RU2831944C1 - Method for combined treatment of chronic tonsillitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology, and can be used for combined treatment of chronic tonsillitis. Method involves the combined effect on the area of pathologically changed palatine tonsils by a complex of physical and physical-chemical factors representing: high-amplitude ultrasound – f = 26.5 kHz; vacuum with rarefaction of 0.15 kgf/cm² and 0.35 kgf/cm²; ozone/NO - and ozonide/NO-containing medicinal substances in different phase states; photosensitizer – 1 % aqueous solution of methylene blue, pulsed red laser radiation with wavelength - λ= 635 nm, initiating photoactivation of photosensitizer, absorbing radiation of red spectrum; photochromic-ultrasonic exposure to high-amplitude ultrasound - f = 44 kHz and photochromic illumination of the sonicated area with a matrix of semiconductor light-emitting diodes of superbright radiation of the red spectrum with wavelength - λ= 630 nm; intermediate capillary-porous gasket from sorption bactericidal non-woven fibrous material with active centres fixed on its fibres in the form of aluminium oxide hydrate particles bonded with particles of bactericidal component - colloidal silver, which is a carrier of ozone/NO- and ozonide/NO-containing solutions of medicinal substances, which are used in combination.

EFFECT: use of the invention enables to increase the effectiveness of the antibacterial photodynamic therapy of chronic tonsillitis, prevent the onset of relapses and reduce the course of treating the disease by optimizing the hydrodynamic sanitation processes, as well as hydro- and photodynamic sensitization, carried out by high-amplitude ultrasonic and pulsed laser exposure on palatine tonsil, allowing to achieve destruction of mature biofilms containing associative pathogenic flora and inactivation of endotoxins.

3 cl, 16 dwg, 2 ex

Description

The invention relates to medicine and medical technology, namely to methods and devices for their implementation, used in otolaryngology for conservative treatment of chronic tonsillitis and related diseases, where it is advisable to use as therapeutic agents a complex of physical and physicochemical factors that act remotely or in contact on the tissues of the lymphoid-pharyngeal ring and their regional hemo- and lymphatic systems. It can be used in other branches of medicine in the treatment of foci of inflammation, wounds and wound infection.

The study of the processes of transformation of the palatine tonsil from an organ performing useful functions into a source of infection is one of the key issues of the tonsillar problem. It is known [1] that the pathology of ENT organs includes various foci of infection affecting individual organs and systems of the body. Focality is mainly characteristic of formations of the lymphadenoid tissue of the Waldeyer-Pirogov ring, but a special role in the development of focal infection belongs to the pathology of the palatine tonsils - chronic tonsillitis (CT), characterized by a violation of the protective and adaptive mechanisms of the tissues of the palatine tonsils (tonsils) and bacterial infection, contributing to the maintenance of the inflammatory process and disruption of the drainage function of the tonsils, arising against the background of cicatricial changes in the area of the mouths of the lacunae, the capsule of the tonsil and the tonsillar arches. Which leads to intoxication of the body, forming tonsillogenic diseases, which are derivatives of the primary focus of infection in the tonsils and affect, first of all, the heart and cardiovascular system, joints, kidneys, liver and other organs and systems of the body. The main etiological factor in the development of HT and its complications is bacterial microflora, including β-hemolytic streptococcus group A, detected in up to 60% of cases (M. Pichichero, 1991), characterized by intracellular vegetating and the ability, along with staphylococci, adenoviruses and other associative pathogens to form biofilms in the lacunae of the tonsils, contributing to the chronic recurrent course of the pathological process, leading to metatonsillar complications [2-4, etc.]. The most unfavorable and difficult to treat are polymicrobial communities (polymicrobial associations or polymicrobial associates) of pathogenic staphylococci with fungi of the genus Candida albicans and Aspergillis flavus.

Tonsillogenic damage may affect organs and systems of the body remote from the primary source of infection - the palatine tonsils, where there are no direct connections between organs and where the hemato-lymphogenous pathway of their damage is basically due to the irradiation of infection with the blood and lymph flow to all organs and tissues. At the same time, chronic inflammation does not carry the protective mechanisms inherent in the acute inflammatory process, which is accompanied by the development of tonsillar complications not only in the interictal period of the disease, but also in the absence of exacerbations, when HT is non-anginal. Chronic inflammation as a source of infection is a source of infectious, toxic and metabolic products entering the regional and general circulation, turning the local process - inflammation, into a general reaction - disease.

There are more than 100 different diseases of the organs and systems of the body, not only initiated by HT, but also supporting their associated painful conditions [5]. Until recently, in order to minimize and exclude the possibility of tonsillogenic lesions of the organs and systems of the body by pathologically altered tonsils, surgeons performed, under anesthesia, classical tonsillectomy, which is one of the most common operations in ENT clinics around the world. The high trauma of the operation and the desire to minimize it still stimulate the development and improvement of the surgical technique, which made it possible to introduce into the clinic such surgical options as cryotonsillectomy, laser tonsillectomy, monopolar and bipolar diathermy dissection, cold plasma tonsillectomy, shaver tonsillectomy, low-frequency ultrasound tonsillectomy, etc. [6-8, etc.], used as an alternative to classical tonsillectomy, to which some patients with HT have contraindications.

However, the above-mentioned surgical treatment methods for HT are highly invasive and traumatic, and may be accompanied by pain, burns of the mucous membrane of nearby tissues; bleeding both during and after surgery; pronounced development of scarring, provocation of pharyngitis, as well as a violation of the psychogenic status of the operated, which is unacceptable. Removal of the palatine tonsils, which are an immunocompetent organ that plays an important role in the reactions of local and general immunity of the body, is not indifferent to the immune system of patients, and, above all, children and adolescents. With incomplete removal of tonsil tissue, there is a high probability of relapse of the disease.

There are known methods of "gentle" tonsillectomy [9-15, etc.]: cryo- and cryoultrasonic tonsillotomy, cryodestruction of tonsil lacunae, galvanotomy of lacunae, radio wave lacunatomy, laser lacunatomy, surgical dissection of lacunae. Even in cases of "gentle" effects, they often cause a violation of the drainage function of the tonsils due to cicatricial changes in the structure of the lacunar apparatus, contributing to damage to large areas of the cryptal epithelium - a component structure of the cryptolymphocyte and, as a consequence, lead to the formation of pathological pockets with a violation of the drainage function of the tonsil, leading to tissue hypoxia and the formation of biofilms with subsequent endotoxicosis, which play a known role in the pathogenesis of HT and the occurrence of complications.

Problems arising when using the methods of classical and "gentle" tonsillectomy, as well as the need for maximum possible preservation of the tonsil function as an immunocompetent organ, determine the tactics of the attending physician aimed at performing "gentle" sanitation of the source of infection, by choosing a surgical or conservative method of treatment of XT, based on the well-known classifications of B.S. Preobrazhensky (1970), V.T. Palchun (1974). An indispensable condition for the effectiveness of conservative treatment is drainage of the lacunae of the palatine tonsils, cleansing the tonsillar folds, pockets from pathological exudate and detritus.

The need to improve the results of conservative methods of treating HT has stimulated, since the 1960-80s of the last century, the development and clinical application of various types of energy in combination with medicinal substances in the conservative treatment of patients with HT: cryotherapy with intralacunar administration of antiseptic paste; UHF microwave therapy; high-frequency ultrasound phonophoresis with lidase; electropulse therapy; therapy with low-intensity laser radiation and laserphoresis of medicinal solutions; therapy with constant and alternating magnetic fields; magneto-laser and photochromic therapy, for example, with super-bright LEDs, etc. [16-22, etc.].

Despite some improvement in the treatment results for various forms of CT, the duration of conservative treatment ranged from several weeks to a month or more, and the effectiveness was about 71-85%, not excluding the possibility of the disease returning in the future [23, etc.]. The use of the above and other conservative treatment regimens for CT did not significantly improve the long-term treatment results for patients. The presence of many conservative treatment methods for patients with CT indicates their insufficient effectiveness and instability of positive results. Often, temporary success was noted in the use of known conservative treatment methods for patients, when after remission of the disease, an exacerbation of the disease occurred again.

To improve the effectiveness of conservative methods of treating patients with HT, in 1973-77, the designer of the OKB PO Polet (Omsk) V.V. Pedder was proposed and, later, together with bioengineers, health care organizers, and clinicians - otolaryngologists (V.V. Pedder, Yu.M. Ovchinnikov, T.I. Noskova, E.V. Khrustaleva, V.G. Papulov, G.G. Sergienko, V.I. Loshchilov, S.I. Shchukin, V.T. Timofeev, T.M. Kalemina, N.V. Mishenkin), for the first time introduced into the clinical practice of otolaryngology of the USSR and the Russian Federation a highly effective, to date, method of treatment XT, using the energy of high-amplitude ultrasound of the low-frequency range (high-amplitude ultrasound) with a frequency of ultrasonic oscillations of f = 25-44 kHz and an amplitude of oscillations of waveguides-instruments of ξ up to 100 μm) for sonification of the tonsil through intermediate medicinal solutions in combination with a vacuum, simultaneously affecting the tonsil both remotely and by contact [24-26, etc.]. This allowed, in a single technological process of tonsil sanitation, at the first stage of its sonification to ensure high-quality cleaning of the lacunae, crypts and parenchyma from purulent-necrotic contents, including purulent-caseous plugs, by means of distant ultrasonic drainage, with the restoration of their drainage function. And at the second stage - contact or intermittent-contact sonification of the tonsil (high-amplitude phonophoresis), initiating ultrasonic impregnation of the medicinal solution into the lacunae, crypts and parenchyma of the tonsil cleaned at the first stage with the creation of a depot of the medicinal substance in them. In addition, before the tonsil sanitation with a waveguide-sprayer, the possibility of high-amplitude ultrasonic aerosol or jet-aerosol irrigation of the tonsils and surrounding infected tissues of the mouth and nasopharynx with a medicinal solution activated by high-amplitude ultrasound was provided [27-29, etc.].

The development and pathogenetically substantiated improvement of the specified method in the direction of its combined use with such highly active biotropic gas components as ozone, nitrogen oxide (NO), ozone/NO-containing gas mixtures, ozone/NO - or ozonide/NO-containing medicinal substances in different phase states, was implemented by the Committee on New Medical Equipment of the USSR Ministry of Health, and then by Roszdravnadzor, with newly developed equipment: ultrasound otolaryngological devices and complexes of the Tonsillor, Tonsillor-2, Tonsillor-MM, Tonsillor-3MM, Aeroton-MM type, as well as ozone/NO-generating devices: Ozotron, Ozonarm-MM, etc.

Long-term practice has shown [30-38, etc.] that the said devices and hardware complexes implementing a highly effective method of treating patients with CT and its modifications based on the use of high-amplitude ultrasound energy in combination with ozone/NO-containing medicinal substances have made it possible to significantly reduce the severity of the infectious-allergic process in patients with both compensated and decompensated forms of CT. This has made it possible, in accordance with the established procedure, to ensure the introduction and use of the method not only in the treatment of patients with CT, but also in the treatment of other diseases of the ENT organs (adenoiditis, sinusitis, pharyngitis and pharyngomycosis, sinusitis, otitis, diseases of the operated ear, nasal cavity and paranasal sinuses, etc.) not only in the USSR and the Russian Federation, but also abroad.

The currently observed ever-increasing contacts in society, as well as the noted decrease in the immune status in most potential patients with ENT pathology, manifested during the Covid-19 pandemic, against the background of increasing aggressiveness of pathogenic microorganisms and their resistance to modern antibacterial agents, explained by uncontrolled antibiotic therapy, as well as the presence of biofilm substances in many CT patients, including a wide range of polymicrobial associations, caused a pronounced violation of the body's immunological resistance, an increase in the duration of disease remission and an increase in metatonsillar complications. Against the background of the surrounding unfavorable epidemiological situation, difficulties in the treatment of CT patients have again increased, despite the high efficiency of the use of ozone / NO and ozonide / NO ultrasound methods in the treatment of inflammatory diseases, wounds and wound infections. These difficulties in the treatment of CT and bacterial infections in other areas of clinical medicine are determined by the formation of microbial biofilms in the patient’s body (85-99% of infection cases), which are one of the main phases of bacterial development associated with the survival of bacteria and the formation of chronic infection [39-44, etc.].

Mature, clinically formed biofilms consist of differentiated bacterial cells, which make up to 15% of the biofilm mass, enclosed in an intercellular matrix of extracellular polymeric substances synthesized by them, in the form of a mucous exopolymer three-dimensional framework. It is penetrated by voids, heterogeneous microniches, transport and water channels in the form of a structured circulatory capillary-porous system that transports nutrients and oxygen from the external to the internal parts of the biofilm, and removes bacterial metabolites [43 and others]. Fluctuations in the levels of oxygen, acidity, nutrients, cell metabolites, etc. cause the formation of heterogeneous areas - heterogeneous microniches in biofilms, adapting to which bacteria form a multitude of phenotypes - polymicrobial associations with broad metabolic and replicative properties, located in the stationary growth phase and resisting stress factors, thanks to the exopolymer matrix, which limits the diffusion of medicinal substances from the outside and binds antimicrobial drugs that are effective only against rapidly growing planktonic cells. The matrix of a mature biofilm protects the bacteria in it from unfavorable physical, chemical and biological factors of the external environment: heating, drying, osmotic shock, UV, chemical effects, changes in the pH of the environment, phagocytosis, humoral and cellular factors of the immune defense of the macroorganism, etc. Biofilms that include polymicrobial associations can be restored even after massive antibacterial therapy, and the bacteria in them acquire resistance to antibiotics up to 1000 times.

The structure of biofilms facilitates the exchange of genetic information due to close contact and stable spatial localization of cells, which increases the virulence and pathogenicity of microorganisms. In the biofilm phase, they actively produce metabolites and release endotoxins, which leads to chronic inflammation and hypertrophy of the tonsils. Periodic release of planktonic forms of bacteria from biofilms correlates with relapses of the chronic process in CT (R.A. Chole, B.T. Faddis, 2003). In the lacunae of the tonsils, both gram-positive coccal flora are found: streptococci, staphylococci, pneumococci, and gram-negative microorganisms: Haemophilus influenzae, Neisseria, Escherichia, Listeria, Salmonella, Klebsiella, Moraxella [45, etc.]. A special role in the etiopathogenesis of HT is given to intracellular microorganisms (viruses, chlamydia, mycoplasma), as well as fungi, which support the inflammatory process in the tonsils and have a pronounced immunosuppressive effect. The most significant are considered to be associations of pathogenic staphylococci with fungi of the genus Candida albicans and Aspergillus flavus, the product of whose vital activity is a low-molecular toxin - aflatoxin B1, the membrane-toxic effect of which, as well as saponins and other produced bacterial toxins, is accompanied by a violation of the structure of phospholipids and the formation of intermediate hydrolysis products that cause mutagenic and carcinogenic effects (A.S. Vladyka, E.R. Levitsky, L.P. Poddubnaya et al., 1987; M.E. Pichchero, 1991; Yu.V. Sergeev, 2013, etc.). Highly pathogenic polymicrobial associations, including intracellularly vegetating β-hemolytic group A streptococcus, and other highly pathogenic microorganisms and fungi, initiating the formation of protective biofilm substances, colonize the surface of the tonsils affected by the process, their lacunae, and further, the tree-like branching and interconnected crypts of the I-V order, penetrating the thickness of the tonsil parenchyma and forming interconnected cavities in the parenchyma (hereinafter - lacuna-cryptal space). Which contributes to the survival of highly pathogenic polymicrobial associations in them, in the formed exopolymer matrix of biofilms under the influence of unfavorable physical, chemical and biological factors.

In our opinion, overcoming the difficulties in the treatment of CT complicated by the formation of microbial biofilms that contribute to the chronic course of the disease can be solved by using combined methods and treatment agents that implement a comprehensive antibiofilm effect on clinically formed mature biofilms as objects subject to degradation and destruction of their matrix with simultaneous sterilization of the polymicrobial associations contained in them, including staphylococci, pneumococci, Haemophilus influenzae, erobic diplococcus, β-hemolytic group A streptococcus, as well as inactivation of the metabolites (endotoxins) produced by them with simultaneous reliable evacuation of pathological contents from the lacunocryptal space of the sanitized tonsil.

