Возможности противовоспалительной терапии в лечении пациентов с аденоидитом

Abstract

The search for new ways to treat adenoiditis in children is relevant and in demand. Existing therapeutic options (eliminationirrigation therapy, topical antimicrobials, mucolytic drugs) in some cases (with a prolonged course of inflammation in the pharyngeal tonsil, in the presence of concomitant otorhinolaryngological or infectious pathology) have a limitation on the duration of course admission and require the search for new treatment regimens. Promising in this regard is the inclusion of antiinflammatory drugs in the treatment of patients with inflammation of the pharyngeal tonsil. Patients and methods. We observed 2 groups of patients (main (n = 52) and comparison (n = 20)) with signs of inflammation of the pharyngeal tonsil (adenoiditis). Patients of the main group were additionally prescribed ammonium glycyrrhizinate (Reglisam) in an age-appropriate dosage in accordance with the instructions for use for 30 days in the treatment regimen. On the 1st, 7th and 30th days of therapy, all patients underwent endoscopy of the nasal cavity and nasopharynx, assessment of complaints and symptoms on a 10-point visual analog scale (VAS), PCR-diagnosis of herpesvirus pathogens in a smear from the surface of the pharyngeal tonsil. Results. In patients of the main group after the course of treatment (on the 30th day of follow-up), the severity of the "snoring" symptom was 67% lower (p = 0.001) relative to the comparison group, the intensity of the symptoms of "nasal breathing difficulty" and "cough" was 20% and 50% less, respectively. Also in the main group, there was a decrease in the proportion of patients with grade 3 adenoid hypertrophy (from 54% to 33%, p = 0.029) and grade 2 (from 15% to 4%, p = 0.046), accompanied by a block of the pharyngeal mouths of the auditory tubes (no such positive dynamics was noted in the comparison group). Among initially EBV-positive patients, the virus eradication was 78% in the main group, in the comparison group it did not exceed 12% (p = 0.015). Conclusion. The inclusion of the anti-inflammatory drug Reglisam in the treatment regimen of adenoiditis contributed to a more effective reduction in the severity of the symptoms of the disease ("nasal congestion", "cough", "snoring") and the restoration of nasal breathing, which was associated not only with the absence of signs of inflammation, but also with a decrease in the size of the pharyngeal tonsil. The antiviral effect of Reglisam against Epstein–Barr virus (EBV) turned out to be interesting from a practical point of view (in 78% of cases, there was no virus among initially EBV-positive patients). Key words: adenoiditis, Epstein–Barr virus, ammonium glycyrrhizinate, glycyrrhizic acid