A method of treating chronic inflammation trepanations cavity after radical surgery on the middle ear

 

(57) Abstract:

The invention relates to medicine, in particular to the ENT, and can be used for the treatment of chronic inflammation trepanations cavity after radical surgery on the middle ear. Offered for cleansing the cavity from necrotic masses within 5 days to use papain 3 times a day with 15-20 min exposure and concentration of 20 mg in 1 ml of physiological solution. Then to improve tissue regeneration cavity buried curiosin 1-2 ml 2 times a day with the exposure time of 15-20 minutes the Treatment is carried out under bacteriological and cytological control and indications stages of treatment repeat. The method improves the efficiency and reduces the time of treatment.

The present invention relates to medicine, namely to otolaryngology, and can be used to improve the efficiency of treatment of patients undergoing radical surgery on the middle ear.

Relevance due to the significant prevalence of chronic purulent middle otitis, as well as a large number of poor morphological and functional results in the complex treatment of patients with this pathology. Noactivity organism and the properties of bacteria, the accumulation of practical experience in using the currently accepted principles of diagnosis and treatment of patients with chronic suppurative otitis media cause to reconsider some of the established regulations, as well as to develop new and innovative research areas designed to improve the efficiency of treatment of patients with this pathology.

The known method (Manual of otorhinolaryngology / Ed. by I. B. Soldatova. - M.: Medicine. - 1994. - 608 S.) conservative treatment of chronic inflammation in the middle ear. The first stage is conducted toilet tympanic cavity and auditory tube of antiseptic solutions, which in turn decreases the intensity of the inflammatory process in the middle ear and the microflora is deprived of the nutrient medium. The second stage of treatment is the direct effect on the mucous membrane of the middle ear of various medicinal substances. Used antibacterial drugs, deistvuya on gram-negative bacteria (1% solution dioksidina and others), antibiotic Treatment is carried out with sensitivity, it microflora. If allergic manifestations in the ear prescribed drugs glucocorticosteroids. The disadvantages of this method Le is STI from their properties and nature of the pathological process in the middle ear lack of effectiveness of the treatment.

For the prototype we have adopted the scheme of treatment of non-healing trepanation RAS mastoid (D. I. Tarasov, O. K. Fedorov, V. P. Bykov. Diseases of the middle ear. A guide for physicians. M.: Medicine, 1988. - 288 S.), including daily washing of the postoperative cavity with antiseptic solutions (furacin), 3% aqueous solution of boric acid) with subsequent instillation of 1% dioksidina. Frequently observed inflammation and the accumulation of crusts allow the widespread use of drugs, alcohol, oil and wax based proteolytic enzymes. Fine granulation can be taxiroute cauterizing liquid or delete a curette, and areas of edematous mucosa to taxiroute 1-10% solution of silver nitrate. You can complete the treatment by physiotherapy and restorative therapy, antihistamines. The disadvantages of this method, in our opinion, the same as in the above analogue.

The objectives of this new method are improving efficiency, achieving stable results in the treatment of patients who are concerned about the continuing otaria from the operated ear.

The essence of the method is the application of the second treatment by putting it on for 15-20 minutes in the ear canal 1-2 ml (20 mg in 1 ml of physiological solution), 3 times a day. Then move on to curiosin 1-2 ml, 2 times a day for 10 days, the exhibition also 15-20 minutes. At the same time patients spend cavity lavage solutions furacin or boric acid instillation of a 1% solution dioksidina.

A proteolytic enzyme of plant origin papain for local application shows high lytic activity against non-viable tissue, blood clots, almost without acting on living tissue. Along with necroticism action has mucolytic effect, ie, the ability to break down the various exudates and purulent masses, which leads to improvement of drainage features in the area of inflammation and creating conditions to accelerate tissue regeneration. Thanks to the active destruction and removal of necrotic masses and exudate are created unfavorable conditions for microorganisms, as well as improving the contact of antibacterial drugs with the microbial cell.

