Topical etiotropic drugs in therapy of infectious inflammatory diseases of pharynx in preschool children. Results of a multicenter randomized comparative clinical trial

In accordance with modern clinical guidelines, systemic antibiotic therapy for infectious and inflammatory diseases of the throat is recommended only when beta-hemolytic group A streptococcus is detected. In other cases, it is advisable to use topical drugs of etiotropic, pathogenetic and symptomatic action. The combined preparation Grammidin® has a wide spectrum of etiotropic activity (antiviral, antibacterial and antifungal). Objective of the study: to assess the safety and efficacy of the use of Grammidin® for children (dosage form – metered spray) in the treatment of inflammatory diseases of the pharynx in preschool children. Materials and methods. An open comparative multicenter randomized study was carried out in two parallel groups with the participation of 160 patients aged 3–5 years with an infectious-inflammatory disease of the pharynx of nonstreptococcal etiology. The disease was established clinically by the presence of: a symptom of «sore throat» according to the Wong-Baker (WB) scale, as well as two or more local signs of acute inflammation of the oropharynx (hyperemia of the pharyngeal mucosa, edema of the pharyngeal mucosa, edema of the soft tissues of the posterior and lateral pharyngeal walls, an increase in lymphoid granules of the posterior pharyngeal wall and lateral columns, swelling of the uvula) according to pharyngoscopy. The randomized patients received Grammidin® for children or Hexoral® for 7 days according to the instructions for medical use. Safety was assessed by the incidence of adverse events (AEs) and by monitoring vital signs (body temperature, blood pressure, respiration and heart rate) with monitoring of blood and urine tests. Efficacy was assessed by the decrease in mean disease severity (modified TSS) at visit 2 from baseline – the primary endpoint. Changes were used as secondary endpoints: the severity of the disease (TSS scale), the severity of the sore throat symptom (WB scale), the severity of each of the catarrhal symptoms initially identified according to pharyngoscopy data, the proportion of patients with no sore throat (WB scale), the proportion of patients with the absence of all catarrhal phenomena (pharyngoscopy) at visits 2 and 3. Results. Primary efficacy endpoint: change in mean disease severity on the TSS scale at Visit 2 from baseline in Group 1 was –1,80 (95% CI –1,98 – –1.61) points and –1,31 (95 % CI –1,50 – –1,12) points - in group 2 (p = 0.003). Secondary performance endpoints. According to the analysis of variance in Group 1, there was a statistically significant predominance of the therapeutic effect throughout the treatment in relation to the severity of the disease on the Total Symptoms Score (TSS) scale (p = 0,006), the severity of sore throat on the WB scale (p = 0,006), as well as the severity of individual signsof the disease: «Hyperemia of the pharyngeal mucosa» (p = 0,036) and «edema of the pharynx» (p = 0,037). The rates of relief of symptoms: «the severity of lymphoid granules of the posterior pharyngeal wall and lateral columns» and «uvula edema» were similar in both groups. The proportion of children with no sore throat at visit 2 was statistically significantly different: 46 and 29% for Group 1 and Group 2, respectively (p = 0,022). Safety assessment. In the course of the study, 1 child was registered in each group who developed 1 AE of mild severity, had a doubtful connection with the study drugs, did not require their cancellation and additional therapy, and spontaneously ended without consequences by visit 3. Conclusions. The combined drug Grammidin® for children in the form of a metered spray was well tolerated by children aged 3–5 years and according to a number of main criteria of efficacy (total severity of symptoms of the disease, sore throat, hyperemia and swelling of the pharyngeal mucosa) showed a pronounced and statistically significant advantage in speed and severity effect over a monocomponent preparation containing hexetidine in the form of an aerosol.

