RU2552488C1 - Method of treating rhinosinusites and device for its realisation - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: patient takes drainage position for each nasal sinus subjected to treatment and creates negative pressure in nasal cavity. Creation of negative pressure is realised due to suction power of patient's chest during last 10-20% of inhalation time. Hermetisation of nasal vestibule is simultaneously performed by pressing nose wings and inserted into nasal vestibule soft silicone tube with fingers to nasal cavity septum. Supply of aerosol into nasal cavity is realised through nebuliser and soft silicone tube for 80-90% of exhalation act time. To increase volume rate of supply, aerosol from nebuliser pressure, is used as air jet, created during act of exhalation through mouth and directed into nebuliser chamber. To facilitate exhalation act patient gradually releases nose wings, starting with one, which presses silicone tube, and takes out soft silicone tube from nose vestibule before exhalation of residual air through nose. Last 10-20% of exhalation volume are realised in focused way through nose. Also claimed is device for method realisation, which contains nebuliser with additionally introduced to bottom of its chamber tube and tube from soft silicone, put on output pipe of nebuliser.

EFFECT: effective treatment of said pathology due to provision of delivery of aerosol, accumulated in nasopharynx with first portion of exhaled through nose air into middle nasal meatus under higher pressure.

2 cl, 5 dwg, 4 ex

Description

The invention relates to medicine and is used to treat rhinosinitis.

Relevance. Up to 15% of the world's adult population suffers from various forms of rhinosinusitis. Chronic rhinosinusitis is one of the 10 most common diagnoses in outpatient practice (M.A. Khorokholskaya Microendoscopic features of the nasal mucosa in chronic rhinosinusitis during treatment with Sinuforte / M.A. Khorokholskaya, S.G. Vakhrushev, N.V. Terskova // Bulletin of otorhinolaryngology. - 2011. - No. 5. - P.59-61).

A known method of treating rhinosinusitis using a device by which the separation of the nasal cavity from the external environment is carried out using inflatable balloons. Negative pressure is created in the nasal cavity, as a result, pathological contents are evacuated from the paranasal sinuses, nasal cavity and negative pressure is created in the sinuses with passable anastomosis. At the next stage of treatment, a solution of the drug is injected into the nasal cavity, which enters the sinuses with passable anastomosis with increasing pressure in the nasal cavity (see AS No. 1768141, class A61B 17/12, 17/24, 1992).

A known method of treating rhinosinusitis, which consists in retrograde feeding an aerosol into the nasal cavity, which, in accordance with the data on the aerodynamics of the nasal cavity, improves the delivery of medicinal aerosols to the anastomoses of the paranasal sinuses of the anterior group and to the paranasal sinuses with passable anastomosis. In this case, the supply of medicinal aerosol to the respiratory tract is carried out through the oral cavity at the moment of short-term breath holding on inhalation and during the exhalation phase (see RF patent No. 2362592, IPC 7 - A61M 11/00, registered July 27, 2009) (Analog).

There is a method of treating rhinosinusitis and a device for its implementation, including the delimitation of the nasal cavity and nasopharynx from the external environment by raising the soft palate - increasing pressure in the oral cavity, oropharynx and lower respiratory tract (for example, exhaling into the mouth with a closed mouth) and introducing olives into vestibule of the nasal cavity. Olives have channels equipped with remote valves through which a number of procedures are carried out. The procedure for reducing atmospheric pressure in the nasal cavity (sinus drainage); the procedure for cleaning the nasal cavity from discharge from the sinuses by feeding a medicinal aerosol through one half of the nasal cavity and removing it through the other half of the nasal cavity (cavum lavash) and the procedure for injecting drugs into the nasal cavity and paranasal sinuses in the form of a medicinal aerosol after creating negative pressure in nasal cavities and paranasal sinuses (sinus injection) (see patent 2213530, IPC 7 AB 17/24, registered on October 10, 2003) (Prototype).