Therefore, the promising methods and means used in the treatment of HT may include the combined use of high-amplitude ultrasound energy and ozone/NO and ozonide/NO-containing medicinal substances in different phase states, in combination with the method of antimicrobial photodynamic therapy (aPDT).

aPDT is a physicochemical method of local illumination, for example, by laser radiation of the site of infection with a light-sensitive substance introduced into it - a photosensitizer (PS), selectively absorbed by the cells of pathologically altered tissues and pathogenic associative microflora. Electromagnetic radiation of the optical range with a wavelength of the visible spectrum corresponding to the maximum absorption of the PS initiates photoactivation and relaxation of its excited state with the transfer of energy to organic substrates and oxygen dissolved in tissues with its subsequent transition to a biologically active form - singlet oxygen with the formation, with its participation, of hydroxyl radicals and peroxides, which in turn implement the processes of deactivation and defertilization of polymicrobial communities (associations), as well as inactivation of the endotoxins produced by them with the destruction, to one degree or another, of biofilms, etc.

A method of complex treatment of chronic tonsillitis is known [46], which consists of introducing 3 ml of 0.5% dihydroquercetin solution into the cavity of 6-8 lacunae of the palatine tonsils, followed by illumination of the mucous membrane of each of the palatine tonsils with red LED radiation with a wavelength of λ = 630-640 nm, supplied to the tonsil by the distal end of the flexible light guide of the LED device, with an output radiation power of 120 mW, a light spot diameter of 3-5 cm and an exposure of 5 minutes for each tonsil. The course of treatment is 5 sessions.

The method has limitations in the treatment of patients with HT both with compensated and, above all, patients with decompensated HT, where in almost 100% of cases bacterial populations and intracellular microorganisms (viruses, chlamydia, mycoplasma), as well as fungi, are able to form biofilms, which are an integral part of their life cycle and a successful strategy for protection from unfavorable environmental factors. The exopolymer matrix of mature biofilms limits diffusion and inhibits the beneficial properties of the antioxidant - 0.5% dihydroquercetin solution (anti-inflammatory, antioxidant, detoxifying, etc.), exceeding the effects of laser phoresis initiated by distant LED phototherapy. In addition, if the evacuation of contents from the tonsil lacunae is insufficient, the possibility of exacerbation and relapse of the disease cannot be ruled out due to the possible stimulation of the proliferation of polymicrobial associations in biofilm substances when they are illuminated with red spectrum radiation with a wavelength of λ=630-640 nm [47].

A method for treating chronic tonsillitis is known [48], which involves irrigating the palatine tonsils with a solution of 0.006% chlorhexidine heated to 40°C, using a high-amplitude ultrasonic nebulizer for 3 minutes, intermittently. The course of treatment is up to 10 days.

However, this method of treating HT does not exclude relapse of the disease due to the impossibility of degradation and destruction of mature biofilms, including polymicrobial associations, by a distantly acting jet-aerosol or aerosol torch of irrigating chlorhexidine solution heated to 40°C, not only on the surface of the tonsils, but also, first of all, due to the impossibility of degradation and destruction of biofilms located in the capillary-porous system of lacuna-cryptal spaces, inaccessible to the torch of chlorhexidine solution, due to the smallness of its kinetic energy, as well as due to cooling of the solution during irrigation with it, for 3 minutes, of each of the tonsils with a spray torch. Also doubtful is the assertion about the "sanitation" of the lacunae of the palatine tonsils by opening their lumen and removing pathological contents from them by cavitation "vortex flows", while the tonsils are only irrigated by a torch of sprayed solution, the energy of which is insufficient to "open" the lacunae of the tonsils. The course of treatment is long - up to 10 days.

Modern methods of treating onco- and infectious-inflammatory diseases in experimental and clinical medicine include the actively developing high-tech method of photodynamic therapy, used in the treatment of ENT organs and, in particular, XT.

A method for treating chronic tonsillitis is known [49] (analogue), which involves daily, for 10-15 days, application of aPDT, including: sensitization by washing the lacunae of the tonsils until clean with a solution of a photosensitizer (PS) that absorbs radiation in the red and infrared spectral ranges and is introduced into the lacunae with a syringe with a Hartmann cannula; rinsing the throat with a physiological solution; alternate distant illumination of each tonsil with radiation in the red and infrared absorption spectrum ranges of the PS, with an exposure of 2-3 minutes. In this case, a 0.01-0.1% aqueous solution of methylene blue or an aqueous solution of chlorophyllipt are used as the PS. The method is implemented by red (spectral range - λ=625-700 nm) and infrared (spectral range - λ=840-1270 nm) light-emitting diodes of the phototherapy apparatus, initiating aPDT with distant illumination of FS-sensitized tonsil biotissues with the specified optical radiation.

However, the effectiveness of this method in the treatment of patients with HT is limited:

- using FS-chlorophyllipt solution, which has obviously lower antimicrobial photodynamic efficiency than FS-methylene blue solution;

- the invasiveness of the procedure of alternately washing the pathological contents of the “accessible” lacunae (about 6-8 lacunae out of more than 12-20 lacunae) of each tonsil with simultaneous sensitization of the lacunae with a solution of FS - methylene blue or chlorophyllipt, injected into the lacunae with a syringe with a Hartmann cannula, often traumatizing the mucous membrane of the lacuno-cryptal space, as well as the total duration of the procedure of washing the lacunae of the sensitized tonsils with a FS solution;

- the possibility of spraying the FS solution and staining the surrounding, significant in area, native tissues of the oropharynx, in the process of alternately washing the lacuna-cryptal space of the tonsils from pathological contents with the FS solution, sensitizing the tissues of the lacunae, crypts and the surface of the tonsils. In this case, the diffusion of FS affects not only the altered tissues of the tonsils and pathogenic microorganisms (targets), where FS binds to them. But also FS sprayed in the oral cavity can penetrate into its mucous membranes unchanged by the process and then be absorbed into the blood, lymph and tissue fluids, which does not exclude the initiation, when they are illuminated with red and infrared radiation, of photodynamic damage to healthy tissues of the oropharynx, formed elements of the blood and lymph outside the pathologically altered XT tissues of the tonsils;

- the insufficiency of the method's effectiveness, demonstrated by the data on the pathogen Staphylococcus aureus strain 209 in an agar culture: Fig. 1 - control growth of an agar culture of staphylococci; Fig. 2 - growth of staphylococci in a culture after exposure to FS - 0.01% methylene blue and its subsequent illumination with red and infrared radiation; Table 1, which shows that after modeling aPDT in relation to staphylococcus, about 25% of its colonies are preserved, which does not exclude explosive growth of this pathogen and relapse of CT. In addition, staphylococcus is only one of many pathogens (more than 50 species) in microbial communities that survive in biofilms despite antibiotic therapy. The role of fungal pathogens in the development of CT is known, and the most common of them are yeast fungi of the genus Candida, often in association with Aspergillus, the first of which is detected in 56% of cases in patients with CT in the form of candidal-bacterial lesions associated with: staphylococci (30%), streptococci (35%), Proteus and staphylococci (20%), Neisseria (10%), Neisseria and staphylococci (5%) [45 and others];

- the impossibility of degradation, destruction and removal of mature biofilms containing microbial communities from the depths of the lacuno-cryptal space and the affected capillary-porous system of the tonsil parenchyma, which complicates their extraction outward from the tonsil, and therefore the dispersion of microbial communities with the transition of pathogenic microflora into a planktonic form, accessible for interaction with FS and laser radiation during aPDT, facilitating the sterilization of microflora and the inactivation of its endogenous toxins;

- the duration of treatment of patients with HT for 10-15 days, which is apparently associated with the insufficiency of the antimicrobial effect of aPDT, realized during the photodynamic interaction of tonsil tissues sensitized with PS (solutions of methylene blue and chlorophyllipt), illuminated by broadband radiation of the red and infrared spectra of the LED matrix of the Dune-T LED phototherapy device.

A method for treating chronic tonsillitis is known [44] (prototype), which consists of performing aPDT, including: taking a smear from the lacunae of the palatine tonsils to assess the microbial landscape; rinsing the lacunae of the tonsils with a saline solution to evacuate pathological contents from them; introducing a 10% aqueous solution of N-acetylcysteine (Fluimucil, a muculitic and antioxidant agent) into the lacunae of the tonsils in a volume of 2 ml per tonsil with an exposure of the solution of up to 40 minutes; sensitization by staining the lacunae and crypts of the tonsils with a 0.35% aqueous solution of the photosensitizer Radachlorin with an exposure of FS - up to 20 minutes; rinsing the lacunae with a saline solution; illumination of sensitized tonsil tissues for 20 minutes with red spectrum laser radiation - λ = 662 nm, power - 0.5 W. At the end of aPDT, a smear is taken from the tonsil lacunae to determine the residual microflora, and then a probiotic suspension containing at least 10 ⁷ CFU of probiotic cultures per 1 ml - the drug Florin forte - is introduced into each accessible lacuna. After the treatment, for 2-3 weeks, the oropharynx is rinsed with the said suspension once a day.

However, this method of XT treatment has disadvantages associated with:

- the invasiveness of the procedures for washing the accessible lacunae of the tonsils with a physiological solution and evacuating their contents; the invasiveness of the procedures for staining the accessible lacunae and crypts of the tonsils when introducing a 0.35% solution of the photosensitizer Radachlorin into them, as well as introducing a suspension of the probiotic drug Florin forte into each accessible lacuna of the tonsil at the final stage of the XT treatment session, usually carried out with a syringe with a Hartmann cannula or other similar device that injures the mucous membrane of the lacuno-cryptic space;

- large expenditure of time for conducting a treatment session, including: duration of exposure of diffusion interaction of 10% aqueous solution of N-acetylcysteine installed in the lacunae of the tonsils with their contents - up to 40 minutes; duration of diffusion sensitization of tonsil tissues with FS Radachlorin - up to 20 minutes; duration of illumination of FS-sensitized tonsil tissues with laser radiation of the red spectrum - λ = 662 nm - up to 20 minutes; duration of installation of probiotic suspension - the drug Florin forte in accessible lacunae of the tonsils at the final stage of the treatment session;

- a long cycle of the general course of treatment of the patient with XT - 2-3 weeks, with daily rinsing of the oropharynx with a suspension of probiotic cultures - the drug Florin forte and its subsequent oral administration - 1 time per day (2-3 weeks).

- the practical difficulty, during the indicated treatment procedures, of ensuring reliable degradation, destruction and evacuation of mature biofilms containing polymicrobial associations, their disinfection, as well as inactivation of their endotoxins from the lacuno-cryptal space and the affected capillary-porous system of the tonsil parenchyma, which, apparently, determines the long cycle of the general course of XT treatment, which does not exclude a relapse of the disease.

The technical result of the invention is to increase the effectiveness of antibacterial photodynamic therapy of chronic tonsillitis, preventing the occurrence of relapses and shortening the course of treatment of the disease, due to the optimization of the processes of hydrodynamic sanitation, as well as hydro- and photodynamic sensitization, carried out by high-amplitude ultrasound and pulsed laser effects on the palatine tonsil, allowing reliable degradation and destruction of mature biofilms, after which the associative pathogenic flora contained in them, passing into a planktonic form, is defertilized, their endotoxins are inactivated and, then, the pathological contents, in a deactivated state, are evacuated from the site of inflammation.

The technical result of the invention is achieved in that, according to the method of combined treatment of chronic tonsillitis, implemented by using antimicrobial photodynamic therapy, including sensitization, washing the lacunae of the palatine tonsils until clean with a solution of a photosensitizer that absorbs optical radiation in the spectral range, initiating its photoactivation; gargling with a physiological solution; alternately illuminating the sensitized tissues of each of the tonsils with photoactivating optical radiation of a radiation source, characterized in that the area of the palatine tonsils pathologically altered by chronic tonsillitis is exposed to a combined effect of a set of physical and physicochemical factors, including: high-amplitude ultrasound - f = 26.5 kHz; vacuum with a vacuum of 0.15 kgf/cm ² and 0.35 kgf/cm ² ; ozone/NO- and ozonide/NO-containing medicinal substances; photosensitizer - 1% aqueous solution of methylene blue; pulsed laser radiation of the red spectrum with a wavelength of λ=635 nm, initiating photoactivation of the photosensitizer, which absorbs radiation of the red spectrum; photochromic-ultrasonic action of high-amplitude ultrasound - f=44 kHz and photochromic illumination of the area being sounded, a matrix of semiconductor LEDs of super-bright radiation of the red spectrum with a wavelength of λ=630 nm; an intermediate capillary-porous lining made of sorption bactericidal non-woven fibrous material with active centers fixed to its fibers in the form of aluminum oxide hydrate particles associated with particles of a bactericidal component - colloidal silver, which is a carrier of ozone/NO- and ozonide/NO-containing solutions of medicinal substances used in combination, and implementing in a single technological process a multi-stage medical technology of aPDT in the treatment of patients with chronic tonsillitis, where:

- at the first stage of combined treatment, after sanitation of the nasopharynx and oropharynx, alternate distant ultrasonic irrigation of the nasal mucosa is carried out for a time of τ = 20 seconds (for each half of the nose) and the oropharynx mucosa for a time of τ = 20 seconds, implemented with a jet-aerosol torch of ozone/NO-containing physiological solution with concentrations of: ozone - 2.5 mg / l and nitrogen oxide - 0.3 mg / l, by spraying it with high-amplitude ultrasound at a frequency of f = 26.5 kHz and with an oscillation amplitude of the waveguide-instrument of ξ = 80 μm.

- at the second stage of the combined treatment, after local application anesthesia of the pharynx, suppressing the pharyngeal reflex, alternate distant ultrasonic cleaning is carried out by washing the altered tissues of the lacuna-cryptal space and the parenchyma of the tonsils, under conditions of its vacuum at a vacuum of - 0.35 kgf/ ^cm2 , and insonification for a time of - τ = 60 seconds with high-amplitude ultrasound at a frequency of - f = 26.5 kHz and at an oscillation amplitude of the waveguide-instrument "peak" - ξ = 60 μm, conducted through an intermediate ozone/NO-containing physiological solution with concentrations of: ozone - 2.5 mg/l and nitric oxide - 0.3 mg/l;

- at the third stage of the combined treatment, alternate distant ultrasound sensitization of the altered tissues of the lacuna-cryptal space and the parenchyma tissues of the tonsils, previously cleaned by washing, is carried out under vacuum conditions at a vacuum of - 0.35 kgf/ ^cm2 , and insonification for a time of - τ = 20 seconds with high-amplitude ultrasound at a frequency of - f = 26.5 kHz and at an oscillation amplitude of the waveguide-instrument "peak" - ξ = 60 μm through an intermediate solution of a photosensitizer - 1% aqueous solution of methylene blue, the sensitized tissues are kept for a time of - τ = 5 minutes, which is the period of their sensitization, after which the oral cavity is rinsed with a physiological solution - 100 ml;

- at the fourth stage of the combined treatment, at the end of the period of sensitization of the tissues of the lacunocryptal space and the parenchyma of the tonsils, alternate distant illumination is carried out, for a time of τ = 5 minutes, of each of the tonsils, with pulsed laser radiation of the red spectrum - λ = 635 nm, initiating photoactivation of the photosensitizer - 1% aqueous solution of methylene blue, implemented by supplying a flow of illuminating pulsed laser radiation to the tonsil, placed, under vacuum conditions - at a vacuum of - 0.15 kgf/cm ² , in the sealing funnel of the applicator-limiter, the outer forming surface of which is made optically opaque, and delimiting the surrounding tissues of the oropharynx from the illuminated tonsil;

- at the fifth stage of the combined treatment, alternate extraction by ultrasonic drainage from possible residual contents in the lacuna-cryptal spaces and parenchyma tissues of each of the tonsils is carried out by means of distant high-amplitude ultrasound at a frequency of - f = 26.5 kHz and at an oscillation amplitude of the waveguide-instrument "cup-shaped radiating disk" of - ξ = 60 μm, for a time of - τ = 30 seconds, through a gas gap layer, which is the region of the acoustic boundary layer between the radiating end of the waveguide-instrument and the surface of the tonsil, including an intermediate gasket with a solution of 10% ozonide/NO-containing oil emulsion of the "oil in water" type with a peroxide number for ozonides of P = 150, fixed on the working part of the waveguide-instrument "cup-shaped radiating disk", equipped with concentrically located drainage nozzle channels;

- at the sixth stage of the combined treatment, alternate ultrasonic impregnation is carried out into the sanitized lacuna-cryptal spaces and parenchyma tissues of each of the tonsils by intermittent contact sonication with high-amplitude ultrasound at a frequency of - f = 26.5 kHz and with an oscillation amplitude of the waveguide-instrument "cup-shaped radiating disk" of - ξ = 40 μm, for a time of - τ = 20 seconds, conducted through an intermediate gasket with a solution of 10% ozonide/NO-containing oil emulsion of the "oil in water" type with a peroxide number for ozonides of P = 150, fixed on the working part of the waveguide-instrument "cup-shaped radiating disk", not equipped with drainage nozzle channels;

- at the seventh stage of combined treatment, initially, the following is carried out: labile photochromo-ultrasonic lymphotropic impregnation over the surface, through an intermediate lining with a solution of 10% ozonide/NO-containing oil emulsion of the "oil in water" type with a peroxide number for ozonides of P = 150, into the regional lymph nodes and the interstitium of the lymph region both in the projection area of the tonsils and to the subsequent lymph nodes and adjacent zones of the interstitium of the lymph region of the face and neck, along the lymphatic pathways draining from the tonsils, by intermittent contact insonification, for a time of τ = 2 s / cm ² , with a disc-shaped waveguide-instrument of the photochromo-ultrasonic applicator, oscillating with a frequency of f = 44 kHz and with an oscillation amplitude of ξ = 20 μm with simultaneous photochromic illumination, insonified high-amplitude ultrasound of the area, a matrix of semiconductor light-emitting diodes of super-bright radiation of the red spectrum - λ = 630 nm, and then, repeatedly, along the specified paths, ultrasonic lymphotropic impregnation is carried out in them, through an intermediate gasket with an ozone/NO-containing physiological solution with a concentration of: ozone - 2.5 mg / l and nitrogen oxide - 0.3 mg / l, implemented by a waveguide-instrument "emitting disk" intermittently-contact acting high-amplitude ultrasound at a frequency of - f = 26.5 kHz and with an oscillation amplitude of - ξ = 40 μm, for a time of - τ = 2 s / cm ² ;

- at the final stage of the combined treatment session, take succinic acid Forte, 1 tablet after meals, daily dose - 200 mg.

