RU2523417C1 - Method of treating chronic tonsillitis in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves drug and irrigation therapy, laser therapy covering a sub-mandibular region; the novel is that drug therapy represents administering the hydrogel sterile material 'Coletex-gel-DNK-L' or 'Coletex-gel-ADL' 1-3 ml into each tonsil lacunas. Laser therapy additionally covers a projection of the common carotid artery, the carotid sinus, internal and external jugulars, the vagus nerve and the upper cervical sympathetic ganglion; these regions and the sub-mandibular region are pre-coated with the sterile textile tissue 'Coletex-AND' or 'Coletex ADL'. The exposure is performed in the infrared band series from both sides at a frequency of 1000 to 1500 Hz, output power 10 to 20 mW, length of exposure 2 to 8 min; after the procedure, the used tissue is left for 6-8 hours; the course consists of 3-10 daily procedures.

EFFECT: sequence of therapeutic procedures enables regaining a structural balance of the immune regulation that provides the central determination of eliminating the immunological reactivity disorders specific for children suffering chronic tonsillitis, eliminating manifested autonomic nervous system imbalance, providing the higher clinical effectiveness.

Description

The invention relates to medicine, namely to physiotherapy and otorhinolaryngology, and can be used to treat a compensated and decompensated form of chronic tonsillitis, including in the acute stage.

Tonsillitis is one of the most common diseases of ENT organs. The basis of the disease is an infectious-allergic component, accompanied by a variety of violations of the immunological reactivity of the body, the causes of which may be endogenous and exogenous infection. It occurs when the body reactivity changes associated with intoxication, general or local cooling of the body, etc. Having arisen once, tonsillitis often passes into a chronic form. The main methods of treating chronic tonsillitis are currently conservative and surgical.

A known method of exposure to chronic tonsillitis with infrared laser and incoherent monochromatic radiation, carried out by an external method. Tonsils are irradiated from submandibular zones (2 fields). A laser emitter or an LED matrix is placed in contact in the submandibular zone with gentle pressure on the tissue. Use continuous or intermittent radiation. Procedures are carried out daily. Course - 10-15 procedures. (A.V. Maksimov. Physiotherapy for diseases of the nasopharynx and hearing organs. - Physiotherapy and balneology / Edited by V.M. Bogolyubov - Book Ш-М. Publishing house BINOM, 2009 - p.170.)

The disadvantage of this method is the impact only in the projection area of the tonsils in the submandibular region by a point laser emitter, which does not allow to capture regional lymph nodes, or using an LED matrix that does not have the same anti-inflammatory effect characteristic of infrared laser radiation, in addition, differentiated exposure depending on the stage of the inflammatory process and the age of the child.

The introduction of pharmaceuticals into the gaps of tonsils with tonsillitis is known, followed by their laser irradiation in the red range with a wavelength of 0.63 microns and an exposure of 5 minutes per tonsil. At the same time, each lacunae is pretreated with 1% solutions of methylene blue in glycerol and, after 10 minutes, an intralacular laser is applied with a power at the output of the fiber of 15–20 mW (RF Patent No. 2234959, IPC A61N 5/067, publ. 2004).

The disadvantage of this method of treatment is a 10-minute exposure of the pharmaceutical preparation before laser therapy, which contributes to the leaching of the drug from the gaps due to copious salivation. In young children, it is impossible to introduce a monofilament hard fiber into the gaps without prior anesthesia, which reduces the effectiveness of therapeutic measures. The method does not allow to activate microcirculation in the tonsils and stabilize the altered vegetative status, especially in young children, which can lead to a relapse of the inflammatory process in the tonsils.

The closest is a method of treating patients with chronic tonsillitis, which consists in the use of laser and irrigation therapy. The patient is administered zinnat in an amount of 125-250 mg per dose 2 times a day for 5-7 days orally against a background of laser and irrigation therapy, moreover, a 2% solution of ascorbic acid is used for irrigation therapy, and laser therapy is additionally performed on the submandibular region (RF Patent No. 2110301, IPC A61N 5/067, publ. 1998).