The disadvantages of the known methods are:

1) the drainage of the nasal cavity is carried out against the main direction of movement of the ciliated epithelium (the movement of the ciliated epithelium, with the exception of a small portion of the anterior sections of the mucous membrane of the nasal cavity, is directed towards the choanus, see Palchun V.T. Otorhinolaryngology / V.T. Palchun, A. I. Kryukov - M .: Medicine, 2001 on p. 34);

2) when applying aerosols to the nose retrograde through the oral cavity, a significant part of the aerosol settles in the pharynx by the inertial mechanism due to bending and narrowing of the airway (entrance to the nasopharynx, choanas); when applying an aerosol through the nose while inhaling, it poorly enters the middle nasal passage and paranasal sinuses when inhaling, because at this moment negative pressure is created in the nasal cavity and air escapes from the paranasal sinuses (SZ Piskunov, “Some Issues of Physiology and Pathophysiology of the Nose and Paranasal Sinuses,” proceedings of the conference dedicated to the fifth anniversary of the Russian Society of Rhinologists, Moscow, 1997, pp. .fourteen);

3) the need to use an external device to create negative pressure in the nasal cavity and paranasal sinuses;

4) when creating negative pressure in the nasal cavity, pressure regulation is carried out according to the testimony of a manometer and taking into account the patient's sensations during the procedure. The reaction to the patient’s sensations and the pressure gauge in the form of a change in the parameters of the procedure is possible after their occurrence (measurement) and description by the patient. As a result, it is possible to use excessive negative pressure, which can increase the swelling of the mucous membrane of the nasal cavity and worsen the drainage properties of the anastomoses of the paranasal sinuses due to their narrowing of the edematous mucous membrane.

The objective of the proposed method of treatment is to increase the effectiveness of treatment of paranasal rhinosinitis by improving the evacuation of pathological contents from the paranasal sinuses and nasal cavity as a result of creating negative pressure in the nasal cavity, the vector of which coincides with the direction of movement of the ciliated epithelium in the nasal cavity; reduction of aerosol sedimentation in the airways outside the nasal cavity and paranasal sinuses due to the optimization of the delivery route; operational regulation of the parameters of the procedure by the patient himself in accordance with the sensations; further increasing the availability of procedures for the patient by simplifying the design of the device.

This is achieved by creating negative pressure in the nasal cavity and paranasal sinuses (with passable fistula), the vector of which coincides with the direction of movement of the ciliated epithelium in the nasal cavity, due to the use of physical processes that occur in the patient’s body (lowering the atmospheric pressure in the airways when inhaling and increase it on exhalation); using the special method by the patient himself, inhale through the nose in the last 10-20% of the inhalation time with the nose closed, regulating the level of rarefaction in the nasal cavity and nasopharynx by the patient in accordance with his sensations (eliminating unpleasant sensations arising from excessive negative pressure); introduction through a nebulizer under a greater than usual pressure and with a greater volumetric velocity into the nasal cavity and paranasal sinuses of drugs in the form of an aerosol (using an air stream created when the patient exhales for 80-90% of the inhalation time through the mouth into the nebulizer chamber). Particles of drug aerosol enter the nasal cavity, the fistula of the paranasal sinuses and the paranasal sinuses with passable fistula when equalizing the pressure previously reduced in the nasal cavity and paranasal sinuses, as well as as a result of increased pressure in the nasal cavity during forced exhalation of aerosol previously received through the nasopharynx in the last phase (10-20% of the time) of the act of exhalation (before that, exhalation is performed through the mouth into the nebulizer chamber). The increase in pressure is especially pronounced in the middle nasal passage, where the air stream meets an obstacle in the form of a hook-shaped process (SZ Piskunov, “Some problems of the physiology and pathophysiology of the nose and paranasal sinuses”, proceedings of the conference dedicated to the fifth anniversary of the Russian Society of Rhinologists, Moscow , 1997, pp. 12-15).

General features of the proposed method with the prototype:

- creating a negative pressure in the nasal cavity before the stage of aerosol administration;

- periodic changes in pressure in the nasal cavity with the creation of negative and positive pressure;

- the introduction of drugs into the nasal cavity after creating negative pressure in it.

New features of the proposed method in comparison with the prototype:

- negative pressure in the nasal cavity and nasopharynx is created by the patient himself due to the suction action of the chest;

- negative pressure in the nasal cavity is created during the last 10-20% of the inspiratory time;

- negative pressure in the nasal cavity and nasopharynx is regulated by sensations by the patient;

- negative pressure in the nasal cavity has a vector that coincides with the motion vector of the cilia of the ciliated epithelium;

- sealing of the nasal cavity and nasopharynx from the side of the oral cavity during exhalation through the mouth and nebulizer chamber into the nasal cavity occurs due to increased pressure in the airways (in the oral cavity, oropharynx) as a result of resistance to the exhaled air stream;

- the positive pressure necessary for the forced flow of aerosol into the nasal cavity and nasopharynx from the nebulizer is created by the patient himself due to exhalation force;

- during the first 80-90% of the exhalation act, the patient gradually releases the wings of the nose (starting from the one that presses the silicone tube), the aerosol fills the nasal cavity and nasopharynx, where a vacuum was previously created through the vestibule of the nose, and then the aerosol flows from the nasopharynx into the cavity nose and in the middle nasal passage to the anastomoses of the anterior group of the paranasal sinuses with the first portion of forced expiration during the last 10-20% of the expiration time.