In this case, a capillary-porous fabric made of sorption bactericidal non-woven material with active centers fixed to its fibers is used as an intermediate lining, and particles of aluminum oxide hydrate associated with particles of a bactericidal component in the form of colloidal silver are used as active centers.

The conducted patent search showed that, as of the filing date of the application for the invention, there is no known method for treating CT by means of a combined effect of a set of physical and physicochemical factors on a focal infection with the specified distinctive features that implement the inhibition of a large number of links in the pathological circle of CT development, allowing for the simultaneous provision of: during the treatment: dispersion, deactivation and evacuation from the lacunocryptal space and the parenchyma of the tonsil of disintegrated biofilms, destroyed polymicrobial associations, inactivated endotoxins with the restoration of the drainage function of the tonsils and the relief of the inflammatory process, reducing the severity of the intoxication syndrome characteristic of patients with CT, initiating subsequent complications. The proposed technical solution allows not only high-quality sanitation of the primary focus of infection caused by CT in the form of an inflammatory process of the lymphoid-pharyngeal ring, by the combined effect of a complex of physical and physicochemical factors on the primary focus of infection - the palatine tonsils, but also stimulates the processes of normalization of the sanogenic-potent functions of the lymphatic system in the areas of the palatine tonsils, nasopharynx and oropharynx, as well as on the lymphatic drainage pathways due to the effect, in the field of high-amplitude ultrasound, of highly active medicinal substances on the "interested" lymphatic regions related to the focus of infection of the lymphoregion of the head and neck, and, consequently, on a larger number of regional lymph nodes and draining lymphatic vessels drained by ultrasound and photochromic-ultrasound effects. This promotes targeted and general lymphopharmacotherapy, initiating stimulation and activation of restorative processes that interrupt chain free-radical reactions that excessively produce ROS during HT, and accelerate the removal and inactivation of LPO products from the lymphoid-pharyngeal ring tissues and adjacent tissues altered by the process.

Among the physical and physicochemical factors used are:

- high-amplitude ultrasound with a frequency of f=26.5 kHz, allowing the waveguide-instrument to oscillate with an amplitude of ξ=80 μm. It is implemented by the ultrasound unit and the acoustic system of the Aeroton-MM ultrasound therapeutic device (Aeroton-MM device);

- high-amplitude ultrasound with a frequency of f=26.5 kHz, allowing to obtain the oscillation amplitude of the waveguide instruments - ξ=60 μm and ξ=40 μm. It is implemented by the ultrasound unit and acoustic systems of the ozone/NO-ultrasound otolaryngological complex Tonsillor-3MM (Tonsillor-3MM complex);

- high-amplitude ultrasound with a frequency of f=44 kHz, allowing the amplitude of oscillations of a disk-shaped waveguide-instrument with a large radiation area to be obtained - ξ=20 μm, is implemented by the ultrasound unit and the acoustic system of the applicator of the photochromic-ultrasound physiotherapeutic ultrasound apparatus Rossonic-MM (the Rossonic-MM apparatus);

- vacuum with a negative pressure of 0.35 kgf/ ^cm2 , implemented by the vacuum unit of the Tonsillor-3MM complex;

- vacuum with a negative pressure of 0.15 kgf/ ^cm2 , implemented by the vacuum unit of the EOHM or the vacuum unit of the laser physiotherapy apparatus Lazmik (Lazmik apparatus);

- pulsed laser radiation of the red spectrum - λ=635 nm with a pulse power of 5 W, an average power of 10 mW, a pulse duration of 100 ns, and a frequency of 80 Hz. Implemented by the basic unit of the Lazmik device;

- photochromic illumination of the sound area by a matrix of semiconductor LEDs of super-bright red spectrum radiation with a wavelength of λ=630 nm, implemented by the photochromic illumination unit of the Rossonic-MM device.

When implementing the method of combined treatment of chronic tonsillitis in its complex therapy in patients, along with known drugs, the use of highly active ozone/NO- and ozonide/NO-containing drugs in different phase states is justified [54, 55, etc.].

The following are used as highly active medicinal substances in different phase states:

- ozone/NO-containing gas mixture with concentrations of: ozone - 3.0 mg/l and nitrogen oxide - 0.4 mg/l, produced by the ozone/NO-containing gas mixture generation unit Ozotron of the Tonsilor-3MM complex;

- ozone/NO-containing physiological solution with ozone concentrations of 2.5 mg/l and nitric oxide

- 0.3 mg/l, obtained by bubbling the initial physiological solution with an ozone/NO-containing gas mixture with concentrations of: ozone - 3.0 mg/l and nitric oxide - 0.4 mg/l, obtained from the Ozotron unit of the Tonsilor-3MM complex;

- 10% ozonide/NO-containing oil emulsion of the "oil in water" type with a peroxide number of P=150, obtained by bubbling the original vegetable oil (sunflower, olive) with an ozone/NO-containing gas mixture with concentrations of: ozone - 3.0 mg/l and nitrogen oxide - 0.4 mg/l, obtained from the Ozotron unit of the Tonsilor-3MM complex;

- ozone/NO-containing physiological solution or ozonide/NO-containing oil emulsion of the “oil in water” type can be used as initial components for obtaining a jet-aerosol torch of ozone/NO - or ozonide/NO-containing medicinal substance created by the Aeroton-MM device;

- photosensitizer - phenothiazine dye, for example, 1% aqueous solution of methylene blue.

Medicinal substances that exhibit high bactericidal, fungicidal, virucidal and antioxidant properties:

- ozone ( _O3 ), nitric oxide (NO), ozone/NO- and ozonide/NO-containing medicinal substances obtained on their basis;

- photosensitizers - phenothiazine dye, for example, 1% aqueous solution of methylene blue;

- succinic acid (antioxidant), for example, succinic acid Forte in tablet form - 1 tablet after meals, daily dose - 200 mg;

- a capillary-porous pad made of sorption bactericidal non-woven fibrous material with active centers fixed to its fibers in the form of aluminum oxide hydrate particles associated with particles of a bactericidal component - colloidal silver (antimicrobial dressing VitaVallis).

The indicated medicinal substances in different phase states, both together and separately, are advisable to use with photochromic illumination by a matrix of semiconductor light-emitting diodes, with or without sound, implementing the effect of narrow-band super-bright radiation of the red spectrum during photochromic-ultrasonic action on the “interested” areas, including regional lymph nodes and the interstitial system of the lymph region of the face and neck in the projection area of the tonsil and further on the subsequent lymph nodes, adjacent zones of the interstitial system along the lymphatic pathways leading from the tonsil. Since endogenous intoxication in patients suffering from HT is usually high (against the background of a reduced immune status, as well as a reduced level of NO and ROS inhibitors involved in the pathogenesis of HT and inhibiting the processes of proliferation and apoptosis of macrophages, etc. [58-60], then the above-mentioned ozone/NO and ozonide/NO-containing medicinal substances should be used, as prescribed by the attending physician, and in combination with highly active antioxidant substances, using, among other things, such an accessible and highly active metabolite with antioxidant and detoxifying properties as succinic acid, for example, succinic acid Forte, etc.

Each of these hardware and treatment factors is used in a complex, in various combinations and at different stages of the implementation of the combined method of treatment, against the background of concomitant manifestations of the infectious process characteristic of HT, realizing its significant properties and indicators for the successful solution of the invention problem.

1. High-amplitude ultrasound of low-frequency range (A.A. Orlova; G.A. Nikolaev, V.I. Loshchilov, 1972-90; V.V. Pedder, Yu.V. Seleznev, Yu.M. Ovchinnikov, I.V. Mozgovoy, G.G. Sergienko, 1972-91 and others), in our case - f=26.5 kHz and f=44 kHz, has a multifunctional effect on infection and altered tissues of the palatine tonsils with the energy of high-amplitude ultrasound of high intensity, through solutions of intermediate medicinal substances, increasing the effectiveness of XT treatment due to initiation of a complex of physical, physicochemical and biological processes: cavitation; variable sound pressure; acoustic flows; sound-chemical and sound-capillary effects; absorption of ultrasound by the medium and its dissipative heating; cavitation spraying of medicinal solutions; vibrowave drainage and massage at the tissue and cellular levels, etc., affecting mass exchange processes in the capillary-porous tissue structure of the tonsil at the interfaces "waveguide-instrument - medicinal solution - tonsil", providing:

- superficial sanitation of infection foci, in the field of high-amplitude ultrasound, irrigation of the mucous membranes of the nasopharynx and oropharynx with a jet-aerosol torch of an ozone/NO solution or an ozonide/NO-containing medicinal substance with bactericidal, antioxidant, regenerative properties, etc.;

- high-quality ultrasonic cleaning, in a high-amplitude ultrasound field, through an intermediate solution of ozone/NO or ozonide/NO-drug, of the tonsil surface, its lacuna-cryptal space and parenchyma from purulent-necrotic contents, including biofilms with polymicrobial associates, endotoxins, purulent-caseous plugs that seal the mouths of the lacunae and prevent effective extraction of pathological contents from the capillary-porous system of the tonsil by ultrasonic drainage, initiated by the “reverse” ultrasonic capillary effect, allowing the restoration of its drainage function;

- disinfection of pathological contents, sounded by high-amplitude ultrasound through intermediate medicinal solutions, for example, a solution of highly active ozone/NO - or ozonide/NO-medicinal substance, as well as a solution of a photosensitizer, for example, a phenothiazine dye: 1% aqueous solution of methylene blue.

At the same time, due to the practically simultaneous and complex physical, physicochemical and biochemical effects on biofilms, polymicrobial associations and the endotoxins produced by them, the following is achieved (due to the pronounced secondary effects of ultrasound): dispersion of biofilms with the destruction and deactivation of microbial associations, inactivation of endotoxins, and their evacuation.

2. Ozone/NO - and ozonide/NO-containing medicinal substances (S. Rilling, R. Vibahn, 1985; S.P. Peretyagin, 1992; V.V. Pedder et al. 1985-2023; A.B. Shekhter, 1998; E.B. Menshikova, 2006, etc.).

They implement the mechanisms of the therapeutic action of exogenously introduced ozone ( _O3 ) and nitrogen oxide (NO) in the form of an ozone/NO-containing air mixture, as well as in the form of medicinal solutions: ozone/NO-containing saline solution, 10% ozonide/NO-containing oil emulsion of the "oil in water" type, which are azeotropic with respect to the body, i.e., they behave as biologically pure and compatible substances with the body, affecting many pathogenetic links of diseases (impaired blood and lymph circulation, diffuse hypoxia, anaerobic glycolysis, accumulation of active radicals, SEI, hypercoagulation syndrome, immunodeficiency states, etc.). The effectiveness of their use lies in:

- manifestation of bactericidal, fungicidal and virucidal effects, not only externally, but also at the intracellular level, where the majority of the viral and bacterial load accumulates;

- activation of oxygen-dependent processes, normalization of lipid peroxidation, acid-base balance and the antioxidant system, reduction of erythrocyte agglutination, increase in erythrocyte deformability and oxygen-transport function of the blood, in a saturating effect;

- regulation of photoreactivity of the blood and lymph microcirculation system with the participation of, for example, nitric oxide (NO) under conditions of laser and photochromic illumination of the oral cavity and oropharynx;

- direct supply of oxygen to the body, inhibiting hypoxic damage to cells, reducing viscosity and improving the rheological properties of blood and lymph, normalizing microcirculatory disorders in the circulatory and lymphatic systems, as well as enhancing vascular trophism and tissue metabolism, reducing the content of lipids and glucose in the blood;

- a decrease in the level of platelet aggregation and adhesion of neutrophils to the vascular endothelium, etc.

The key role of nitric oxide (NO) in the control of vascular tone, maintenance of hemostasis, regulation of respiration, immunity and mechanisms of neurotransmission, manifestation of cytotoxic and cytostatic effects is noted. Deficiency of nitric oxide NO generation in the body leads to a number of pathological conditions (V.G. Granik, N.B. Grigoriev, 2015).

The above stimulates oxygenating, vasodilating, bactericidal, mycocidal and virucidal, antihypoxic, antioxidant, detoxifying, immunomodulating, anticoagulant and other effects, which are decisive in solving the problems of treating XT, which, along with the use of solutions of ozone/NO- and ozonide/NO-containing medicinal substances, when illuminating the tissues of the palatine tonsils with pulsed laser (λ=635 nm) and photochromic radiation of the red spectrum (λ=630 nm), is promising in relation to enhancing microcirculation and general blood and lymph flow, detoxification, removal of endogenous toxins, etc.

3. Treatment of biological tissues with pulsed laser radiation of the red spectrum (S.V. Moskvin, 1999-2020; A.V. Nikitin et al., 2000; A.V. Geynits et al., 2012, etc.).

It is known that the interaction of coherent, monochromatic and polarized low-intensity laser radiation (LLLR) with biological tissues initiates an effective response of the body's systems that maintain homeostasis. The primary mechanism of its biological action is associated with thermodynamic shifts caused by the absorption of laser light by intracellular components, as well as a short-term temperature gradient that initiates the thermodynamic launch of Ca ²⁺ -dependent processes both at the cellular and tissue levels, followed by the development of secondary responses of the body that normalize the functioning of the immune, nervous, circulatory, lymphatic and hormonal systems that regulate and maintain hemostasis (S.V. Moskvin, A.A. Minenkov, 2010). The introduction of hydrophilic solutions of drugs into tissues initiated by LLLR - laserphoresis - is an important direction in solving problems in infectology, including the treatment of HT. LILI has a desensitizing effect, improves microcirculation and rheological properties of blood, improves hemodynamics, reduces hypercoagulability potential of blood, stimulates phagocytosis, activates the antioxidant system and synthesis of endogenous interferons by cells, has anti-inflammatory, bactericidal, immunocorrective, regenerative effects, etc. The pulsed mode of laser radiation, in comparison with continuous, due to the high concentration of energy in the light pulse, increases the effect of therapy with lower average energy introduced into the illuminated tissues, which is useful in the implementation of antimicrobial photodynamic therapy (aPDT) XT.

4. Phenothiazine dyes in antimicrobial photodynamic therapy XT (Khadzhibaev A.M. et al., 2013; Gureev A.P., Samoilova N.A., Potanina D.V. et al., 2021, etc.).