The disadvantages of this method of treatment is the use of a systemic antibiotic - zinnat (cefuroxime), which can cause toxic and allergic manifestations, and is not always advisable for exacerbations of compensated chronic tonsillitis. The method is used in children, mainly with strangulated tonsils with their hypertrophy and infiltration of the palatine arches, which limits its use.

The objective of the invention is to eliminate these drawbacks, increase the effectiveness of treatment of children with chronic tonsillitis, prevent the development of decompensated tonsillitis and extend the remission due to the activation of venous-lymphatic outflow from the tonsils and the concentration of pharmaceuticals in the tonsils and lymph nodes of the neck, and prevent the spread of the inflammatory process from tonsils to the area of the pharynx, normalizing the effect on the vegetative status of the child.

The method includes drug and irrigation therapy, laser therapy on the submandibular region, new is that as a drug therapy, hydrogel sterile material (hydrogel napkin) “Coletex-gel-DNA-L” or “Coletex-gel-ADL” is introduced into tonsil lacunae 1-3 ml in the gaps of each tonsil. Laser therapy is additionally carried out on the projection zones of the common carotid artery, carotid sinus, internal and external jugular veins, the vagus nerve and the superior cervical sympathetic ganglion, with the Coletex-ADN or Coletex ADL sterile textile towel being placed on these zones and in the submandibular region. ". In this case, the exposure is carried out in the infrared range sequentially on both sides with a frequency of 1000 to 1500 Hz with an output power of 10 to 20 mW, the exposure time is 2 to 8 minutes, after the end of the procedure, the used tissue is left for 6-8 hours, for course 3 -10 daily treatments.

This sequence of therapeutic measures allows you to restore balance in the work of structures involved in the regulation of immunity, which, in general, determines the central determination of the elimination of immunological reactivity disorders characteristic of children with chronic tonsillitis, eliminating the pronounced imbalance of the autonomic nervous system. The impact in the projection of the accumulation of vegetative nerve formations allows you to have a normalizing effect on the heart rhythm and reduce the heart rate, increased in all children in the presence of acute and chronic inflammatory process in the tonsils, and normalize the altered vegetative status of the child. The main venous collector and lymphatic vessels are in the affected area, which contributes to the activation of venous-lymphatic outflow from the tonsils and the concentration of pharmaceuticals in the lymph nodes of the neck due to the active absorption and deposition in the tonsils and anterolateral surface of the neck. The approach used stops the course of chronic inflammatory diseases of the lymphopharyngeal ring, restoring the interaction in the adrenergic receptors of neurons and preventing the development of the mechanism of trigger breakdown of autonomic synergism with subsequent associated disorganization of other nerve structures. The “tonsillogenic” neurodystrophic process undergoes reverse development, which is due to the direct prolonged exposure in the projection of the carotid glomus. The latter contains a large number of vessels and nerves, and is a chemoreceptor that responds to changes in oxygen concentration, which, as we have proved, increases under the influence of drug laser phoresis.

The implementation of the method shown in specific clinical examples.

Example 1

Patient P., 12 years old, turned to the otorhinolaryngologist with complaints of frequent acute tonsillitis (up to 5-6 times a year), weakness, sweating, and fast fatigue. Sick from 3 years of age, repeatedly treated on an outpatient basis, but not effective enough. Surgical treatment was recommended to the patient in the clinic at the place of residence.

