RU2085180C1 - Method for treating inflammatory diseases of upper respiratory tracts - Google Patents

Abstract

FIELD: medicine; otorhinolaryngology; treatment of pathologic conditions of nose and nasopharynx. SUBSTANCE: proposed method resides in treating nose, nasopharynx and tonsils with infusion of celandine herb by administering it directly into tonsil crypts or into accessory nasal sinuses 7-10 times, while, simultaneously, irrigating them with same infusion daily, 3-4 times a day. Infusion is prepared by heating celandine herb for at least 45 min., followed by holding it for 5-30 min. EFFECT: as distinct from prior-art methods, proposed one offers longer remission periods (from 1,5 to 2 years), while aggravations occur less frequently and last shorter time.

Description

 The invention relates to medicine, namely to otorhinolaryngology, and may find application in the treatment of pathological conditions of the upper respiratory tract.

 The main way to treat diseases of the upper respiratory tract (URTI) is currently medication: the appointment of antimicrobials (antibiotics and / or sulfamides).

 However, it is known that in addition to the microbial factor (staphylococci and streptococci), in addition to the microbial factor (the staphylococci and streptococci), it is known that the state of the body's immunological reactivity plays an important role. Therefore, in recent years, increasing attention in the treatment of both acute and, in the first place, chronic diseases of UDT has been given to regulators of cellular immunity, mainly, correctors of T-cell immunity. Moreover, among immunoregulators, preference is given to drugs of natural origin. This is due to the fact that many synthetic immunomodulating agents not only do not give the desired effect, but also often cause negative reactions in the body: hepatotoxicity and nephrotoxicity, hematopoiesis inhibition, various allergic manifestations, reduce the body's resistance to viral infection.

 The invention relates to the use of a medicament for the treatment of chronic diseases of the UDT, combining antimicrobial and anti-inflammatory, as well as immunomodulating properties. Such is celandine.

 A method for the treatment of diseases of the UD through the official infusion of celandine herb was developed at the St. Petersburg Research Institute of ENT SPECIALIST with the aim of preventing relapse of the disease and enhancing the effectiveness of the main treatment methods. This method is taken by us as a prototype.

 The method consists in prescribing the infusion of celandine grass in chronic purulent rhinosititis locally and inward. For topical use, celandine infusion is used, prepared by heating for 15 minutes 2 tbsp. tablespoons of grass in 200 ml of water. The resulting solution is used for 5-7 days for irrigation of the nasopharynx and nasal cavity 2 times a day, and with combined sinus damage (sinusoethmoiditis, hemisinitis) for infusion by the Proetz movement method. Local treatment is necessarily combined with general, i.e. taking the solution inside. Such a solution is prepared less concentrated at the rate of 2 tsp. herbs in a glass of water and is prescribed 3-4 times a day for 1/4 cup. The duration of the course of general treatment is 30 days.

 Observation of patients immediately after a course of treatment and at a remote time (after 1 g) indicates an improvement in a number of immunological parameters: the relative and absolute content of T-lymphocytes increases, the metabolism of magnesium and perperdinogenesis are normalized, bacterial contamination and detoxification are significantly reduced. These changes are quite stable and persist in most cases for 1-1.5 years. Over this period, more than half of the examined individuals with chronic rhinosititis had no exacerbations of the disease, while the rest had a decrease in relapses of the disease during the year (up to 1-2 times instead of 5-7 exacerbations per year).

 It is known to use infusions of celandine herbs for chronic tonsillitis in children. Local and general treatment led to a significant increase in T-cell immunity in all children. 4-7 days after the end of the course of treatment, a distinct decrease in the number of hemolytically active forms of microorganisms in the tonsil lacunae was established. Observations of 30 children with a tendency to sore throats showed that sore throats stopped in 65% of cases, the number of relapses of tonsillitis decreased in 25%, while the incidence of acute respiratory infections was noted. The clinical effect was absent in 10% of the examined.

 Thus, both in the case of chronic rhinosinitis and in chronic tonsillitis, the authors note a decrease in the number of relapses (on average in 50% of cases) and an increase in remission of the disease to 1 g in about half of the examined individuals, as well as a decrease in relapses of angina.

 All of the above indicates a sufficiently high efficiency in the treatment of diseases of the airborne diseases with the help of celandine herb infusions. These first, but, of course, convincing treatment results obtained by our colleagues indicate the promise of using celandine in wide medical practice.

