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EFFICIENCY AND SAFETY OF USING “OZONE” IN THERAPY OF
PATIENTS WITH CHRONIC TUBERCULOSIS OF THE MIDDLE EAR IN
PATIENTS WITH PULMONARY TUBERCULOSIS
Iskandarova Shahina Khamitovna
Assistant of the department of Otorhinolaryngology № 1, Samarkand State
Medical University
Abstract.
Chronic tuberculosis of the middle ear (CTME) is one of the urgent
problems of modern clinical otology and phthisiology. Among the various methods
of treating chronic tuberculous otitis media, a rational combination of systemic
etiotropic therapy of exposure to the div with local treatment is currently
considered. A comparative analysis of the effectiveness of transtepanal injection of
a solution of decasan o, oo2% in combination with O3 in special therapeutic
regimens is carried out, the advantage of this technique and its mechanism are
described. The results of treatment of 20 patients are presented. All patients
underwent daily ear toilet, rinsing of the middle ear cavity with antiseptic solutions
followed by the introduction of a solution of decasan in combination with ozone.
Despite this, in patients of group 1 (9%), group 2 (2.6%), the effect was noted.
Key words:
chronic tuberculous otitis media, otoendoscopy, otomicroscopy,
transtymponal injection of drugs, ear lavage, ozone.
Introduction.
Chronic middle ear tuberculosis (tuberculous otitis) is a
relatively rare, but severe form of tuberculosis infection, characterized by long-term
consequences. It often occurs in combination with complicated forms of the general
tuberculosis process, especially pulmonary tuberculosis. In such cases, patients have
a weakened general immunity, prolonged intoxication and foci of inflammation,
hematogenous or lymphogenous spread of tuberculosis bacteria to other organs and
tissues.
Middle ear tuberculosis can manifest clinically with various symptoms:
persistent or recurrent ear discharge, hearing loss, earache, and sometimes
neurological symptoms such as facial nerve paralysis. In cases of chronic form,
complete loss of the ear, bone tissue erosion, and intracranial complications may
develop. This makes traditional treatment measures for such patients completely
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ineffective. Although standard anti-tuberculosis treatment regimens (DOTS
strategy) are currently used, complications arise in extrapulmonary forms of
tuberculosis, in particular in ear foci due to drug-resistant strains or slow
inflammatory and regenerative processes. Therefore, the need for additional or
adjuvant therapy is increasing.
Main part.
In recent years, interest in ozone therapy has increased. Ozone is
a gaseous substance with strong oxidizing, bactericidal and immunomodulatory
properties, which is used in medicine for local and systemic effects. It has the
properties of reducing inflammation, accelerating tissue regeneration and improving
microcirculation. At the same time, ozone therapy can increase the overall reactivity
of the div in tuberculosis and enhance the effectiveness of basic treatments. In this
study, the therapeutic efficacy and safety of ozone therapy are studied in patients
with pulmonary tuberculosis and chronic middle ear tuberculosis. The goal is to
determine the impact of ozone therapy on the healing process, its role in suppressing
infection, and its importance in improving the overall condition of patients.
HTSU occurs with the involvement of the mucous membrane of the tympanic
cavity and other formations related to the middle ear system. [2]. Despite scientific
achievements aimed at diagnostics, treatment and prevention of ear tuberculosis
(TU), the frequency of their occurrence does not decrease, constituting 3-5% among
specific lesions of the ENT organs [1,3]. In 1% of all cases, tuberculous ear damage
is primary, not combined with tuberculosis of other organs.
The main principle of conservative treatment of CTSU, as well as other focal
infections, is a rational combination of general measures of influence on the div
with local treatment. The former should be aimed at eliminating the general infection
in CTSU and increasing the div's immunological strength. Local treatment consists
of creating optimal conditions for elimination in the focus of inflammation,
suppression of local infection and stimulation of reparative processes [4,7].
The effectiveness of the treatment of CTSU largely depends, along with
systemic etiotropic therapy, on the local treatment used for introduction into the
tympanic cavity (TC). Drug-resistant microflora is the cause not only of increased
treatment periods, but also of a more severe course of diseases and the development
of complications [2]. In this regard, it is necessary to study the effectiveness of new
anti-tuberculosis drugs in the treatment of CTSU and to develop optimal methods
for their use.
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Taking into account the above, we found it interesting to study the effect of
medical ozone (O3), ozone-containing drugs in the treatment of CTSU in
combination with a solution of decasan. Ozone, regulating the course of protective
reactions, reduces the destructive phase of inflammation and reduces the risk of
formation of necrotic and ulcerative areas in the tympanic cavity, promotes the
fusion of connective tissue around tuberculous nodules. However, there is no
information on the most appropriate time of action of O3 on various microbial
factors, its effect on various populations of microbes depending on time, as well as
in combination with anti-tuberculosis chemotherapy.
