RU2646492C1 - Method of treating polypous rhinosinusitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to otorhinolaryngology, and can be used for treating polypous rhinosinusitis. Method comprises exposure to electric current through an electrode placed in the nasal passage. Electrode is wrapped with a damp "Coletex-SMC" napkin, on which a medicinal preparation or a mixture of medicinal preparations is applied. Medicinal preparation used is a mixture of "Coletex-ADL" hydrogel napkin and Ruzam drug at a ratio of 2.0:0.10, respectively and is used in the first and subsequent odd days of exposure. Medicinal preparation used on even days of exposure is hydrogel material "Coletex-gel-DNA" with hyaluronic acid, with a course of 7–10 procedures daily, repeated course after 3–4 months.

EFFECT: invention enables to reduce the dose load on the patient's body, reduce the risk of allergization, improve the quality of life of patients.

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Description

The invention relates to medicine, namely to otorhinolaryngology, and can be used to treat polypous rhinosinusitis by a conservative method.

A known method of treating polyposis of rhinosinusitis, including therapy with the drug "Longidase" in the form of injections into the polyp tissue at 3000 units per procedure. Conduct a course of 5-10 procedures with an interval of 5 days. Moreover, the total dose is from 15,000 to 30,000 units (RF Patent No. 2329059, IPC A61K 38/43, 31/496, publ. 2008).

The disadvantage of this method is its invasiveness, that is, the inability to refuse injections (patients very often categorically refuse to use them), as well as the high dose load of the drug, which is injected. In addition, the disadvantage of this method is the ambiguous reaction of the polyp (polypous tissue) to injection, the complexity of introducing the drug into the tissue of the polyp located in the ethmoid labyrinth and paranasal sinuses; the need to attract highly qualified doctors for the procedures. The possibility of violations of local immune reactions, as well as atrophic phenomena in the area of application of topical corticosteroids, leading to complications in the form of bleeding and dry nose, is not ruled out.

The closest is a method of exposure to the body, including exposure to an electric current through an electrode placed in the nasal passage, while the electrode is wrapped with a wet Coletex-SMC wipe, on which a drug or a mixture of drugs is applied (RF Patent No. 2502528, IPC A61N 1 / 20, A61K 31/167, 31/734, publ. 2013).

The disadvantage of this method is that its use in the treatment of polypous sinusitis does not provide a sufficient anti-inflammatory effect and a locally stimulating immune response.

The task of the invention is to remedy these shortcomings, increase the effectiveness of treatment, increase the period of remission, by strengthening local immune effects, increase the anti-inflammatory and reparative effect, improve the quality of life of this category of patients.

To solve this problem in the treatment of polyposis of rhinosinusitis, including exposure to electric current through an electrode placed in the nasal passage, which is wrapped with a Coletex-SMC wet wipe with a medicinal product or a mixture of medicines applied to it. New is that, as a medicine, a mixture of a Coletex-ADL hydrogel napkin and Ruzam is applied at a ratio of 2.0: 0.10, respectively, and is used on the first and subsequent odd days of exposure, and as a medicine on even days of exposure use the Coletex-gel-DNA hydrogel material with hyaluronic acid, a course of 7-10 procedures daily, a repeated course after 3-4 months.

The use of the drug Ruzam locally in combination with electric exposure (electrophoresis) made it possible to abandon its injection effects, that is, from surgical injections, and its use in a mixture with Kolegel-ADL simultaneously achieve anti-inflammatory and analgesic effects, abandon antibiotic therapy, achieving high treatment effectiveness.

Thus, the application of the proposed method provides the following advantages:

- contributes to the regression of chronic polypous inflammation;

- allows you to abandon minimally invasive and surgical methods of treatment of this pathology;

- allows you to reduce the drug load, refuse injections and oral administration of drugs;

- provides regression of swelling of the nasal mucosa and paranasal sinuses;

- reduces, and in some cases prevents, the formation of scars in the parietal zone of the paranasal sinuses;

- improves the quality of life of this category of patients;

- increases the period of remission by conducting preventive sessions;

- expands the arsenal of treatments for this disease.

Previously, local immunostimulating effects in chronic inflammation (polyposis sinusitis) were not used.

In FIG. 1, 2 - CT examination of patient A. at admission and at discharge, example 1; in FIG. 3, 4 - the same patient C, example 2.

The method is as follows.

