RU2604413C1 - Method of treating chronic allergic external otitis media - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to otorhinolaryngology, and can be used in treating chronic allergic external otitis. Method involves application in external auditory canal fenistil or Psilo-Balsam on turunda 2-3 times a day for 3-4 weeks. Essentiale forte is simultaneously orally administered in a dose of 2 capsules 3 times a day for 3-4 weeks, and then Carsil in a dose of 1-2 tablets 2 times a day for 1-2 months.

EFFECT: using invention provides higher clinical effectiveness, reduces number of recurrences.

1 cl, 2 ex

Description

The invention relates to medicine, namely to otorhinolaryngology.

To date, there are a number of methods for conservative treatment of otitis externa with a complaint of severe itching in the ear. The most common method is the use of antifungal ointments, such as Pimafucin 2%, Clotrimazole 1%, as well as antifungal solutions, such as Nitrofungin, Exoderil (Kryukov A.I., Palchun V.T., Kunelskaya V.Ya. Inflammatory diseases of the outer ear and modern methods of their treatment. - M., 2010). This method involves instillation in the ear or laying on turunda drug substance (cream, ointment or solution) 1-4 times a day. The disadvantage of this method is the long term use of these drugs. No visible clinical therapeutic effect is observed.

Another method of treatment is the use of externally hormone-containing creams, ointments, such as Pimafucort, Hydrocortisone on turunds in the external auditory meatus at least 2 times a day (Guide to Otorhinolaryngology // Ed. By I. B. Soldatov. - Ed. 2, revised . and add. - M .: Medicine, 1977). This method involves prolonged use, almost constant. The disadvantage of this method is the uncontrolled use by the patient of this group of drugs, which subsequently leads to a lack of effect. And in addition to the above, oral antihistamines such as Cetrin 10 mg, Claritin 10 mg, Zirtek 10 mg, taken 1 tablet per day, and Suprastin, Tavegil, taken 3 tab. per day for a good therapeutic effect. (A.V. Sobolev, M.A. Shevyakov. Skin itching in the practice of a doctor // Textbook. - St. Petersburg., 2006). The disadvantage of this method is the following: also a long course of treatment. The need for ongoing medical supervision. The use of antihistamines can cause drowsiness. The inability to use in pregnant women and lactating in connection with the excretion of the main substance in breast milk. And also there is no persistent clinical therapeutic effect. Patients noted improvement during treatment and the resumption of complaints of itching some time after the end of the course of treatment.

The aim of the invention is to increase the effectiveness of treatment of patients with allergic diseases of the external auditory canal, accompanied by severe itching, leading to deformation of the external auditory canal and auricle, prevention of exacerbations in the form of acute bacterial and fungal otitis externa.

This goal is achieved by the fact that the proposed method of treatment, which consists in the use of drugs in the external auditory canal, such as Fenistil gel or Psilo-Balsam on turunda and the simultaneous use of Essentiale forte, and then Carsil orally, since the appointment by the otorhinolaryngologist only "local "drugs do not bring visible results.

The treatment method is as follows: the first course is prescribed the drug Essentiale forte N, capsules. 2 capsules - 3 times a day with meals, course 3-4 weeks, then the drug Karsil 2 tablets 2-3 times a day, course up to 1-2 months. At the same time, Fenistil gel or Psilo-balm gel is used on turunds or simply lubrication of the external auditory canal through a cotton swab by the patient 1-2-3 times a day. Control at the ENT of a doctor 1 time in 1-2 weeks, then 1 time in 2-3 weeks. Such courses should be carried out 2 times a year, usually in spring and autumn, especially in the first year after treatment, without waiting for a second exacerbation. It should be noted that the hepatoprotective and choleretic drugs in the above method (main and auxiliary ingredients) are of plant origin, namely: phospholipids from soybeans, flowers and thistle stems, which does not limit the duration of use. And also are not contraindicated during pregnancy.

The treatment according to the proposed method was performed in 104 patients aged 19-75 years for more than a 10-year period. The clinical effectiveness of the treatment was evaluated by the following parameters:

- reduction or disappearance of itching in the external auditory meatus for more than 6 months;

- the number of relapses: the appearance of itching in 6 months, 1 year;

- the number of relapses of acute external bacterial or fungal otitis media for 1 year;

- restoration of ceruminous and sebaceous glands of the skin of the external auditory canal.

