New possibilities for local therapy of adenoiditis in children

In children of preschool and primary school age, the most common diseases of the upper respiratory tract (URT) are hypertrophy and inflammation of the pharyngeal and palatine tonsils, which accounts for about 62% in the structure of ENT pathology and 28% of respiratory tract diseases [1]. The Pirogov-Waldeyer lymphoepithelial pharyngeal ring contains lymphoid tissue associated with the mucous membrane. Direct contact with the external environment determines the functions of the tonsils as organs that are the first to be directly exposed to antigenic material, react to it in a certain way and prepare the body for the most optimal immune response [2, 3].

The important physiological role of the tonsils of the lymphoid ring in creating the immune barrier of the mucous membranes and regulating its function justifies organ-preserving tactics for the treatment of tonsillar disease in early childhood [4, 5]. Work in recent years has shown differences in the cellular composition of the main populations and subpopulations of lymphocytes in the palatine tonsils in children and adults, which indicate a more active immunological function of the tonsils in childhood. The immunological function of the pharyngeal tonsil in young children, manifested by the development of adenoid vegetations, is characterized by high production of B-1 cells with the phenotype CD19+, CD5+, which quickly produce specific antibodies and activate the cytokine function of CD4+ and T cells, in contrast to B-2- cells with the same phenotype, which are characterized by delayed activation. With age, the number of B-1 cells decreases [6].

Thus, it has been proven that the immunological activity of the pharyngeal tonsil is most pronounced in children under 5 years of age. It is at this age that local immunity of the mucous membrane of the upper respiratory tract is intensively formed.

Histological and immunohistochemical studies of adenoid vegetations confirmed their correspondence to secondary organs of immunity, the main function of which is the induction of an immune response, i.e., the reproduction of immunocompetent cells in the form of clones with a certain specificity [2]. Thanks to mucociliary clearance, viruses and bacteria that colonize the mucous membrane of the nose and paranasal sinuses are transported to the area of ​​the pharyngeal tonsil, which responds with reactive hyperplasia of its lymphoid tissue, which is clinically manifested in the form of adenoid growths. Essentially, adenoids are a physiological protective reaction of one of the organs of the immune system, which is specialized in relation to pathogenic microflora of the upper respiratory tract [7, 8].

According to modern data, the pharyngeal tonsil in a state of hypertrophy actively generates specifically responsive clones of memory lymphoid cells and supplies them to the mucous membrane of the nose and paranasal sinuses, forming its own immune barrier.

Thus, the clinical and morphological experience gained over the last decade convinces of the need for careful treatment of adenoid vegetations, especially in children of younger age groups [9, 10].

The purpose of the study is to investigate the clinical effectiveness of the use of natural drugs Tonsilotren and Cinnabsin in the complex therapy of chronic adenoiditis in children.

Compound

Active substances in the composition:

• Pulsatilla ZNS – 0.33 mg;
• Allium cepa C3 – 0.33 mg;
• Sabadilla C3 – 0.33 mg;
• Belladonna C3 – 0.33 mg;
• Kalium bichromicumC3 – 0.33 mg;
• Gelsemium C3 – 0.33 mg.

Additional excipients:

• Magnesium stearate;
• acacia gum;
• sucrose;
• talc.

Additional excipients of the drug shell:

• sucrose;
• gelatin;
• acacia gum;
• white beeswax;
• carnauba wax – 300 mg;
• talc.

Coryzalia, instructions for use (Method and dosage)

Coryzalia tablets are intended for sublingual (placing the medicine into the oral cavity) use. The tablet should be placed under the tongue, not divided into parts or crushed. Keep until completely dissolved. To achieve the maximum therapeutic effect, you should not eat or drink for 30 minutes after taking the medicine. If the drug is prescribed to children under 6 years of age, it can be dissolved in water immediately before administration. The timing of treatment with Coryzalia should be selected in consultation with your doctor.

Typically one tablet is prescribed every hour for the first day of treatment. Then in the next 4 days, the drug can be taken 1 tablet every 2 hours. If the patient’s condition progressively improves, then from the second day of treatment you can take 1 tablet 3–4 times a day.

