RU2792245C1 - Method for treatment of chronic tonsillitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to otorhinolaryngology, and is intended for the treatment of chronic tonsillitis. At the first stage, the lacunae of the palatine tonsils are washed with 40 ml of saline using the Tonsillor-MM device. Immediately after, the lacunae of the palatine tonsils are washed with 40 ml of saline using a Hartmann cannula according to the Belogolovy method. Next, the lacunae are exposed to nitric monoxide as a form of NO-therapy, by processing a lacuna intralacunarly for 5 seconds at the exhalation, but not more than 30 seconds on each palatine tonsil. After that, intralacunar impregnation of a solution of chlorophyllipt is carried out at the rate of 1.0 ml for both palatine tonsils; the procedures are carried out every other day in a 10-procedure course, the treatment course is repeated after 6 months.

EFFECT: method ensures increasing the efficiency of treatment of chronic tonsillitis due to a combination of sequential exposure of the Tonsillor-MM device, washing the fragments of exfoliated bacterial films out of the lacunae of the palatine tonsils and subsequent blowing with nitrogen monoxide and introducing a solution of chlorophyllipt into the NM lacunae, followed by a repetition of the procedure course after six months, which avoids relapses of the disease.

1 cl, 4 tbl, 2 ex

Description

The invention relates to medicine, namely to otorhinolaryngology, and is intended for the treatment of chronic tonsillitis (XT).

XT is a chronic inflammation of the palatine tonsils (NM) with all its inherent pathophysiological and morphological features, consisting in the suppression of nonspecific factors of the body's natural resistance, impaired humoral and cellular immunity.

Despite the apparent simplicity of the XT problem, every otorhinolaryngologist sooner or later faces difficulties in deciding on the tactics of its treatment. Sometimes it is not easy to decide whether to remove or preserve NM, whether they are a focus of infection or an organ of immunity. For the correct solution of these issues, it is necessary to have a good understanding of the role of NM, as well as the main pathogenetic mechanisms of the influence of the pathological process in them on the body as a whole. It is known that NMs play an important role in regional local immunity and serve as a powerful inductive site for the immune response in the upper respiratory tract. In the inductive zones, or sites, the presentation and induction of the immune response take place. Here, antigens are recognized, phagocytosed, and presented to B- and T-cells, and antigen-specific T- and B-cell responses develop here.

The most difficult issue is the choice of the correct treatment tactics. In recent years, a sharp decrease in the number of tonsillectomy has led to an increase in the number of complications of XT. Along with the growth of local purulent complications, a steady increase in the incidence of rheumatism is observed. Considering that NM are the main localization of b-hemolytic streptococcus of group A, we can talk about the untimely detection of this pathogen and the lack of sanitation of its habitats.

So, in the prior art there is a method for the treatment of chronic tonsillitis (Maltseva G.S., Chronic tonsillitis: topical issues (clinical lecture) | Consilium Medicum, T. 13, No. 1, p. 32-38), including traditional local therapeutic effects on NM (lacunae flushing, physiotherapy) and systemic antibiotic therapy, and if there are changes in systemic immunity, immunocorrective therapy. This source does not disclose the sequence of manipulations performed, as well as the modes of their use, which does not allow us to judge the effectiveness of the method.