The technical result is to improve the delivery of drugs to the paranasal sinuses and their natural fistulas, to all bottlenecks of the nasal cavity.

The exudate released from the sinuses during the creation of negative pressure in the nasal cavity and present in the nasal cavity moves along the matching vectors of mucociliary transport and negative pressure. This facilitates the transport of exudate. The patient independently regulates the level of dilution in the nasal cavity, avoiding unpleasant sensations and without aggravating the swelling of the mucous membrane of the nasal cavity and, therefore, without impairing the drainage properties of the natural anastomoses of the paranasal sinuses. Medicinal aerosol enters the nasal cavity when a negative pressure is created in the nasal cavity and sinuses with passable fistula under positive pressure created by the patient's exhalation and at a greater volumetric velocity, which significantly exceeds the pressure and volumetric velocity of the aerosol created by the nebulizer itself. Under the influence of the pressure difference, the drug aerosol is better supplied to all narrow places of the nasal cavity, to the anastomoses of the paranasal sinuses and to the paranasal sinuses with a functioning anastomosis. Small aerosol particles created by nebulizers contribute to this. At the time of expiration of 80-90% of the expiration time through the mouth, a medicinal aerosol fills the nasopharynx and the opposite half of the nose. When exhaling the portion of air remaining in the lungs and lower respiratory tract through the nose, it enters the nasal cavity with the first portion of air exhaled through the nasopharynx and participates in creating increased pressure in the middle nasal passage, is delivered in addition to the anastomoses of the anterior group of the paranasal sinuses.

Common features of the claimed device with a prototype:

- a spray of drugs.

New features of the claimed device with a prototype:

- a tube of soft elastic silicone for insertion into the vestibule of the nasal cavity;

- lack of suction line;

- an exhalation tube connected by a nebulizer chamber and brought to its bottom.

The invention is illustrated in the drawings (Fig.1-5).

Figure 1 shows a device containing a tube 1 of soft silicone, worn on the pipe 2 of the chamber of the nebulizer 3. Into the chamber of the nebulizer 3 introduced a tube for exhaling 4, which is brought to the bottom of the chamber of the nebulizer 3.

The device operates as follows. Preliminarily, anemization of the mucous membrane of the nasal cavity with vasoconstrictive drops is performed. The patient occupies a drainage position individually for each sinus to be treated. By the drainage position we understand the position of the sinus, in which the plane of the anastomosis is at the bottom of the sinus and the perpendicular drawn to this plane coincides with the vector of the Earth's gravitational field. Fulfillment of this condition is important for maintaining the conditions for fulfilling the law of communicating vessels between the sinus undergoing treatment and the nasal cavity.

1. According to the proposed method, the patient inserts a soft silicone tube 1 of the device in the vestibule of the nasal cavity. For approximately 80-90% of the time of inspiration, it is carried out through the mouth, with the direction of air 5 movement in the oropharynx and the underlying airways (see Figure 2).

2. After approximately 80-90% of the inhalation time through the mouth, the patient presses the wings of the nose with a soft silicone tube with the fingers of the leading hand to the nasal septum with the fingers of the leading hand, sealing the entrance to the nose 6. Then continues the inhalation through the nose with the air flow 7 oropharynx and the underlying airways, as a result, negative pressure is created in the nasal cavity and paranasal sinuses with functioning anastomosis, the vector of which is directed to the nasopharynx (inverse experience of Valsalva) (see Figure 3).

3. After creating negative pressure in the nasal cavity, the patient tightly covers the exhalation tube with his lips 4. During 80-90% of the exhalation time, he exhales into the exhalation tube 4, gradually releasing the nasal wings pressed earlier to the septum as resistance builds up (starting from the one that presses the silicone tube) and stopping the sealing of the vestibule of the nasal cavity 6. At the same time, the warm air, which has been moistened in the lungs and coming through the nebulizer tube 3 into the nebulizer chamber 3, will be forced out of the chamber connected to it nebulizer drug aerosol through the outlet of the nebulizer 2 and tube 1 in direction 8 into the nasal cavity, nasopharynx and the opposite half of the nose, where negative pressure is created. Aerosol enters the sinuses with functioning anastomoses, in which negative pressure was previously created.

