathogenic bacteria in the focus of inflammation under the action of bacteriophages. Regardless of the method of administration of the drug, bacteriophages penetrate the blood and lymph and enter the focus of inflammation. It was found that pyobacteriophage stimulates the regeneration processes, has a stimulating effect on the patient’s immune system. Positive qualities of bacteriophages were noted: the absence of toxic effects on the body, the development of allergic reactions, dysbiosis [7, 13].

The need to start vibration massage with a low frequency of 20 Hz is due to its draining, anti-inflammatory, trophostimulating effects, which prepare the larynx for a more intense vibration massage in order to further restore the voice. The frequency sequence (20 Hz, 40 Hz, 60 Hz) also takes into account the fact that, first of all, when voice is restored, low-frequency overtones appear, and later high-frequency ones, so vibration massage is performed starting from a low frequency of 20 Hz. "Imposing" the necessary frequency of oscillations of the vocal folds, while exerting a training effect on the vocal folds, preparing them to pronounce higher sounds, which takes place with further voice correction, vibration massage is performed with a gradual transition to higher frequencies: 40 Hz and 60 Hz .

The sequence of procedures is endolaryngial infusion of the pyobacteriophage and subsequent phased vibration of the larynx region due to the additional effect of vibrophoresis of the pyobacteriophage due to increased blood flow vibration and increased absorption capacity of the mucosa, during which phonopedic gymnastics is performed with the pronunciation of phonemes “M”, “O”, "," U ".

As an example of the method, we provide extracts from outpatient records of two patients.

Clinical examples

Example 1

Patient Mr. N.I., Dr. 02.24.56 g., The treatment period from 05.28.10 g. - 06.06.10 g.

Diagnosis: chronic catarrhal laryngitis, in the acute stage.

She complained of a lack of voice for 2 days, pain during phonation, shortness of breath, dry cough, sore throat. Ill acutely.

Objectively: the larynx - the mucous membrane is hyperemic, sharply swollen, the lumen of the larynx is narrowed, the elements of the larynx are smoothed. True vocal folds are pink, with phonation, the closure is complete.

Auditory assessment of voice: hoarse, hoarse voice, pronounced dysphonia (4), aspiratory attack - solid.

Computer voice analysis: HNR signal-to-noise ratio was 13.3 dB, Jitter was 1.0%, Shimmer was 10.8%.

Laryngostroboscopy: oscillations are slowed down, there is no vertical component in the opening phase, negative stroboscopic comfort.

Functional voice tests were significantly shortened: I - 8 s, O - 8 s, Y - 8 s, A - 11 s, E - 11 s.

Bacteriological analysis of microflora from the laryngeal mucosa - St. aureus.

Ultrasound of the thyroid gland - no echoscopic changes were detected.

The treatment was prescribed according to the proposed method: voice rest, general and local anti-inflammatory drug treatment in accordance with the standards, installation of the pyobacteriophage, as well as after the vibration procedure with exposure to 3 fields: 1st field: lateral surface of the neck, labile technique, frequency 20 Hz 30 s on each side; 2nd field: the technique is stable, the impact on the region of the anterior surface of the sternocleidomastoid muscle at the level of the upper edge of the notch of the thyroid cartilage with a frequency of 40 Hz for 30 s and with a frequency of 60 Hz for 30 s on each side; 3rd field: the collar zone from the paravertebral line at the level of C5-C7 to the shoulder area at a frequency of 30-40 Hz and an exposure of 1 minute on each side.

The patient tolerated the prescribed treatment well. By the 4th day of treatment, I felt an improvement in overall health and mood. Upon completion of treatment, the voice recovered completely.

Auditory assessment of voice in dynamics: before treatment, the patient's hoarse voice corresponded to the most pronounced degree (4). After treatment, the voice recovered to normal (0) in the shortest possible time of 8 days (Table 1).

The laryngoscopic picture in dynamics normalized.

Computer analysis of voice showed an improvement in some objective ways.

The signal-to-noise ratio HNR increased from 13.3 dB to 20.9 dB (57%). Jitter and Shimmer indices decreased to optimal values: Jitter - from 1.0 to 0.34 (by 66%), Shimmer - from 10.8 to 3.4 (by 78%), which determines the positive dynamics of changes in the patient’s functional state (Table 2).

According to electronic stroboscopy, the index of vibratory insufficiency (IVN) decreased from 1.6 to 1, which corresponds to the norm (Table 3).