 The antimicrobial effect of the official infusion of celandine used in the prototype method lasts only a few hours and therefore its use for several days reduces the value of the treatment method. We also revealed a strong contamination of this infusion with microorganisms of several species (as you know, in natural conditions, landfills of waste and garbage are a favorite place for growing celandine). As we have shown, the total number of microorganisms is 50-100 thousand microbial bodies in 1 ml of official infusion.

 Since different microorganisms are isolated from different batches of plant materials, the total number of which varies significantly, it can be thought that this is the reason for the prototype method of unstable treatment results obtained by the authors.

 The technical result of the invention is to increase the stability of treatment results, namely, to prolong remission and reduce the number of relapses of the disease.

 This result is achieved by the fact that in the known method of treating chronic inflammatory diseases of the UD by introducing the infusion of celandine grass into the nasopharynx, according to the invention, the celandine infusion is preheated in a water bath for at least 45 minutes, then treated with low-frequency ultrasound for 5-30 minutes, after which it is additionally injected directly into the crypts of the tonsils or paranasal sinuses daily or every other day 7-10 times per course of treatment.

 Additional heating of the infusion of celandine increases its antimicrobial activity due to the release of biologically active fractions into the solution and, as a result, its bacterial contamination is significantly reduced. We have shown that when infusions are heated for 45 minutes, their antimicrobial activity increases by 2–3 times. After a day, the bacterial growth of Staphylococcus aureus culture is significantly slowed down, but there is no pronounced bactericidal effect of such infusions. Moreover, an increase in the heating time does not give their additional positive effect.

 In this regard, we undertook scoring of heated solutions. It turned out that their additional low-frequency scoring provides a sufficiently high bactericidal effect, almost sterile. Of the 28 studies we performed, in 21 of them, the infusions had a sterilizing effect on the introduced culture of staphylococcus (100 thousand microbial cells per 1 ml) and only in 7 cases did the growth of single colonies show an average of 4% of the initial concentration. In this case, the infusions, heated for 15 minutes (official) and then voiced, had no effect on the introduced culture of staphylococcus a day its abundant growth was noted.

 The scoring time is determined by us empirically and depends on the volume of the prepared infusion. For one introduction to the crypts of tonsils, for example, 3-10 ml is required, such a volume, as we have shown, must be voiced for 5 minutes. For the preparation of 100 ml it takes 10 minutes, 300 ml 30 minutes. This amount of infusion is quite enough for the treatment of several patients at the same time. Such solutions can be stored without changing antimicrobial activity for a week.

 Their introduction into the crypts of the tonsils, carried out using a curved cannula with an outer diameter of 1-1.2 mm, has a direct fatal effect on the infected contents of the gaps.

 Simultaneous irrigation of the nasopharynx with the same solution kills the pathological microflora located in the nasal cavity and pharynx, thereby enhancing the therapeutic effect. It manifests itself in the rather rapid elimination of pathological discharge from gaps, contraction of the tonsils, the disappearance of hyperemia of the palatine arches, and the reduction of regional lymph nodes (if any). By the end of treatment, the patient’s temperature, ESR normalizes, the number of eosinophils decreases, which in these patients, as a rule, is quite high, and the number of leukocytes normalizes.

 The introduction of the celandine infusion into the paranasal sinuses by the Proetz method after preliminary elimination of the purulent exudate from them and the washing of the nasal cavity along the Spray with the same solution 3-4 times a day contributes to the rapid termination of the mucopurulent departments, and removes the swelling of the mucous membrane of the nasal cavity and nasal sinks, eliminates congestion and shortness of breath.

 As shown by clinical trials of celandine infusion prepared by the above method, in the case of chronic tonsillitis and rhinosinitis, 7-10 rinses of lacunae or paranasal sinuses are sufficient to achieve a positive therapeutic effect.

 In addition to achieving a direct therapeutic effect in both cases, after 2-3 months, patients have a positive dynamics of the main immune indicators, which is crucial to reduce the frequency and duration of exacerbations of the disease. Our analysis of immunograms of patients before and 3 months after treatment reflects an increase in the phagocytic activity of neutrophils (the percentage of phagocytosis, phagocytic index increases), an increase in the concentration of properdine and magnesium ions is observed in the blood serum, which indicates a positive dynamics of nonspecific resistance of patients. All this helps to maintain the achieved therapeutic effect, as we have shown, in more than half of the examined individuals for 1.5 years. So, the absence of relapses during this period was noted by us in 56% of cases, a decrease in the frequency and duration of exacerbations in 30% of patients with chronic rhinosinitis.

