Author:
- Elena Vitalievna Naumova, otolaryngologist, leading doctor of the clinic
5.00 (Votes: 1)
In the treatment of various pathologies of the ear, nose and throat, along with local non-invasive treatment (washing, drops, application of medicinal substances) and physiotherapy, invasive (injection) methods are widely used, which give an excellent therapeutic effect, and for some diseases they are practically the only and unique method of treatment.
Intranasal blockades
Intranasal blockades are a nonspecific treatment method used for various pathologies, since the nasal mucosa is an extensive reflexogenic zone due to its rich blood supply and innervation.
Indications for intranasal blockade
This method is widely used for persistent vasomotor rhinitis, when conservative methods do not give a positive effect, or it is insufficient in severity and duration. It is also used for various inflammatory diseases of the nasal cavity, pharynx, larynx, postoperative facial swelling, Meniere's disease, etc.
One of the most common diseases in the treatment of which intranasal blockades are successfully used is vasomotor rhinitis. This is a disease in which, for various reasons, vascular dysfunction develops in the submucosal layer of the nasal turbinates, especially the inferior turbinate. Since the vessels of the nasal cavity have a fairly extensive cavernous network, with their dysfunction and expansion, severe swelling of the mucous membrane of the nasal turbinates occurs, nasal breathing is disrupted until it is completely absent. Prolonged difficulty in nasal breathing or its complete absence leads to impaired blood oxygenation and brain hypoxia, which triggers complex biochemical processes and disrupts the functioning of the entire body at the molecular level, and at the everyday level it causes severe discomfort to a person and disrupts his normal functioning. For the treatment of vasomotor rhinitis, and in particular, relieving swelling in the nose and eliminating nasal congestion, there are many methods and schemes, including various non-invasive medical manipulations, physiotherapeutic treatment, radical surgical methods (cryosurgery, laser and radio wave surgery).
Intranasal blockades are prescribed when conservative treatment methods are ineffective, persistent nasal congestion, patients refuse surgical treatment, or if there are contraindications to it.
How does an intranasal blockade work?
Intranasal blockades are performed on an outpatient basis. Before the blockade, the patient is given application and infiltrative anesthesia at the site of the blockade to level out discomfort and pain during its implementation. Then the intranasal blockade itself is carried out, after which the doctor observes the patient’s possible reaction for 10-15 minutes. As a rule, the procedure is well tolerated by patients and after half an hour the patient can carry out normal activities.
For acute pathology, 1-3 procedures are sufficient; for chronic disease, it is recommended to carry out a course of treatment, including 8-10 procedures.
How much does an intranasal blockade cost?
At the ENT Clinic in Chertanovo you can undergo a course of treatment, the cost of one procedure is 1,200 rubles .
Study design
A double-blind, placebo-controlled, randomized study was conducted from April 2013 to February 2015. The analysis included 576 adult patients presenting to their GP for acute sore throat (Southern and Western England). Sore throat did not require immediate prescription of antibacterial drugs.
Patients were prescribed a single dose of dexamethasone 10 mg (n = 293) or placebo (n = 283).
The primary endpoint was the proportion of patients who experienced complete resolution of symptoms within 24 hours. Secondary outcomes included: complete resolution of symptoms after 48 hours, duration of moderate symptoms assessed on a Likert scale (0 = normal, 6 = worst), pain intensity on a visual analogue scale (0 to 100), number of days away from work. or study, use of antibiotics or other drugs, frequency of adverse events.
Meatotympanic (behind the ear) blockade
Meatotympanic or postauricular blockade is used for inflammatory diseases of the ear, when there is severe pain, for pathology of the auditory nerve, accompanied by severe noise in the ear and hearing loss, to reduce dizziness in Meniere's disease. The method is based on the reflex effect of the drug on nerve endings and is a nonspecific treatment method.
Indications for BTE blockade
For blockade, solutions of anesthetics or neuroprotectors are used that improve the transmission of impulses along nerve fibers. The procedures are performed on an outpatient basis; to relieve pain, application and/or infiltration anesthesia is first performed. As a rule, patients tolerate the procedure well and immediately feel improvement after it: pain relief, reduction or disappearance of noise in the ear on the affected side. In an acute condition, 1-2 procedures are sufficient to relieve symptoms and switch to conservative treatment methods. In case of a chronic process, a full course of treatment is required, consisting of 8-10 procedures performed every other day.
