Effect of ultrasonic cavitation on pro-inflammatory cytokine profile in complex therapy of patients with acute rhinosinusitis and exacerbation of chronic suppurative otitis media

Abstract

Patients with exacerbated chronic suppurative otitis media occurring in subjects with acute rhinosinusitis often consulted by ENT spacialists. A literature review has shown that much attention is paid to improving conservative therapy for such patients, and non-drug techniques remain applied rarely. In this context, based on a detailed study of biophysical characteristics, an opportunity of using low-frequency ultrasonic cavitation in combination therapy to increase local immunological resistance of mucous membranes in ENT organ cavities is justified. The aim of the study was to increase clinical therapeutic effectiveness of acute rhinosinusitis and exacerbated chronic suppurative otitis media based on examining timeframe necessary for normalization of pro-inflammatory cytokine profile after using low-frequency ultrasonic cavitation in combination therapy. 63 patients were enrolled to the study. The control group (n = 15) consisted of healthy volunteers, whereas main group had 48 patients with acute rhinosinusitis and exacerbated chronic suppurative otitis media, subdivided into 2 subgroups: subgroup 1 (n = 20) – patients receiving conventional treatment methods (elimination, unloading, local and systemic antibacterial therapy, puncture and anti-inflammatory treatment), subgroup 2 (n = 28) – patients underwent low-frequency ultrasonic cavitation (frequency 29 kHz, amplitude 25 μm) in combination therapy. Washouts from the surface mucous membranes of nasal cavity and nasopharynx were examined for level of IL-1β, IL-2, IL-8, IL-10, TNFα, IFNγ levels before treatment, at day 2, 7, 10 days and in one month after treatment. Application of low-frequency ultrasonic cavitation in combination therapy in patients with acute rhinosinusitis associated with exacerbated chronic suppurative otitis media is accompanied by early recovery of balance in pro-inflammatory cytokines comparewd with conventional treatment methods. Data analysis showed that positive and satisfactory treatment result was achieved in 11 (56.2%) and 22 (78.2%) as well as 7 (36.2%) and 6 (21.8%) patients from subgroup 1 and 2, respectively. In two patients from subgroup 1 the result was noted as unsatisfactory. Early recovery in balance of pro-inflammatory cytokines, improvement of clinical results and shortened treatment duration were observed after using low-frequency ultrasonic cavitation in combination therapy of patients with acute rhinosinusitis and exacerbated chronic purulent otitis. The data obtained may serve to justify introduction of low-frequency ultrasonic cavitation into combination conservative therapy of infected nasal and middle ear cavities as an effective and non-invasive approach.