The electrode from the apparatus "Potok-1" GE-50-2 is wrapped with a textile towel "Coletex-SMCH", which is pre-moistened with 1 ml of saline and applied to it a drug or a mixture of drugs. On the first and subsequent odd days of exposure, use a mixture of hydrogel napkins "Coletex-ADL" and Ruzama in a ratio of 2.0: 0.1. On even days of exposure, the Coletex-gel-DNA hydrogel material with hyaluronic acid is used in a volume of 1.5-2 g. An electrode (+) with a napkin is placed in the nasal passage to a depth of 2 cm, a second electrode (-) is usually placed , on the back of the neck in the region of the lower cervical vertebrae, or in the back, or others, the device is connected to the network at a set force varying from 0.5 to 2 mA and a frequency of 50 Hz, the exposure time is shown in the table (example 1 ) Treatment is carried out with a course of 7-10 daily, a repeated course is prescribed after 3-4 months.

Example 1

Patient A., 41 years old, was admitted to the hospital on an emergency basis with complaints of severe headaches, heaviness in the left half of the face, aggravated by a change in position of the head, pain of a constant nature. He refused treatment (sinus puncture, antibiotic therapy, injection). At the time of receipt of T 37.5 ° C, a general clinical blood test: hemoglobin - 104, white blood cells - 12, ESR - 28. Computed tomography of the paranasal sinuses: exacerbation of chronic rhinosinusitis, polypous cystic sinusitis on the left.

The patient was treated according to the proposed method with a course of 7 procedures daily according to the standard scheme:

During the entire period of treatment, the patient received ascorbic acid 0.5 to 3 times a day (in the form of dragees).

The patient was discharged on the 7th day. Pain relief, normalization of temperature, nasal breathing, positive dynamics of general clinical blood parameters were noted: hemoglobin changed from 104 to 120; white blood cells from 12 to 7.8; ESR from 28 to 12. Computed tomography confirmed the absence of pathological changes in the paranasal sinuses.

The course is repeated after 3 months in a similar regimen, relapses and complications were not noted, treatment gave a positive result.

Example 2

Patient S., 37 years old, was admitted to the clinic of the BUZ of the Voronezh region, VGKB BSMP No. 1 with a diagnosis of chronic polypous sinusitis, vasomotor rhinitis, sluggish left-sided otitis media (complication); sick for 2 months; history of repeated nasal polypotomy. Prior to hospitalization, he received long-term antibiotic therapy (cephalosporins, quinolones), corticosteroids, various manipulations were performed; despite this, hearing impairment progressed. Nasal congestion, difficulty in nasal breathing. Upon admission, the temperature was 37.2 ° C, headaches, discharge from the nose, nasal congestion, general clinical blood test: hemoglobin - 117, white blood cells - 14, ESR - 28, CT examinations: parietal polyposis of the maxillary sinus on the left, mastoid on the left; with rhinoscopy in the left middle nasal passage, an altered polypous tissue. The patient refused to manipulate the surgical treatment of taking antibiotics, hormonal drugs and any kind of injection.

The treatment was carried out according to the proposed method with a course of 10 procedures.

During the entire period of treatment, the patient received ascorbic acid 0.5 to 3 times a day (in the form of dragees).

The patient was discharged on the 10th day. Pain relief, normalization of temperature, nasal breathing and hearing, positive dynamics of general clinical indicators of blood were noted: hemoglobin changed from 117 to 130; white blood cells from 14 to 7.2; ESR decreased from 28 to 8. Computed tomography: no pathological changes in the paranasal sinuses and temporal bones were detected. After 4 months, the patient was examined and a preventive course of treatment was prescribed for 7 days. At the end of the course, no complications were noted.

A total of 150 patients were treated by the specified method, there were no adverse reactions and complications.

Given that polypous rhinosinusitis is a chronic inflammation, this method can be implemented for dispensary patients in polyclinics, which can reduce the burden on the hospital, reduce the dose on the patient’s body, reduce the risk of allergies, improve the quality of life of patients, including those who categorically refuse surgical interventions, the use of antibiotics, hormones, which at the same time have a complication - the pathology of ENT organs against chronic rhinosinusitis (polypous-cystic w), reduce the burden on medical personnel, reduce the cost of treating a patient.

Claims (1)

A method of treating polyposis of rhinosinusitis, comprising applying an electric current through an electrode placed in the nasal passage, the electrode being wrapped with a Coletex-SMC wet wipe, on which a drug or a mixture of drugs is applied, characterized in that a wipe mixture is applied as a drug hydrogel "Coletex-ADL" and the drug Ruzam with a ratio of 2.0: 0.10, respectively, and is used on the first and subsequent odd days of exposure, and as a medicine on even On days of exposure, the Coletex-gel-DNA hydrogel material with hyaluronic acid is used, with a course of 7-10 procedures daily, a repeated course in 3-4 months.

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