According to the instructions for Corizalia, the total duration of the therapeutic course is 5 days. The maximum daily dose of the drug can be 12 tablets.

Patients and research methods

90 children aged 3 to 12 years diagnosed with chronic adenoiditis.

Depending on drug therapy, patients were divided into three groups of 30 people each:

Group 1 received a course of Tonsilotren along with anti-inflammatory therapy. The drug Tonsilotren was prescribed 8 tablets per day for 2 days, and then 1 tablet 3 times a day for up to 30 days.

Group 2 received a course of Tonsilotren and Cinnabsin along with anti-inflammatory therapy. Tonsilotren - according to the above scheme. Cinnabsin 1 tablet 6 times a day for 2 days, and then 1 tablet 3 times a day for up to 30 days.

Group 3 received a course of anti-inflammatory therapy. Anti-inflammatory therapy included washing the nasopharynx with antiseptics for 14 days.

As anti-inflammatory therapy in all groups, silver-based drugs (2% nasal drops) were used, which were administered 2-5 drops (depending on age) 3 times a day with the patient lying on his back with his head sharply thrown back. Previously, the nasopharynx was washed 3 times a day with sterile sea water preparations.

Tonsilotren is a complex drug (registration No. 012166/01−020318) and in low pharmacological doses (about 10−2 - 10−8 mass fractions) contains 5 components that have a pronounced affinity for the lymphoid tissue of the Pirogov-Waldeyer pharyngeal ring. The active substances have a synergistic effect, allowing for anti-inflammatory, decongestant, analgesic and drainage effects, and ultimately accelerate the restoration of the structure and functions of the lymphoid formations of the nasopharynx and oropharynx [11]. Cinnabsin is also a complex drug (registration No. 013317/01−190318), which has a targeted effect on the epithelium of the mucous membrane of the nasopharynx and paranasal sinuses. The complex of active ingredients of Cinnabsin realizes its effects in target tissues, provides secretolytic, secretomotor and drainage effects, restores the functions of the ciliated epithelium and helps to quickly reduce inflammation [12].

During the study, we studied the clinical dynamics of symptoms (difficulty in nasal breathing, discharge from the nose and nasopharynx, night snoring) and the dynamics of endoscopic signs (swelling of the nasal mucosa, the size of the nasal cavity, the relationship of the bladder with the choanae and pharyngeal openings of the auditory tubes, the presence of pathological discharge). Examinations were carried out before the start of treatment, on the 14th and 30th days.

The effectiveness of treatment was assessed by the dynamics of clinical (objective and subjective) signs, as well as by endoscopic data. The results of the clinical examination were recorded in a specially designed questionnaire and assessed on a scale from 0 to 3 points. In this case, the objective examination data were distributed as follows: 0 points were assigned in the absence of inflammatory manifestations from the nasal cavity and nasopharynx; 1 point - for mild inflammatory manifestations (minor swelling of the nasal mucosa); 2 points - with moderate severity of inflammatory manifestations (moderate swelling of the mucous membrane in the nasal cavity and nasopharynx, mucous discharge in the nasal cavity and nasopharynx); 3 points - with significant severity of inflammatory manifestations (severe hyperemia and swelling of the mucous membrane of the nasal cavity and nasopharynx, purulent discharge in the nasal cavity and nasopharynx).

The size of the pharyngeal tonsil was assessed during endoscopic examination: 1 point corresponded to the 1st degree of hypertrophy, 2 points to the 2nd degree, 3 points to the 3rd degree.

During endoscopy of the nasopharynx, attention was paid to the presence of dysfunction of the auditory tube: 0 points - absence, 1 point - slightly expressed phenomena (tubal ridges are partially covered by adenoid tissue), 2 points - tubo-otitis phenomena are significantly expressed.

Subjective data (degree of difficulty in nasal breathing, nasal discharge, night snoring) were also assessed using a scoring system. In this case, 0 points corresponded to the absence of subjective symptoms. Mild, periodically occurring, but easily tolerated symptoms were taken as 1 point; 2 points - with moderately severe symptoms that attract attention and affect daily activity; A score of 3 corresponded to significant impairment of daytime activity and nighttime sleep.

