Treatment method for chronic purulent otitis media

FIELD: medicine; otorhinolaryngology.

SUBSTANCE: in early postoperative period, after finishing antibiotic system and local therapy course, into patient's ear his own saliva is instilled. The saliva is taken fasting in the morning, after oral cavity cleaning, by spitting into boil treated glass. 3 drops of saliva 3 times a day during 20 to 45 days is instilled.

EFFECT: disease recurrence reducing due to mastoidal cavity populating with normal microflora.

1 tbl, 2 ex


The invention relates to medicine, namely to otolaryngology, and can be used in the treatment of chronic suppurative otitis media after sanitizing operations on the middle ear.

Hitherto the mainstay of therapy of chronic suppurative otitis media after holding a sanitizing operation is systemic and local antibiotic therapy. As a result of such treatment the cavity of the middle ear, as a rule, exempt from pathogenic organisms, and, unfortunately, at the same time suffers saprophyticus microflora, vegetating on the skin of the ear canal is normal. Sanitized cavity of the middle ear in the absence of competing interactions with saprophytes and reduced local immunity against a background of chronic inflammation again obamanauts aggressive pathogens, leading to relapse of chronic suppurative otitis media and the formation of diseases of the operated ear. Numerous studies have shown that a stable remission of chronic suppurative otitis media involves vegetariana in the cavities of the middle ear saprophyticus microflora (Tarasov DI, Fedorova O.K., V.P. Bykov Diseases of the middle ear. - M.: Medicine 1988. - 288 S.). We investigated the microbial landscape of the middle ear in 17 patients previously underwent radical surgery in the state of stable long-term clinical remission is thew not less than 3 years. In 35.2% of observations microflora is not verified, 53% gave a moderate increase, basically no predominance of individual representatives. Abundant growth in a smear from ear had 2 people (11%), suffering from chronic diseases of the pharynx with carriage of Staphylococcus aureus. In microbial landscape was dominated by saprophytes: S.epidermidis (29,4%), S.saprophiticus (23,5%), H.influensia (11,7%). Significantly less frequent carriage of pathogenic species: S.aureus (11,7%), at all and diphtheroids (5,8%) - p<0.05 using the ratio of the total share of saprophytes and pathogens (Spotin VP, Proskurin A.I. and other Microflora when epitympanic in remote terms after sanitizing operations // Abstracts of XVII Congress of otolaryngologists of the Russian Federation. - Nizhny Novgorod, June 7-9, 2006. - S-152).

Thus, there is a need to find ways of settling postoperative cavities nonpathogenic saprophyticus microflora.

In the last decade, widespread probiotics preparations containing strains of microorganisms that are useful to the organism. Requirements that must be met by probiotics: healthy according to the human microflora, high viability and biological activity, antagonism to conditionally pathogenic and pathogenic flora, resistance to physical and chemical factors (pH, osmotic shock, temperature, the same action is cnyh acids, etc.) (Khoroshilova, NV Immunomodulatory and therapeutic effect of probiotics // Immunology. - 2003. No. 6. - S-356). Probiotics are widely spread in veterinary medicine (Bakulina L. F., Permanova N.G., I. Timofeev, and other Probiotics on the basis of spore-forming microorganisms and their use in veterinary medicine // Biotechnology. - 2001. No. 2. - P.48-56) and gastroenterology (Uchaikin V.F., Gasparyan MO, Novokshonov A.A. and other Probiotics in complex therapy of acute intestinal infections in children // Biological products. - 2001. No. 1. - C.2-4). The use of probiotics in otorhinolaryngology limited due to the absence of microorganisms, vegetating in a healthy ENT organs.

As a natural probiotic can be considered the saliva of a person that is not sterile and contains saprophyticus microorganisms. The oral cavity of a healthy person is rich in flora, characterized by relative stability, supported antibacterial properties of saliva. The concentration of microbial cells in 1 ml of saliva may be in the range of 107-1010and on the mucous membrane in gingival pockets and 1011CFU (colony forming units). These include aerobic and anaerobic gram-positive and grammatically rod-shaped and coccoid saprophytes. (Bondarenko A.V., Bondarenko WLM, Bondarenko V.M. Ways to improve etiopathogenetic therapy dysbacteriosis // Ukr. microbio is., Epidemiol. and immunobiol. - 1998. No. 5. - Pp.96-101). We conducted microbiological testing of saliva in 23 persons with purulent otitis media and 20 healthy people. In 32 of them in the saliva found non-pathogenic saprophyticus microorganisms (epidermal and saprophyticus staphylococci, H.influensia). 5 patients with otitis and 3 healthy people on nutrient media derived the growth of Staphylococcus aureus (4 cases), Klebsiella (2 cases), hemolytic Streptococcus (1 case) and Escherichia coli (1 case). In all cases, pathogenic seeding patients had or chronic disorders of the oropharynx, or multiple caries.

