CC BY
8
УДК: 616.28-002.053:615.03
Daliev A. G.
T. F. D.
Usmanova N.A.
Numonzhonov B.Sh.
Department of Otorhinolaryngology Andijan State Medical Institute
IMPROVING THE DIAGNOSIS AND EFFECTIVENESS OF TREATMENT OF ACUTE EXUDATIVE OTITIS MEDIA IN
CHILDREN
Resume: One of the urgent tasks of the modern otorhinolaryngological service remains the development of means and methods to improve the effectiveness of treatment ofpatients with chronic purulent otitis media.
Currently, there is no doubt among clinicians that surgical treatment is necessary for all patients with HCG, regardless of the nature and prevalence of the pathological process in the middle ear.
Keywords: mesotimpanitis, childhood, efficacy, comprehensive assessment.
Relevance. An urgent problem of modern otolaryngology is the problem of treatment and rehabilitation of patients with impaired auditory function of various genesis [3,6].
In the general structure of the pathology of the auditory analyzer, a high proportion is occupied by chronic purulent inflammatory diseases of the middle ear, which often lead not only to temporary disability, restriction of professional activity in people of working age, but also to the development of various complications [1,8].
In recent years, views on the indications and nature of surgical interventions for otitis media have been significantly revised. The position of striving for the earliest possible surgical effect on the focus of chronic infection in order to preserve the most complete auditory function is increasingly recognized [2,5].
For a long time, the success of surgical intervention was associated with the qualification, the level of professional training of an otosurgeon, the availability of high-quality magnifying optics and modern microsurgical instruments [4,7].
However, practice has shown a clear insufficiency of such an approach, which in general is currently manifested in all medical specialties and requires the development of fundamentally new approaches to improving the effectiveness and quality of treatment [5].
The scientific searches of the last decades in this direction have practically led to the creation of three new concepts and methodological approaches: the concept of quality of life, the concept of quality of medical care and the concept of evidence-based medicine [8]. All these concepts are closely intertwined and mutually complement each other, solving one main task — improving the efficiency and quality of treatment of patients.
The purpose of the study. The purpose of this study was to develop a system for evaluating the effectiveness of surgical treatment of patients with chronic purulent otitis media as a method of improving the quality of surgical interventions for this disease.
Research methods Over the past 3 years, we have observed 56 children with chronic purulent otitis media, of which 22 (39.2%) are girls and 34 (60.7%) are boys. In 32 (61.7%) patients, the process was one-sided. The distribution of patients with chronic purulent otitis media by clinical forms was as follows: mesotimpanitis was diagnosed in 28 (50%) patients, epimesotimpanitis - in 5 (8.9%), epitimpanitis - in 23 (41%). Conservative treatment of patients with purulent epithympanitis, mesotimpanitis and epimesotimpanitis was carried out only in the absence of indications for surgical treatment (absence of destruction of bone walls, confirmed by X-ray or CT examination).
The results of the study. Analysis of the results of a microbiological study showed that in mesotimpanitis, the main causative agents of the disease were gram-positive strains of microorganisms - golden and epidermal staphylococci.
With epimesotimpanitis and epitimpanitis, polymorphic flora was also often found in the middle ear. It was noted that the most effective treatment with ozone and miramidez was in patients with mesotimpanitis. Starting from 4-5 days from the beginning of treatment, positive dynamics was recorded, there was a significant decrease in purulent discharge.
On average, by the end of the first week there was a complete decontamination of pathogenic microflora, confirmed by microbiological examination. Clinical recovery (restoration of hearing, confirmed by audiological examination) occurred on average on the 15th-18th day from the onset of the disease. Dynamic observation of the condition of the middle ear cavities and microbiological studies conducted during treatment in patients with chronic purulent otitis media allow us to conclude that the course of the disease depends on the nature of the microflora.
Already on the 4th-5th day of treatment, positive dynamics was noted in patients in whom pathogenic staphylococci were the etiological factor of the disease (the degree of contamination of the middle ear cavity was in the range of 103 -105 CFU/tampon): purulent discharge from the ears significantly decreased, the mucous membrane of the medial wall of the tympanic cavity became noticeably less hyperemic and edematous, the function of the auditory pipes, which in turn led to improved aeration of the middle ear cavity and
elimination of purulent contents. In 2 patients whose exacerbation of chronic otitis media was caused by E. coli, remission occurred on the 9th day from the start of treatment. In 26 patients, signs of inflammation subsided at an earlier time (on day 4).
Relapse of the disease was observed in 3 patients in whom the causative agents of the disease were staphylococci and fungi of the genus Candida. They had a long-term chronic disease. In 31 (55.3%) patients, clinical recovery occurred on the 5th-6th day from the start of treatment, in 19 (33.9%) - on the 7th-8th day, in 6 (10.7%) - at a later date. Thus, the use of the drug miramidez, in particular the ozone-oxygen mixture, proved effective in the treatment of patients with chronic diseases of the middle ear of fungal and microbial etiology.
Conclusion. The practical significance of the conducted studies lies in the fact that their results allowed us to obtain a quantitative characteristic of the medical and microsocial effectiveness of the quality of medical care for patients with chronic purulent otitis media.
The practical significance of the conducted research also lies in the fact that a method of comprehensive assessment of the quality of surgical treatment of patients with chronic purulent otitis media has been developed and applied in clinical practice. The developed methodology makes it possible to standardize approaches to determining the quality of medical care, objectify its indicators and conduct a comparative analysis when studying the effectiveness and quality of new methods of surgical treatment of patients with chronic purulent otitis media.
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