The average Navy value before treatment was 8.4 seconds, after treatment - 12.2 seconds - increased by 45% (Table 4).

Thus, according to all subjective and objective indicators as a result of treatment, improvement has come. Disability period - 7 days.

Based on the totality of clinical and paraclinical data, the result of treatment was assessed as “recovery” in the shortest possible time.

Example 2

Patient Ia L.A., Dr. 09/29.60, the treatment period 2.01.11-10.01.11.

Diagnosis: chronic catarrhal laryngitis in the acute stage.

Dysphonia of a pronounced degree.

The patient complained of a hoarse voice for 3 weeks, dry cough, sore throat. From the anamnesis: voice loss occurs 3-4 times a year, its appearance is associated with a cold and excessive voice load.

Objectively: the voice is hoarse, hoarse, pronounced dysphonia (4), aspiratory attack is solid.

Larynx - the mucous membrane is moderately hyperemic, the true vocal folds are thickened, injected. The free edge is rounded in the form of a spindle, the mucous membrane is somewhat thickened in the middle of the true vocal folds. With phonation, the closure is incomplete, the closure defect is determined in the form of a triangle with a base in m / h space.

Computer voice analysis: HNR signal-to-noise ratio was 17.07 dB, Jitter was 0.63%, Shimmer was 3.72%.

Laryngostroboscopy - asynchronous oscillations, changes in the phase of opening and closing, changes in the amplitude and synchronism of oscillations, stroboscopic comfort are negative.

Clinical and laboratory data did not reveal significant changes.

Ultrasound of the thyroid gland is the norm.

Bacterial analysis - S. Aureus.

The treatment was prescribed according to the proposed method: voice rest. General and local anti-inflammatory drug treatment in accordance with the standards. As well as the installation of the pyobacteriophage 1 ml endolaryngially followed by a vibration procedure with exposure to 3 fields: 1st field: lateral surface of the neck, labile technique, frequency 20 Hz for 1 minute on each side; 2nd field: the technique is stable, the impact on the region of the anterior surface of the sternocleidomastoid muscle at the level of the upper edge of the notch of the thyroid cartilage with a frequency of 40 Hz for 1 minute and with a frequency of 60 Hz for 1 minute on each side; 3rd field: the collar zone from the paravertebral line at the level of C5-C7 to the shoulder area at a frequency of 30-40 Hz and an exposure of 1 minute on each side. The course of treatment is 10 procedures.

The patient tolerated the prescribed treatment well. By 4-5 days of treatment, I felt an improvement in my voice. Feeling good and good mood.

Upon completion of treatment, the voice improved significantly. The auditory assessment of a voice with (4) a pronounced degree of dysphonia is normalized to (1), i.e. to mild voice changes.

The laryngoscopic picture improved overall from 2.5 to 0.33 points (Table 5).

Computer analysis of voice showed an improvement in terms of objective indicators: the signal-to-noise ratio HNR reached a value of more than 21 dB. Jitter and Shimmer decreased to optimal values: Jitter - below 0.4, Shimmer - below 3.4, which characterizes the dynamics of changes in the patient's condition as positive (Table 6).

Thus, according to electronic laryngoscopy, the index of vibratory insufficiency from 1.4 to treatment is set to 1, which corresponds to the norm (Table 7).

In the dynamics of the Navy, there is also an improvement in average indicators upward from 8.4 seconds to 15.2 seconds (by 33%) (Table 8).

Thus, according to all subjective and objective indicators as a result of treatment, improvement has come. Disability period is 8 days.

Based on the totality of clinical and paraclinical data, the result of treatment was assessed as “improvement” with minimal periods of disability.

The mode of the method is based on the analysis of clinical observation data. A clinical study was performed on 80 patients. Two groups of patients were studied: patients with exacerbation of chronic laryngitis (58 people), the treatment of which was carried out according to the developed method using vibromassage and bacteriophage therapy; and similar patients treated by the traditional method in accordance with existing standards (22 people). The treatment contributed to the actual disappearance or a significant reduction in the clinical manifestations of exacerbation of laryngitis (Table 9).

In the group after treatment according to the claimed method, the number of patients without signs of active inflammation increased by more than 2 times. Confirmation of the improvement of the patient’s condition as a result of using the claimed method was the dynamics of computer voice analysis data (table 10).