 Approximately the same picture is observed in the case of chronic tonsillitis. The observed remission in children is currently 2 g, in adults also up to 2 years. Moreover, patients continue to be observed.

 Example 1. Patient Z. 1981 year of birth medical history N 136, turned to the NOR ENT on October 20, 1993 with complaints of frequent colds, accompanied by sore throats (3-4 times a year), recurring tonsillitis, weakness, low-grade fever. Within 2 weeks, the girl complains of "flying" pain in the joints of the lower extremities. In the blood test at this time, L 10.2, eosinophilia 20% accelerated ESR (22 mm). In the immunogram there are signs of irritation of the immune system with an increased content of T cells and enhanced receptor function. Noteworthy were the extremely low numbers of phagocytosis: T-lymph.- 1.61, T-lymph.act. 1.18, phagocytosis 28, phagocytic index 1.8.

 When examining the ENT organs revealed hypertrophy of the tonsils 2 tbsp. hyperemia of the palatine arches, liquid pus in the gaps. Regional lymph nodes are enlarged to 1 cm in diameter, moderately painful on palpation.

 Survey data, medical history, laboratory examination results made it possible to diagnose chronic decompensated tonsillitis.

 The girl was prescribed a course of treatment with the infusion of celandine grass prepared by the method developed at the Scientific Research Institute of ENT SPECIALIST: warming the infusion for 45 minutes, followed by voicing 100 ml of the solution for 10 minutes.

 Every day she was irrigated with the nasopharynx with this solution, and an additional day later, 20 ml of infusion was introduced into the crypts of the tonsils. After 3 rinses of the gaps in the tonsils, pus disappeared, gradually they began to contract, and hyperemia of the palatine arches decreased. A total of 7 procedures for introducing celandine infusion into the crypts of the tonsils in combination with daily washing of the nasopharynx with the same solution 3-4 times a day were performed. The girl’s well-being improved, her temperature returned to normal, joint pain disappeared. Positive clinical dynamics were also observed: tonsils contracted, hyperemia of the arches disappeared. In the blood test, eosinophilia halved to 10%, the number of leukocytes and ESR normalized.

 The girl was discharged from the clinic in good condition under the supervision of a local doctor with the appearance at the Research Institute of ENT after 3 months.

 At the control examination, the condition is good, no abnormalities on the part of the throat and nasopharynx, tonsils are clean. According to the mother, for three months the girl felt well, there were no colds.

An immunogram shows an increase in the phagocytic activity of neutrophils (% phagocytosis 96, phagocytic index 10.)
At the last examination in September 1995 (after 2 g), the girl’s condition was still good, she didn’t have tonsillitis, she underwent acute respiratory infections 2 times without complications from the tonsils. 2 years old girl is in remission.

 In this way, 29 children with chronic tonsillitis have been treated to date, moreover, in 14 children, it proceeded with relapses of tonsillitis from 1 to 4 times a year, in 15 children the course of the disease is non-anginal. All children very often suffered from viral infections. In all children, sensitization to staphylococcus or streptococcus antigens was detected, an increased content of T cells was detected in immunograms, receptor function was strengthened, and phagocytosis numbers were reduced. In blood tests in some children, accelerated ESR, increased eosinophilia, high leukocytosis were observed.

 All children underwent celandine treatment according to the method described above. All children without exception received a positive clinical effect. As for the long-term results, only in two children the achieved effect was very short-lived, they were still often ill, which served as the basis for prescribing tonsillectomy to them. In the other 27 children, the achieved treatment result was quite stable: they were less likely and usually had ARVI without complications (1-2 times a year), children prone to angina before treatment did not have angina for 2 years. In these children, at the time of repeated examinations at the Research Institute of ENT SPECIALIST, blood and phagocytic activity were within normal limits. Thus, the observed remission is 2 years.

 EXAMPLE 2. Patient F. 41 years old, medical history N 387, was admitted to the clinic of the Institute of ENT in February 1994 with a diagnosis of chronic tonsillitis, concomitant obesity of the III degree, non-toxic diffuse-nodular goiter, myocardial dystrophy.

 The patient complained of frequent sore throats (1-2 times a year), accompanied by subfebrile condition, headaches, sore throat and severe weakness, sweating. In addition, periodically there were pains in the region of the heart, in the joints of the limbs, soreness when swallowing, sore throat. From the anamnesis of the disease, it was found that she had chronic tonsillitis for about 10 years, she was repeatedly treated conservatively at the place of residence (washing the lacunae of the tonsils with furacilin solutions, rinsing the pharynx with chamomile herb extracts, calendula), but all this had a short-term effect.