"Curiosin" produced by the Hungarian company Gedeon Richter is associate hyaluronic acid and zinc. The local increase in the concentration of hyaluronic acid in the process of tissue regeneration creates optimal conditions for ACTIVIA is the improvement of local microcirculation. The zinc hyaluronate, which is part of kuriozine, has an antiseptic effect.

We have conducted research on the application of papain and kuriozine in the early postoperative period after sanitizing and sluhouluchshayuschego operations on the middle ear. The results of these studies, we noted that curiosin compared with more active papain reduces bacterial colonization and causes faster epithelization of the wound surface, at the same time, papain before curiosin leads to cleanse the wound of necrotic tissue.

Examples: 1. Patient S , 19 years old, was treated at the Krasnodar regional ENT center with 31.05.2000, 15.06.2000, the Diagnosis of Left-sided chronic suppurative epitympanic. Condition after radical surgery on his left ear. Was admitted with complaints purulent discharge with odor from the left ear. From the anamnesis it is known that in 1998, underwent radical surgery on the left middle ear. One year after surgery on the background of SARS gnetaceae from ear resumed. Was treated conservatively by place of residence, the effect is negligible. Enrolled in ENT center to teach a course of conservative treatment. Objective: the cavity after RO correct form, epithelisation not pornological study the value of CFU/ml above 1105. Papain and curiosin applied according to the scheme: during the first 5 days of treatment prescribed by papain instillation of 20 minutes in the ear canal 1 ml, 3 times per day. Then moved to curiosin 2 ml, 2 times a day for 10 days, exposure time 20 minutes. At the same time were washing the cavity with restrrom of furacin, instillation of a 1% solution dioksidina. On the background of lecheria trepanation cavity was cleansed from necrotic masses, microbial seeding did not exceed the critical value. At discharge: cavity after radical surgery correct form, detachable no, kapitalizirovana more than 2/3 of the cavity surface. At the control examination after 3 months, 6 months and 1 year no complaints, the cavity epithelisation, without pathological discharge.

Example 2: Patient S. , 33 years, treated at the ENT centre was 12.12.2000, 27.12.2000, Diagnosis: Bilateral chronic suppurative epitympanic. Condition after radical surgery on both ears. From the anamnesis: in 1987 he moved RO the right, in 2000, radical surgery with tympanoplasty type III on the left middle ear. Was admitted with complaints of recurrent purulent discharge from the right ear, the last exacerbation began more than a month the STV purulent and necrotic masses. Papain was administered during the first 5 days of treatment. For 15 minutes in the ear canal dug 2 ml, 3 times per day. Then moved to curiosin: 1 ml, 2 times a day for 10 days, the exposure time is 15 minutes. The patient was conducted cavity lavage solution furacin, instillation of a 1% solution dioksidina. On the background of therapy the cavity after the operation was purified from the discharge, while sowing the value of CFU/ml did not exceed the critical value 1105in 1 ml. Kapitalizirovana about 2/3 of the cavity surface. After 2 months the patient was admitted with complaints on a newly emerged gnetaceae from the ear. Was carried out a second course of treatment under the above scheme. Was discharged in good condition: no complaints, no detachable, kapitalizirovana more than 2/3 of the cavity surface. At the control examination after 6 months the cavity after surgery the correct form, detachable no, epithelisation.

The use of papain and kuriozine for the treatment of diseases trepanations cavity improves the efficiency and reduce the duration of treatment of patients with this pathology.

A method of treating chronic inflammation trepanations cavity after radical surgery on the middle ear, including the value of 5 days at a concentration of 20 mg in 1 ml of physiological solution, 3 times a day with the exposure time of 15-20 min for purification cavity from necrotic masses using papain, then to improve tissue regeneration cavity buried curiosin 1-2 ml 2 times a day, with exposure time of 15-20 min, and the treatment is carried out under bacteriological and cytological control and indications stages of treatment repeat.

 

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