Since ancient times for therapeutic purposes are used excreta and fluids of the human body. For millennia, the use of saliva that was stopped and resumed in different modifications. The saliva of a fasting person has been used to remove warts, abscesses, tumors, and birthmarks. Ringworm and skin ulcers in ancient times was treated with compresses of saliva. To get rid of stubborn calluses them put the baking soda, which previously spit (Babylonian Talmud. Chapter 91). The healing features of saliva were observed by ancient healers and successfully applied them not only for the treatment of external injuries and internal ailments. Medical sources Sumerian, Agip TSCA, Tibetan and Greek authors we find information about this unique matter. "It is the only substance created by the body, which is not deduced from it, and like the tides and low tides cyclically pulsing in him, rising and opda." (Abu Ali Ibn Sina. Canon of medical science // 3 parts / Comp. Wierema, August. - Tashkent. Publishing house "Fan" of the Academy of Sciences of the Republic of Uzbekistan, 1994. 400 S. + 360 C. to + 232 C).

In classical and modern literature we have not found sources that indicate the use of human saliva in the treatment of chronic suppurative otitis media. In this regard, as a prototype of the selected method of treatment of chronic purulent middle otitis using other biological fluids - autoseparate (Korsakov B.C., Abant R.K., Scriabin, AS the Results of reconstructive surgery for chronic suppurative otitis media using autoseparate and collagen sponges // West. torinla. - 1998. No. 1. - p.56-58; Korsakov B.C., Scriabin A.S., Fedorova O.K. Method of treatment of chronic purulent middle otitis // Patent RF №2099064 from 20.12.97).

The disadvantages of the prototype include:

- the need for multiple intravenous fences blood that is required for more invasive procedures;

- autoseparate sterile and does not perform the function of settling the middle ear cavity saprophyte the mi;

- as a good medium for microorganisms, autoseparate may, under certain circumstances even to provoke exacerbation of chronic suppurative otitis media;

- requires the attachment of the patient to a medical institution for a long time restricted work.

The aim of the invention is to optimize postoperative treatment of chronic suppurative otitis media and reducing the frequency of its recurrence.

The proposed method of treatment of chronic suppurative otitis media includes sanitizing operation and landfill biological fluid in the ear after surgery. Put in the invention the objective is achieved by the fact that in the early postoperative period, after the completion of systemic and local antibiotic therapy, ear buried on 3 drops of saliva of the patient, obtained in the morning on an empty stomach after toilet mouth by Slavyane processed by boiling in a beaker, burial spend 3 times daily for 3 weeks to 1.5 months.

In the proposed method, the saliva is used in the postoperative period within 8-12 days. During surgery on the ear, made by "open" option, well-formed foreseeable accessible for visual inspection and injecting fluids mastodynia cavity in which to 8-12 day begin the process of epidermization. the usual by this time, under favorable postoperative period, the course system and antibiotic therapy, removed stitches from the ear wounds and patients are discharged to outpatient aftercare. In a smear from the ear before discharge almost most patients not detected the growth of microflora, which speaks to the effectiveness of a hospital treatment. However, due to impaired immunity, as a result of chronic inflammation and transactions, and the absence of competitive impacts of saprophyticus microflora postoperative cavity newly colonized by pathogens, leading to relapse of epitympanic. To avoid this, after discharge, patients begin to drip in the operated ear saliva. The argument of using saliva as a probiotic is vegetariana it saprophyticus microflora. In diseases of oral cavity, salivary glands and pharynx saliva inoculated pathogens in these cases, the use of saliva contraindicated to rehabilitation foci of inflammation. Recommended patients dosage is 3 drops 3 times a day, were chosen empirically and it paid off: at lower dosages saliva had time to dry, at large, because of the abundance of fluids, slowing the reparative processes. The collection of saliva was carried out by patients themselves, in the morning and on an empty stomach after using the toilet strips and mouth (toothpaste, mouthwash). Patients did not change their usual way of toilet mouth when seed after him, from saliva saprophyticus microflora. Saliva was cplegialas processed by boiling a glass beaker and was used during the day, the next day was going to a new portion. The duration of such treatment varied from 3 weeks to 1.5 months depending on the individual capabilities of reparation and the reactivity of the organism. During this period ends, the full epidermization postoperative cavity, it is cleared from the exudate. The criterion for ending the use of saliva was not only a visual inspection, but also microbiological examination with the sowing of the middle ear saprophyticus microflora.