With pharyngoscopy: the mucosa of the pharynx and posterior pharyngeal wall is sharply hyperemic, hypertrophy of the palatine tonsils of the 2nd degree, the presence of caseous contents in the gaps. From the rest of the ENT organs, there were no signs of pathology. Regional lymph nodes are enlarged to 1-1.5 cm in diameter, painful on palpation. In the blood test, leukocytes - 10.2 · 10 ⁹ / l, eosinophilia - 15%, ESR acceleration to 15 mm / h, which indicates the presence of an inflammatory process and allergization of the body. The immunogram shows signs of inhibition of the phagocytic system of immunity with the presence of sensitization to staphylococcal antigen (phagocytosis in neutrophils - 38%, phagocytic index in neutrophils 3.81 units, RTML with hemolytic staphylococcus allergen 133%). Violations of the immunogram in exocrine secrets were noted (the content of immunoglobulin A in saliva was increased - 0.152 g / l, which proves the presence of an acute inflammatory process in the body). Allergization of the body was detected, an increased content of immunoglobulin E in the blood was detected up to 250 KE / L. Bacteriological examination of the material from the tonsils revealed an increase in microbial seeding with the presence in the flora of the contents of the palatine tonsils of Staphylococcus aureus (S. Aureus). A cytological examination of the contents of the tonsils revealed leukocytes 20-35 in n / a, eosinophils 8-10 in n / a. On the basis of the examination data, medical history, and laboratory examination results, an exacerbation of chronic compensated tonsillitis was diagnosed. According to spectrophotometry, a decrease in Vcr (by 38.6%) and S02 (by 23.2%) was revealed. The vegetative status of the Kerdo index indicated sympathicotonia and amounted to +23 units.

The patient was offered conservative treatment by the proposed method. Irrigation therapy was carried out with 15-20 ml of saline for each tonsil. Then, after the palatine tonsils were sanitized, the Coletex-gel-DNA-L hydrogel material with derinate (sodium deoxyribonucleate) and 3 ml lidocaine on both sides were successively introduced into the lacunae of the tonsils. A moistened textile towel “Coletex-ADN” with sodium deoxyribonucleate (derinate) with sticky edges under the laser matrix was placed and fixed on the projection zones of the common carotid artery, carotid sinus, internal and external jugular veins, vagus nerve and superior cervical sympathetic ganglion. Laser exposure was carried out with a laser matrix with 12 laser fibers from the Standard apparatus sequentially from both sides with a frequency of 1000 Hz, with an output power of 20 mW for 8 min each left and right. At the end of the procedure, the Coletex-ADN napkin was left for 8 hours, keeping it moist. A course of 10 procedures daily.

The pain syndrome stopped when swallowing and resumed only after 10 hours on the first day, by the third day the child did not complain of pain when swallowing. On day 8, the patient noted an improvement in overall health, weakness, sweating decreased.

With pharyngoscopy: palatine tonsils cleared of pathological contents, decreased hyperemia of the palatine arches. After completing the course of treatment, the state of health improved significantly: he did not show complaints of soreness in the throat, and his working capacity increased (studies, playing sports). A positive clinical picture was observed: tonsils decreased in size, hyperemia of the palatine arches disappeared, lymph nodes decreased. In the blood test, eosinophilia decreased to 5%, the number of leukocytes (4.3 · 10 ⁹ / l), ESR (3 mm / h) normalized. The immunogram picture stabilized, sensitization to staphylococcal antigen disappeared (phagocytosis in neutrophils 58%, phagocytic index in neutrophils 4.62 units, RTML with alleukocytegen hemolytic staphylococcus 90%). The content of immunoglobulin A in saliva normalized (0.05 g / l), which proved the absence of an inflammatory process, and the normalization of immunoglobulin E in the blood (80 KE / l) indicated the absence of sensitization in the body. With repeated bacteriological examination, Staphylococcus aureus was not found. Cytology noted leukocytes - 5-6 in n / a, eosinophils 3-4 in n / a. After the course of treatment according to the proposed scheme, an increase in SO ₂ was noted and its deviation from the norm was only 8.5%,) and oxygen utilization Vcr increased by 11.3%. The Kerdo index corresponded to the upper limits of normosthenia and amounted to +8 units. The patient was discharged to continue schooling in satisfactory condition with the appearance for re-examination after six months. At the follow-up examination after six months: exacerbations of chronic tonsillitis were not observed, during this period SARS did not hurt. Laboratory indicators are also within normal limits. Currently, the patient continues to be observed.