Depressurization of the nasal cavity from the side of the nasopharynx does not occur, because due to resistance to the air stream during exhalation through the tube 4 into the chamber of the nebulizer 3 and the tube 1, the air pressure in the oral cavity rises and the soft palate closes the entrance to the nasopharynx.

After releasing the wings of the nose and stop sealing the vestibule of the nasal cavity 6, the drug aerosol continues to flow into the nasal cavity and nasopharynx under pressure due to the exhalation force in direction 9, filling the nasal cavity and nasopharynx in direction 8 (see Figure 4).

4. After 80-90% of the expiration time, the patient removes the nozzle 1 from the nose and carries out forced expiration through the nose with the direction of air movement 10. In this case, the aerosol that fills the nasopharynx rushes with the first portion of the incoming air into the nasal cavity and is directed by the rear end of the lower nasal shells in the middle nasal passage to the anastomoses of the anterior group of the paranasal sinuses, where increased pressure is created when the airflow meets the hook-shaped process (see Figure 5). After 1-2 cycles, the inhalation-exhalation procedure is repeated.

Example 1. Patient M., 39 years old, turned to the ENT department with acute rhinosinusitis (right-sided acute purulent maxillitis). With a puncture of the right maxillary sinus, a purulent discharge of 2 ml was obtained. Along with general treatment, treatment according to the proposed method with a 0.01% solution of miramistin was prescribed. After 5 days, there are no complaints, with a control puncture of the right maxillary sinus, the washings are clean.

Example 2. Patient M., 45 years old, was admitted to the ENT department with a diagnosis of acute rhinosinusitis. With a puncture of the jaw sinuses in the washings, 2-3 ml of mucus. Along with general treatment, treatment according to the proposed method with a 0.1% solution of etonium was prescribed. On the fifth day: no complaints, inflammation in the nose subsided, nasal breathing recovered. With a control puncture of the maxillary sinuses, the washings are clean.

Example 3. Patient C., age 53 years. Was in the ENT department due to exacerbation of chronic purulent rhinosinitis. On the radiograph - a decrease in pneumatization of the right jaw sinus.

With a puncture of the right maxillary sinus in the washings, pus. Due to the inefficiency of prolonged conservative treatment, the patient underwent surgical endoscopic revision of the right maxillary sinus, removal of polyps, restoration of patency of the natural anastomosis. In the postoperative period, pains in the right jaw area were disturbed, with a control puncture in the sinus, mucosal discharge. The treatment according to the proposed method with a 0.01% solution of miramistin was prescribed. There are no complaints on the 3rd day. The inflammation subsided. Nasal breathing restored. The bosom is clean.

Example 4. Patient J., 40 years old, turned to the ENT office with bilateral ethmoiditis, which for a week did not respond to treatment on an outpatient basis. Along with general treatment, treatment according to the proposed method with a 0.01% solution of miramistin was prescribed. There are no complaints on the 3rd day. The inflammation subsided. Nasal breathing restored.

Claims (2)

1. A method of treating paranasal rhinosinusitis, comprising sealing the nasal cavity; periodic changes in pressure in the nasal cavity with the creation of negative and positive pressure; the introduction of an aerosol of a medicinal substance into the nasal cavity at the time of creating negative pressure in it, characterized in that the patient takes a drainage position for each sinus of the nose to be treated and creates negative pressure in the nasal cavity using the suction force of his chest at the time of the last 10-20% inspiratory time with simultaneous sealing of the nasal vestibule by pressing the wings of the nose and a soft silicone tube inserted into the vestibule of the nasal cavity with your fingers to the septum of the nasal cavity, feeding a erosol into the nasal cavity is carried out through a nebulizer and a soft silicone tube for 80-90% of the time of the exhalation act, while to increase the volumetric feed rate, aerosol pressure from the nebulizer, an air stream arises during the exhalation act through the mouth and directed into the nebulizer chamber, to facilitate the act of exhalation, the patient gradually releases the wings of the nose, starting from the one that presses the silicone tube, and removes the soft silicone tube from the vestibule of the nose before exhaling residual air through the nose, after 10-20% of expiratory volume it carries out forcefully through the nose. 2. The device for implementing the method according to claim 1, comprising a nebulizer with an additional tube and a soft silicone tube inserted to the outlet of the nebulizer additionally inserted to the bottom of its chamber.

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