Phenothiazine dyes, such as methylene blue (MB) and its metabolites, are still promising in the implementation of the aPDT method for infectious and inflammatory diseases initiated by pathogens with multiple drug resistance [50-53]. MS and its derivatives are capable of absorbing light in the visible range (laser radiation of the red spectrum: λ=635 nm and λ=630 nm), penetrating into tissues sensitized by them. And the resulting photosensitization leads to the formation of singlet oxygen ¹ O ₂ with a relatively large quantum yield, initiating the antimicrobial effect. They are characterized by high light toxicity when binding a photosensitizer (PS) with bacteria, pathologically altered cells of biological tissues when initiating their photoreactive activity. PS are sensitive to changes in pH in the bacterial environment, due to the absorption of neutral PS by bacteria, and subsequent photoactivation of cations of PS dyes at their lower concentrations.

Scientists from Japan have shown [51] that phenothiazine dyes oxidize proteins and DNA due to photoinduced electron transfer in the absence of oxygen. These dyes photosensitize the oxidation of nicotinamide adenine dinucleotide (reduced form - NADH) by transferring electrons. The resulting reduced forms of the dyes are re-oxidized to the original cationic forms, forming a complete photooxidation cycle. The process of electron transfer from NADH to phenothiazine molecules starts a chain reaction of NADH oxidation. The presence of oxygen molecules, along with the photosensitization that takes place, leading to the production of singlet oxygen ¹ O ₂ , also determines the formation of secondary O ₂ ^- and H ₂ O ₂ . The mechanism presented by the researchers plays an important role in photosterilization under hypoxic conditions, which, in our opinion, is typical in cases with HT patients.

In this technical solution, as applied to aPDT, carried out in the treatment of patients with CT, where the actors: pathological contents (mature biofilms with polymicrobial associates, their endotoxins) and tissues of the lacunocryptal space and the parenchyma of the tonsils changed by the process, are in conditions of acute oxygen deficiency (hypoxia), the specified mechanism serves as an additional justification for the exogenous introduction into the lacunocryptal space and the parenchyma of the tonsils of ozone/NO- and ozonide/NO-containing medicinal substances, which, in addition to the implementation of their main beneficial properties indicated earlier, contribute, in the field of high-amplitude ultrasound and pronounced oxygenation of the specified actors, to an increase in the amount of oxygen in them. An increased concentration of oxygen during photoactivation of photosensitized actors by red spectrum laser radiation will allow obtaining a higher yield of singlet oxygen ¹ O ₂ , as well as secondary active forms of oxygen: O ₂ ^- (superoxide anion oxygen radical), H ₂ O ₂ (hydrogen peroxide), etc., which contribute to an increase in the bactericidal effect.

5. Antioxidant substances (E.B. Menshikova et al., 2006; V.G. Ivanov et al., 2009; V.G. Granik, N.B. Grigoriev, 2015, etc.).

It is known that the amount of endogenous antioxidants is significantly reduced in pathological processes. Exogenous supply of ozone ( _O3 ) and nitric oxide (NO) to the site of infection in the form of ozone/NO- and ozonide/NO-containing medicinal substances with antioxidant properties, as well as the antioxidant succinic acid and other antioxidants, inhibits chain free-radical reactions that produce toxic oxygen radicals that promote excessive formation of ROS, development of lipid peroxidation, causing oxidative modification of proteins, etc. Antioxidants implement a membrane-stabilizing effect and reduce the level of cytolysis; inhibit the processes of atrophy of nervous tissue; normalize metabolic processes; stimulate anti-inflammatory action and reparative processes; accelerate the transition of anaerobic processes to aerobic. They stimulate: microcirculation in the blood, lympho- and interstitial systems of the body, reducing the level of acidosis and endogenous intoxication; oxygen absorption by tissue cells; stabilization of the structure and functional activity of mitochondria, stimulation, along with red spectrum laser radiation + succinic acid, of Ca ²⁺ -dependent processes that increase the energy potential of cells and the body as a whole, etc.

The combination of the specified physical and physicochemical factors affecting focal infection promotes synergy in achieving a successful solution to the problem of the invention, and the physiological meaning of their complex effect, in various combinations, on the primary source of infection (Waldeyer-Pirogov lymphoid-pharyngeal ring and, above all, on the palatine tonsils), which forms tonsillogenic diseases, consists in ensuring [11-14; 54-57]:

- increasing the contact surface and Gibbs energy of a solution of a highly active medicinal substance (ozone/NO and ozonide/NO-containing substances, antioxidants, etc.) sprayed into a high-amplitude ultrasound field with the formation of ultrasound-activated aerosols capable of highly adhesive bonding with infected mucous membranes of the nasopharynx and oropharynx, tonsils, as well as with biofilms, allowing - to reduce the initial level of bacterial contamination while ensuring extensive superficial sanitation of the infection site, namely, the tissues of the Waldeyer-Pirogov lymphoid-pharyngeal ring and, above all, the palatine tonsils;

- high-quality sanitation of the cavities of the lacunae and crypts - the lacuna-cryptal space, as well as the parenchyma of the tonsil through an intermediate medicinal solution and without it due to distant high-amplitude ultrasound phonoporation and dispersion of biofilms that suppress the biofilm-forming activity of polymicrobial associates, as well as cells of biofilm communities, usually including β-hemolytic streptococcus, with subsequent detoxification of endotoxins and evacuation of the extracted lacunar contents of the tonsil and biofilm dispersant from the site of infection;

- intensification, in the field of high-amplitude ultrasound, of impregnation of a solution of a highly active medicinal substance into the mucous membranes of the nasopharynx and oropharynx and, above all, into the lacuna-cryptal space and the parenchyma of the tonsil with the creation of its depot in the tissues of the infection site;

- vasodilation, in the field of high-amplitude ultrasound, of the circulatory system and microcirculatory bed (due to the "forced" exogenous supply of ozone - O ₃ and nitric oxide - NO to the tissues of the primary infection site, its regional hemato- and lymphatic system and the hemato-lymphatic system of the body as a whole, including to the tissues of the tonsillogenic lesion site), which allows to enhance the antioxidant protection of the body as a whole and inhibit processes associated with lipid peroxidation, acidosis, ischemia, etc. This contributes to the normalization of the oxygen-transport function of the blood and the protective function of the lymphatic system, activating lymphatic drainage and, accordingly, accelerating the deactivation and elimination of circulating infectious, toxic and metabolic products from the infection site and the body as a whole;

- intensification of detoxification, in the field of high-amplitude ultrasound and in the environment of highly active medicinal substances, of the pathogenic contents of the tonsils, mucous membranes of the nasopharynx and oropharynx, as well as correction of the free radical status and activation of the antioxidant defense system of the body at the local level - the level of the Waldeyer-Pirogov lymphoid-pharyngeal ring;

- systemic endogenous detoxification of the body as a whole, due to both intravenous and external lymphotropic administration of highly active medicinal substances, for example, in the case of photochromic-ultrasound and ultrasound options of the non-invasive prelymphatic route of their administration through intact skin into the blood and lymphatic system and the interstitial space of the “interested” area of the lymphatic region and the body as a whole;

- stimulation of the processes of normalization of the sanogenic-potent functions of the lymphatic system in the areas of the tonsils, nasopharynx and oropharynx, as well as on the lymphatic drainage pathways due to the effect of highly active medicinal substances, in the field of high-amplitude ultrasound, on the “interested” areas of the lymphatic regions related to the source of infection, and, consequently, on a larger number of regional lymph nodes and draining lymphatic vessels with the provision of targeted and general lymphopharmacotherapy;

- drainage of regional lymph nodes and draining lymphatic vessels, including the interstitial space related to the tonsils, nasal cavities and paranasal sinuses, oropharynx, which helps to enhance their drainage, detoxification, and immune functions;

- stimulation of reparative regeneration of the tissues of the tonsils, mucous membranes of the nasopharynx and oropharynx, as well as local and general immunity, etc. This allows us to classify the proposed method of combined treatment of patients with HT as lymphogenic methods of its treatment.

The physiological meaning of the impact on the links of the pathological circle of development of an infectious-allergic disease, characteristic of HT both in its compensated form and, above all, in its decompensated form, arising as a result of long-term interaction of the infectious agent and the macroorganism with altered general reactivity and insufficiency of the formed immunity, lies in the combined impact of a set of physical and physicochemical factors on the primary focus of infection: the palatine tonsils and the related "interested" blood, lymph, and interstitial systems of the body in the lymph region of the head and neck, namely: high-amplitude ultrasound of the low-frequency range; pulsed laser radiation of the red spectrum; phenothiazine dyes, for example, methylene blue; ozone/NO- and ozonide/NO-containing drugs; antioxidant drugs, low vacuum, allowing in a single technological process of treatment to provide:

1) Sanitation of the primary source of infection in the form of an inflammatory process of the lymphoid-pharyngeal ring and, above all, altered palatine tonsils, by disinfecting the mucous membranes of the nasopharynx and oropharynx with ultrasonic irrigation of a jet-aerosol torch of a solution of a highly active medicinal substance in the acoustic field of high-amplitude ultrasound, since with CT there is an interdependent high infection rate of the tissues of the nasopharynx and oropharynx;

2) Preliminary extraction (cleaning) by ultrasonic drainage of pathological contents from the capillary-porous system of the lacunocryptal space and the tonsil parenchyma altered during CT by distant insonation through an intermediate ozone/NO-containing medicinal solution, high-amplitude ultrasound, allowing for the simultaneous provision of: evacuation of pathological contents from the lacunocryptal space and the tonsil parenchyma in the cavitating environment of the solution circulating during vacuumization in the cavity of the funnel of the applicator-limiter, isolating the insonated tonsil from the oropharynx. The contents extracted by ultrasound are subject to: dispersion - caseous plugs, mature biofilms, microbial associations; deactivation and sterilization - bacteria, fungi, viruses; inactivation - endotoxins of bacteria, fungi, viruses, etc., realized in the cavitating environment of the circulating ozone/NO-containing medicinal solution, and then the disinfected contents of the tonsil are evacuated with the restoration of its drainage function;

3) Sensitization of altered XT tissues of the lacunocryptic space and the parenchyma of the tonsil, during its vacuumization in the cavity of the funnel of the applicator-limiter, isolating the tonsil being sounded from the oropharynx and its distant sounding with high-amplitude ultrasound through an intermediate aqueous solution of a photosensitizer having photoactivity in the red spectral range of pulsed laser illumination. This ensures - accelerated high-amplitude ultrasound sensitization of the photosensitizer (tens of seconds, instead of tens of minutes, hours) of altered XT tissues of the lacunocryptic space and the parenchyma of the tonsil, as well as possible remnants of biofilms and bacteria in them, including intracellular ones, due to the implementation of ultrasonic impregnation of the photosensitizer in the tissue. In addition, the use of a specialized applicator with a sealing funnel that separates the tonsil sensitized by the photosensitizer from the surrounding tissues of the oropharynx eliminates the splashing of the photosensitizer in the oropharynx cavity, which could cause damage to healthy tissues that are not subject to sensitization during further illumination of the oropharynx with laser radiation.

4) Photoactivation of altered tissues of the lacunocryptic space and parenchyma of the tonsil sensitized by the photosensitizer, as well as possible remnants of biofilms and bacteria in them, including intracellular ones, by supplying an illuminating flow of pulsed laser radiation, initiating the production of singlet oxygen ¹ O ₂ . Taking into account the presence of excess oxygen molecules in the tissues introduced at the stages of sanitation of the primary focus of infection and preliminary extraction (cleaning) of the tonsil by ultrasonic drainage using ozone/NO - and ozonide/NO-containing drugs exogenously introduced by ultrasound, the presence of secondary highly active O ₂ ^- and H ₂ O ₂ , contributing to an increase in the antibacterial effectiveness of the proposed method of treating HT, cannot be ruled out. In order to isolate the illuminated tonsil from the oropharynx and improve the conditions for its absorption of pulsed laser radiation, simultaneously with illumination, the tonsil is vacuumized, which is implemented using the above-mentioned applicator with a sealing funnel, connected to a low-pressure pneumatic system;

5) Impregnation into previously sanitized lacuna-cryptal spaces and the parenchyma of the tonsil through a capillary-porous pad with an ozonide/NO-containing oil emulsion of the “oil in water” type, carried out by intermittent contact sonication with high-amplitude ultrasound, allowing the creation of a long-term depot of the medicinal substance in the tonsil and reducing the risk of reinfection during its subsequent regeneration.

6) Activating superficial and intermittent-contact: photochromic-ultrasonic and ultrasound effects on regional lymph nodes and the interstitium of the lymph region both in the projection area of the tonsils and on subsequent lymph nodes and adjacent zones of the interstitium of the lymph region of the face and neck, along the lymphatic pathways leading away from the tonsils, carried out through a capillary-porous pad impregnated with a solution of ozone/NO - or ozonide/NO-containing medicinal substance, both with simultaneous photochromic illumination with super-bright radiation of the red spectrum of the specified area sounded with high-amplitude ultrasound, and using only their sounding with high-amplitude ultrasound. This ensures the activation of particles of the bactericidal component dispersed in the cavitation zone in the form of colloidal silver, which is part of the capillary-porous pad made of sorption bactericidal non-woven fibrous material, interacting with molecules of the medicinal substance, impregnated with high-amplitude ultrasound, as well as photophoresis in the regional lymph nodes and interstitium of the lymph region both in the projection area of the tonsils, and in the subsequent lymph nodes and adjacent zones of the interstitium of the lymph region of the face and neck along the course of the lymphatic pathways draining from the tonsils.

The essence of the invention is explained by photograms and graphically, where:

- Fig. 1 - schematic representation of the stage of high-amplitude ultrasonic treatment of the mucous membranes of the nasal cavities by distant jet-aerosol spraying of a solution of ozone/NO- or ozonide/NO-containing medicinal substance, implemented by the Aeroton-MM device;

- Fig. 2 - schematic representation of the stage of high-amplitude ultrasonic treatment of the oropharynx by sanitation with distant jet-aerosol spraying of a solution of ozone/NO- or ozonide/NO-containing medicinal substance, implemented by the Aeroton-MM device;

- Fig. 3 - schematic representation of the ultrasonic injector of the Aeroton-MM device, view A Fig. 2;

- Fig. 4 - schematic representation of the ultrasonic injector of the Aeroton-MM device, section B-B in Fig. 3;

- Fig. 5 - image of the stage of distant high-amplitude ultrasonic cleaning by washing the lacunar-cryptal space and the parenchyma of the tonsils through an intermediate ozone/NO-containing saline solution using an applicator with a replaceable funnel, from the border of the tonsil being sounded from the surrounding tissues of the Waldeyer-Pirogov lymphoid-pharyngeal ring and a two-half-wave waveguide-instrument "pika" from the set of waveguide-instruments of the Tonsillor-3MM complex;

- Fig. 6a, b - schematic representation of the stage (Fig. 5) of distant high-amplitude ultrasonic cleaning by washing the lacunar-cryptal space and the parenchyma of the tonsils through an intermediate ozone/NO-containing physiological solution - Fig. 6a, and in Fig. 6b - the dynamics of distant ultrasonic phonoporation, dispersion, dissolution and extraction of superficial protein deposits, caseous plugs, biofilms with polymicrobial associates and endotoxins with their subsequent evacuation by a circulating solution of the medicinal substance, under vacuum in the “funnel - applicator - electric aspirator” hydraulic system;

- Fig. 7a, b - schematic representation of the stage of distant high-amplitude ultrasound sensitization of tissues of the lacunar-cryptal space and parenchyma of the tonsils through an intermediate aqueous solution of the photosensitizer - methylene blue - Fig. 7a. In Fig. 7b - an image of distant ultrasound sensitization with a photosensitizer, accelerated by high-amplitude ultrasound impregnation into the altered tissues of the lacunar-cryptal space and parenchyma of the tonsil, as well as possible remnants of biofilms, polymicrobial associates and endotoxins in the depth of the insonified tonsil with their additional dispersion, and subsequent evacuation by the circulating spent solution of the photosensitizer, under vacuum, in the "funnel - applicator - electric aspirator" hydraulic system. The stage is implemented by the Tonsillor-3MM complex using a two-half-wave waveguide instrument “pike” and an applicator with a replaceable optically transparent funnel that seals the tonsil;