A positive effect was obtained in all patients: from the first course of treatment, itching in the ear practically does not bother or does not bother at all; again, the appearance of itching is noted by some patients after 6-7 months from the start of treatment, some by 7-8 months, but with the start of a new course of treatment, all complaints go away quickly; with the beginning of treatment, less intense itching causes the patient to comb the ear, which contributes to the development of acute external fungal or bacterial external otitis media, or these complications are much less common; over time, the ceruminous and sebaceous glands of the skin of the external auditory canal are restored, which have protective properties, namely: the presence of fatty acids in the secretion of the sebaceous glands, the lysozyme content in the secretion of the ceruminous glands, low pH, as well as the self-cleaning mechanism with external migration of the epithelium of the external auditory canal . During follow-up observation after 1 year, 2 years, some patients 7 years - exacerbations are not observed with preventive treatment 1 time in 1-2 years. There were no complications.

Example 1. Patient L., 56 years old, complained of intolerable itching in both ears for a long time, intensifying in the evening, lack of sulfur in the external auditory canals. As well as periodic sneezing and nasal congestion after working with chemicals. The patient is a pharmacist working in the prescription department in a pharmacy. Work experience in a pharmacy is 35 years. After a thorough history, it turned out that genital itching was also a concern. Moreover, the patient takes Cetrin (an antiallergic oral agent) 1 tablet and its nasal congestion and sneezing pass. Itching does not go away. I used different ointments, but there is practically no effect. When examining the ENT organs: nose - the external shape of the nose is not changed; the nasal septum is straight, the nasal mucosa is slightly swollen, pale, in the common nasal passages a clear discharge; nasopharynx - mucous pink, pale; oropharynx - the mucosa of the posterior pharyngeal wall is pink, loose, lymphoid follicles are enlarged, tonsils are not enlarged, there are no caseous contents; ears - AS and AD: the external auditory canals are wide, the skin is thinned, dry, there is no hyperemia, parietal - dry crusts, the tympanic membranes are not changed: pearly, slightly retracted. Microscopic examination of the scales from the external auditory meatus - there are no leukocytes in the preparation, the epithelium is completely flat, the microflora is absent. No fungal elements were found. Diagnosed with Allergic otitis externa, chronic form. Vasomotor rhinitis, allergic form. OAK and OAM, as well as blood biochemistry - unchanged. Ultrasound of the liver, pancreas and gall bladder - signs of fatty liver, cholecystitis and the presence of "sand" in the bottom of the gall bladder. Treatment was prescribed based on the methodology described above. The condition improved significantly by the end of the first week: itching decreased many times. After the course of treatment, the general condition also improved. By week 7, itching did not bother. After 6 months, the patient was prescribed a second course. After 1 year, a second ultrasound was performed, which showed the absence of “sand”, good contractile function of the gallbladder, fatty degeneration: insignificant degree. Then the patient took such courses 2 times a year. When examining this patient after 5 and 7 years, there is a restoration of all the functions of the skin of the external auditory canal (with the restoration of ceruminous and sebaceous glands). There is no clinical data for exacerbation of external otitis media. Genital itching also does not bother.