EFFECTIVENESS OF COMPOSED HERBAL EXTRACT IN THE TREATMENT OF GINGIVITIS AND ORAL AND PHARYNGEAL MUCOSA – REVIEW OF STUDIES

Intensive studies on properties of synthetic compounds are simultaneously conducted with studies on the effectiveness and safety of drugs derived from natural compounds. These drugs have been effectively used for years in dentistry, in treatment of inflammatory conditions of the oral cavity and in laryngology, in treatment of pharyngeal inflammatory conditions. The subject of this article is a compilation of studies conducted on medicinal products containing composed ethanolic extract as an active substance, and obtained from: chamomile capitulum (Matricaria recutita L.), oak bark (Quercus spp.), sage leaf (Salvia officinalis L.), arnica herb (Arnica spp.), calamus rhizome (Acorus calamus L.), peppermint herb (Mentha piperita L.), thyme herb (Thymus spp.) Preclinical studies confirmed that a particular tested plant extract exhibits antimicrobial (antibacterial, antifungal and antiprotozoal) as well as anti-inflammatory, immunomodulatory and astringent properties. Under clinical conditions, it was confirmed that drugs containing the analysed extract used in periodontology, in prevention and complex treatment of gingivitis, periodontitis as well as diseases of oral mucosa (but also the throat) of viral, bacterial, fungal and protozoal aetiology significantly improved the effectiveness of therapy, shortened the treatment and improved the patients’ quality of life. The above preparations used in dental surgery contributed to faster tissue regeneration, more quickly relieved pain and swelling after a surgery or difficult dentition. Furthermore, drugs containing the above-mentioned extract can also be successfully used for oral cavity decontamination in the case of various diseases of teeth or the oral and pharyngeal mucosa. The tested composed herbal extract (CHE), applied in the form of a mouthwash and in the form for topical application with benzocaine content (CHEB), is a component of drugs which are great alternatives to widely used synthetic drugs. They are characterised with high effectiveness, comparable to that of synthetic agents, and a higher safety profile. Results of pharmacological and clinical studies justify their use in both prevention and treatment of inflammatory diseases of the gums, periodontium, oral cavity and pharynx.

A method of reducing the frequency of local postoperative complications after laryngectomy incancer of the larynx T3N0M0

The problem of healing of postoperative wounds in oncologic patients remains relevant still the present time. After laryngectomy the percentage of primary healing of postoperative wounds does not exceed 40–60%. After surgical intervention there are favorable conditions for the activation of pathogenic microorganisms of the pharyngeal mucosa. The aim of our study was to develop preventive measures to reduce the percentage of healing of postoperative wounds by means of secondary intention after laryngectomy. The course of prevention consisted in daily treatment of the pharyngeal mucosa with successively freshly prepared ozonated saline solution with an ozone content of 0.15 g/l in an amount of 3 ml; and then with a bifidobacteria probiotic in in an amount of 2 ml. After this course of prevention, the number of pathogenic and opportunistic microorganisms decreased on the pharyngeal mucosa, bifidobacteria and lactobacilli appeared. Preoperative preparation for laryngectomy by irrigation of the pharyngeal mucosa with ozonated saline solution and probiotic helps to reduce the number of local complications of infectious origin by 16.7% of cases. There is no negative effect Bifidobacterium longum MC-42 on long – term oncological.

Non-infectious causes of chronic pharyngitis

Chronic pharyngitis (CP) is a common disease that is not associated with infections and does not require administration of any systemic antibiotic therapy. Many non-infectious factors cause CP. Despite diversity and variability of factors, the inflammatory process of the pharyngeal mucosa lie at the root of the pathogenesis of CP. A sore throat is the main symptom of this process, which can be successfully relieved with local drugs.

Retropharyngeal Dissection by Parker Flex-Tip Nasal Endotracheal Tube

Possible complications of nasotracheal intubation include injury to the nasal or pharyngeal mucosa. Dissection of the retropharyngeal tissue by the endotracheal tube is one of the rarer of the more severe complications. Previous studies have indicated that the Parker Flex-Tip (PFT) tracheal tube (Parker Medical, Highlands Ranch, Colo) reduces the incidence of mucosal injury. We experienced a case involving inadvertent retropharyngeal placement of a PFT tube in a 29-year-old patient during nasotracheal intubation under general anesthesia for elective dental treatment. Despite thermosoftening the PFT tube, expanding the nasal meatus, and ensuring gentle maneuvering, the tube intruded into the left retropharyngeal mucosa. However, the injury was not severe, and the only required treatment was the administration of antibiotics and corticosteroids. Even when a PFT tube is utilized, pharyngeal dissection is possible. When resistance is felt during passing of the PFT tube through the nasopharynx, an alternative method to overcome this resistance should be utilized.