Also, a method for the treatment of chronic tonsillitis is known from the prior art (Pedder V.V. et al., Treatment of diseases of the ENT organs using the ozone / ME-ultrasound therapeutic otorhinolaryngological complex "Tonsillor-3MM": Guidelines, Omsk, 2017, p. 26 -30), including the sanitation of the NM, the combined effect of NO-therapy and exposure to the Tonsillor-MM* apparatus, followed by impregnation of the drug solution into the gaps and crypts of the NM, which we have chosen as a prototype. So, in this method, the sanitation of NM, the combined effect of nitrogen monoxide and the apparatus Tonsillor-MM * are essentially low-frequency ultrasonic sanitation through an intermediate ozone / NO-containing saline solution (for example, ozonized saline solution or ozonated 5-10% oil emulsion of the type " oil in water") with the application of the applicator on each palatine tonsil for at least 60 seconds. The next step is to carry out contact low-frequency ultrasonic impregnation, into previously sanitized lacunae and crypts of the tonsil, of a medicinal solution stimulating the reparative regeneration of the parenchyma of the tonsil (lysozyme, human leukocyte interferon, hydrocortisone suspension, honey-propolis mixture, ozonized 5-10% oil emulsion of the "oil in water", etc.). The method has the following disadvantages. After exposure to the Tonsillor-MM* apparatus, exfoliated caseous particles and fragments of bacterial films partially remain in the crypts and lacunae of the NM, which can significantly reduce the effectiveness of NO-therapy in this case. In addition, subsequent impregnation with the drug solution seals these fragments in the crypts and lacunae of the NM, which can provoke subsequent relapses of the disease.

Thus, there is a need for a method for the treatment of chronic tonsillitis, devoid of the above disadvantages.

The technical result of the proposed method is to increase the effectiveness of treatment due to a combination of sequential exposure to the Tonsillor-MM apparatus, washing the lacunae of the palatine tonsils from fragments of exfoliated bacterial films, subsequent blowing with nitrogen monoxide and introducing a solution of chlorophyllipt into the lacunae of the NM, followed by a repetition of the course by a combination of procedures after six months, which allows you to most effectively influence the NM and avoid subsequent relapses of the disease.

To achieve this technical result in a method for the treatment of chronic tonsillitis, including sanitation of the NM, the combined effect of nitrogen monoxide and the Tonsillor-MM apparatus, followed by impregnation of the drug solution into the lacunae and crypts of the NM, it is proposed at the first stage to wash the lacunae of the palatine tonsils with 40 ml of saline at using the Tonsillor-MM apparatus, immediately after which the lacunae of the palatine tonsils are washed with 40 ml of saline using the Harman cannula according to the Belogolovy method, then the exposure to nitric monoxide in the form of NO-therapy is carried out, acting intralacunarly for 5 seconds in each lacuna on the exhalation of the patient, but no more than 30 seconds for each palatine tonsil, after which chlorophyllipt solution is injected intralacunarly at the rate of 1.0 ml for both palatine tonsils; procedures are carried out every other day, a course of 10 procedures, the course of treatment is repeated after 6 months.

The method is carried out as follows.

At the first stage, the patient is washed with NM lacunae. To do this, an applicator with a waveguide-instrument "VIZ" and a funnel corresponding to the size of the NM is installed on the NM, an electric suction device is turned on, the applicator valve is set in the "open" position. On the electric suction device, the vacuum regulator in the applicator system sets a vacuum of 0.3-0.4 kgf/cm ² . Thanks to the above actions, the applicator is well fixed on the NM, effective vacuum drainage of the NM lacunae is performed. Washing is carried out with a saline solution of 20 ml for each palatine tonsil. The time interval for the acoustic system is set to 20 seconds, the amplitude is set to the maximum value - to the "5" position.

Immediately after this, the lacunae of the palatine tonsils are washed using the Hartmann cannula according to the Belogolovy method with 40 ml of saline, completely washing away all exfoliated caseous particles and fragments of bacterial films.

Next, exposure to nitric monoxide in the form of NO-therapy (we used the Plazon apparatus) is performed intralacunarly for 5 seconds for each lacuna, but not more than 30 seconds for each palatine tonsil. The impact is important to carry out on the exhalation of the patient, which avoids swallowing and involuntary reflexes during exposure. Experimental studies have shown that NO generated by the plasma-chemical method from atmospheric air normalizes microcirculation, has an antibacterial effect, stops infection and inflammation, activates the function of macrophages and fibroblast proliferation (not only in vivo, but also in cell culture), stimulates tissue regeneration, significantly speeds up healing. At the same time, the EPR method established NO diffusion not only through the wound surface, but also through intact skin, mucous membranes, cornea and sclera of the eye, which opens up the possibility of the impact of NO-containing gas flows on deep tissue lesions in chronic inflammatory processes of organs and tissues.