- Fig. 8 - schematic representation of the stage of distant illumination with pulsed laser radiation of the red spectrum - λ=635 nm, of the tonsil tissues sensitized with a photosensitizer and its contents, initiating their photoactivation using the laser emitting head of the Lazmik device, coupled with an applicator having a replaceable sealing funnel, which, under conditions of low vacuum - 0.15 kgf/ ^cm2 , separates the sensitized tonsil from the surrounding tissues of the Waldeyer-Pirogov lymphoid-pharyngeal ring, the outer forming surface of which is made optically opaque;

- Fig. 9a, b, c - schematic representation of the stage of distant ultrasonic extraction by high-amplitude ultrasonic drainage initiated by the "reverse" ultrasonic capillary effect, into the intermediate capillary-porous pad, from the lacunar-cryptal space and the capillary-porous system of the tonsil parenchyma of the unremoved by vacuum residues of the photosensitizer solution associated with the deactivated contents of the tonsil, including a suspension of a dispersant of biofilms, polymicrobial associates and endotoxins rejected by ultrasound from healthy tissue structures. In this case, the following are used: an intermediate pad containing particles of a bactericidal component - colloidal silver, and impregnated with a solution of ozone/NO - or ozonide/NO- containing a medicinal substance, as well as a two-half-wave waveguide-instrument "cup-shaped radiating disk" with drainage nozzles channels from the set of waveguide instruments of the Tonsillor-3MM complex;

- Fig. 10a, b, c - image of the stage of distant high-amplitude ultrasonic intermittent-contact treatment of previously cleaned and sanitized tonsils by photosensitization (Fig. 6a, b; Fig. 7a, b; Fig. 8), implementing high-amplitude ultrasonic impregnation from an intermediate lining, including a solution of a medicinal substance - ozonide/NO-containing oil emulsion of the "oil in water" type and particles of a bactericidal component - colloidal silver into the lacunar-cryptal space and the parenchyma of the tonsil using a two-half-wave waveguide-instrument "cup-shaped radiating disk" without drainage nozzle channels from a set of waveguide-instruments of the Tonsilor-3MM complex;

- Fig. 11a, b, c - show the stage of surface intermittent-contact high-amplitude photochromic-ultrasonic lymphotropic impregnation (Fig. 11a, c) of a solution of 10% ozonide/NO-containing oil emulsion of the "oil in water" type, as well as high-amplitude ultrasonic lymphotropic impregnation (Fig. 11b, c) of a solution of ozone/NO-containing physiological solution with a concentration of: ozone - 2.5 mg/l and nitric oxide - 0.3 mg/l, through the corresponding intermediate pads impregnated with them, containing particles of a bactericidal component - colloidal silver. Lymphotropic impregnations were carried out in the “interested” areas - regional lymph nodes and the interstitial system of the lymph region of the face and neck in the area of the projection of the tonsil and then - in the subsequent lymph nodes and adjacent areas of the interstitial system along the lymphatic pathways leading from the tonsils (lymphotropic effects of physical and physicochemical factors), using:

- an applicator of the photochromic-ultrasonic device Rossonic-MM (Fig. 11a, c; Fig. 15), which, when insonifying the “interested” area, provides its photochromic illumination with a matrix of semiconductor LEDs that act with super-bright radiation of the red spectrum;

- a single-half-wave waveguide-instrument “radiating disk” (Fig. 11b, c; Fig. 14) or a “cup-shaped radiating disk” without drainage nozzle channels (Fig. 14) from the set of waveguide-instruments of the Tonsillor-3MM complex;

- Fig. 12 - image of the Aeroton-MM apparatus;

- Fig. 13 - image of the Tonsillor-3MM complex (without a set of waveguide instruments);

- Fig. 14 - image of a set of waveguide instruments connected to the acoustic systems of the Tonsillor-3MM complex: waveguide instruments: "peak"; "cup-shaped radiating disk" with drainage nozzle channels; "cup-shaped radiating disk" without drainage nozzle channels; "radiating disk", in demand in the sequential implementation of different stages of the method of combined treatment of chronic tonsillitis;

- Fig. 15a, b - image of the Lazmik device with an additional set of devices for implementing the stage of photoactivation of sensitized tonsil tissues, biofilm residues, polymicrobial associates, endotoxins (Fig. 8), including: the basic unit of the Lazmik device, the EOHM vacuum unit, the LOK2 laser emitting head, coupled with an applicator having a replaceable funnel, the outer generatrix of which is optically opaque and allows, under hermetic conditions, illumination of the sensitized tonsil with a pulsed laser radiation flow, initiating a photodynamic effect practically in its entire volume. This eliminates the interaction of laser radiation with areas of the surrounding healthy tissues of the Waldeyer-Pirogov lymphoid-pharyngeal ring "inadvertently" stained with a photosensitizer, which can cause their damage.

- Fig. 16 - image of the Rossonic device, which implements photochromic-ultrasonic action on the “interested” areas during the combined treatment of patients with HT.

The device for implementing the method of combined treatment XT, in the order of its application, includes:

- ultrasonic therapeutic device Aeroton-MM 1 (Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 12), consisting of a control unit 1.1 and an ultrasonic injector 1.2 (injector 1.2). The Aeroton-MM 1 device kit additionally includes: a nasal cavity dilator 1.3 with an insulating sleeve 1.3.1, a container 1.4 connected to an excess ozone deactivator 1.4.1, a barbation tip 1.4.2 and a collection unit 1.4.3 for the prepared solution - ozone/NO - or ozonide/NO-containing medicinal substance 1.5, obtained by barbating a physiological solution with an ozone/NO-containing gas mixture generated by the Ozotron 2.3 unit, which is part of the Tonsillor-3MM 2 complex. The injector 1.2 contains: a container 1.2.1 with a solution of medicinal substance 1.5; acoustic system 1.2.2 with an attached waveguide-instrument "sprayer" 1.2.3 with a nozzle 1.2.4, having a through central opening 1.2.5 communicating with container 1.2.1. Container 1.2.1 is connected to pneumatic compressor 1.2.6 and acoustic system 1.2.2 by means of pipes 1.2.7 and 1.2.8, providing supply of a solution of ozone/NO- or ozonide/NO-containing medicinal substance 1.5 from container 1.2.1, through pipe 1.2.8, and then - through through opening 1.2.5, to nozzle 1.2.4 of waveguide-instrument "sprayer" 1.2.3. After switching on the control unit 1.1, the time of ultrasonic irrigation of the nasal cavities or oropharynx is set, and the board 1.2.9 is switched on - control of the acoustic system 1.2.2, as well as the board 1.2.10 - control of the rate of supply of the medicinal solution by the pneumatic compressor 1.2.10 with obtaining spraying of the solution of the medicinal substance 1.5 in the form of a jet-aerosol torch 1.6 sprayed on the mucous membranes of the cavities of the nose or oropharynx during the treatment of XT. Button 1.2.11 - increases the supply of the solution of the medicinal substance 1.5 to the waveguide-instrument "sprayer" 1.2.3 with the nozzle 1.2.4 to obtain a jet-aerosol flow of the spray torch 1.6. Button 1.2.12 - reduces the supply of the solution of the medicinal substance 1.5 to the waveguide-instrument "sprayer" 1.2.3 with the nozzle 1.2.4 to obtain a flow of the spray torch 1.6 with a larger aerosol component. Button 1.2.13, on the handle of the injector 1.2, "switches on - off" the mode of ultrasonic spraying of the medicinal solution;

- Ozone/NO-ultrasonic otolaryngological complex Tonsillor-3MM 2 (Fig. 5; Fig. 6a, b; Fig. 7a, b; Fig. 9a, b, c; Fig. 10a, b, c; Fig. 13; Fig. 14). The Tonsillor-3MM 2 complex contains: a control unit 2.1 with the main assembly units: an ultrasound unit 2.2; an ozone/NO-containing gas mixture generating unit Ozotron 2.3; a vacuum unit with an electric aspirator 2.4 and collection jars 2.4.1; a set of acoustic systems 2.5, equipped with waveguides-instruments attached to them with different radiating working ends of the following type: a two-half-wave waveguide-instrument "pike" (n=2) 2.5.1; two-half-wave waveguide-instrument "cup-shaped radiating disk" 2.5.2 (n=2) with drainage nozzle channels 2.5.2.1; two-half-wave waveguide-instrument "cup-shaped radiating disk" 2.5.3 (n=2) without drainage nozzle channels 2.5.2.1; one-half-wave waveguide-instrument "radiating disk" 2.5.4 (n=1) without drainage nozzle channels, in demand in the process of implementing the method of combined treatment XT. Also, the Tonsillor-3M 2 complex contains applicators 2.6 with replaceable funnels 2.7, separating the tonsil from the surrounding tissues and the oropharynx environment. In this case, applicator 2.6 with replaceable funnel 2.7, connected to hydraulic system 2.8, is intended both for distant high-amplitude ultrasonic cleaning by washing the lacunar-cryptal space and parenchyma of the tonsils through intermediate solutions of ozone/NO - or ozonide/NO-containing medicinal substance 2.8.1, and for distant high-amplitude ultrasonic sensitization of pre-sanitized tissues of the lacunar-cryptal space and parenchyma of the tonsil through an intermediate aqueous solution of photosensitizer - 2.8.2 (methylene blue);

- Laser physiotherapeutic device Lazmik 3 (Fig. 8, Fig. 15). The Lazmik 3 device includes: a base unit 3.1, a laser emitting head 3.2, a vacuum unit 3.3 providing a vacuum in the pneumatic system from 0 to 0.75 kgf/ ^cm2 . The Lazmik 3 device is equipped with an applicator 3.4 with a replaceable funnel 3.5 (hereinafter referred to as funnel 3.5) that seals the illuminated tonsil, as well as a branch pipe 3.6 connecting the cavity 3.5.1 of the funnel 3.5 of the applicator 3.4, through a breaker 3.3.2, with the vacuum unit 3.3. Applicator 3.4 with funnel 3.5 is intended for distant, in hermetic conditions, illumination with a pulsed flow of laser radiation of the red spectrum - λ=635 nm of sensitized tissues of the tonsil and its contents with a photosensitizer, for example, methylene blue, initiating (during illumination) photoactivation of previously sensitized tissues of the lacuna-cryptic space and the parenchyma of the tonsil with radiation generated by laser head 3.2, coupled by means of adapter-holder 3.7 with applicator 3.4. In this case, the funnel 3.5, as a whole, is made of a composite optically transparent to laser radiation, in the form of a quartz-polymer material having a quartz light-guiding base 3.5.2 and a polymer light-reflecting, into the cavity of the funnel 3.5.1, shell 3.5.3 with a double polymer coating - a primary light-reflecting one made of organosilicon elastomers of the SIEL type and a secondary protective coating made of thermoplastic materials such as polyamides, a copolymer of tetrafluoroethylene with ethylene, etc. [63]. This makes the outer forming surface of the funnel 3.5 optically opaque and separating the surrounding non-sensitized tissues of the oropharynx from their illumination, from the cavity of the funnel 3.5.1, by a pulsed flow of laser radiation, excluding interaction with areas of healthy tissues of the oropharynx "inadvertently" colored by the photosensitizer, which can cause their damage. This provides significant functionality for Funnel 3.5. On the one hand,

- with a 3.5 funnel, the illuminated tonsil is hermetically separated from the oropharynx by vacuum, and on the other hand, under conditions of the provided low vacuum (vacuum - 0.15 kgf/ ^cm2 ), it promotes the activation of the tonsil vascular system, namely, passive and active hyperemia of the parenchyma, ensuring the greatest interaction and absorption of laser radiation by the circulating blood in the illuminated parenchyma. When sensitized tonsil tissues are illuminated with a pulsed stream of red spectrum laser radiation - λ = 635 nm, in addition to the implementation of the photodynamic effect, practically in the entire volume of the parenchyma, accompanied by degradation of biofilms, deactivation and sterilization of polymicrobial associates, the following occurs: maximum absorption of laser radiation by hemoglobin of the parenchyma circulatory system, accompanied by activation of the immune system of the mucous membranes and cellular immunity of the tonsils, and also, indirectly, of the mucous tissues of the oropharynx [22,64, etc.]. Which refers to the factors that contribute to an increase in the effectiveness of aPDT in the combined treatment of chronic tonsillitis, implemented by the proposed method of its treatment. To supply a pulsed laser radiation flow to the tonsil (Fig. 8), located in the distal part of the cavity of the funnel 3.5, a light guide 3.8 is used, including: an adapter-holder 3.7, which fixes, relative to the radiation axis of the laser emitting head 3.2, a rod optical attachment 3.8.1 (hereinafter referred to as the optical attachment 3.8.1), made of a special organic glass with a transmittance of about 0.65 and coupled with an optical diffusing element 3.8.2 (hereinafter referred to as the diffuser 3.8.2);

- Physiotherapeutic apparatus Rossonic-MM 4 (Fig. 11a, b; Fig. 16). The Rossonic-MM 4 device contains: a control unit 4.1 and a photochromo-ultrasonic applicator 4.2, which performs photochromo-ultrasonic effects (1=630 nm; ξ=20 μm) and thermal effects (no more than 45°C) due to the absorption of ultrasound by the “interested” area, including the regional lymph nodes and the interstitial system of the lymphoregion of the face and neck in the projection area of the tonsil, etc. The photochromo-ultrasonic applicator 4.2, in turn, contains: an acoustic unit with a waveguide-instrument 4.2.1, the working part of which is made in the form of a large-area disk and with a convex emitting end, as well as a ring matrix of semiconductor super-bright light-emitting diodes 4.2.2, emitting in the visible part of the spectrum - red (λ=630 nm); - Gasket 5 (Fig. 9a, b; Fig. 10a, b, c; Fig. 11a, b, c). Gasket 5 is made of a sorption-bactericidal non-woven fibrous capillary-porous material (thickness 2-3 mm, pore size - 2-10 μm), on the fibers of which active centers are fixed - particles of aluminum oxide hydrate associated with particles of a bactericidal component in the form of colloidal silver (antimicrobial dressing VitaValis [61]). The pad 5 used in the combined treatment of XT, with distant continuous or intermittent-contact high-amplitude ultrasound treatment of the tonsil (ξ=20 μm; ξ=40 μm and ξ=60 μm), is a sorbent element including active centers with a bactericidal component impregnated with a solution of a highly active medicinal substance, for example, in the form of an ozone/NO-containing physiological solution or an ozonide/NO-containing oil emulsion of the “oil in water” type. The gasket 5, fixed on the radiating working end of the disc-shaped waveguide-instruments of type 2.5.2, provides, when the ultrasound is turned on, on the one hand - distant high-amplitude extraction, and on the other - simultaneously, high-amplitude dispersion of the liquid phase (L) - pathological contents (L) extracted from the capillary-porous system (T) of the tonsil, which allows the gasket 5, which is a volumetric capillary-porous depositing element, to rapidly absorb, extracted by ultrasonic drainage, from the lacunar-cryptal space and the parenchyma of the tonsil, a suspension of dispersed inflammation products in the form of degraded, upon photoactivation, sensitized by FS residues of biofilms with degerminated polymicrobial associates and deactivated endotoxins (Fig. 9a, b, c). Which is intensified by initiating the "reverse" ultrasonic capillary effect, discovered by V.V. Pedder in 1980-82 in the laboratory "Ultrasound in Medicine" of the Omsk Polytechnic Institute [65], which made it possible (in 1985-86) to implement an effective technology for distant ultrasonic extraction of liquid phases (L) from capillary-porous systems of the "solid" phase (S) of different types - living and nonliving nature - filled with them [24-26, 62, etc.]. On the other hand - with continuous, contact-intermittent or contact high-amplitude ultrasonic treatment of the tonsil, at the stages of its saturation with a medicinal substance with the creation of its depot in it. The pad 5, fixed on the radiating working end of the disc-shaped waveguide instruments of type 2.5.3 and 2.5.4, impregnated with a solution of the medicinal substance, is its volumetric capillary-porous carrier element, ensuring the implementation of the process of high-amplitude impregnation of the liquid phase of the medicinal solution (G) from the capillary-porous system of the “solid” phase (T) of the pad 5 into the previously sanitized tissues of the tonsil, namely into its lacuna-cryptal space and parenchyma, which are the capillary-porous system of the “solid” phase (T) of the tonsil, with the creation in them of a long-acting depot of an effective ozone/NO - or ozonide/NO-containing medicinal substance (Fig. 10a, b, c). Taking into account the above, it is possible to use waveguide instruments of type 2.5.3 and 2.5.4 (Fig. 10a, c), as well as a photochromic-ultrasonic applicator (Fig. 10a, c) in the implementation of non-invasive transcutaneous contact-intermittent or contact impregnation of the said solutions of medicinal substances into the “interested” areas, including regional lymph nodes and the interstitial system of the lymph region of the face and neck in the projection zone of the tonsil and further into the subsequent lymph nodes and the interstitial systems adjacent to them along the course of the lymphatic pathways draining from the tonsil (Fig. 11c).