Example 2

Patient A., 1.5 years. Received with a diagnosis of acute tonsillitis, tonsil hypertrophy. Medical history: child from 2 pregnancies, 2 urgent deliveries. During pregnancy, the girl’s mother suffered a sore throat in the period of 19 weeks. I did not receive antibiotics. Childbirth proceeded without complications. The child is rated on the Apgar scale of 8-9 points, with a mass of 3250, an increase of 55 cm. On natural feeding up to 11 months. Up to 1 year, the girl was not sick. Vaccinations according to plan. Allergy to cow protein was noted, mild. Upon receipt of a complaint of sleep disturbance, severe salivation, difficulty and painful swallowing, tearfulness, sleep disturbance, severe sweating, fever up to 37.8 ° C.

On examination, the mucous membrane of the pharynx is hyperemic, the anterior arch is hyperemic, infiltrated, palatine tonsils are enlarged, purulent contents in the gaps. In the blood test, leukocytosis is up to 10.5 · 10 ⁹ / l, ESR is increased to 15 mm / h. Microbiological examination of the contents of palatine tonsil lacunae revealed microbial associations with a predominance of gram-positive flora (St.spp. 2 × 10 ⁴ CFU, Streptococcus viridans 2 × 10 ³ CFU, Enterococcus faecalis 1.4 × 10 ² CFU). Submandibular lymph nodes are slightly enlarged, slightly painful on palpation. According to spectrophotometry, a decrease in Vcr (by 42.8%) and SO ₂ (by 20.3%) was revealed. The Kerdo index testified to sympathicotonia and amounted to +21 units.

Conservative treatment according to the proposed method is proposed. The child received 5 ml of irrigation therapy with saline solution on both sides, 1 ml of Coletex-Gel-ADL was introduced into lacunae on both sides, a similar Coletex ADL tissue towel with sticky edges was fixed in the projection zone of the common carotid artery, carotid sinus, internal and external jugular veins, vagus nerve and superior cervical sympathetic ganglion, laser irradiation with a matrix emitter was performed sequentially on both sides with a frequency of 1500 Hz with an output power of 10 mW for 2 min on the left and right, for a course of 5 procedures daily. At the end of each procedure, tissue napkins with sticky edges are left for 6 hours.

2-3 hours after the first procedure, it was noted that the child could swallow and take pills, salivation decreased, due to the analgesic effect of lidocaine.

After the course of treatment, clinical improvement, increased appetite, restful sleep, normalization of body temperature, and easy swallowing were noted. There was no hyperemia and infiltration of the anterior arches, the mucous membrane of the pharynx was pink, moist, palatine tonsils decreased to normal sizes, no pathological contents were noted in the gaps. Blood and urine tests are within normal limits. After the course of treatment according to the proposed scheme, an increase in SO ₂ was noted and its deviation from the norm was only 10.5%, and oxygen utilization Vcr increased by 10.2%. The Kerdo index corresponded to intermediate indicators between the norm and parasympathicotonia and amounted to -5 units. During the follow-up examination after 1, 3 and 6 months there were no complaints, the child develops according to age, normal physique, the achieved result is saved. To date (more than one year), the child is in remission.

Treatment was carried out in 57 patients aged 1 to 16 years with a diagnosis of exacerbation of chronic compensated and decompensated tonsillitis, which had previously been conservative methods: antibiotic therapy, anti-inflammatory drugs, palatine tonsil sanitation with furacilin, laser therapy with flaccid, long-term and frequent recurrence of tonsillitis .