After NO-therapy intralacunar carry out the introduction of a solution of chlorophyllipt at the rate of 1.0 ml on both palatine tonsils, carefully processing all the crypts and lacunae. The procedures are carried out every other day, a course of 10 procedures, the course of treatment is repeated after 6 months.

The effectiveness of the proposed method is confirmed by the following clinical examples.

Example 1. Patient A., 49 years old.

I went to the clinic in February 2021 with complaints of frequent sore throats (2-3 times a year), throat discomfort when swallowing, persistent sore throat, bad breath, and occasional joint pain. Previously, the ENT doctor was not observed. She underwent symptomatic treatment by a therapist during an exacerbation of sore throat. Conducted repeated courses of antibiotic therapy. The last dose of antibiotics was 3 months ago.

On examination: anterior rhinoscopy and otoscopy revealed no pathology.

With mesopharyngoscopy: hyperemia of the palatine arches and posterior pharyngeal wall. Palatine tonsils of 1-2 degrees of hypertrophy, palatine arches and palatine tonsils are edematous, there is an abundance of caseous masses in the lacunae, lacunae of the palatine tonsils have cicatricial changes. Enlarged submandibular lymph nodes (up to 1 cm, painless on palpation, mobile). After examination, the diagnosis was made: Chronic tonsillitis, a simple form.

A comprehensive examination of the patient was carried out:

1) bacteriological culture from the surface of the palatine tonsils: kleb.pneumonia 10 * 6; st.aureus 10*2; strep.gr.viridans 10*6

2) scraping from the surface of the palatine tonsils for PCR viruses:

herpes 1,2 types - negative,

herpes type 6 - negative,

cytomegalovirus - negative,

Epstein-Barr virus - negative:

3) blood test for rheumatic tests:

Antistreptolysin-O 156.0 IU/ml,

C-reactive protein 8.6 mg/l,

Rheumatoid factor 16.2 RU/ml.

4) assessment of the immune status

5) general urine analysis: relative density - 1.025; urine pH 6.0; protein - negative;

6) clinical blood test: Leukocytes 5.3×10 ⁹ /l; neutrophils 74%, lymphocytes 20%, ESR 5 mm/hour

A course of treatment was carried out according to the proposed method No. 10: washing the lacunae of the palatine tonsils with 40 ml of saline using the Tonsillor-MM apparatus, followed by washing the lacunae of the palatine tonsils using the Hartmann cannula according to the Belogolovy method with 40 ml of saline. After washing the lacunae of the palatine tonsils, NO-therapy, acting intralacunar for 5 seconds on each lacuna on the exhalation of the patient, but not more than 30 seconds on each palatine tonsil. After completion of exposure to nitrogen monoxide, a 1.0 ml solution of chlorophyllipt was injected into the lacunae of the palatine tonsils. The procedures were carried out every other day.

Against the background of the treatment, a positive trend was noted. After the 3rd procedure, the patient noted the absence of discomfort in the throat when swallowing. During mesopharyngoscopy after the 5th procedure, it was noted that the mucous membrane of the anterior palatine arches had a pale pink color, the palatine tonsils decreased in size, single small caseous plugs remained. The complete disappearance of caseous masses was noted after the 6th procedure.

After the end of treatment, the mesopharyngoscope picture: the anterior palatine arches are pale pink, not edematous, the lacunae of the palatine tonsils are clean, the mucous membrane of the posterior pharyngeal wall is pale pink.

At the control examination after 1 month, the patient said that during the observation period she had not noted complaints of discomfort in the throat, bad breath, general malaise, no sore throats. During mesopharyngoscopy, a normal picture was preserved: palatine tonsils are not enlarged, pale pink, not edematous. The lacunae of the palatine tonsils were washed, caseous plugs were not found.