The proposed method of combined treatment of chronic tonsillitis is carried out in stages in a single technological cycle of treatment using the specified hardware and drugs approved by Roszdravnadzor for use in healthcare.

At the first stage of the combined XT treatment session (Fig. 1 - Fig. 4), high-amplitude ultrasound treatment of the mucous membranes of the nose and oropharynx is performed by sanitizing them with distant jet-aerosol spraying of an ozone/NO or ozonide/NO-containing medicinal substance solution. After cleaning the mucous membranes of the nasal cavities and assessing the condition of the mucous membranes of the nasopharynx and oropharynx, the patient is placed in a chair in a "semi-sitting" position, with the head turned 20-30° back. Initially, sequentially opening the nasal cavities with a nasal dilator, each of them is examined to clarify the condition of the mucous membranes. After this, distant high-amplitude ultrasound irrigation of the mucous membranes of the nose and nasopharynx is performed with a spray flow of 1.6 in the form of a jet-aerosol torch of a medicinal substance solution of 1.5, the duration of irrigation of which depends on the condition of the mucous membranes. For this purpose, the Aeroton-MM 1 device is used, consisting of a control unit 1.1 and an ultrasonic injector 1.2 (injector 1.2) with a container 1.2.1 installed in it, filled with a solution of a medicinal substance 1.5 in the form of an ozone/NO-containing physiological solution with concentrations of: ozone - 2.5 mg/l and nitric oxide - 0.3 mg/l.

Then (Fig. 1), preparation for ultrasonic action on the olfactory epithelium of the nasal cavity mucosa is carried out endonasally with a stream of aerosol spray torch 1.6 of medicinal solution 1.5. By squeezing the branches of nasal dilator 1.3 with its delimiting sponges, the vestibule is expanded to the limits allowing an overview of the mucous cavity with determination of the localization of infection. Injector 1.2 with waveguide-instrument 1.2.3, having nozzle 1.2.4 and through central opening 1.2.5, is mated with insulator sleeve 1.3.1 of nasal dilator 1.3, introducing it into the vestibule of one of the halves of the nasal cavity. On control unit 1.1, standby mode is turned on, then the ultrasonic generator unit with acoustic system control board 1.2.2 is turned on, and the irrigation time is set with the timer. Including board 1.2.9 - control of acoustic system 1.2.2 and board 1.2.10 - control of the feed rate of medicinal solution 1.5 by pneumatic compressor 1.2.10, carried out by means of buttons 1.2.11 and 1.2 12, provide obtaining of spray flow 1.6, respectively, in the form of jet-aerosol or aerosol torch, sprayed on mucous membranes of nose and nasopharynx. Then, waveguide-instrument 1.2.3 is inserted into nasal dilator 1.3 and oriented, relative to visually determined source of infection, by its angular rotation and reciprocating movement relative to bushing-insulator 1.3.1 of nasal dilator 1.3. The control unit 1.1 and the injector 1.2 of the Aeroton-2MM 1 device are switched on in the mode of sanitizing ultrasonic irrigation with a jet-aerosol spray flow 1.6 of a medicinal solution 1.5 sprayed onto the infected mucous membrane of the cavity of one of the halves of the nose, in the form of a jet-aerosol torch, realized at a frequency of - f = 26.5 kHz and with an amplitude of ultrasonic vibrations of the waveguide-instrument 1.2.3 - ξ = 80 hμm, for a time of - τ = 20 seconds (for each half of the nose). During distant ultrasonic irrigation of the infection site in the nasal cavities and nasopharynx, and later the oropharynx, with a spray stream 1.6 of a medicinal substance 1.5 in the form of a jet-aerosol torch sprayed onto the mucous membranes, particles of aerosol, clusters of individual drops and intermittent jets are torn off from the emitting nozzle 1.2.4, possessing kinetic energy that ensures: sanitation and disinfection of tissues from its altered tissue structures, biofilms with polymicrobial associates and endotoxins. At the same time, the drug 1.5 is introduced into the olfactory epithelium of the nasal mucosa and the mucous tissues of the airways of the nasopharynx, suppressing both extracellular and intracellular pathogens, etc. The latter is ensured by the formation, during cavitation, in solution 1.5 of free radicals, as well as ozone and ozonide derivatives with high virucidal, fungicidal and bactericidal activity. Upon completion of the manipulations associated with ozone/NO or ozonide/NO ultrasonic irrigation of the nasal cavities and nasopharynx, the supply of the drug 1.5 solution carried out by injector 1.2 is shut off by turning off the ultrasonic spray mode using button 1.2.13 "on - off" on the handle of injector 1.2. Nasal dilator 1.3 and waveguide instrument 1.2.3 are removed from the vestibule and nasal cavity. Then, on the other half of the nose, similarly, high-amplitude ultrasound irrigation of the mucous membranes of the nasal cavity and nasopharynx is carried out with a spray flow 1.6 in the form of a jet-aerosol torch of a solution of a medicinal substance 1.5. Simultaneously with the nasal cavities, the mucous membranes of the nasopharynx and sinuses communicating with them are sanitized, indirectly.

After this (Fig. 2), similar to the above, oral sanitation of the oropharynx is carried out by means of distant high-amplitude ultrasound irrigation of its mucous membranes, carried out similarly to the previous procedure of endonasal action on the olfactory epithelium of the mucous membrane of the nasal cavity (Fig. 1), which implements disinfection of the infection in the airways of the oropharynx, bronchi and underlying parts of the lung by oral sanitation of their mucous membranes with a spray stream 1.6 in the form of a jet-aerosol or aerosol torch of a medicinal substance 1.5, for a time of τ = 20 seconds, with periodic breath holding. This achieves synergy in obtaining high-quality superficial sanitation of the olfactory epithelium of the mucous membrane of the nasal cavities, nasopharynx and oropharynx, carried out by a 1.5 solution of the medicinal substance activated in a high-amplitude ultrasound field, simultaneously ensuring its impregnation deep into the mucous membranes and suppression of pathogenic microflora both externally and deep in the infection site.

The parameters and modes of distant high-amplitude ultrasound irrigation of the mucous membranes of the nose, nasopharynx and oropharynx, implemented by ozone/NO or ozonide/NO ultrasound sanitation, and indirectly, the paranasal sinuses, bronchi and underlying parts of the lungs are as follows:

- frequency of ultrasonic vibrations - f=26.5 kHz;

- amplitude of ultrasonic vibrations of the waveguide-instrument - ξ=80 µm;

- exposure time of high-amplitude ultrasound endonasal and oral jet-aerosol irrigation with ozone/NO- or ozonide/NO-containing solution of the medicinal substance of the mucous cavities of each half of the nose, as well as the mucous membranes of the oropharynx - τ = 20 seconds;

- medicinal solution - ozone/NO-containing physiological solution at concentrations: ozone - 2.5 mg/l and nitric oxide - 0.3 mg/l;

- implementation features - the stage is performed during each of the 6 sessions implementing the XT treatment course according to the proposed method of its combined treatment.

Ozone/NO- or ozonide/NO-containing medicinal substance 1.5 is obtained by bubbling a physiological solution with an ozone/NO-containing gas mixture generated by the Ozotron 2.3 unit (Fig. 1) of the Tonsillor-3MM 2 complex. This procedure is justified by the fact that during dystrophic processes connective tissues, including lymphoid tissues of the Waldeyer-Pirogov ring, consume more oxygen than tissues not affected by the process (Yu.F. Isakov, 1990). Aerosol particles - components of the torch of the medicinal substance solution sprayed by ultrasound, have a high value of the Gibbs surface energy, allowing aerosols to actively sorb and superficially bind ozone ( _O3 ) and nitrogen oxide (NO) molecules (V.V. Pedder, 1996). The resulting associates of aqueous solution molecules with ozone, nitrogen oxide and their derivatives, absorbed by aerosol or jet-aerosol particles, are transferred by gravity and kinetic energy of the ultrasonic torch to the surface of the mucous cavities of the nose and oropharynx. They coalesce with the mucous membranes and diffusely penetrate into them, and then into the circulatory bed, and further - to the lymphoid tissues of the Waldeyer-Pirogov ring and tissue fluid, absorbing ozone and nitrogen oxide with the formation of highly active ozonides, derivatives of ozone and nitrogen oxide, which are biotropic antiseptics. This ensures: one-time sanitation of the nasopharynx and oropharynx, reducing bacterial contamination of the tissues of these cavities, mucous palatine tonsils; stimulation of vasodilating, oxygenating, anti-acidosis, detoxifying, antioxidant effects, etc. [54, 57, 66, 67], which has a positive effect on the microcirculatory bed of the blood and lymphatic systems, and through them on the primary source of infection in chronic tonsillitis - the lymphoid tissues of the Waldeyer-Pirogov ring.

At the second stage of the combined treatment session (Fig. 5, Fig. 6a, b, Fig. 13, Fig. 14), distant high-amplitude ultrasonic cleaning is performed by washing the lacunar-cryptal space and the parenchyma of the tonsils through an intermediate ozone/NO-containing saline solution using the Tonsillor-3MM 2 complex. Alternating distant high-amplitude ultrasonic cleaning is performed by washing the lacunar-cryptal space and the parenchyma of the tonsils from pathological contents, including altered tissue structures, biofilms with polymicrobial associations and endotoxins, by their high-amplitude ultrasonic sanitizing treatment through an intermediate solution of a medicinal substance - ozone/NO-containing saline solution.

Initially, local application anesthesia of the pharynx is performed with a 2% lidocaine solution (at stage 2 of each of the 6 sessions) to suppress the pharyngeal reflex. The patient is in a chair in a "semi-recumbent" position, the head is turned towards the tonsil being voiced. A limiting applicator 2.6 (applicator 2.6) with a limiting funnel 2.7 (funnel 2.7) of the required size is applied to one of the tonsils, in which a vacuum of -0.35 kgf/ ^cm2 is created by a vacuum unit 2.4, which is necessary for reliable fixation of the applicator 2.6 on the tonsil and for performing vacuum drainage of the lacuna-cryptal space and the parenchyma of the tonsil from pathological contents and for creating, at the surface of the tonsil, the circulation of an ozone/NO-containing physiological solution with a concentration of: ozone - 2.5 mg/l and nitric oxide - 0.3 mg/l, supplied from the hydraulic system 2.8. After filling the funnel 2.7 with the specified solution, turn on the ultrasound unit 2.2, set the amplitude of the waveguide-instrument 2.5.1, allowing insonification in the cavitation mode. Turn on the "insonification" button and perform distant - from a distance of about 12 mm, high-amplitude insonification of the tonsil, through the specified medicinal solution, for a time of - τ = 60 seconds, with a two-half-wave waveguide-instrument "pika" 2.5.1.

In combination, the following phenomena occurring in the medicinal solution under the influence of ultrasound: cavitation, variable sound pressure, acoustic currents, high-speed liquid jets directed to the surface of the tonsil being sounded cause: washing away and dispersion of superficial protein deposits, expansion and opening of the mouths of lacunae and crypts with washing out of the main volume of pathological contents from them - caseous plugs, biofilms, polymicrobial associates, and endogenous toxins, with initiation of the sound-capillary effect in the capillary-porous system of the lacuna-cryptal space and the parenchyma of the tonsil, accompanied by high-amplitude ultrasound extraction of the contents and drainage of the lacuna-cryptal space and the parenchyma of the tonsil, as well as impregnation of the ozone/NO-containing medicinal solution in them. Which ultimately leads to intensification of tonsil cleaning from pathological contents, inactivation of microflora and endotoxins, concomitant deposition of medicinal solution into the cleaned lacuna-cryptal space and tonsil parenchyma. Medicinal solution circulating near the tonsil in funnel 2.7, on the one hand, cools the radiating end of the waveguide-instrument "peak" 2.5.1, excluding thermal destruction of the surface of the tonsil being sounded, and on the other hand, the contents of the tonsil extracted by ultrasound are evacuated with the "used" flow of solution into the collection jar 2.4.1 of the electric aspirator of the vacuuming unit 2.4. After sounding the tonsil, the tap of the applicator 2.6 is set to the "closed" position, the electric aspirator and control unit 2.1 are switched off.

The patient takes a sitting position in the chair while holding his breath, the applicator 2.6 is removed from the tonsil. In a similar manner, distant high-amplitude ultrasound cleaning of the contents of the second tonsil is carried out by ultrasound washing of its lacuno-cryptal space and parenchyma.

Parameters of distant high-amplitude ultrasonic sanitation of tonsils by ultrasonic cleaning and rinsing with a highly active medicinal solution:

- frequency of ultrasonic vibrations of the waveguide-instrument - f=26.5 kHz;

- the amplitude of ultrasonic vibrations of the waveguide-instrument, in cavitation mode - ξ=60 µm;

- exposure of the tonsil sound - τ=60 seconds;

- vacuum in the applicator system with a funnel - 0.35 kgf/ ^cm2 ;

- the distance between the surface of the tonsil being sounded and the radiating end of the waveguide-instrument “peak” - L=12 mm;

- highly active medicinal solution - ozone/NO-containing physiological solution with concentrations of: ozone - 2.5 mg/l and nitric oxide - 0.3 mg/l;

- implementation features - the stage is performed during each of the 6 sessions implementing the XT treatment course according to the proposed method of its combined treatment.

At the third stage of the session of combined treatment of chronic tonsillitis (Fig. 7a, b, Fig. 13, Fig. 14) using the Tonsillor-3MM 2 complex, the process of distant high-amplitude ultrasound sensitization of the tissues of the lacunar-cryptal space and the parenchyma of the tonsils is implemented through an intermediate solution of a photosensitizer - a 1% aqueous solution of methylene blue. With local application anesthesia of the pharynx in effect, high-amplitude ultrasound sensitization was performed for a time of τ = 20 seconds on each of the tonsils, previously cleaned by washing the tissues of the lacuna-cryptal space and parenchyma, under conditions of their vacuumization with a vacuum of - 0.35 kgf / cm ² , and through an intermediate 1% aqueous solution of methylene blue, implemented by distant ultrasound impregnation of the photosensitizer solution into the altered tissues of the tonsils and possible remnants of pathological contents, including biofilms, polymicrobial associates and endotoxins. This, the third stage of the combined treatment session, is performed similarly to the second stage, i.e. with the same parameters of tonsil insonification and the same two-half-wave rod waveguide-instrument "pika" - 2.5.1. But the parameter - the time of high-amplitude ultrasound sensitization is accepted as sufficient in the value - τ = 20 seconds due to the impregnation process intensified by the acoustic field of high-amplitude ultrasound and, accordingly, the accelerated penetration of photosensitizer 2.8.2 into the tissues of the lacuna-cryptal spaces and the parenchyma of the tonsils, as well as the use of photosensitizer 2.8.2 - 1% aqueous solution of methylene blue, instead of medicinal solution 2.8.1 - ozone/NO-containing physiological solution with concentrations: ozone - 2.5 mg / l and nitric oxide - 0.3 mg / l.

This ensures accelerated saturation and biochemical interaction of photosensitizer 2.8.2 with the affected tissues of the lacunocryptal spaces and the parenchyma of the tonsils, as well as with their pathological contents, reducing the period of their sensitization.

Parameters of distant high-amplitude ultrasound sensitization of tissues of the lacunocryptal space and parenchyma of the tonsil with a photosensitizer:

- frequency of ultrasonic vibrations of the waveguide-instrument - f=26.5 kHz;

- the amplitude of ultrasonic vibrations of the waveguide-instrument, in cavitation mode - ξ=60 µm;

- exposure time of the tonsil sounding - τ=20 seconds;

- vacuum in the applicator system with a funnel - 0.35 kgf/ ^cm2 ,

- the distance between the surface of the tonsil being sounded and the radiating end of the waveguide-instrument “peak” - L=12 mm;

- photosensitizer - 1% aqueous solution of methylene blue;

- implementation features - the stage is performed in the 2nd and 3rd sessions of the treatment course, consisting of 6 sessions implementing the XT treatment course according to the proposed method of its combined treatment.