Example 3

Patient P., 5 years old, frequent acute tonsillitis (up to 5-6 times a year), weakness, sweating, fatigue. Sick from an early age, was repeatedly treated on an outpatient basis (beta-lactam antibiotics were used, to which allergic reactions in the form of a skin rash, immune preparations have been appearing in recent years, rinsing of the pharynx with furacilin has been performed repeatedly, physiotherapeutic methods, as well as homeopathic therapy), however, the expected result was not received. The child was sent to the clinic at the place of residence for a consultation with an ENT doctor. Medical history: child from 2 pregnancies, 2 urgent deliveries. During pregnancy, the girl’s mother suffered a sore throat in the period of 19 weeks. I did not receive antibiotics. ARVI was found out from the anamnesis 3 times, 24 weeks, 33 and 37 weeks. Diseases of moderate and mild severity, respectively. In childhood, the mother of the child was registered with an otorhinolaryngologist with a diagnosis of chronic tonsillitis, compensated, an adenotomy was performed at 4 years old. In childhood, she noted food allergies, currently there is an allergic reaction in the form of “tickle” in the throat, rhinorrhea, sneezing - to house dust, hay fever to flowering cereals. After a year, the child began to suffer from frequent viral diseases. At 1 year and 6 months, the girl began to attend preschool institutions. There is a brother of 10 years, a schoolboy. It is observed at the doctor of an otorhinolarynologist with chronic compensated tonsillitis. Adenoids 1-2 degrees. The girl’s father is healthy. At the initial examination - with anterior rhinoscopy, the nasal mucosa is somewhat swollen, hyperemic, and the mucous discharge in the middle nasal passage is noted. The architectonics of the nose is not changed, the septum is in the midline. Palpation and percussion of the paranasal structures is painless. There is no swelling of soft tissues in the projections of the paranasal sinuses. The exit sites of the trigeminal nerve are painless symmetrically on both sides. With posterior rhinoscopy, adenoid vegetation of the 1st degree was noted, with a small amount of mucous discharge, mucus was noted on the posterior pharyngeal wall, mucous membranes of the posterior pharyngeal wall are somewhat irritated. Endoscopic examination confirmed the degree of adenoid vegetation. The mouth of the auditory tube is free, with no signs of inflammation. Ultrasound of the paranasal structures and X-ray examination noted a small swelling of the mucous membranes of the maxillary sinuses, and we no longer performed a small swelling of the mucous membranes of the nasal cavity due to the reliability of the ultrasound method and the absence of radiation exposure to the child. Odorimetry 2 degrees. The child does not perceive light odors.

With pharyngoscopy, loosened palatine tonsils, lacunae prone to sclerotherapy are detected, there is no fusion of the tonsils with the palatine arches, the surface of the tonsils is uneven, "tuberous." Caseous plugs are noted in the gaps; with light pressure with a spatula, their easy separation from the gaps is noted. When separating plugs, erosive surfaces were not detected. The mucous surface of the palatine arches is hyperemic (especially their free edge). Regional lymph nodes are enlarged to 1 cm and are somewhat painful on palpation. Hypertrophy of palatine tonsils of the 2nd degree was noted. The pharynx is symmetrical. The soft palate is movable when asked to sing "E." When otoscopy pathology was not detected. In the blood test, L - 10.2 "109 / l, eosinophilia - 15%, accelerated ESR (12 mm / h), which indicates the presence of an inflammatory process and allergization of the body. Bacteriological examination of palatine tonsil material revealed an increase in microbial seeding with the presence of Staphylococcus aureus Staphylococcus aureus (2 × 10 ⁶ CFU) in the flora of the contents of the palatine tonsils. A cytological examination of the contents of the tonsils revealed leukocytes 20-35 in n / a, eosinophils 8-10 in n / a. Based on the examination data, medical history, and laboratory examination results, chronic compensated tonsillitis was diagnosed. According to spectrophotometry, a decrease in Vcr (by 41.5%) and 80 g (by 24.1%) was revealed. The Kerdo index testified to sympathicotonia and amounted to +28 units. Conducted conservative treatment of the proposed method.

The child received 12 ml of irrigation therapy with saline solution on both sides, 1.5 ml of Coletex-Gel-ADL was introduced into the lacunae on both sides, a similar Coletex ADL tissue napkin with sticky edges was applied to the projection of the common carotid artery, carotid sinus , internal and external jugular veins, vagus nerve and upper cervical sympathetic ganglion. Laser irradiation with a matrix emitter was carried out sequentially on both sides with a frequency of 1000 Hz with an output power of 15 mW for 5 min, for a course of 5 procedures daily. At the end of each procedure, tissue napkins with sticky edges are left for 6 hours.

After the course of treatment, her state of health improved significantly: she did not show complaints of sore throat, her activity increased, her appetite and sleep improved (during classes with a speech therapist, positive dynamics were observed in the classes. Attention concentration improved).