It was found that after treatment, the signal-to-noise ratio HNR increased from 16.41 + _4.41 to 18.79 + _3.93 dB at p <0.000 (by 14.5%). The performance of Jitter and Shimmer decreased to optimal values: Jitter - from 0.65 + _0.41 to 0.53 + _0.53 at p <0.025 (by 22.6%), Shimmer - from 6.05 + _3.82 to 4.26 + _2.48 at p <0.002 (42%), which determines the positive dynamics of changes in the condition of patients.

Comparing the results of treatment according to the claimed method with the treatment in accordance with the existing standard and with the treatment according to the prototype (Table 11), the shortest treatment time in the claimed method was revealed, the clinical effect appeared after the first vibration therapy procedure, a higher percentage of achieving complete restoration of the vocal apparatus function. All of the above indicates the advantages of the proposed method.

Information sources

1. Vasilenko Yu.S. Vote. Phoniatric aspects // M .: Energoizdat. 2002 .-- 480 p.

2. Gerasimova I.Yu., Osipov V.D. A method for the complex treatment of chronic functional voice disorders // Pat. 2,284,806; publ. 10/10/2006.

3. Grigoryan S. S., Demchenko E. V., Ivanchenko G. F. A method for the treatment of chronic hyperplastic laryngitis // Pat. 2214249; publ. 10/20/2003.

4. Demchenko E.V., Ivanchenko G.F., Grigoryan S.S., Prozorovskaya K.N. A method for the treatment of chronic hyperplastic laryngitis // Pat. 2,144,331; publ. 01/20/2000.

5. Demchenko E.V., Ivanchenko G.F., Novakovsky D.L. Modern aspects of clinical and laboratory diagnosis and treatment of chronic hyperplastic laryngitis // Quality of life. The medicine. - 2007. - P.35-38.

6. Kunelskaya N.L., Gurov A.V. Possibilities of using azalides in otorhinolaryngological practice // Medical business. - 2010. - No. 4. - 7 p.

7. Lazareva E.B. Bacteriophages and pectins in the correction of disorders of microbiocenoses in purulent-inflammatory processes .: Abstract. diss. doctor med. Sciences // M.- 2007. - 18 p.

8. Nikolaevsky V.P., Vasilenko Yu.S., Leontiev A.P., Minchenkova B.I. The therapeutic use of ultrasound in some inflammatory diseases and benign laryngeal formations. Methodical recommendations // M. - 1978. - 11 p.

9. Osipenko E.V. Anti-inflammatory therapy in the treatment of patients with chronic laryngitis // Bulletin of Otorhinolaryngology. - 2009. - No. 4. - S. 63-65.

10. Ryabova M.A., Nemykh O.V. Chronic laryngitis: principles of pathogenetic treatment // St. Petersburg. - 2010 .-- 139 p.

11. Svistushkin V.M. Empirical antibacterial therapy for acute inflammatory diseases of the upper respiratory tract // Russian Medical Journal. - 2005. - T.13. - No. 4. - S. 57-61.

12. Sturov N.V., Ushkalova E.A. Efficacy and safety of azithromycin in the treatment of upper respiratory tract infections // Farmateka. - 2008. - No. 4. - S. 65-68.

13. Fattakhov B.T. The use of pyobacteriophage in the treatment and prevention of wound infection of the eye: Abstract. diss. Cand. honey. Sciences // Ufa, 1999 .-- 18 p.

14. Esposito S, Bosis S, Begliatti E, et al. Acute tonsillopharyngitis associated with atypical bacterial infection in children: natural history and impact of macrolide therapy // Clin Infect Dis. - 2006 .-- 43 (2). 206-09.

application

Table 1

Dynamics of laryngoscopic picture data and auditory assessment of voice.

table 2

Dynamics of computer voice analysis data

Table 3

Dynamics of electronic laryngostroboscopy data

Table 4

Dynamics of time data of maximum phonation (Navy)

Table 5

Dynamics of laryngoscopic picture data and auditory assessment of voice

Table 6

Dynamics of computer voice analysis data

Table 7

Dynamics of electronic laryngostroboscopy data

Table 8

Dynamics of maximum phonation time data (Navy in s)

Table 9

The dynamics of the severity of the main clinical manifestations of inflammatory diseases of the larynx during treatment according to the claimed method in points (n = 58)

Table 10

The dynamics of the initially altered indicators of computer voice analysis during treatment according to the claimed method (n = 58)

Table 11

Comparative results of using various treatment methods in the treatment of patients with exacerbation of chronic laryngitis

