RU2771259C1 - Method for restoring nasal breathing in children with adenoiditis - Google Patents

Abstract

FIELD: medicine; otorhinolaryngology; reflexology; restorative medicine.

SUBSTANCE: invention relates to medicine, namely to otorhinolaryngology, reflexology and restorative medicine; it can be used for restoring nasal breathing in children with adenoiditis. Daily irrigation therapy is conducted with preparations of a sterile isotonic solution of seawater, 3 times a day, followed by washing the nasal cavity. Then, acupressure and post-isometric relaxation of posterior neck muscle groups is conducted every other day for 7-10 procedures per the course.

EFFECT: method allows for reduction in the necessity of invasive interventions and use of medical preparations by the removal of edema of the tonsil and nasal mucosa due to improvement of venous and lymphatic outflow.

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Description

The invention relates to medicine, namely to otorhinolaryngology, reflexology and restorative medicine, and can be used to restore nasal breathing in children with adenoiditis.

Normal physiological breathing should be through the nose. Moisturizing, warming and bacteriological purification of the inhaled air takes place in the nasal cavity. Further, the prepared air enters the nasopharynx and lower respiratory tract. Under the influence of various pathogenic factors, the protective reaction of the body is activated, which in the nasopharynx is represented by immune defense organs - the tonsils (adenotonsillar ring). An increase in adenoids when the body collides with various negative factors often provokes a violation of nasal breathing, which is clinically expressed in nasal congestion, the appearance of mucous discharge from the nose, night snoring, sniffling, reflex cough (often diagnosed as prolonged bronchitis, tracheobronchitis), and in advanced cases - up to a change in the maxillofacial apparatus of the child, due to the need to breathe through the mouth (“adenoid face”), and a decrease in the intellectual abilities of the child due to chronic hypoxia of the brain. And the “useful” protective property of the adenoids, provided by nature, becomes pathological with prolonged “hard” work and the absence of timely help.

The main methods of treatment of adenoiditis, aimed at restoring nasal breathing, at the present stage are conservative [Tarasova G.D. Adenoids: cause, effect or ..? RMJ, No. 6 dated 04/29/2016, p. 391-394] and surgical [Rusetsky Yu.Yu., Latysheva E.N., Spiranskaya O.A., Malyavina U.S. Surgical treatment of adenoids. RMJ, No. 6 dated 04/08/2015 p. 339]. The main methods of conservative therapy include: sanitation of the tonsils - irrigation by irrigation, washing the lacunae and / or nasopharynx, desensitization, immunocorrection, general metabolic therapy, physiotherapy, drug treatment. Drug treatment, including hormonal drugs, has an initial temporary effect, which, however, is not always effective and cannot be used also in case of drug incompatibility, besides, long-term use leads to drug tolerance.

A combined method for the treatment of chronic adenoiditis in children is known, including endoscopic irrigation of the pharyngeal tonsil with 10 ml of a 0.01% solution of Miramistin diluted with distilled water in a ratio of 1: 2 with simultaneous suction of the washing liquid and additional exposure to defocused coherent monochromatic red laser light λ=6328Å, power of 10 mW/cm ² by introducing a fiber into each half of the nose to the nasopharynx for 5 minutes, one procedure a day for 5-7 days (RF Patent 2307686, IPC A61N 5/067, A61K 31/14 - 10.10.2007 Bulletin No. 28).

The disadvantages of the method are:

1) the traumatic nature of the treatment due to the discomfort of simultaneously inserting a rigid endoscope and electric suction, and then a light guide into the child's nasopharynx for 5-7 minutes;

2) miramistin, being a cationic detergent, increases the permeability of the cell wall not only of microorganisms, but also of the mucous membrane of the nose and nasopharynx, thereby leading to cytolysis, hypersensitivity, and inhibition of mucociliary clearance. This is manifested by a burning sensation;

3) a wide antimicrobial spectrum of miramistin does not help reduce the destructive effect of free radicals and lipid peroxidation products;

4) it is generally accepted that laser systems are monochromatic, limited to a very narrow frequency range and transmit a large amount of energy. Moreover, a laser system is characterized by coherence - temporal and spatial synchronization of the movement of light waves, and therefore, the intensity is summed up. Thus, the laser affects the application area with a non-constant, unstable intensity. This does not allow the use of radiation of much lower intensity;

5) the biological effect that appears during the laser exposure is identified exclusively as the activation of the lymphatic system - the effect of an immunostimulant.

To date, the restoration of nasal breathing is also achieved with the help of minimally invasive surgical interventions, and, as a rule, ends with an operation to remove the adenoids. This, of course, quickly restores lost nasal breathing, but there are no longer protective barriers, in particular, the pharyngeal tonsil, in the way of infections. The operation is often psychologically very difficult for young patients, has a number of complications in the postoperative period and does not exclude the need for repeated interventions.

The existing range of methods of conservative treatment is diverse and due to the lack of a long-term effect. In addition, the complexity of the conservative treatment of chronic adenoiditis is due to the inaccessibility of the pharyngeal tonsil, the proximity of important anatomical structures, the complexity of drug delivery and rehabilitation measures.

Taking into account the importance of the tonsil complex of the lymphoepithelial ring as the main source of effector cells of the immune system, the objective of the claimed invention is to create a method for restoring nasal breathing in adenoiditis while preserving the tonsils.

The technical result of the claimed invention is the preservation of the body, reducing the need for invasive interventions and the use of medications.