Ultrasound did not reveal edema of the paranasal sinuses. With endoscopy of the nasopharynx, adenoid vegetation of the 1st degree, without signs of inflammation. There is no mucous discharge, the nasopharynx is free. Odorimetry without pathology. The girl perceives light smells. For other ENT, pathology organs were not detected. A positive clinical picture was observed: tonsils decreased in size, hyperemia of the palatine arches disappeared, lymph nodes decreased, pain on palpation was not. In a clinical blood test, eosinophilia decreased to 5%, the number of leukocytes (4.3 · 10 ⁹ / l), ESR (3 mm / h) normalized. During repeated bacteriological examination of Staphylococcus aureus, Staphylococcus aureus was not found. Cytology noted leukocytes -5-6 in n / a, eosinophils 3-4 in n / a. After a course of treatment according to the proposed scheme, an increase in SO ₂ was noted and its deviation from the norm was only 4.2%, oxygen utilization Vcr increased by 12.8%. The Kerdo index corresponded to normosthenia and amounted to +5 units. The patient was discharged to kindergarten in satisfactory condition with the appearance for re-examination after six months. At the follow-up examination after six months: exacerbations of chronic tonsillitis were not observed, during this period ARVI was not sick. Laboratory indicators are also within normal limits. The girl attends the kindergarten, began to do gymnastics 3 times a week. He copes with the load in the sports section. Currently, the patient continues to be observed.

The positive effect of the proposed method is confirmed by the improvement of indicators: clinical blood analysis (the number of leukocytes, eosinophils and ESR had normal values), blood immunograms and exocrine secrets (functional activity of phagocytic blood cells, increased secretory immunoglobulin A level in saliva, immunoglobulin E in the blood), immunological functions of the tonsils. The most significant is the regulation of vegetative status, which is manifested by the normalization of the Kerdo index. After the course according to the developed scheme, a shift in indicators towards normostenia was revealed (Kerdo index 5 ± 3 units), which was accompanied by an increase in the adaptive reserves of the body. This indicates a persistent improvement not only in subjective, but also in objective indicators. Laser spectrophotometry ("Spectrotest") revealed the dynamics of changes in the volume of microcirculation (Vcr) and oxygen concentration (SO ₂ ) in the tissues in the course of treatment. If before the course, a decrease in Vcr (by 46.6 ± 0.1%) and SO ₂ (by 19.8 ± 1.2%) was detected, which was associated with edema and stagnation due to inflammation, then after the course of treatment according to the proposed scheme a decrease in SO ₂ (by 28.5 ± 0.2%) and an increase in oxygen utilization Vcr (10.5 ± 0.1 %%), which indicates the activation of oxygen-absorbing processes in inflamed tissues and indicates relief of acute or exacerbation of chronic tonsillitis and confirms the effectiveness of the technique and reflect the restoration of metabolic processes in tissues (the numbers of indicators correspond dissolved age and are given in the examples). A supporting pathological link is the predominance of the spastic reaction of the microvasculature, increased heart rate due to intoxication with tonsillitis, which is manifested by sympathicotonia (Kerdo index + 23 ± 5 units).

It is possible to use this method for prophylactic purposes, while it is advisable to conduct repeated courses, especially in the autumn-spring period, when frequent colds are observed, exacerbations of many infectious diseases leading to a weakening of the body's immunobiological system.

Claims (1)

A method of treating chronic tonsillitis in children, including drug and irrigation therapy, laser therapy in the submandibular region, characterized in that the hydrogel material Coletex-gel-DNA-L or Coletex-gel-ADL is introduced into tonsil lacunae as a drug therapy 1-3 ml in each amygdala, laser therapy is additionally carried out on the projection zones of the common carotid artery, carotid sinus, internal and external jugular veins, vagus nerve and superior cervical sympathetic ganglion, and previously on these zones and in the the napkin “Coletex-ADN” or “Coletex ADL” is placed in the chandelier region, the exposure is carried out in the infrared range sequentially on both sides with a frequency of 1000 to 1500 Hz with an output power of 10 to 20 mW, exposure time of 2 to 8 minutes, after the procedure, the used napkin is left for 6-8 hours, for a course of 3-10 daily procedures.