What to take with damage to the auditory nerve. Ear contusion: how dangerous is the injury, how to treat it, consequences and prevention

It is human nature to calm oneself down and thus alleviate the seriousness of the problem. So, the presence of hearing problems, and even at a young age (not to mention the older one), is associated with natural process, but few people compare this fact with such a disease as acoustic neuritis. This ailment occurs as a result of damage to the auditory nerve. All about inflammation of the auditory nerve, symptoms and treatment will be discussed in this article, however, everything in order ...

The ear itself has three sections:

1. External.
2. Average.
3. Internal.

The physiology of human hearing is such that all three sections are involved in its perception and processing, and each of these sections has its own function.

The outer ear picks up sound (acts as a kind of locator), recognizes its source, frequency, and conducts it to the eardrum.

The anatomy of the outer ear involves, among other things, the protection of the entire system from dirt, infections, etc. due to earwax and small hairs growing inside.

The middle ear has the following structure:

1. drum cavity.
2. Auditory bones (hammer, anvil and stirrup).

The middle ear plays only a conducting function.

The inner ear has:

1. Snail.
2. Semicircular canals.

The scheme of the inner ear suggests the presence of not only an organ responsible for sound and its transmission, but also a special department that performs the function of maintaining balance.

The auditory nerve originates from the auricle, or to be precise from its deepest part, the inner ear. It has two branches:

1. The part responsible for hearing.
2. The part responsible for balance.

Acoustic neuritis is often confused with a disease such as sensorineural hearing loss, however, this is fundamentally wrong.

Sensorineural hearing loss is a consequence, not a cause, and certainly not the same thing as damage to the auditory nerve.

Another common misconception is comparing neuritis with eustachitis. Eustachitis is a disease of the middle ear, and it has the same symptoms as neuritis, but not the causes.

In addition, the cause of hearing loss is often the defeat of the outer, middle or inner ear, which also has nothing to do with the nervous system.

Causes of the disease

The cause of the development of neuritis of the auditory nerve can be different. The main thing is the presence of external influence on the auditory nerve or provoking factors. So, the possible causes of neuralgia can be:

• flu;
• SARS;
• otitis;
• mumps (mumps);
• rubella;
• abuse of certain drugs;
• accumulation of heavy metals in the body;
• bad habits;
• traumatic brain injury;
• regular exposure to loud sounds, vibrations (acoustic trauma);
• arterial hypertension;
• thrombosis;
• swelling in the ear
• age (over 60 years);
• stroke;
• allergic reactions.

The most common cause of inflammation of the auditory nerve is the presence of an infection or virus in the body, which leads to hearing impairment, and in especially neglected situations, to its complete loss.

The most dangerous in this situation are not so much the sudden onset of infectious diseases, but their chronic subspecies.

As a rule, the patient refuses to visit a doctor, thereby delaying the recovery process. In turn, a damaged nerve that does not receive proper treatment can completely deprive the patient of hearing.

In addition to infection, physical damage that occurs as a result of a traumatic brain injury (bruise, fracture, etc.) has no less terrible consequences. It is quite difficult to bruise the auditory nerve, but hemorrhage and swelling can be provoked, which, in turn, will affect the nerve, causing a painful reaction.

It is possible to damage the auditory nerve without injuring the skull, through acoustic trauma. This reason may cause nerve impingement and further neuralgic symptoms.

As a result of prolonged use of antibiotics, the patient may experience atrophy of the auditory nerve, which also causes neuritis (neuralgia).

In the presence of internal inflammation, the development of hypoxia of the cells of the nerve trunk of the auditory nerve is possible, as a result of which the neurons begin to perform their function worse, the nerve endings do not tolerate information well, which leads to the development of symptoms of neuritis.

Classification

Inflammation or pinching of the auditory nerve in neurology is called cochlear neuritis of the auditory nerve, which has the following classification:

1. Spicy.
2. Chronic.

In addition, typical cochlear neuritis is:

• Congenital.
• Acquired.

Acute neuritis is characterized by transient stable development. So, the patient's hearing gradually deteriorates, he begins to hear tinnitus. Distinctive feature such a state - the absence of discomfort on early stages.

The favorable course of the acute type of the disease is its reversible form, which gradually disappears completely. As a rule, such a subspecies occurs after the transfer of an infectious disease.

The chronic form of the disease often develops as a result of the lack of proper treatment and is characterized by a longer course.

In this case, the patient gradually begins to experience discomfort from symptoms, he may have a violation of social activity, the development of depression.

Often, the disease develops on one side (right-sided, left-sided), but it is also possible to develop bilateral neuritis (both left and right). Naturally, bilateral neuritis is much more difficult for patients to tolerate and causes more discomfort.

As for the congenital form of the disease, it is quite rare, and occurs during childbirth or during pregnancy, ever the lifestyle of the expectant mother or the unprofessionalism of doctors provokes pinching of the auditory nerve or injury. It is possible to pinch a nerve even after birth, but in such a situation it will no longer be a congenital type of ailment, but an acquired one.