The technical result of the claimed invention is achieved due to the fact that daily irrigation therapy is carried out with preparations of a sterile isotonic solution of sea water 3 times a day, followed by a thorough toilet of the nasal cavity, the peculiarity lies in the fact that acupressure and postisometric relaxation of the posterior cervical muscle groups are additionally performed with the restoration of venous and lymphatic outflow, every other day, 7-10 procedures per course.

The advantage provided by the given combination of features is the improvement of venous and lymphatic outflow, which helps to relieve swelling of the tonsils and nasal mucosa and increase the lumen of the nasal cavity.

Implementation of the invention

The procedure takes place in 2 stages. The position of the patient during acupressure should be on the back. The doctor is at the head of the patient.

Stage 1: By bimanual laying on of hands on the back of the neck, the doctor tests the painfully compacted muscles of the posterior cervical regions, determines the localization and degree of tension, and selects the nature of the impact aimed at relieving pathological hypertonicity. The direction of massage manipulations corresponds to the main course of venous lymphatic outflow. As a result, there is a general relaxation and a feeling of warmth in the affected area. The duration of the procedure is 5-7 minutes.

Stage 2: finger kneading of painfully tense muscle seals in the thickness of the trapezius and posterior muscle groups is performed. To destroy the trigger points of myopically, elements of post-isometric relaxation and elements of acupressure are used. The doctor, manipulating the index fingers of both hands, restores symmetrical muscle balance on both sides. Postisometric relaxation is carried out according to the generally accepted standard method of exposure, which consists in a combination of short-term isometric work for 5-7 seconds.

The method is illustrated by specific clinical examples.

Example 1

Patient L-v AE, 3 years old. Diagnosis: Chronic adenoiditis of 1-2 degrees. Complaints about periodically congestion and mucous discharge of the nose, breathes mainly through the mouth, periodically night snoring. Within 2 months he receives vasoconstrictor drops in the nose, drops with dexamethasone without a visible effect.

On examination: during endoscopic examination: the nasal mucosa is pale pink, edematous with mucous discharge, the mucosa of the inferior turbinate is pale pink, edematous with transparent mucous secretions at the bottom of the nasal cavity, the dimensions of the posterior ends of the inferior turbinates are increased due to edema. The tissue of the pharyngeal tonsil overlaps the lumen of the choana from the vault of the nasopharynx by 1/3-1/2, edematous, pale pink. The tubal tonsils are edematous, the mouths of the auditory tubes are not obturated. The function of the auditory tube is not broken.

Conducted 7 sessions of acupressure and postisometric relaxation of the posterior cervical muscle groups every other day. It is also recommended daily irrigation therapy with preparations of sterile isotonic sea water solution 3 times a day, followed by a thorough toilet of the nasal cavity.

After 1 session, the patient began to breathe through the nose, the mucous secretions decreased.

After 3 sessions, a decrease in night snoring was noted.

After the 7th session, complete restoration of nasal breathing and no complaints were noted.

At repeated endoscopic examination: the nasal mucosa is pink, there is no discharge, the mucosa of the inferior turbinate is pink, the dimensions of the posterior ends of the inferior turbinates are not enlarged. The lumen of the choan is free.

Example 2

Patient A-a A.A., 4 years old. Chronic adenoiditis 2 degrees.

Complaints of persistent nasal congestion, mucous discharge, restlessness of the child, poor sleep with frequent awakenings, occasional nighttime snoring. Against the background of the ineffectiveness of standard drug therapy, surgical treatment was recommended, from which the parents abstained.

On examination: during endoscopic examination: the nasal mucosa is pale pink, edematous with mucous discharge, the mucosa of the inferior turbinate is pale pink, edematous with transparent mucous secretions at the bottom of the nasal cavity, the dimensions of the posterior ends of the inferior turbinates are increased due to edema. The tissue of the pharyngeal tonsil overlaps the lumen of the choana from the arch of the nasopharynx by 1/2, edematous, pale pink. The tubal tonsils are edematous, the mouths of the auditory tubes are not obturated. The function of the auditory tube is not broken.

Conducted 10 sessions of acupressure and postisometric relaxation of the posterior cervical muscle groups every other day. It is also recommended daily irrigation therapy with preparations of sterile isotonic sea water solution 3 times a day, followed by a thorough toilet of the nasal cavity.

After 1 session, the patient began to breathe through the nose, the mucous secretions decreased.

Nasal congestion persisted.

After the 10th session, nasal breathing was restored, there was no discharge from the nose, sleep was calm, a decrease in night snoring was noted.

At repeated endoscopic examination: the nasal mucosa is pink, there is no discharge, the mucosa of the inferior turbinate is pink, the dimensions of the posterior ends of the inferior turbinates are not enlarged. The lumen of the choan is free.

Claims (1)

A method for restoring nasal breathing in adenoiditis in children, including daily irrigation therapy with preparations of a sterile isotonic solution of sea water 3 times a day, followed by the toilet of the nasal cavity, characterized in that additional acupressure and postisometric relaxation of the trapezius and posterior cervical muscle groups are performed every other day, 7 -10 procedures per course, at the same time, at the first stage, a point massage of the posterior cervical muscle group is performed in the position of the patient on the back with the direction of massage manipulations in accordance with the course of the venous and lymphatic outflow, then at the second stage, finger kneading of muscle seals in the thickness of the trapezoid and posterior cervical groups is performed muscles combined with post-isometric relaxation.