Analysis and results.
We observed 20 patients with CTSU. Endoscopic
examination revealed infiltration and swelling of the eardrum, its single or multiple
defects and granulations. Our laboratory studies (cytology, bacterial culture, ELISA
and PCR) showed that in most cases Mycobacterium tuberculosis was detected in
patients with CTSU, and more often M. Hominis and M. Bovis. Depending on the
treatment method, the patients were divided into two groups.
In the 1st group, 11 patients underwent deep ozonation of the middle ear using
freshly prepared ozone containing a solution of decasan in combination with anti-
tuberculosis drugs (rifampicin, isoniazid). The 2nd group was a control group and
consisted of 9 patients who underwent traditional therapy, rinsing the ear with a
solution of furacillin 1:5000 according to the standard treatment method.
For the treatment we used <<OZONATOR 0-1M>> (Metromed, Samarkand)
which has a hole at the end. We used -0.002% Dekasan as the ozonized solution.
The solution was bubbling for 5 minutes. During the five-minute bubbling, a
solution containing ozone at a concentration of 600 μg/l was obtained. Only freshly
prepared ozonized solution was used for the treatment. To introduce the medicinal
substance into the middle ear cavity, we needed a disposable sterile syringe (5 ml
for the treatment of otitis), a 4 cm long piece of plastic connecting tube from an
intravenous infusion system and a movable obturating balloon with a non-return
valve or an inflatable rubber cuff of any other design suitable for the lumen of the
external auditory canal.
To perform the treatment, first, the end of the connecting tube is hermetically
fixed in the external auditory canal with a movable occluding balloon. 5 ml of
preheated ozonized solution is drawn into a sterile disposable syringe.
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The next step is to insert the syringe into the free end of the connecting tube.
Then, the syringe piston is pulled "towards you", which reduces the pressure in the
external auditory canal. Air begins to flow into the auditory canal and the syringe,
and the drug moves into the tympanic cavity. Complete administration of the drug
is achieved by several return tractions of the piston.
During the treatment, patients of the first group underwent 7 procedures of
deep ozonation of the middle ear cavities in a controlled baro mode. The procedure
was performed daily for 5 minutes. Dosage 6 mcg / l per minute. One session at a
concentration of 6 mcg / l. min. for 5 minutes. Is 30 mcg / l. The duration of treatment
depended on the dynamics of the disease. The results of treatment were assessed
based on the amount of washing, ozonation, endo-otoscopy and CT examination, as
well as functional, laboratory and other studies. We recorded "recovery" in patients
with the absence of subjective and objective symptoms of the disease, cessation of
vision from the ear, persistent remission of the inflammatory reaction and
stimulation of regeneration elements, normalization of functional and laboratory
research.
"Improvement" we considered such a condition when the general well-being
of patients normalized, headaches stopped, discharge from the ear decreased,
hearing improved. The absence of significant changes in the course of the disease or
the onset of a short-term improvement in the disease were assessed by us as "lack of
effectiveness". There was no deterioration of the disease in any case. An important
indicator of the effectiveness of the treatment of patients with CTSU is the number
of BP lavages, transtymponal administration of drugs and the time of ozonation
necessary to achieve a therapeutic effect.
The time of finding the tip and the number of lavages with subsequent
ozonation of the ear in the 1st main group with CTSU were - respectively - 2.8 ±
0.8. In patients of the control group, the number of washes through the tip and the
introduction of decamitoxin solution was 5.0 ± 0.58 with HTSU. The disappearance
of clinical manifestations of the disease with HTSU in patients of the main groups
was observed after 5.5 - 0.2 and 5.8 ± 0.2 days, and in the control group - after 14.2
± 0.2 days.
As for the effectiveness of treatment, normalization, as well as a significant
improvement in hearing function corresponded to "clinical recovery and
improvement". When conducting a traditional method of treatment, the temperature
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in the ear increases slightly. After the end of the course of treatment, a decrease in
local temperature was noted, which is confirmed by the abatement of inflammatory
phenomena after the treatment. The laboratory studies revealed changes in the
microbial landscape of the ear.
Conclusion.
Thus, the results of treatment of patients with CTSU by
ozonation method, testify to the effectiveness of this method. In connection with the
wide use of ototoxic drugs for the treatment of tuberculosis, it is necessary to
strengthen the monitoring of the hearing condition when prescribing aminoglycoside
drugs. The use of ozonized solution of decasan contributes to the increase in the
effectiveness of treatment of patients with CTSU.
Ozone therapy is an effective and safe method for treating chronic middle ear
tuberculosis on the background of pulmonary tuberculosis. It can be recommended
as a complement to the main antituberculosis therapy.
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