Coryzalia price, where to buy?

This homeopathic medicine can be bought in pharmacies. Prices for Corizaliya tablets for the common cold vary from 160 to 225 rubles per pack.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine

ZdravCity

• Coryzalia tablets p.p.o.
  40pcs BOIRON RUR 403 order

Pharmacy Dialogue

• Coryzalia tablets No. 40Boiron

  426 rub. order

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New possibilities for local therapy of adenoiditis in children

Various diseases of the ENT organs have been and remain one of the main problems of both otorhinolaryngology and pediatrics. The structure of ENT pathology changes somewhat as the child’s body grows and develops. In the first years of life (preschool and early school periods), the leading position among diseases of the ENT organs in children is occupied by pathological changes in the adenoid vegetations. There is a clear upward trend in this pathology: in the 1960s. XX century hypertrophy of the pharyngeal tonsil occurred in 4–16% of children, in 1970–80. in 9.9–29.2%, and in 1999 its share increased to 37–76% (F. Levy, 1999; E. G. Neuwirth, S. M. Pukhlik, 2000).

In 32.8% of cases, adenoid vegetations are accompanied by an inflammatory process (G. D. Tarasova, L. S. Strachunsky, 2000), i.e., adenoiditis occurs (acute or chronic), which can cause the occurrence, recurrence and chronicity of diseases upper and lower respiratory tract. According to other data, adenoiditis occurs in almost half (43.8%) of preschoolers.

One of the possible reasons for this is bacterial contamination of the pharyngeal tonsil. The microbiological composition of the nasopharynx is quite diverse. According to a number of authors (AV Talaat et al., 1989; G. Cantella et al., 1989), the infectious factor affects the degree of hypertrophy of adenoid vegetations. Scientists have not yet come to a consensus as to which factor is considered the leading infectious agent. Some (Z.M. Grekova, V.R. Savin, 1977; I.M. Budnik, 1998) believe that these are streptococci, others believe that these are staphylococci, others (Yu. A. Lotsmanov et al., 1994; A. S.-U. Batchaev, 2002) talk about a combination of pathogenic and non-pathogenic forms of streptococci and staphylococci. Cantella et al (1989), in a microbiological study of pharyngeal tonsil tissue, identified 93 species of aerobic and 56 anaerobic microorganisms. However, according to some data, there are no differences in the rates of microbial flora contamination of the nasopharynx of sick and healthy children. There is also evidence of the absence of pathogenic microorganisms in lymphoid tissue under conditions of acute inflammation. In recent years, information has emerged about the dominant role of Haemophilis influenzae, Streptococcus pneumonia, Moraxella catarrhalis in the pathogenesis of hypertrophy and inflammatory changes in the pharyngeal tonsil. There is ambiguous opinion about the role of fungal flora in the pathogenesis of hypertrophy and inflammation of the pharyngeal tonsil tissue.

Clinically, adenoiditis is manifested by frequent runny nose or nasal congestion, cough, and frequent colds. An endoscopic examination reveals an accumulation of pathological discharge in the posterior parts of the nasal cavity and nasopharynx. Discharge from the nasal cavity is possible, and more often - drainage of discharge down the back wall of the pharynx (with the development of secondary pharyngitis). A cough is typical in the morning or after a nap. In some cases, adenoiditis is accompanied by exudative otitis media (EO) (including bilateral). This is especially true for preschool children who do not complain of hearing loss (and the pain syndrome with ESD, as a rule, is not pronounced).

The most accurate is endoscopic diagnosis, which allows you to assess not only the size, but also the location of the lymphoid tissue in the nasopharynx, the condition of the pharyngeal mouth of the auditory tube. The classification of the degree of hypertrophy of adenoid vegetations is based on endoscopic assessment of the degree of overlap of the vomer with lymphoid tissue:

1st degree - lymphoid tissue covers the vomer by 1/3;

2nd degree - lymphoid tissue covers the vomer up to 2/3;

3rd degree - lymphoid tissue covers the vomer more than 2/3.