Six months later, the patient came back for an examination and a second course of treatment according to the proposed method.

During the observation period of 6 months, the patient did not have a sore throat, she rarely had bad breath, discomfort in the throat appeared only in the last month.

An improvement in clinical and laboratory parameters was noted. In bacteriological culture there is no kieb.pneumonia 10*6 and st.aureus 10*2; normalized C-reactive protein 6.4 mg/l.

In the clinical analysis of blood: Leukocytes 6.0×10 ⁹ /l; neutrophils 65%, lymphocytes 29%, ESR 5 mm/hour.

With mesopharyngoscopy, the mucous membrane of the palatine arches and the posterior pharyngeal wall is pink. Palatine tonsils of 1-2 degrees of hypertrophy, palatine arches and palatine tonsils are slightly edematous, there are single caseous plugs in the lacunae.

After a repeated course of conservative therapy according to the proposed method, normalization of the mesopharyngoscope pattern is noted: the palatine tonsils are pale pink, there is no edema and hyperemia of the mucous membrane of the palatine arches, there are no caseous plugs in the lacunae of the palatine tonsils. The patient does not complain.

At the follow-up examination 12 months after the start of treatment, the patient has no initial complaints of discomfort in the throat when swallowing, persistent sore throat, bad breath, and no periodic pain in the joints. For 12 months there was no angina. During mesopharyngoscopy: the mucous membrane of the palatine arches and the posterior pharyngeal wall is pale pink, the palatine arches are not edematous, the palatine tonsils are pale pink, 1 degree of hypertrophy, when washing the lacunae of the palatine tonsils, no caseous plugs were found.

Example 2. Patient B, 29 years old.

I went to the clinic in April 2021 with complaints of constant discomfort in the throat, bad breath, general malaise, a daily increase in body temperature up to 37.3 C, tonsillitis 2 times a year, reduced performance. He was observed by an ENT doctor, where the lacunae of the palatine tonsils were washed 3-4 times a year and these were one-time procedures. He underwent symptomatic treatment during an exacerbation of sore throat.

On examination: anterior rhinoscopy, otoscopy revealed no pathology.

With mesopharyngoscopy: hyperemia of the palatine arches and posterior pharyngeal wall. The palatine tonsils of the 2nd degree of hypertrophy, the palatine arches and palatine tonsils are edematous, there is an abundance of caseous masses in the lacunae, the lacunae of the palatine tonsils have cicatricial changes. Enlarged submandibular lymph nodes (up to 1 cm, painless on palpation, mobile).

After examination, the diagnosis was made: Chronic tonsillitis, toxic-allergic form I.

A comprehensive examination of the patient was carried out:

1) bacteriological culture from the surface of the palatine tonsils:

strep.millerigr 10*5; st.aureus 10*5; strep.gr.viridans 10*5

2) scraping from the surface of the palatine tonsils for PCR viruses:

herpes 1,2 types - negative,

herpes type 6 - negative,

cytomegalovirus - negative,

Epstein-Barr virus - negative:

3) blood test for rheumatic tests:

Antistreptolysin-O 141.0 IU/ml,

C-reactive protein 1.0 mg/l,

Rheumatoid factor 21.22 RU/ml.

4) assessment of the immune status

5) general urine analysis: relative density - 1.015; urine pH 6.5; protein - negative;

6) clinical blood test: Leukocytes 5.2×10 ⁹ /l; neutrophils 54%, lymphocytes 36%, ESR 12 mm/hour

A course of treatment was carried out according to the proposed method No. 10: washing the lacunae of the palatine tonsils with 40 ml of saline using the Tonsillor-MM apparatus, followed by washing the lacunae of the palatine tonsils using the Hartmann cannula according to the Belogolovy method with 40 ml of saline. After washing the lacunae of the palatine tonsils, NO-therapy, acting intralacunar for 5 seconds on each lacuna on the exhalation of the patient, but not more than 30 seconds on each palatine tonsil. After completion of exposure to nitrogen monoxide, a 1.0 ml solution of chlorophyllipt was injected into the lacunae of the palatine tonsils. The procedures were carried out every other day.