The proposed method is performed as follows: after discharge from hospital (8-12 days of the postoperative period), when finished systemic and local antibiotic therapy and stitches BTE wounds, patients in the outpatient setting are beginning to place in the operated ear saliva. Saliva receive daily in the morning before eating and after toilet mouth by Slavyane. A prerequisite for the use of saliva was complete sanitation of the oral cavity and the absence of microbiological examination of pathogenic microflora. We recommended that the instillation of 3 drops 3 times a day is. Permanent fence saliva was not required, it was enough of a morning portion collected processed by boiling a glass beaker. The duration of this treatment was from 3 weeks to 1.5 months, depending on otoscopes and microbial dynamics. Criteria for discontinuing the use of saliva was either the appearance of purulent exudate that spoke of incomplete rehabilitation postoperative cavity from pathogenic microorganisms and demanded the renewal rate of the local anti-inflammatory therapy and then re-use saliva as a probiotic, or termination of exudation, finished epidermization postoperative cavity and seeding in the control of microbiological research saprophyticus microflora.

The difference of the proposed method from the prototype is:

- the use of saliva is a simple method that does not require material expenditures and invasive methods of sampling;

the patient independently, without participation of health workers in the home can use this method of treatment;

- saliva due to the content factors of nonspecific and specific protection, is anti-inflammatory and protective properties;

- in the saliva cultivate non-pathogenic microorganisms, are the same as on the skin, allowing you to use it as probiotics settlement postoperative mastoianni cavity normal for such localization microflora;

- the formation of balanced microflora by instillation into the ear of saliva allows to achieve stable remission chronic suppurative otitis media and to avoid diseases of the operated ear.

We compared the results of treatment of chronic suppurative otitis media in groups of patients with the use of saliva (n = 23) and without the use of saliva (31 people). Microbiological criteria for comparison were: the lack of growth on nutrient media, seeding saprophyticus and pathogenic organisms in smears from the middle ear, which is determined before discharge, after 3 weeks, 1.5 and 3 months after surgery. Clinical comparison criteria were: disease recurrence in the first year after surgery, epidermization postoperative cavity, the presence of productive elements and pathological scarring. The comparison results are presented in table 1.

Table 1
The results of treatment of patients with chronic suppurative otitis media depending on the application of saliva
Using saliva (n=23)Without the use of saliva (n=31)
There is OST microflora Before discharge2295,62993,5
After 3 weeks0018to 58.1
1.5 months003the 9.7
After 3 months0013,2
Saprophyticus microfloraBefore discharge0000
After 3 weeks21for 91.3722,6
1.5 months231002064,5
After 3 months231001961,2
Pathogenic microfloraBefore discharge14,326,4
After 3 weeks28,7619,4
1.5 months00825,8
After 3 months001135,4
Relapse in the first year after surgery1 4,3825,8
State trepanations cavity in the late postoperative periodEpidermization2295,62477,4
Pathological scarring0026,5

As can be seen from table 1, the majority of patients in both groups at discharge from hospital in smears from the cavity of the middle ear is not received by the growth of microorganisms. In the group of patients who have not applied saliva (31 people), the absence of microflora in smears after 3 weeks remained in 18 (58.1 per cent) persons, 1,5 month 3 (9,7%), 3 months - 1 (3,2%) person. Postoperative cavity of patients in this group was gradually colonized by microorganisms, three months after surgery in 19 of them (61,2%) was sown saprophytes, 11 (35.4%) of pathogenic microorganisms. All patients (100%) chronic suppurative otitis media, for which treatment was applied saliva, after 1.5 and 3 months after surgery of the ear was sown only saprophytes.

The efficiency of proposed method for the treatment of chronic suppurative otitis media can serve as a stable remission EPI is impunity most-treated saliva of patients, relapse in the first year after surgery occurred in 1 patient (4.3 percent) incomplete epidermization postoperative cavity and growth of granulations. At the same time, the patients of the comparison group relapse in the first year after surgery were recorded 6 times more often (25.8%) and were the result of incomplete epidermization (22,6%), education productive elements (16,1%) and pathological scarring with separation trepanations cavity (6,5%).

Our proposed method is embedded in the work of otorhinolaryngological Department Alexander Mariinsky regional hospital Astrakhan and used in the treatment and rehabilitation of 23 patients with chronic purulent middle otitis. Below are examples of approbation.