The conservative treatment plan for adenoiditis includes reducing inflammation of the lymphoid tissue, reducing sensitization and increasing the immunological reactivity of the body.

It is recommended to begin conservative treatment with elimination therapy, which helps cleanse the nasal cavity and nasopharynx from pathological contents. For this, saline solutions and mucolytic drugs are used (for thick and viscous secretions). After this, antiseptics and/or drugs for local antibacterial therapy are used.

Antimicrobial agents for local action on mucous membranes can be prescribed as part of a combination treatment or as monotherapy. One such drug is octenisept. Octenisept has a wide spectrum of antimicrobial action, effective against aerobic-anaerobic and gram-positive/gram-negative bacteria, including pathogens of nosocomial infections; mycobacteria tuberculosis, chlamydia, mycoplasma, fungi of the genus Candida and yeast-like, protozoa, as well as viruses (herpes, hepatitis B, C and D; HIV). The effect of the drug begins almost immediately (in a minute) and lasts for an hour. The drug has no toxic effect and is not absorbed through the intact mucous membrane. At a dilution of 1:5 (1:6) it does not inhibit the function of the ciliated epithelium of the upper respiratory tract.

We treated a group of children (50 people - 100%) with various forms of adenoiditis: acute adenoiditis was detected in 43 (86%) children, chronic - in 7 (14%) children. Among them there were 34 (68%) boys and 16 (32%) girls. The age of the children ranged from 2 to 12 years, the average age was 5 years.

All patients underwent:

• general assessment of the patient's condition;
• ENT examination, including endoscopy of the nasal cavity and nasopharynx;
• objective assessment of the condition of the auditory analyzer (acoustic impedance measurement);
• microbiological examination of discharged lymphoid tissue of the nasopharynx. In 19 (38%) children, opportunistic flora was detected, in 31 (62%) - various pathogens, including S. pneumonia, H. influenzea, B. catarrhalis, S. aureus, S. pyogenus, etc., as monocultures or in various combinations.

The drug octenisept was prescribed in a dilution of 1:5 for rinsing the nasopharynx 2 times a day, 5–10 ml in each nostril per procedure as monotherapy. Analysis of the results of using the drug octenisept after 1 month revealed the following.

Before treatment, all patients or their parents complained of nasal congestion, discharge (either from the nasal cavity or along the back of the throat), cough, and hearing loss of varying severity. It was proposed to evaluate the severity of each symptom in points: 0 - the symptom was absent, 3 - the symptom was maximally expressed. From the data presented in Figure 1, we can conclude that by the 5th–7th day of using the drug, the severity of symptoms decreased by almost half, by the 14th day it was small, and by the 28th day it was minimal. As can be seen from Figure 2, children were most bothered by hearing loss for the longest time (most often manifested by ear congestion, which is not constant, and is associated with intense or incorrect blowing of the child’s nose), while nasal congestion, discharge and cough were almost absent.

During monotherapy with octenisept, it was noted that purulent discharge almost completely stopped by the 5th–7th day of treatment (Fig. 3).

It is important to change the degree of hypertrophy of adenoid vegetations (Fig. 4). Before treatment, 32 children (64%) had grade 2 adenoids, and 18 children (36%) had grade 3 adenoids. After the course of treatment, in 5 children (10%) the adenoids were reduced to the 1st degree, and the adenoids of the 3rd degree were determined only in 7 children (14%).

Based on the data obtained (clinical examination results), as well as interviews with patients and their parents, the following conclusions can be drawn:

• already by the 3rd–5th day of using the drug octenisept, there is a significant improvement in the condition of children and a clinically detectable improvement in the endoscopic picture of the nasopharynx;
• the drug is well tolerated by patients.

All of the above allows us to recommend the drug octenisept for use as monotherapy for adenoiditis in children.

E. Yu. Radtsig , Doctor of Medical Sciences, Russian State Medical University, Moscow