Example 2. Patient L., 37 years old. He complained of pain in his right ear, felt when scratching the ear with a key, and also a constant pronounced itching in both ears, worse in the evening. The patient is a master in the furniture workshop. He claims that he follows safety rules and uses a protective mask, but nevertheless, wood dust, paints are felt in the throat, as well as complaints of nasal congestion and sore throat, sneezing. He does not take medications. When examining the ENT organs: nose - the external shape of the nose is not changed; nasal septum in the midline; nasal mucosa swollen, whitish; in the general nasal passages an abundant amount of transparent discharge; nasopharynx - mucous pale pink; oropharynx - the mucosa of the posterior pharyngeal wall is pink, granular, tonsils are not enlarged, there are no caseous contents; ears - AS: the external auditory meatus is wide, free, the skin is thinned, dry, there is no hyperemia, the eardrum is not changed: gray, thickened, slightly retracted. AD: the external auditory meatus is wide, with a scratch and slight hemorrhage on the lateral wall of the external auditory meatus. The skin at the site of injury is thickened, hyperemic, swollen; the eardrum is not changed: gray, thickened, slightly retracted. Microscopic examination of scrapings from the left external auditory canal - the flat epithelium is completely, hairs, microflora are extremely scarce, mixed, single white blood cells. Microscopy from the right external auditory canal - abundant white blood cells in the field of vision, cocci flora, abundant. No fungal elements were found. From ultrasound examination of the liver, pancreas and gall bladder: pronounced signs of fatty liver, "suspension" in the bottom of the gall bladder. The diagnosis was made: Chronic bilateral allergic otitis externa, exacerbation on the right (trauma to the external auditory canal). Vasomotor rhinitis, mixed form. For the nose, it is prescribed: washing the nose with saline using the Dolphin device and spraying Polydex with phenylephrine in the nose for 2 injections - 3 times a day for 7 days, then injecting Nazonex in the nose for 2 doses in the morning in each nostril for a month, then 1 dose per month. An additional treatment was prescribed for the right ear: Polydex ear drops on turunda 3 times a day for 3-4 days with the transition then, upon improvement, to the scheme proposed above. For the left ear - according to the scheme. Polydex ear drops were canceled after 4 days due to improvement: there was no edema and hyperemia. Treatment according to the main schedule was continued up to 6 weeks. The itching practically did not bother and stopped completely after 3 months from the start of treatment. Courses were repeated after 6 months, after 12 months, after 18 months. Accordingly, during these time intervals the patient was examined. There were no complaints. The condition and nose improved. Sleep has improved. The general state of health has improved. With a second ultrasound study, the picture changed: almost 2 years after the start of treatment, there were no signs of fatty liver, contractile function of the gallbladder was satisfactory.

Thus, the data obtained as a result of clinical studies will allow the practice of otorhinolaryngologists and dermatovenerologists to introduce the optimal tactics of treating patients with external otitis media, and ultrasound diagnostics will allow to overestimate the importance of liver and biliary tract pathology and optimize the diagnosis of external otitis media. Which will lead to a decrease in the number of diseases of the outer ear, will shorten the treatment of patients with external otitis media. The view on the causal factor of the occurrence of various pathological processes in the external auditory canal will be revised. The practical significance of the use of choleretic and hepatoprotective drugs to improve the treatment of external otitis media has been studied and proved. Accordingly, it will significantly improve the quality of life of these patients.

Information sources

1. Berb Hans, Kashke Oliver, Navka Tadeus, Swift Andrew. Diseases of the ear, nose and throat. - M .: MEDpress-inform, 2012.

2. Sobolev A.V., Shevyakov M.A. Itchy skin in the practice of a doctor. // Tutorial. - SPb., 2006.

3. Watering A.M. Inflammatory diseases of the outer ear. // Abstract of thesis. Cand. honey. Sciences, - M., 2005.

4. Khamaganova I.V., Piven N.P. Combined therapy of diseases of the external auditory canal in the practice of a dermatovenerologist. - M.: Bulletin of Otorhinolaryngology, 2006.

5. Orlov A.V. Dermatitis of the external auditory canal (diagnosis, treatment). // Abstract of thesis. Cand. honey. sciences. - M., 2000.

6. Kryukov A.I., Palchun V.T., Kunelskaya V.Ya. Inflammatory diseases of the outer ear and modern methods of their treatment. - M., 2010.

7. Guide to otorhinolaryngology. // Ed. I.B. Soldatova. - Ed. 2nd, rev. and add. - M .: Medicine, 1977.

Claims (1)

A method of treating chronic allergic otitis externa, accompanied by severe itching, which consists in the use of drugs in the external auditory canal, characterized in that for 3-4 weeks Fenistil or Psilo-Balm are used on turunda 2-3 times a day with simultaneous oral administration of Essentiale forte 2 capsules 3 times a day, and then 1-2 months Karsil 1-2 tablets 2 times a day.