Cost of behind-the-ear blockade
At the ENT Clinic in Chertanovo, the cost of one procedure is 1,500 rubles ; discounts are possible for course treatment.
Antibiotics for the treatment of sore throat: for or against?
During the discussion the following points were discussed:
It is important to emphasize the difference between sore throat, pharyngitis and tonsillitis: the latter two refer to a physical finding, while the former is a subjective symptom.
A sore throat is often associated with a cold. According to a recent study, more than 80% of students with an acute viral respiratory tract infection had pain at the onset of the disease.
Viruses can be detected in nearly two-thirds of children with pharyngitis using polymerase chain reaction testing. Scientists estimate that antibiotics should be prescribed to 30-40% of patients with confirmed GAS (Group A streptococcus) infection. The potential role of Fusobacterium necrophorum has been reconsidered, but there is no evidence of benefit from antibiotic treatment in cases of this infection.
It has been suggested that rather than focusing on a sore throat, there should be a discussion about whether antibiotics should be used to treat GAS infection. The question of confirming the diagnosis remained open. Diagnostic tools such as Centor, McIsaac and FeverPAIN have been recommended: the higher the score, the more likely the patient is to have a GAS infection.
Symptom assessment is often inaccurate, especially in young children. An example was a report that examined the use of the Centor tool in 441 children attending a pediatric emergency department. The authors concluded that the Centor criteria were ineffective in predicting positive GAS culture in throat swabs collected from symptomatic patients.
It is widely accepted that antibiotics should be avoided for viral infections. A clinical case was discussed of a patient with a 2-day history of sore throat, fever, enlarged tonsils and cervical lymph nodes, but no cough or rhinitis; the patient had a FeverPAIN score of 4–5 and 4 points, according to European recommendations, this is an indication for antibiotic treatment. However, the smears turned out to be positive for adenovirus.
In a similar case, a 5-year-old boy had a FeverPAIN score of 4-5 and a Centor score of 3. The culture from his throat swab was GAS positive, illustrating the problem of distinguishing between bacterial and viral infections.
If a throat culture is GAS positive, is this a direct indication for antibiotic therapy? On the one hand, this prevents serious complications such as rheumatic fever. At the same time, there is a low rate of acute rheumatic fever in developed countries (there have been no cases in Hungary in the last 30 years).
There is currently no statistically significant evidence that antibiotics prevent the development of sore throat. Delays in seeking medical attention mean that the window for treatment is often missed. However, if symptoms appear early, there is no statistical evidence that taking antibiotics can prevent the development of a sore throat. In addition, such prevention means excessive use of antibiotics.
A Cochrane review indicates a reduction in the duration of sore throat and fever with antibiotic therapy. In addition, compared with placebo, antibiotics reduced the incidence of suppurative complications such as acute otitis media and sinusitis after sore throat. Other studies have also pointed to the potential benefits of reducing transmission within families where one of the relatives with pharyngitis was GAS-positive.
Source:
medscape.com/viewarticle/942876#vp_1
Intrapharyngeal injections (blockades)
Intrapharyngeal injection (blockade) is the introduction of medicinal substances under the mucous layer of the posterior wall of the pharynx and/or into the thickness of the hypertrophied lateral ridges of the pharynx. This nonspecific treatment method, like other injection methods of treatment, is based on the impact on the reflexogenic zone of the posterior pharyngeal wall. This treatment method is used for atrophic and subatrophic pharyngitis to improve the trophism of the mucous membrane of the posterior wall, and for hypertrophy of the lateral ridges or lymphoid follicles to reduce proliferation, inflammation and swelling of the mucous membrane.
How does an intrapharyngeal block work?
Intrapharyngeal blockades are performed on an outpatient basis; they are well tolerated by patients and, with regular treatment, have a positive effect, apparently improving the patient’s condition after the first procedure. Before performing the injection, the mucous membrane of the posterior wall is anesthetized by application and infiltration anesthesia with modern anesthetics. Then the drug is injected with a thin needle into the mucosa in several places most susceptible to pathological changes. A course of treatment involves 8-10 procedures performed every other day.
results
Of the 565 study participants (mean age 34 years (range 26 to 45 years)), 75.2% were women. All patients completed the study (288 received dexamethasone and 277 received placebo).