At the fourth stage of the combined treatment session for chronic tonsillitis (Fig. 8. Fig. 15), carried out using the Lazmik 3 device, distant illumination with pulsed laser radiation of the red spectrum is implemented, previously sensitized with the photosensitizer of the tonsil tissues and its contents, causing their photoactivation. After the end of the sensitization period (no more than 10 minutes) of the tissues of the lacuna-cryptal space and the parenchyma of the tonsil with the photosensitizer 2.8.2, the oropharynx is rinsed with a physiological solution - 100 ml.

Then, alternate distant illumination of each of the tonsils is carried out with pulsed laser radiation of the red spectrum (λ=635 nm), at a low vacuum of 0.15 kgf/ ^cm2 , created in the applicator 3.4 and the optically transparent funnel 3.5 associated with it, the outer forming surface of which is made optically opaque, and in the cavity of the funnel 3.5 the illuminated tonsil is sealed and separated from the surrounding tissues by the Waldeyer-Pirogov ring. At the same time, funnel 3.5, in addition to the outer layer of its surface generatrix, is generally made of a composite optically transparent to laser radiation - a quartz-polymer material having a quartz light-guiding base 3.5.2 (Fig. 8) and a polymer light-reflecting shell 3.5.3, channeling virtually the entire light flux of pulsed laser radiation supplied to the cavity of funnel 3.5.1 from the emitting head 3.2, and then - by means of the light-guiding path 3.8, including the optical attachment 3.8.1 and the diffuser 3.8.2, to the palatine tonsil, allowing, emitting the internal cavity of funnel 3.5.1 to illuminate with laser radiation a large part of the generatrix surface of the sensitized tonsil with penetration into the depth of the parenchyma, ensuring illumination of virtually the entire volume of tissue structures, including lacunar-cryptal space. This allows to provide a high level of formation of highly active products of photochemical reactions, increasing the reliability of photodynamic disinfection and inactivation of possible residues of polymicrobial associates and endotoxins in the deep sections of tissue structures of lacunar-cryptal spaces and parenchyma of the tonsil, since the flow of pulsed laser radiation penetrating both distally and from the side of the lateral forming surface of the tonsil allows to fully initiate, at a depth of up to 8 mm, photoactivation of the sensitizer with the formation of singlet oxygen ¹ O ₂ , including secondary ROS - O ₂ ^- , H ₂ O _{2 ,} etc.

To perform the fourth stage, the patient is placed in a chair in a sitting position, the head is turned towards the illuminated tonsil. Applicator 3.4 with a delimiting funnel 3.5 of the required size is applied to the tonsil, including the vacuum unit 3.3, a vacuum of - 0.15 kgf/ ^cm2 is created, which is necessary both for fixing the delimiting funnel 3.5, coupled with applicator 3.4 on the tonsil, and for stimulating active hyperemia of the parenchyma, which promotes better absorption of laser radiation by the circulating blood in the illuminated tissues of the lacuna-cryptal space and the parenchyma of the tonsil, and therefore with the affected tissue areas of the tonsil sensitized by the photosensitizer and its pathological contents. Then, sequentially turn on: the base unit of the Lazmik 3.1 device with the Power button and set the exposure time of distant illumination of each of the sensitized tonsils; the Channel On button and the Start button, performing distant illumination of the evacuated tonsil from a distance of L ₁ = 10 mm with pulsed laser radiation of the red spectrum, for a time of τ - up to 5 minutes, which is located distally in the cavity of the delimiting funnel 3.5, the outer forming surface of which is made optically opaque - to exclude illumination of the surrounding healthy tissues of the oropharynx, which may be "inadvertently" sensitized by the photosensitizer solution from illumination of them with pulsed laser radiation of the red spectrum, due to an error in performing the third stage of the combined XT treatment. After illuminating the first tonsil, the Lazmik 3.1 device is switched off in the reverse order, and then, after switching off the vacuum unit 3.3, the applicator 3.4 with the separating funnel 3.5 is removed from the tonsil. In a similar manner, distant illuminating of the second tonsil is carried out with pulsed laser radiation of the red spectrum.

Parameters and modes of the fourth stage of distant illumination with pulsed laser radiation of sensitized tissues of the tonsil and its contents, initiating photoactivation:

- wavelength of red spectrum laser radiation - L=635 nm;

- illumination mode of the laser emitting head - pulsed;

- pulse duration - 100 ns (10 ^-7 sec.);

- frequency - f=80 Hz;

- pulse power - 5 W;

- average power - 10 mW;

- lighting mode - distant, from a distance of L ₁ - 10 mm;

- exposure time of illumination - τ=5 minutes;

- vacuum in the pneumatic system: “vacuum block-applicator-separating funnel” - 0.15 kgf/ ^cm2 ;

- implementation features - the stage is performed in the 2nd and 3rd sessions of the treatment course, consisting of 6 sessions implementing the XT treatment course according to the proposed method of its combined treatment.

At the fifth stage of the combined treatment session for chronic tonsillitis (Fig. 9a, b, c; Fig. 3; Fig. 14), alternate distant extraction is performed by high-amplitude ultrasound drainage from the lacunocryptal space and the parenchyma of the tonsils, possibly not removed by vacuum from the capillary-porous system of the tonsil of the remains of the aqueous solution of the spent photosensitizer associated with the deactivated contents of the tonsil. With local application anesthesia of the pharynx - 2% lidocaine solution, suppressing the pharyngeal reflex, the patient is placed in a chair in a "semi-sitting" position with the head turned 20-30° back and towards the tonsil being sounded. A two-half-wave waveguide-instrument “cup-shaped radiating disk” 2.5.2 with drainage nozzle channels on the radiating disk and a gasket 5 fixed to it, containing particles of a bactericidal component - colloidal silver, and impregnated with a solution of 10% ozonide/NO-containing oil emulsion of the “oil in water” type with a peroxide number P=150 (Fig. 9a, b, c) is connected to the acoustic system 2.5 (from the Tonsillor-3MM 2 complex set). By switching on the ultrasonic unit 2.2 (Fig. 13), distant high-amplitude insonification of the tonsil is carried out by the waveguide-instrument “cup-shaped radiating disk” 2.5.2 through the layer of gas gap L ₂ (acoustic boundary layer) between the radiating end of the waveguide-instrument “cup-shaped radiating disk” 2.5.2 (hereinafter referred to as the waveguide-instrument 2.5.2) and the surface of the tonsil being insonified, including the gasket 5 with the solution of the medicinal substance (Fig. 9 b).

Parameters and modes of distant extraction by high-amplitude ultrasonic drainage with a waveguide-instrument 2.5.2 with a 5 gasket:

- frequency of ultrasonic vibrations of the waveguide-instrument 2.5.2 - f=26.5 kHz;

- the amplitude of ultrasonic vibrations of the waveguide-instrument 2.5.2 - ξ=60 μm, acting through the gas gap layer _L2 , defined as the area of the acoustic boundary layer between the insonified surface of the tonsil and the radiating end of the waveguide-instrument 2.5.2 with a gasket 5 with a solution of the medicinal substance fixed to its working end;

- exposure time of the tonsil sounding - τ=30 seconds;

- the distance between the surface of the tonsil being sounded and the radiating end of the waveguide-instrument 2.5.2: the area of the acoustic boundary layer - L ₂ - up to 5 mm;

- medicinal substance - 10% ozonide/NO-containing oil emulsion of the “oil in water” type with a peroxide value of P=150;

- implementation features - the stage is performed during each of the 6 sessions implementing the XT treatment course according to the proposed method of its combined treatment.

By using the waveguide instrument 2.5.2, the following processes are initiated: phonoporation, ultrasonic drainage and extraction of superficial inflammation products of the tonsil parenchyma, for example, biofilms with biofilm-forming microbial associates and, partially, possible remnants of the contents in the lacuno-cryptal space of the tonsils, including residual or trace amounts of pathogenic microflora and its dispersant, endotoxins (Fig. 9a, b). The above is realized by the “reverse” ultrasonic capillary effect [65, 68, 69, etc.], where the decisive role is given to high-amplitude ultrasonic vibrations, acting remotely (through intermediate media with different acoustic resistances) and initiating the manifestation of: cavitation, harmonic sound pressure, acoustic flows, cumulative processes, etc., causing complex vibrations of the walls of blood vessels, capillaries, slit spaces filled with tissue fluids with pathological contents, etc., i.e. affecting the phase boundary of the solid-liquid (S-L) system, including implementing the force characteristics of the dynamically changing double electric layer (DEL) and other manifestations of the sound-capillary effect, initiating, in turn, the processes of phonoporation and dispersion of biofilms and biofilm-forming polymicrobial associates, as well as ultrasonic drainage of pathological contents from the lacuna-cryptal space and the parenchyma of the tonsil with their subsequent active sorption and extraction into the capillary-porous system of the lining 5, located in the region of the acoustic boundary layer L ₂ (Fig. 9b). In the field of high-amplitude ultrasound, simultaneously interacting with the solution of the medicinal substance impregnating the pad 5 and particles of its bactericidal component in the form of colloidal silver, the processes of deactivation and detoxification of the pathological contents extracted by high-amplitude ultrasound drainage from the lacuno-cryptal space and the parenchyma of the tonsil actively proceed due to the initiation of the above-mentioned "reverse" ultrasound capillary effect. At the same time, local immunity is activated, explained by the enhancement, by high-amplitude ultrasound, of the migration of leukocytes and other formed elements of the blood and lymph to the surface of the sanitized tonsil from its deep tissue structures of the lacuno-cryptal space and parenchyma, representing a capillary-porous network, which increases the local immune response and reduces the risk of local dissemination of infection.

At the sixth stage of the combined treatment session for chronic tonsillitis (Fig. 10a, b, c; Fig. 13; Fig. 14), the process of alternating high-amplitude ultrasound impregnation is performed into the previously sanitized lacuna-cryptal space and parenchyma of each of the tonsils, stimulating the reparative regeneration of their tissue structures affected by CT. This stage is performed immediately after the fifth stage of the combined treatment session for CT. As with the fifth stage, at this stage, with local application anesthesia of the pharynx in effect - 2% lidocaine solution, which suppresses the pharyngeal reflex, the patient is positioned in a chair, in a "semi-sitting" position with the head turned 20-30° back and towards the tonsil being sounded. A two-half-wave waveguide-instrument "cup-shaped radiating disk" 2.5.3 (without drainage nozzle channels on the radiating disk) is connected to the acoustic system 2.5, connected to the ultrasonic unit 2.2 of the Tonsillor-3MM 2 complex, but with a gasket 5 fixed to it, containing particles of a bactericidal component - colloidal silver, and impregnated with a solution of 10% ozonide/NO-containing oil emulsion of the "oil in water" type with a peroxide number for ozonides P = 150. By turning on the ultrasonic unit 2.2 (Fig. 13), high-amplitude ultrasonic impregnation of the medicinal substance into the sanitized, at the early stages, lacuna-cryptal space and parenchyma of the tonsil is carried out. The tonsil is sounded using a waveguide-instrument “cup-shaped radiating disk” 2.5.3, the radiating disk-shaped part of which, with a pad 5 with a medicinal solution fixed to it, is brought to the pharyngeal surface of the tonsil and intermittently-contact, without effort from the waveguide-instrument 2.5.3 with pad 5, its entire accessible surface is sounded, realizing the saturation of the lacuna-cryptal space and the parenchyma of the tonsil with the specified medicinal substance over a period of time - τ = 20 seconds.

Parameters and modes of high-amplitude ultrasonic impregnation:

- frequency of ultrasonic vibrations of the waveguide-instrument - f=26.5 kHz;

- amplitude of ultrasonic vibrations of the waveguide-instrument - ξ=40 µm;

- exposure time of intermittent contact sounding of the tonsil - τ=20 seconds;

- medicinal substance - 10% ozonide/NO-containing oil emulsion of the “oil in water” type with a peroxide value of P=150;

- implementation features - the stage is performed during each of the 6 sessions implementing the XT treatment course according to the proposed method of its combined treatment.

At the seventh stage of the session of combined treatment of chronic tonsillitis (Fig. 11a, b, c; Fig. 13; Fig. 14; Fig. 16), photochromic-ultrasonic and ultrasound effects are performed on the regional lymph nodes and the interstitial system of the lymph region both in the projection area of the tonsils and further, as well as on the subsequent lymph nodes and adjacent interstitial zones of the lymph region of the face and neck, along the course of the lymphatic pathways leading from the tonsils, carried out through a capillary-porous pad impregnated with a solution of ozone/NO- or ozonide/NO-containing medicinal substance. In this case, the impact on the “interested” area can be carried out either by photochromic illumination with super-bright radiation of the red spectrum with simultaneous sounding with high-amplitude ultrasound, or by using only sounding with high-amplitude ultrasound, without photochromic illumination.

For this purpose (Fig. 11a, c; Fig. 16), initially, a pad 5 impregnated with a solution of 10% ozonide/NO-containing oil emulsion of the “oil in water” type with a peroxide number of P=150 is placed on the “interested” area, and photochromo-ultrasonic impregnation of the said medicinal substance is carried out, over a period of time of τ=2 sec/ ^cm2 , by superficial intermittent contact action on it with high-amplitude ultrasound at a frequency of f=44 kHz and with an oscillation amplitude of the waveguide-instrument 4.2.1 - ξ=20 μm. At the same time, the “interested” area is illuminated by narrow-band super-bright radiation of the red spectrum generated by a matrix of semiconductor LEDs 4.2.2 of the photochromic-ultrasonic applicator 4.2 (Rossonic-MM 4 device). Then (Fig. 11a, c), in the same area, for impregnation of the medicinal substance - ozone/NO-containing physiological solution with concentrations: ozone - 2.5 mg/l and nitric oxide - 0.3 mg/l, use the waveguide-instrument "cup-shaped radiating disk" 2.5.3 or "radiating disk" 2.5.4 (from the Tonsillor-3MM 2 complex kit), acting with intermittent contact sound on the "interested" area through a replaceable pad 5 with the specified medicinal substance, for a time of - τ = 2 s/cm ² .

Their use, according to the intermittent-contact scheme of high-amplitude action, is justified by the design features of the disk radiating working ends, allowing the sounding of the "interested" area with a one-sided and uniform field of ultrasonic radiation over the entire frontal surface of the disk radiation, which has a large radiation area in contact with the sounded surface, and allowing, along with the effectiveness of its application - to significantly reduce the time of sounding of the "interested" area, practically by an order of magnitude, which is important for accelerating the treatment process as a whole. In addition, with photochromo-ultrasonic (Fig. 11a, c) and ultrasonic effects (Fig. 11b, c), high-amplitude ultrasound, respectively, at frequencies f = 44 kHz and f = 26.5 kHz using, respectively, waveguide-instrument 4.2.1 photochromo-ultrasonic applicator 4.2 (Rossonic-MM 4 device) or waveguide-instruments 2.5.3 and 2.5.4 (Tonsillor-3MM 2 complex), a thermal effect occurs, arising as a result of energy damping in the acoustic system and axisymmetric heating at the interface "waveguide-instrument - pad with drug solution - biotissue", the severity of which is determined by the difference in their acoustic resistances in the contact insonification zone, as well as the dissipation of ultrasound energy by the pad 5 s ozone/NO - or ozonide/NO-containing medicinal substance and biological tissue, due to losses due to internal friction with its subsequent conversion into heat. Which is accompanied by a gradual, over several minutes, increase in temperature in tissue structures subjected to photochromo-ultrasonic or ultrasound effects. With a labile scheme of photochromo-ultrasonic or ultrasound effects - there is a local increase in temperature to 40 ° C, and with a stable scheme - up to 45 ° C, which is acceptable.

Parameters and modes of implementation of photochromo-ultrasonic and ultrasound effects on regional lymph nodes and the interstitial system of the lymph region both in the projection area of the tonsils and further - on subsequent lymph nodes and adjacent interstitial zones of the lymph region of the face and neck, implementing impregnation of a solution of a medicinal substance in them:

- the frequency of ultrasonic vibrations of waveguides-instruments 2.5.3 and 2.5.4 from the Tonsillor-3MM 2 complex set is f=26.5 kHz, with the amplitude of their vibrations being ξ=40 µm;

- the frequency of ultrasonic vibrations of the waveguide-instrument 4.2.1 of the applicator of the photochromic-ultrasonic 4.2 device Rossonic-MM 4 is f=44 kHz, with the amplitude of its vibrations being ξ=20 µm;

- parameters of photochromic illumination of the “interested” area with super-bright red spectrum radiation - λ=630 nm, I=400 lm;

- the mode of photochromic-ultrasonic surface action on the “interested” area is labile, intermittent-contact, exposure time of action is τ=2 s/ ^cm2 ;

- the thermal environment during photochromic-ultrasonic and ultrasonic effects on the “interested” area is no more than 45°C;

- implementation features - the stage is performed during each of the 6 sessions implementing the XT treatment course according to the proposed method of its combined treatment.