Example 1. Patient H., born in 1980 admitted in ENT Department 26.02.06 history No. 3162) with complaints of pain in right ear, abundant gnetaceae from him with a sharp putrid smell, hearing loss in the right ear. Sick since childhood. In 1997, in an emergency performed radical surgery on the right middle ear and the right-sided GamesIndustry about secondary purulent meningitis and sepsis. After discharge from the hospital remission has not occurred, continued purulent discharge from the right ear, about which repeatedly treated in hospital with short-term clinical improved the eating. Instrumental and x-ray examination at the hospital showed that despite otoscopes uncoupling of the right cavities of the middle ear of the patient continued osteomyelitic process of the temporal bone with the presence of cholesteatoma. In a smear from the right ear detected abundant growth of Staphylococcus aureus, moderate growth of Escherichia coli and colonies of Proteus and Enterococcus. In saliva, on the background of a complete reorganization of the oral cavity, received moderate growth saprophyticus and epidermal staphylococci. 07.03.2006 under endotracheal anesthesia BTE method performed sanitizing reoperate on the right middle ear "open" method. Removed a large cholesteatoma, caries-modified bone, granulation detected destructive bone defects with exposure of the Dura mater of the middle cranial fossa and the sigmoid sinus. All pathological removed until healthy bone. To increase front epidermization from the ear region taken flap on the supply leg, placed at the bottom mastoianni cavity with cover bone defects (Application for invention No. 2006102403 (002596) from 26.01.06 year). The postoperative period was uneventful. He received a course of systemic and local antibiotic therapy. In the control, before discharge, smear from ear growth of microorganisms is not received. In the outpatient setting on the 12th day after the Opera the AI for 1.5 months buried in the operated ear saliva 3 drops 3 times a day. At the control examination after 1.5 and 3 months after surgery - full epidermization cavities of the middle ear cavity was cleansed, it takes they are not. Microbiological research in the cavities of the middle ear detected the colony saprophyticus and epidermal staphylococci.

Example 2: the Patient Y., born in 1962, suffering from left-sided chronic suppurative otitis media since childhood. Repeatedly passed a course of conservative anti-inflammatory therapy with temporary clinical improvement. The last hospitalization 9.11.2005, history No. 18207) in connection with the continuing generous with sharp putrid smell otaria and arose three days before hospitalization facial paresis. When otoscopy: AD - without a pathology. AS - in the ear canal abundant purulent discharge with a putrid odor. Eardrum scar-modified, hyperemic, visualized Subtotal regional defect. Hearing SHR: AD=6 m, AS=1.5 m On the x-ray temporal bones on the background of sclerotic-type structure of the left mastoid process is determined by destructive cavity with sequestration. Microbiological examination of the cavities of the middle ear sown Association pyogenic Streptococcus, Escherichia coli, yeast, and Proteus; from saliva - superficiali aureus and H.influensia. Sanitizing operation performed by sasniedzam on "open" method tympanoplasty type II. During surgery removed carious and cholesteatoma mass found naked facial nerve, which is covered by a flap on the supply leg, cut from the skin of the ear region (Application for invention No. 2006102403 (002596) from 26.01.06 year). The postoperative period is smooth. Getting the exchange rate of local and systemic antibiotic therapy the patient on the 9 day was discharged from the hospital with minor symptoms of paresis of the facial nerve. When microbiological examination before discharge in the postoperative cavity detected a slight increase pyogenic Streptococcus and Proteus. Starting from the 8th day after surgery within 3 weeks the patient dripped into the ear of his own saliva on 3 drops 3 times a day. Control examination after a month: the cavity of the middle ear expressed, dry, fully epidermiology, neethimangala membrane in a satisfactory condition, the effects of facial nerve paresis disappeared completely, whispered speech on the operated ear to 4.5 meters in smears from ear detected a moderate increase saprophyticus Staphylococcus. When using our proposed method of treatment achieved:

- optimize postoperative treatment of chronic suppurative otitis media and reduce the frequency of its recurrence;

- full rehabilitation of the mastoid process due to the content in the saliva of specific and nonspecific factors of protection;

simplify treatment and facilities in the application of saliva by eliminating invasive methods of sampling of biological fluids;

- check the cavities of the middle ear normal microflora to reduce the recovery time and to achieve stable remission;

- the lack of saliva aggressive chemical compounds does not lead to local pain when using it;

- reduce economic costs due to lower expenses for the purchase antiseptic ear drops in the early postoperative period and reduce episodes of exacerbation in late.

The method of treatment of chronic suppurative otitis media, including sanitizing operation and landfill biological fluid in the ear after surgery, characterized in that in the early postoperative period after completion of systemic and local antibiotic therapy in the ear buried on 3 drops of saliva of the patient, obtained in the morning on an empty stomach after toilet mouth by Slavyane processed by boiling in a beaker, burial spend 3 times daily for 3 weeks to 1.5 months


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