Symptoms

One of the most important signs of cochlear neuritis is hearing loss. However, this is far from a complete list. So, the symptoms of acoustic neuritis are as follows:

• noise (ringing) in the ears - this symptom is observed constantly, with the exception of the complete deafness of the patient;
• dizziness, nausea, problems with coordination - develops in case of damage to the part of the auditory nerve responsible for balance;
• painful sensation - usually caused by damage to the eardrum or other internal organ, during acoustic trauma or TBI;
• severe headache, general weakened condition, blanching - develops as a result of poisoning the body with toxic substances, heavy metals or pill abuse;
• symptoms characteristic of infectious diseases of the upper respiratory tract or SARS (cough, fever, runny nose);
• high blood pressure is the first sign of problems with the cardiovascular system.

The most dangerous, in terms of hearing loss, is acute cochlear neuritis. With a similar variant of the course of the disease, there is a sharp increase in symptoms, worsening general condition and oppression nerve cells. If left untreated, the patient can completely lose his hearing in a few days. Therefore, the treatment of patients with a similar diagnosis is carried out only in a hospital, where the patient is hospitalized as soon as possible.

Diagnostics

Diagnostics this disease carried out by an ENT, despite the neurological nature of the disease.

To begin with, the specialist determines the degree of neglect of the disease, and at what stage the hearing loss is. To do this, use a proven method - audiometry (audiogram).

essence this study consists in the gradual supply of sounds of various frequencies into the ear of the patient.

Based on the findings, the degree of hearing loss of the patient is established. There are the following degrees:

• the first (whisper differs from a distance of 1–3 meters, colloquial speech from a distance of 4–5 meters, sounds up to 40 dB are clearly heard);
• the second (colloquial speech differs from a distance of 1-3 meters, sounds up to 55 dB are not heard);
• third (whisper is not distinguishable even at close range, sounds up to 65 dB are not heard);
• fourth (partial deafness, the patient does not distinguish sounds up to 95 dB);
• fifth (complete deafness).

Conducting audiometry is necessary in order to choose the right hearing aid for the patient.

If there are any infectious diseases in the body, or diseases of a different nature, additional diagnostics are possible, which may include:

1. Magnetic resonance imaging (MRI).
2. Computed tomography (CT).
3. Blood and urine tests.

Treatment

Treatment of acoustic neuritis begins after it has been established what caused it to develop. Since each cause has different treatment conditions and different means are used in therapy.

Treatment of cochlear neuritis in infectious diseases:

The most important thing with this treatment option is the appointment of an antibiotic that will fight main reason- infection. If you do not stop the inflammatory process, there will be no results in the treatment of neuritis.

In addition to antibiotic therapy, the patient is shown:

• a large amount of liquid
• complete rest
• taking a vitamin complex
• compliance with the diet (nutrition must be complete)

In the event that the auditory nerve began to become inflamed as a result of intoxication of the body (accumulation of harmful substances in it), it is more difficult to recover from such an ailment.

In such situation medical therapy comprises:

• the use of drugs aimed at removing the toxin from the body;
• the use of symptomatic treatment (elimination of dizziness, nausea, headache, pallor skin etc.);
• Associated treatment (physiotherapy, electrophoresis, acupuncture, sanatorium treatment, mud therapy, etc.).

It is necessary to treat neuritis of the auditory nerve acquired as a result of injuries of various nature in a hospital, since, depending on the nature of the injury, resuscitation may be required.

Among other things, the following treatment is indicated:

• taking painkillers;
• diuretic drugs (contribute to the removal of puffiness);
• drugs that improve blood flow;
• in especially severe cases, surgery is possible (to remove possible fragments of the skull or swollen areas).

In addition to treatment in the ENT department, it is mandatory to prescribe full examination brain and consultation with a neurologist.

The therapy itself consists in restoring the patient and his hearing. Hearing can be restored, but not always.

For treatment use:

• electrophoresis;
• physiotherapy;
• radon baths;
• mud treatment;
• acupuncture;
• magnetotherapy.

After complex treatment, the patient is contraindicated to be under the influence of loud sounds, since the disease may re-develop.

In the event that the hearing is completely lost, it is already meaningless to restore it, and the patient is shown hearing aids.

When age-related changes, which became the main cause of the development of cochlear neuritis, the patient will have to continue treatment for life, since the process of hearing loss is already difficult to reverse. Treatment for the elderly includes:

• taking antihypertensive drugs;
• taking anti-sclerosis drugs;
• taking antiplatelet agents and nootropic substances;
• Physiotherapy.

For an elderly person, in more than 50% of cases it is necessary to resort to the help of a hearing prosthesis, moreover, learning to read lips is possible, if the patient does not develop a degenerative disease that will make the learning process impossible.

In addition, there is a special technique for treating neuritis with a laser. This procedure is carried out only in specialized clinics and usually costs money.