In general, local photochromic ultrasound and ultrasound exposure against the background of ozone/NO or ozonide/NO therapy contribute to: hyperemia and vibrowave defabrating effect on altered tissue structures and, as a consequence, increased microcirculation (blood and lymph flow); absorption of red spectrum light quanta by photosensitizers (porphyrins, etc.), which promote the production of biologically active substances (prostaglandin E1), NO synthase, NO, EDRF factor, vasodilation, increased oxygen in tissues, initiation of Ca ²⁺ -dependent processes, etc. (I.G. Vorobyova, 2005; S.V. Moskvin, A.V. Kochetkov, 2016, etc.); intensification of the impregnation process in the lymph nodes and interstitium of the lymphoregion of the face and neck, etc. solutions of highly active medicinal substances with detoxifying, immunocorrective, bactericidal and other properties, helping to suppress radicals, relieve hypoxia, acidosis, reduce lipid peroxidation, stimulate reparative regeneration in general and improve the results of combined treatment of patients with HT. At the end of this stage of the combined HT treatment session, the Rossonic-MM 4 device and the Tonsillor-3MM 2 complex are switched off.

At the final stage, after each session of combined treatment with XT, take an antioxidant - succinic acid, for example, succinic acid Forte - 1 tablet after meals, daily dose - 200 mg.

Depending on the activity of the pathological process and the level of intoxication syndrome, the number of procedures performed in each session of combined XT treatment may vary by the attending physician. The duration of the course of combined XT treatment is up to 6 procedures, performed both daily and every other day, and depends on the clinical form and stage of XT development.

The method of combined treatment of chronic tonsillitis, which is a medical technology, has been used in the clinic of the Children's and Adult Health Clinical Center (Barnaul) since 2022. To date, 34 patients have been treated for chronic tonsillitis using the proposed method with positive results. The following medical equipment was used, approved by Roszdravnadzor for use in healthcare: the Aeroton-MM ultrasound device; the Tonsilor-3MM ozone/NO-ultrasonic complex, the Rossonic-MM physiotherapeutic device, and the Lazmik device. The following well-known drugs were used in the treatment of HT: saline solution; 2% lidocaine solution; antioxidant - succinic acid Forte, photosensitizer - 1% aqueous solution of methylene blue, as well as ozone/NO - and ozonide/NO-containing drugs produced by the Tonsilor-3MM complex.

Example 1. Patient Sh., 41 years old. Came to see an otolaryngologist at the Children's and Adult Health Clinical and Diagnostic Center with complaints of bad breath, discomfort in the throat, the presence of purulent-caseous plugs in the tonsils, and rapid fatigue. History of the disease: has been bothering her for 3 years. In the last 6 months, after a respiratory infection, bad breath, discomfort, and pain in the throat have increased. Periodically suffers from tonsillitis (3-4 times a year). Outpatient treatment with antibacterial drugs and antiseptic solutions - short-term improvements. Upon examination: general condition is satisfactory, no visible pathological changes in the internal organs. Status localis: submandibular and cervical lymph nodes are not enlarged, painless, mucous membrane of the oropharynx and oral cavity is pink, clean, palatine arches are hyperemic, infiltrated, not fused with tonsils; palatine tonsils - hypertrophy of the 2nd degree, pink, loose, the mouths of the lacunae are widened, tonsils are mobile when pressed with a spatula, caseous detritus in the lacunae. General clinical parameters of blood and urine are within normal limits. Blood level of antistreptolysin-0 (ASLO) 240 IU/ml. Microbiological examination of the contents of the lacunae revealed: microbial associations: Str. Pyogenes 10 ³ , St. aureus 10 ³ , Str. viridans 10 ⁴ .

The patient was offered and underwent 6 sessions of combined treatment for chronic tonsillitis using the proposed method. During sessions 1, 2, 5, 6 and 7 (i.e. days 1, 2, 5 and 6) of treatment, the following stages were performed: distant ultrasonic irrigation of the mucous membranes of the nose and oropharynx with a jet-aerosol torch of ozone/NO-containing saline solution, with the parameters and modes specified in the description of the invention (stage 1); ultrasonic cleaning by washing the altered tissues of the lacunocryptal space and the parenchyma of the tonsil, performed after local application anesthesia of the pharynx with a 2% lidocaine solution, which was administered at stage 2 of each of the 6 sessions; extraction by ultrasonic drainage of possible residual contents from the lacunocryptal spaces and parenchyma tissues of each of the tonsils with the parameters and modes specified in the description of the invention (stage 5); ultrasonic impregnation of 10% ozonide/NO-containing oil emulsion of the "oil in water" type into the sanitized lacuna-cryptal spaces and parenchyma of each of the tonsils, using the parameters and modes specified in the description of the invention (stage 6); labile photochromo-ultrasonic and ultrasound lymphotropic administration over the surface into the regional lymph nodes and interstitium of the lymph region in the projection area of the tonsils and along the lymphatic pathways draining from the tonsils - initially of an ozonide/NO-containing oil emulsion of the "oil in water" type, and then of an ozone/NO-containing physiological solution, using the parameters and modes specified in the description of the invention (stage 7).

Sessions 3 and 4 were conducted on the 3rd and 4th day of the combined treatment. They additionally implemented the corresponding stages associated with accelerated sensitization of the tissues of the lacunocryptal spaces and the parenchyma of the tonsils by ultrasonic impregnation of a photosensitizer in them - 1% aqueous solution of methylene blue, with the parameters and modes specified in the description of the invention (stage 3), with subsequent illumination of the sensitized tissues of the tonsils, pulsed laser radiation of the red spectrum, activating the photosensitizer, with the parameters and modes specified in the description of the invention (stage 4). At the end of each session of the combined treatment of chronic tonsillitis - taking the antioxidant succinic acid Forte - 1 tablet after meals, daily dose - 200 mg (final stage).

After the treatment, mesopharyngoscopy showed that there was no pathological substrate in the lacunae of the palatine tonsils. Microbiological examination of a smear from the lacunae of the tonsils, immediately after the procedure and a week later, showed an increase in normal microflora. ASLO after treatment was 96 IU/ml. During subsequent examinations after 3, 6, and 12 months, the patient had no complaints. Mesopharyngoscopy data: the mucous membrane of the oral cavity and oropharynx is pink, the palatine tonsils are behind the arches, the mouths of the lacunae are wide and free.

Example 2. Patient T., 38 years old. She consulted an otolaryngologist at the Children's and Adult Health Clinical and Diagnostic Center with complaints of frequent colds, sore throats, discomfort in the throat, and the presence of purulent-caseous plugs in the tonsils. From the medical history: the complaints have been bothering her for about 4 years. She suffers from sore throats 3-4 times a year. Outpatient treatment with antibacterial drugs and antiseptic solutions - improvements are short-term and insignificant.

On examination: general condition is satisfactory, no visible pathological changes in the internal organs. Status localis: submandibular, cervical lymph nodes are slightly enlarged, painless, the mucous membrane of the oropharynx and oral cavity is pink, the palatine arches are hyperemic, thickened, not fused with the tonsils. Palatine tonsils - hypertrophy of the 3rd degree, pink, loose, the mouths of the lacunae are widened, when pressing with a spatula, the tonsils are mobile, caseous detritus in the lacunae. General clinical blood and urine parameters are within normal limits. The blood level of antistreptolysin-O (ASLO) is negative. Microbiological examination showed the presence of microbial associations in the contents of the tonsil lacunae: St. aureus 10 ³ , Pseudomonas aeruginosa 10 ⁴ , Enterobacter cloacae 10 ⁴ , Candida albicans 10 ⁵ .

The patient was offered and underwent 6 sessions of combined treatment of chronic tonsillitis according to the proposed method and with the parameters and modes described in detail in the above Example 1. After the treatment: there are no complaints listed above. Mesopharyngoscopy revealed no pathological substrate in the lacunae of the palatine tonsils. Microbiological examination of a smear (scraping) from the lacunae of the tonsils immediately after the procedure and a week later revealed an increase in normal microflora, the level of antistreptolysin-O (ASLO) in the blood was negative.

During subsequent examinations after 3, 6, 12 months, the patient had no complaints. During mesopharyngoscopy, the mucous membrane of the oral cavity and oropharynx was pink, the palatine tonsils protruded from behind the arches, the mouths of the lacunae were wide and free, there was no pathological substrate.

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Claims (11)

1. A method for the combined treatment of chronic tonsillitis implemented through the use of antimicrobial photodynamic therapy, including sensitization, rinsing the lacunae of the palatine tonsils until clean with a solution of a photosensitizer that absorbs optical radiation in the spectral range, initiating its photoactivation; gargling with saline; alternately illuminating the sensitized tissues of each of the tonsils with photoactivating optical radiation from a radiation source, characterized in that the area of the palatine tonsils pathologically altered by chronic tonsillitis is exposed to a combined effect of a set of physical and physicochemical factors, including: high-amplitude ultrasound - f = 26.5 kHz; vacuum with a vacuum of 0.15 kgf/cm ² and 0.35 kgf/cm ² ; ozone/NO - and ozonide/NO-containing drugs; photosensitizer - 1% aqueous solution of methylene blue; pulsed laser radiation of the red spectrum with a wavelength of λ=635 nm, initiating photoactivation of the photosensitizer, which absorbs radiation of the red spectrum; photochromic ultrasound exposure with high-amplitude ultrasound - f=44 kHz and photochromic illumination of the insonified area with a matrix of semiconductor LEDs of super-bright radiation of the red spectrum with a wavelength of λ=630 nm; an intermediate capillary-porous lining made of sorption bactericidal non-woven fibrous material with active centers fixed to its fibers in the form of aluminum oxide hydrate particles associated with particles of a bactericidal component - colloidal silver, which is a carrier of ozone/NO - and ozonide/NO-containing solutions of medicinal substances that are used in combination, and implements in a single technological process a multi-stage medical technology of antibacterial photodynamic therapy in the treatment of patients with chronic tonsillitis, where: - at the first stage of combined treatment, after sanitation of the nasopharynx and oropharynx, alternate distant ultrasonic irrigation of the nasal mucosa is carried out for a time of τ = 20 seconds (for each half of the nose) and the oropharynx mucosa for a time of τ = 20 seconds, implemented with a jet-aerosol torch of an ozone/NO-containing physiological solution with concentrations of: ozone - 2.5 mg / l and nitrogen oxide - 0.3 mg / l, by spraying it with high-amplitude ultrasound at a frequency of - f = 26.5 kHz and with an oscillation amplitude of the waveguide-instrument of - ξ = 80 μm, - at the second stage of the combined treatment, after local application anesthesia of the pharynx, suppressing the pharyngeal reflex, alternate distant ultrasonic cleaning is carried out by washing the altered tissues of the lacuna-cryptal space and the parenchyma of the tonsils, under conditions of its vacuum at a vacuum of - 0.35 kgf/ ^cm2 , and insonification for a time of - τ = 60 seconds with high-amplitude ultrasound at a frequency of - f = 26.5 kHz and at an oscillation amplitude of the waveguide-instrument "peak" - ξ = 60 μm, conducted through an intermediate ozone/NO-containing physiological solution with concentrations of: ozone - 2.5 mg/l and nitric oxide - 0.3 mg/l; - at the third stage of the combined treatment, alternate distant ultrasound sensitization of the altered tissues of the lacuna-cryptal space and the parenchyma of the tonsils, previously cleaned by washing, is carried out under vacuum conditions at a vacuum of - 0.35 kgf/ ^cm2 and insonification for a time of - τ = 20 seconds with high-amplitude ultrasound at a frequency of - f = 26.5 kHz and at an oscillation amplitude of the waveguide-instrument "peak" - ξ = 60 μm through an intermediate solution of a photosensitizer - 1% aqueous solution of methylene blue, the sensitized tissues are kept for a time of - τ = 5 minutes, which is the period of their sensitization, and then the oral cavity is rinsed with a physiological solution - 100 ml; - at the fourth stage of the combined treatment, at the end of the period of sensitization of the tissues of the lacunocryptal space and the tissues of the parenchyma of the tonsils, alternate distant illumination is carried out, for a time of τ = 5 minutes, of each of the tonsils, with pulsed laser radiation of the red spectrum - λ = 635 nm, initiating photoactivation of the photosensitizer - 1% aqueous solution of methylene blue, implemented by supplying a flow of illuminating pulsed laser radiation to the tonsil, placed, under vacuum conditions - at a vacuum of - 0.15 kgf/cm ² , in the sealing funnel of the applicator-limiter, the outer forming surface of which is made optically opaque, and delimiting the surrounding tissues of the oropharynx from the illuminated tonsil; - at the fifth stage of the combined treatment, alternate extraction by ultrasonic drainage from possible remnants of the contents in the lacuna-cryptal spaces and parenchyma tissues of each of the tonsils is carried out by means of distant high-amplitude ultrasound at a frequency of - f = 26.5 kHz and at an oscillation amplitude of the waveguide-instrument "cup-shaped radiating disk" of - ξ = 60 μm, for a time of - τ = 30 seconds, through a gas gap layer, which is the region of the acoustic boundary layer between the radiating end of the waveguide-instrument and the surface of the tonsil, including an intermediate gasket with a solution of 10% ozonide/NO-containing oil emulsion of the "oil in water" type with a peroxide number for ozonides of P = 150, fixed on the working part of the waveguide-instrument "cup-shaped radiating disk", equipped with concentrically located drainage nozzle channels; - at the sixth stage of the combined treatment, alternate ultrasonic impregnation is carried out into the sanitized lacuna-cryptal spaces and parenchyma tissues of each of the tonsils by intermittent contact sonication with high-amplitude ultrasound at a frequency of - f = 26.5 kHz and with an oscillation amplitude of the waveguide-instrument "cup-shaped radiating disk" of - ξ = 40 μm, for a time of - τ = 20 seconds, conducted through an intermediate gasket with a solution of 10% ozonide/NO-containing oil emulsion of the "oil in water" type with a peroxide number for ozonides of P = 150, fixed on the working part of the waveguide-instrument "cup-shaped radiating disk", not equipped with drainage nozzle channels; - at the seventh stage of the combined treatment, initially, the following is carried out: labile photochromo-ultrasonic lymphotropic impregnation over the surface, through an intermediate lining with a solution of 10% ozonide/NO-containing oil emulsion of the "oil in water" type with a peroxide number for ozonides of P = 150, into the regional lymph nodes and the interstitium of the lymph region both in the projection area of the tonsils and into the subsequent lymph nodes and adjacent zones of the interstitium of the lymph region of the face and neck, along the lymphatic pathways draining from the tonsils, by intermittent contact insonification, for a time of τ = 2 s/cm ² , with a disc-shaped waveguide-instrument of the photochromo-ultrasonic applicator, oscillating with a frequency of f = 44 kHz and an oscillation amplitude of ξ = 20 μm, with simultaneous photochromic illumination, the area sounded with high-amplitude ultrasound, a matrix of semiconductor light-emitting diodes of super-bright radiation of the red spectrum - λ = 630 nm, and then, repeatedly, along the specified paths, ultrasonic lymphotropic impregnation is carried out in them, through an intermediate gasket with an ozone/NO-containing physiological solution with a concentration of: ozone - 2.5 mg / l and nitrogen oxide - 0.3 mg / l, implemented by a waveguide-instrument "emitting disk" intermittently-contact acting high-amplitude ultrasound at a frequency of - f = 26.5 kHz and with an oscillation amplitude of - ξ = 40 μm, for a time of - τ = 2 s / cm ² ; - at the final stage of the combined treatment session, take succinic acid Forte, 1 tablet after meals, daily dose - 200 mg. 2. The method according to paragraph 1, characterized in that the intermediate lining is a capillary-porous fabric made of sorption bactericidal non-woven material with active centers fixed to its fibers. 3. The method according to paragraph 1, characterized in that particles of aluminum oxide hydrate associated with particles of a bactericidal component in the form of colloidal silver are used as active centers.