Table 1 Clinical sign Before treatment After treatment Hoarseness four 0 Cough 3 0 The pharynx 3 0 True vocal folds 2 0 Lumen of the larynx 2 0 Mucous 3 0

table 2 Indicators Before treatment After treatment 1. HNR "a" 13.3 20.9 2. Jitter 1,0 0.34 3. Shimmer 10.8 3.4

Table 3 Indicators Before treatment After treatment 1. The presence of fluctuations one one 2. Change in the frequency of oscillations 2 one 3. The change in the amplitude of the oscillations 2 one 4. Change in closing phase one one 5. Change the opening phase 2 one IVN 1,6 one

Table 4 Indicators Before treatment After treatment 1 "A" eleven 12 2 "O" 8 12 3 "U" 8 fifteen 4 "And" 8 12 5 "E" 7 10 Average 8.4 12,2

Table 5 Clinical sign Before treatment After treatment Hoarseness four one Cough one 0 The pharynx 2 0 True vocal folds 3 one Lumen of the larynx 3 0 Mucous 2 0

Table 6 Indicators Before treatment After treatment 1. HNR "a" 17,072 21,499 2. Jitter 0.637 0.373 3. Shimmer 3,727 3,319

Table 7 Indicators Before treatment After treatment 1. The presence of fluctuations one one 2. Change in the frequency of oscillations one one 3. The change in the amplitude of the oscillations one one 4. Change in closing phase 2 one 5. Change the opening phase 2 one Vibrator Failure Index 1.4 one

Table 8 Indicators Before treatment After treatment 1 "A" eleven 12 2 "O" 8 12 3 "U" 8 fifteen 4 "And" 8 12 5 "E" 7 10 Average 8.4 15,2

Table 9 Clinical sign Before treatment (M1 + M1) After treatment (M2 + m2) R Hoarseness 2.91 + _0.68 0.41 + _0.56 0,000 Cough 2.05 + _0.76 0.26 + _0.48 0,000 The pharynx 2.53 + _0.57 0.29 + _0.46 0,000 True vocal folds 2.45 + _0.5 0.57 + _05 0,000 Lumen of the larynx 2.40 + _0.56 0.34 + _0.48 0,000 Mucous 2.74 + _0.44 0.43 + _ 0.50 0,000

Table 10 Indicators Before treatment (M1 + M1) After treatment (M2 + m2) P NHR 16.41 + _4.31 18.79 + _3.93 0,000 Jitter 0.65 + _0.41 0.534_0.35 0,025 Shimmer 6.05 + _3.82 4.26 + _2.48 0.002

Table 11 Indicators The claimed method (n = 58) Standard drug treatment (n = 28) Prototype Disability time, days, disease outcome 16.83 + _3.10 29.50 + _3.56 * 22-24 days * Complete relief of the disease,% 75 twenty* Persistent improvement,% 25 80 * The onset of clinical effect After the first exposure By the end of treatment After 5-7 procedures

Claims (1)

A method of treating exacerbation of chronic laryngitis by exposure to the larynx with a physical factor against the background of standard drug therapy, characterized in that starting from 4-5 days of exacerbation of the disease, an additional 1 ml of specific pyobacteriophage is infused with subsequent low-frequency vibration massage to 3 fields of the larynx and simultaneous phonopedic breathing exercises, while the low-frequency vibration massage begins from the first field, including the side neck surfaces with a frequency of 20 Hz in 1 field, smoothly moving vibratodes upward at a speed of 2-3 mm / s without displacement of the skin, in rectilinear movements to the angle of the lower jaw, then down to the supraclavicular region for 1-2 minutes on each side, in this case, the patient performs phonopedic breathing exercises with the sound “M” pronouncing during each exhalation, then vibromassage is performed on the projection area of the intersection of the plate of the thyroid cartilage and the edge of the sternocleidomastoid muscle (m.sternocleidomastoideus) at the incision of the thyroid cartilage with frequencies 40 Hz and 60 Hz for 1-2 minutes on both sides according to a stable method, while the patient performs phonopedic breathing exercises on the exhale with the pronouncing of vowels “U”, “O”, “A”, then the vibromassage area, including the collar zone at a frequency of 30-40 Hz, while the vibratodes are moved from the paravertebral line to the shoulder joints for 2-3 minutes on each side, the procedure is labile, only 8-10 combined procedures are received per course, received daily.