 When examining a patient in the clinic, bright hyperemia of the mucous membrane of the palatine arches, their swelling is determined. The palatine tonsils are friable, swollen, hypertrophied, in the gaps there is abundant caseous discharge, subfebrile condition.

 In a blood test, L 12.0, eosinophilia 8% ESR 16 mm.

 In the immunogram there are signs of suppression of the immune system with T and B cells at the lower limit of normal, extremely low rates of phagocytic activity of neutrophils (% phagocytosis 26, phagocytic index 1.5).

 Sensitization to hemolytic staphylococcus was revealed. A study of the immunological activity state of palatine tonsils showed that there was an increase in the total bacterial contamination of crypts, in particular hemolytically active forms of microorganisms (6105 microbial bodies in 0.05 mm of crypt contents of the right tonsil and 6030 in the left). This corresponded to an increase in the number of lymphocytes with signs of antigen overload (100.8 lymphocytes in the right tonsil and 860.0 in the left, in 1 large square of Goryaev’s cell).

 Survey data, medical history, laboratory examination results made it possible to diagnose chronic tonsillitis, decompensated form. The patient was prescribed a course of treatment with the infusion of celandine grass prepared by the method developed at the Research Institute of ENT SPECIALIST (heating it for 45 minutes, followed by sounding). With an interval of 1-2 days, the crypts of tonsils were washed with 30 ml of infusion with simultaneous irrigation of the nasopharynx daily 3-4 times a day. In total, 10 tonsil washes were performed, as a result of which they were cleaned of pathological contents, reduced in size, and hyperemia of the arches disappeared. In addition, the general condition of the patient improved significantly, pain in the pharynx, joints and heart stopped. The blood count normalized the number of eosinophils (up to 4%), ESR up to 8 mm / h. From the clinic, the patient was discharged in good condition with a control turnout at the Institute of ENT specialist after 2 months for a follow-up examination. After 2 months there were no changes in the clinical picture from the ENT organs. The patient did not show complaints. There were no relapses of the disease. After 9 months, another control study was conducted. In the immunogram, normalization of cellular and humoral immunity was noted, microbial sensitization disappeared. The content of T-lymphocytes 50% of active T-lymphocytes 31% of B-lymphocytes 31% of phagocytosis 88, phagocytic index 8.3 units. Thus, the patient was in remission for 1 year. To date, she has no longer turned to the institute for help.

 Thus, to date, 51 patients with chronic tonsillitis have been treated, the decompensation of which was manifested in the form of relapses of tonsillitis up to 3-4 times a year, frequent acute respiratory infections (from 2 to 6 times a year), long-term subfebrile condition, in some patients with lymphadenitis. The duration of the disease ranged from 2 to 5 years.

 All patients underwent treatment according to the type of the above example. Further observation of them continued throughout the entire period of remission to the present. In 74% of cases, we observed a positive therapeutic effect that lasted for 2 years.

 EXAMPLE 3. Patient A. 41 years old, medical history N 145, was admitted to the hospital with complaints of headaches, heaviness in the nose, purulent discharge from the nose on both sides, alternating nasal congestion. He considers himself sick for about a month. He was unsuccessfully treated on an outpatient basis: He took antibiotics, physiotherapeutic procedures, and vasoconstrictors in his nose. Prior to this admission to the Research Institute of ENT, the patient suffered three times acute inflammation of the maxillary sinuses.

 Objective picture at admission: Nose mucous membrane is edematous, hyperemic. Swelling of the middle turbinates on both sides. Moderate mucopurulent discharge under the middle nasal concha on the left. Moderate soreness on palpation in the left maxillary sinus.

 Radiologically determined total dimming of both maxillary sinuses and ethmoid cells on both sides. An endoscopic examination of the nasal cavity with the help of rigid Storz endoscopes revealed a drainage of purulent secretion from under the middle nasal concha in the natural fistula of the maxillary sinuses on both sides.

 An immunological study showed severe immunodeficiency and bacterial sensitization to staphylococcal and streptococcal antigens. The latter was expressed in a decrease in cellular immunity (a decrease in the absolute number of active T-lymphocytes, phagocytic activity of neutrophils), as well as in indicators of the inhibition of leukocyte migration with bacterial allergens.

 Based on the history of the disease and the examination, an exacerbation of chronic bilateral purulent sinusitis is diagnosed.

