Комплексный подход в консервативном лечении хронического тонзиллита

Abstract

Chronic tonsillitis (CT) is one of the most common diseases among the pathologies of the ENT organs; in outpatient practice, its share ranges from 4% to 35%. The palatine tonsils (PT) are participants in cellular and humoral immunity. It is important to develop new therapeutic approaches that most effectively influence the tissue focus of inflammation. The attention of clinicians is drawn to the use of physiotherapeutic methods of treating CT. Data were obtained on the ability of nitric oxide (NO) to penetrate deep into tissue through intact skin and mucous membranes. We hypothesized that inclusion of intralacunar exposure to nitrogen monoxide in complex therapy for patients with chemotherapy may be the most effective and promising due to the antibacterial and immunostimulating effect of the gas. 120 patients were examined (Me 36±10,55 years). The control group consisted of 54 practically healthy volunteers (Me 38±10,9 years). The patients were divided into 3 groups, all of them underwent 10 treatment procedures every other day: in the 1st group, treatment of the PT with 0,9% NaCl solution, 40 mL, using the Tonsillor-MM device, and manual washing of the PT with 0,9% NaCl solution, 40 mL, by Belogolovov method with intralacunar injection of chlorophyllipt oil solution, 1.0 mL; in group 2, treatment was supplemented with therapy of low-intensity laser radiation (LILR); in group 3, intralacunar exposure to exogenous nitric oxide. The activity of NETosis transformation of leukocytes was assessed in whole blood and smears from the surface of PT lacunae according to the developed method before treatment and 1 month after treatment. To assess local and systemic immunity, the levels of lactoferrin, lysozyme, and sIgA were determined in blood serum, oral fluid, and swabs from the surface of PT lacunae. The combination of washing the lacunae of the PT and LILR gives a pronounced therapeutic effect, and the inclusion of local NO-therapy procedures in the complex increases the effectiveness of treatment by local action on the tissue focus of inflammation.