- At 24 hours, 65 participants in the dexamethasone group (22.6%) and 49 in the placebo group (17.7%) met the primary endpoint (difference between groups, 4.7% (95% CI, −1.8%-11.2%); relative risk, 1.28 (95% CI; 0.92-1.78); P = 0.14). Thus, patients receiving dexamethasone did not experience statistically significant complete resolution of sore throat compared with the control group.
- At 48 hours, 102 patients in the corticosteroid group (35.4%) compared with 75 patients in the control group (27.1%) had complete resolution (difference, 8.7% (95% CI, 1.2%-16.2%) , relative risk, 1.31 (95% CI, 1.02-1.68); P =0.03).
- The analysis showed significant differences between groups in subsequent antibiotic prescriptions (difference, 10.3% (95% CI, 0.6%-20.1%), relative risk, 1.37 (95% CI, 1.01-1.87); P = 0.046).
- There were no significant differences between the study groups for other endpoints.
OUFK 09
Homemade healing beam. OUFK -09
What if moms and doctors got together and decided to come up with the best cure for diseases? What would it be like?
They would decide that it should be natural, effective, safe, affordable and not give you a stomach ache.
Then it's not really a cure anymore. Maybe this is a device that cures various diseases, and even better prevents the spread of infection?
What should you do if your child goes to kindergarten and no one can remember how to live without a runny nose?
How to make it possible to treat sore throat and otitis without long-term use of antibiotics, and the flu is not transmitted from one family member to another?
Where can you get the sun if it seems like autumn and winter will never end, and your child needs vitamin D?
And let this device be convenient, compact, at home and always at hand.
It should be a “first aid kit for all occasions.” Such a device is the ultraviolet irradiator OUFK-09 - a home healing ray for all diseases, which can be used:
Acute respiratory diseases:
The course of treatment is 4-5 days.
The nozzle (15 mm tube) is inserted into the oral cavity along the midline. Treatment begins with 30 seconds, adding 30 seconds to 4 minutes.
Acute rhinitis:
The course of treatment is 3-4 irradiations.
The nosepiece (tube with a diameter of 5 mm) OUFK-09 is inserted alternately to a shallow depth into the right and left half of the nose. Irradiation begins at 30 seconds and is increased to 2 minutes.
If your child has a sore throat or sore throat:
The course of treatment is 6-10 procedures. Procedures are carried out daily or every other day.
Irradiation is carried out using a nozzle with an oblique cut (15 mm tube with an oblique cut). The OUFK-09 nozzle is inserted deep into the mouth. The radiation is directed first to one and then to the other tonsil. In case of acute inflammation, irradiation begins with 1-1.5 minutes, increases by 1 minute and is brought to 3 minutes for each tonsil. For chronic inflammation, irradiation begins at 1 minute, increases by ½ minute and reaches 2-3 minutes.
Exposure to ultraviolet radiation OUFK-09 in all of the above cases leads to the relief of pain, swelling, and inflammation.
What to do if your ear hurts?
The course of treatment is 5-6 days.
Position: sitting. The nozzle (tube with a diameter of 5 mm) is inserted into the external auditory canal. Irradiation begins with 2 minutes, daily or every other day. The irradiation time is increased by 1 minute per day.
When a child is injured:
Germs can get into open wounds. Before primary surgical treatment, the wound and surrounding skin are irradiated with OUFK-09 for 10 minutes, taking into account its bactericidal effect, and the surface of undamaged skin surrounding the wound is also irradiated at a distance of 3-5 centimeters. In the subsequent days of dressings and suture removal, the procedure is repeated in the same dose.
To make the wound heal faster:
The course of treatment is 10-12 procedures.
After cleansing a purulent wound from necrotic tissue and purulent plaque, ultraviolet irradiation (UVR) is prescribed for rapid healing (epithelialization) of the wound. On the days of dressing, after treating the wound, the surface of the purulent wound and its edges are irradiated with UV radiation. Dose: distance from the surface of the wound to the emitter is 10 cm, duration of irradiation is 2-3 minutes. After 1-2 days, the duration of irradiation is increased by 1 minute to 10 minutes.
If at home, in kindergarten, at school and at work everyone is sneezing and coughing:
Regular treatment of premises with ultraviolet radiation OUFK-09 will reduce the risk of the spread of infectious diseases and complement the necessary infection prevention measures in the autumn-winter period.
Do not forget to consult a specialist and carefully read the instructions.
Health to you and your children!