 In the clinic, the patient underwent the following treatment: introducing the celandine herb infusion by the Proetz method, prepared by our method (heating the infusion with its subsequent sounding), was carried out 10 times daily with simultaneous washing of the nasal cavity according to the Spray.

 The subjective well-being of the patient improved 5 days after the initiation of treatment. This was expressed in the cessation of headaches, mucopurulent discharge from the nose, and improvement of nasal breathing. On the 7th day, objective positive dynamics was observed: the mucous membrane of the nasal cavity turned pink, there was no discharge, nasal breathing was free. Assigned 3 more procedures.

 2 weeks after admission to the clinic, the patient was discharged to work with the appearance at the Institute of ENT for monitoring after 3 months.

 X-ray control after 3 months showed satisfactory pneumatization of the paranasal sinuses. Positive clinical dynamics corresponded to the normalization of immunological parameters. Observation of the patient continues for 1.5 years. There were no relapses of the disease during this time.

 In this way, to date, 20 people have been treated with chronic purulent rhinosinitis, repeatedly treated at the place of residence and not having a persistent positive effect. All of them had headaches, purulent discharge from the nose, nasal congestion and shortness of breath. The duration of the disease in most was 5 years or more. X-ray in 90% of them revealed a total blackout of the paranasal sinuses. In immunological status, a quantitative decrease in cellular immunity (decrease in the number of "active" T-lymphocytes in 10% of patients, impaired lymphokine function of T-cells in 80% and also the ratio of helper cells in 46% of patients). Neutrophil phagocytosis rates were reduced in 50% of patients. Microbial sensitization to hemolytic staphylococcus was detected in 25% hemolytic streptococcus in 37%. Microbiological examination showed a diverse species composition of microflora of pathological nasal secretions. In the first place in the frequency of detection was non-pathogenic epidermal staphylococcus (in 35% of cases), less pathogenic Staphylococcus aureus was sown less frequently (in 25% of cases). In single observations, diphtheroids and gram-negative bacilli were detected (respectively 10% and 10% of cases). Thus, in patients who received treatment, secondary immunodeficiency was revealed with impaired immune status and nonspecific resistance and developed sensitization to bacterial allergens.

A positive clinical effect after treatment with the infusion of celandine grass as indicated in the example method was achieved in almost all patients (99%). The long-term results of treatment were as follows: the absence of relapse of the disease over 1.5 years was observed in 56% of patients, and the decrease in the frequency and duration of exacerbations in 30%. For comparison, in the group of patients treated by the traditional method, the absence of relapse within 1 g was observed only in 25% exacerbation rates in 12% In the group of patients who were prescribed official infusion of celandine, 6 these figures were respectively 48% and 28%
Thus, both in the case of chronic tonsillitis and rhinosititis, the treatment of patients with celandine infusion prepared according to our proposed method, and the introduction of it by the method developed by us, is more effective in relation to the duration of remission (in more than half of patients 1.5 - 2 years), as well as frequency and duration of exacerbations.

Compared with the known, the proposed method for the treatment of chronic inflammatory diseases of the upper respiratory tract has the following significant advantages:
1. Achievement of remission equal to 1.5-2 g in more than half of patients, while in the prototype method, developed and currently used only in the Research Institute of ENT, it reaches 1-1.5 years. As for the traditional methods of treatment, they do not reach even half of the results we obtain.

2. The method is characterized by a significant reduction in the frequency and duration of exacerbations of the disease up to 30% while for the prototype and traditional methods, these figures are equal to 25% and 12%, respectively
3. An important advantage of the proposed method is that we have found and used for treatment a drug that, in addition to antimicrobial and anti-inflammatory properties, also has immunomodulatory drugs, which, in our opinion, is crucial for prolonging the remission of the disease and reducing the frequency and duration of exacerbations. Moreover, this is greatly facilitated by our proposed method of preparing the infusion of celandine, aimed at increasing its bactericidal properties that exceed those in the prototype method.

 The method was developed at the St. Petersburg Research Institute of ENT and has been clinically tested in 3 departments of the institute and with outpatient treatment of more than 300 patients with the achievement of the positive therapeutic effect described in the examples.

Claims (1)

 A method of treating chronic inflammatory diseases of the upper respiratory tract by introducing celandine herb infusion into the nasopharynx, characterized in that the celandine infusion is preheated in a water bath for at least 45 minutes, then treated with low-frequency ultrasound for 5-30 minutes, after which it is additionally injected directly into the crypts tonsils or paranasal sinuses daily or every other day 7 10 times per course of treatment.