Against the background of the treatment, a positive trend was noted. After the 4th procedure, the patient noted a decrease in discomfort in the throat when swallowing. During mesopharyngoscopy after the 5th procedure, it was noted that the mucous membrane of the anterior palatine arches had a pale pink color, the palatine tonsils decreased in size, single small caseous plugs remained. The complete disappearance of caseous masses was noted after the 7th procedure.

After the end of treatment, the mesopharyngoscope picture: the anterior palatine arches are pale pink, not edematous, the lacunae of the palatine tonsils are clean, the mucous membrane of the posterior pharyngeal wall is pale pink.

At the control examination after 1 month, the patient noted a pronounced improvement in general well-being, increased efficiency, normalization of body temperature, disappearance of sore throat and bad breath. During mesopharyngoscopy, a normal picture was preserved: palatine tonsils are not enlarged, pale pink, not edematous. The lacunae of the palatine tonsils were washed, caseous plugs were not found. During the observation period of 6 months, the patient did not have a sore throat, he rarely had bad breath, discomfort in the throat appeared only in the last month, body temperature remained normal.

An improvement in clinical and laboratory parameters was noted:

1) In bacteriological culture, the concentration of st.aureus decreased from 10*5 to 10*2;

3) In the clinical analysis of blood Leukocytes 5.5×10 ⁹ /l; neutrophils 57%, lymphocytes 33%, ESR 7 mm/hour

With mesopharyngoscopy, the mucous membrane of the palatine arches and the posterior pharyngeal wall is pink. Palatine tonsils of 1-2 degrees of hypertrophy, palatine arches and palatine tonsils are edematous, there are single caseous plugs in the lacunae. 6 months after the initial treatment, a second course of treatment was carried out according to the proposed method. After that, normalization of the mesopharyngoscope picture is noted: the palatine tonsils are pale pink, there is no edema and hyperemia of the palatine arches, caseous plugs are not found in the lacunae of the palatine tonsils. The patient does not complain.

At the follow-up examination 12 months after the start of treatment, the patient has no initial complaints of decreased performance, discomfort in the throat when swallowing, persistent sore throat, bad breath, and does not notice an increase in body temperature. For 12 months there was no angina.

At mesopharyngoscopy: the palatine tonsils are pale pink, not edematous, when washing the lacunae of the palatine tonsils, no caseous plugs were found.

Thus, the proposed method is simple and highly effective in the treatment of chronic tonsillitis due to the combination of the sequential action of the Tonsillor-MM apparatus, washing the lacunae of the palatine tonsils from fragments of exfoliated bacterial films, subsequent blowing with nitrogen monoxide and introducing a solution of chlorophyllipt into the lacunae of the NM, followed by a repetition of the course of combined procedures six months later, which allows you to most effectively influence the NM and avoid subsequent relapses of the disease.

Claims (1)

A method for the treatment of chronic tonsillitis, including the sanitation of the palatine tonsils (NM), the combined effect of nitrogen monoxide and the Tonsillor-MM apparatus, followed by impregnation of the drug solution into the lacunae and crypts of the HM, characterized in that at the first stage, the lacunae of the palatine tonsils are washed with 40 ml of saline using the Tonsillor-MM device with a time interval for the acoustic system of 20 seconds and an amplitude in position 5, immediately after which the lacunae of the palatine tonsils are washed with 40 ml of saline using a Hartmann cannula according to the Belogolovy method, then they are exposed to nitrogen monoxide in the form of NO-therapy , acting intralacunarly for 5 seconds on the lacuna on the exhalation of the patient, but not more than 30 seconds on each palatine tonsil, after which chlorophyllipt solution is impregnated intralacunarly at the rate of 1.0 ml on both palatine tonsils; procedures are carried out every other day, a course of 10 procedures, the course of treatment is repeated after 6 months.