The off-season is the period of colds. Untreated banal rhinitis (runny nose) is often complicated by inflammation of the mucous membrane of the paranasal sinuses: sinusitis, frontal sinusitis, ethmoiditis, sphenoiditis. The main cause of sinusitis is the blockage of their excretory ducts with viscous mucus, as a result of which a local infectious and inflammatory process begins in the sinuses.
The program of conservative treatment of sinusitis and other sinusitis, in addition to antibacterial and anti-inflammatory therapy, includes an effective procedure for fluid transfer according to Proetz. Among patients, this procedure is known as "Cuckoo".
The method was developed by an American otolaryngologist in the 20th century by Arthur Proetz. Its essence lies in the fact that during the procedure a negative pressure is artificially created in the nasal cavity, which contributes to the washing of the excretory ducts of the paranasal sinuses and their cavities directly.
Due to the anatomical features of the localization of the maxillary (maxillary) sinuses and their excretory ducts, this method is most effective with sinusitis. Nasal lavage is also indicated for rhinitis of various etiologies, other sinusitis, polyposis, adenoiditis, tonsillitis.
The Cuckoo Method is used in adults and children over 5 years of age. The anatomical features of the structure of the nose in young children do not allow for this procedure. In addition, children are often very active and cannot sit still while being manipulated. Nasal lavage according to Proetz is an alternative, sparing method for the treatment of sinusitis in pregnant women.
The procedure requires a special apparatus that supplies and/or sucks fluid under pressure. It can be an ENT combine or a vacuum aspirator. If there is no special equipment for manipulation, washing can be carried out using a large-volume syringe (without a needle) to supply the solution into the nostril and a douche (“pear”) to suck the contents from the nose.
Before washing, it is necessary to remove the swelling of the nasal mucosa. To do this, vasoconstrictor drops are instilled into both nostrils (“Nafthyzin”, “Galazolin”, “Xylometazoline”, “Sanorin”). The patient is seated in a chair in a semi-sitting position or placed on a couch with his head thrown back. Children can be laid on their side. The end of the solution supply tube is inserted into one nostril, and the end of the suction tube is inserted into the other. Similarly, a syringe tip can be inserted into one nostril and a syringe tip into the other.
Irrigation fluid is delivered under pressure through the delivery tube (or syringe). At the same time, this liquid is sucked out of the other nostril with the dissolved discharge from the nose. To prevent the liquid from entering through the nasopharynx into the pharynx, the patient must pronounce the phrase “ku-ku-ku” during the entire procedure. Thus, the soft palate is raised, which prevents fluid from entering the respiratory tract. In some cases, the doctor during the procedure several times for 2-3 seconds can close one nostril of the patient, and then abruptly release it. This is necessary in order to increase the pressure in the nasal cavity. More often, this technique is used for frontal sinusitis, ethmoiditis and sphenoiditis. The solution for washing at the same time better enters the cavity of the sinuses.
Precautions must be observed for the effectiveness and safety of the procedure. The patient should not move during the procedure. His breathing should be even, and the phrase should be pronounced without stopping. The head should not be tilted more than 45° so that the irrigation solution does not flow through the auditory tube into the middle ear.
Before manipulation, vasoconstrictor drops should be instilled, which will facilitate suction of the fluid and prevent possible bleeding due to damage to the mucous membranes. The solution for washing should correspond to body temperature (35-36 ° C). All instruments, fixtures and flushing fluids used must be sterile. It is very important to create a slow and as constant flow of solution as possible. After the manipulation, the patient should sit with his head tilted forward for several minutes so that the rest of the liquid flows out of the nose. Half an hour or an hour after washing, hypothermia and physical exertion should be avoided, since the nasal mucosa should “rest” after the procedure, and blood circulation in it should be restored. If this rule is not observed, nosebleeds are possible.
The entire procedure lasts 5 to 10 minutes (with the hardware method) or 5-6 20 cc syringes (with the manual method). It is absolutely painless for the patient.
For a full course of treatment, 4 to 10-12 procedures are required, depending on the disease itself. The number of flushes required is determined by the doctor and may change during treatment. You can rinse your nose using the Cuckoo method with a syringe and syringe at home.
Antibiotics are intended for cleansing the nasal cavity and sinuses in case of a bacterial nature of the disease, antimycotics - in case of a fungal one. Antiseptic preparations are used as a washing liquid used for viral diseases and for diseases of unknown etiology.
For washing the nose and paranasal sinuses, the following can be used:
- antiseptics (Furacilin, Chlorhexidine, Miramistin);
- antibacterial agents (“Biomycin”, “Fluimucil”, Gentamycin, “Augmentin”);
- antifungal drugs (antimycotics - Nystatin, Ketoconazole);
- antihistamines and corticosteroids (Dexamethasone, Cromohexal);
- vasoconstrictor, decongestants (Xylometazoline, Naphthyzin). Washing solutions (0.9% saline solution, Aqualor, Aquamaris).
In case of severe swelling of the nasal mucosa and, accordingly, the paranasal sinuses, washing is carried out with liquids with the addition of vasoconstrictor or decongestants. A universal washing liquid is physiological saline (0.9% sodium chloride solution) or boiled warm water.
Contraindications to the procedure
Proetz lavage is contraindicated in patients with epilepsy, mental illness, frequent nosebleeds, bleeding disorders. The procedure is also not carried out for children under 4-5 years old, which is associated with their physiological anatomical features and restlessness.
Some complications may occur during or after the procedure. These include sneezing, stuffy ears, a slight headache, and nosebleeds. Sometimes there is a short reddening of the sclera of the eyes, and in children - a single vomiting. If the irrigation is not carried out correctly, fluid can enter the auditory tube and middle ear, resulting in eustachitis and / or otitis media. Reviews of doctors and patients about this method of treatment are very positive: it helps most patients.The cost of washing the nose of the Cuckoo ranges from 500 to 2000 rubles and more (depending on the drugs used and the form of ownership of the medical institution).
However, the procedure should not be taken as a panacea for all possible diseases of the nose and paranasal sinuses: antibiotics cannot be replaced in case of severe inflammation. The qualification of the staff is also of great importance: mistakes made during the manipulation may not only not help, but also worsen the patient's condition, provoking complications.
At home, Cuckoo flushing can only be performed with a syringe and syringe, and the person performing the procedure must have sufficient experience in performing the manipulation.
Homemade nasal irrigation devices are unacceptable and dangerous to health. On the Internet, you can find tips on building a liquid suction device based on a household vacuum cleaner.
Under no circumstances should this be done: the draft that occurs in the tube when using a vacuum cleaner far exceeds the required draft. At the same time, no liquid cans used to reduce it play a big role. Using such a homemade device, you can provoke detachment of the nasal mucosa, cause nosebleeds and get into intensive care.