The course of laser treatment is about 12 visits, followed by a repeat of the procedure after a few weeks. This technique is quite effective, its only drawback is the need to pay for each procedure.

In addition to the treatment options listed above, acoustic neuritis can be treated with folk remedies. Naturally, before applying these recommendations, it is imperative to consult a doctor in order to avoid complications.

Golden mustache

One large and two small leaves of this herb are finely crumbled and poured with boiling water. After that, it is boiled for 4–5 minutes and insisted in a thermos for up to 2 hours. It is necessary to use four times a day for 1 tsp. It is necessary to give this tincture to the patient for at least 3 weeks.

Juniper tincture

A 100 ml bottle is filled exactly halfway with juniper berries. The second half is filled with boiled water. The resulting substance is infused in a dark place for three weeks.

You do not need to drink the tincture, it is dripped into the snake every day, 3-4 drops. A positive effect appears on the 2nd week of admission.

onion drops

It is necessary to squeeze the juice from one onion head and mix it with vodka in a ratio of one to four (1 part of onion juice to 4 parts of vodka). Drip this solution into the ear no more than 2 drops per day. It is advisable to consult a doctor before use.

garlic pouch

Three drops of camphor oil are mixed with a crushed clove of garlic and the resulting substance is wrapped in gauze. This bag is placed in a sore ear and is not removed until a burning sensation appears. It's important not to overdo it. You can use this bag until the complete disappearance of painful symptoms.

At home, you can use mummy tincture. A compress is made from 10% of the tincture, which is inserted into the sore ear, and in addition, you can take 20 grams of mummy before meals in the morning. The course of treatment is not more than 10 days, after a break for 10 days and repeat. So you can alternate 3-4 times.

soy tincture

Soybeans are soaked for up to seven hours in boiled water, after which the beans are cleaned and crushed. Pour boiling water over a third of a glass and bring to a boil. After straining, you can use a decoction with honey at bedtime until the symptoms stop.

There is a recipe when a solution based on levomycetin is instilled into the ears, but we will not describe it, if your doctor sees fit, he will tell you this recipe.

And probably the most exotic type of therapy is treatment with leeches.

Acoustic neuritis can be treated with hirudotherapy.

The procedure is as follows: the patient is applied 4-5 leeches to the area behind the ears. It is necessary to carry out up to 7-9 sessions until a complete cure.

The child has

Not only an adult, but also a child can damage the auditory nerve. There are no significant differences from the causes, symptoms and diagnostic methods between neuritis in children and adults. Any cause that is typical for an adult (with the exception of age-related changes) can provoke inflammation of the auditory nerve in a baby.

The main symptom for a child, the same as for an adult, is hearing impairment, which is aggravated by concomitant symptoms.

The main difference is the treatment, or rather, in the dosage of the prescribed drugs. After all, the weight and immunity of a child is much less than an adult, and therefore active substance he needs much less of this or that medicine.

Prognosis and prevention of the disease

Many are concerned about the question, is it possible to restore hearing and completely cure cochlear neuritis? Restoration of auditory functions is a complex process when it comes to toxic or complicated neuritis, since in this situation the prognosis is not the most comforting. There is a high probability that a person may partially or completely lose hearing function.

If we are talking about the defeat of the ears with infectious diseases, then such an ailment is curable. The recovery process is much easier.

Poor recovery process and chronic course illness. In 60% of cases, such patients will be diagnosed with hearing loss. It is impossible to die naturally, from this disease, but you can get disability due to deafness.

The most important thing is to start treating as early as possible, and then the chances of a favorable outcome increase significantly.

• Avoid loud sounds, especially in close proximity to your ears. Prolonged exposure to loud music or other sounds may cause inflammation or acoustic injury;
• be sure to protect your ears from the cold, wear a hat in the cold season, this will prevent the development of ear diseases;
• do not stick various objects into your ears, so as not to damage the eardrum;
• avoid contact with toxic substances;
• give up bad habits if possible;
• follow the precautions if you are a representative of a profession that is harmful to the ears.

So, acoustic neuritis is serious and unpleasant disease, which must be treated under the supervision of a specialist. Do not delay in contacting a doctor if you do not want to lose your hearing. Take care of yourself and heal properly.

OTONEUROLOGICAL

AndOTORHINOLARYNGOLOGICAL

EFFECTSSKULL- CEREBRAL

INJURIES

D.N. Kapitanov

Otoneurological disorders in the long term after TBI have important clinical, prognostic, and expert significance (4, 5, 10).

11.1.1. vestibularviolations

Vestibular disorders are the most common in the long-term period of TBI. A significant proportion of patients complain of constant or intermittent dizziness. More often it is observed with damage to the peripheral (fissures of the pyramid) and cortical sections of the analyzer.

Spontaneous nystagmus occurs in almost half of patients who have undergone severe TBI when it is accompanied by cracks in the pyramid of the temporal bone and the base of the skull. In the late period, spontaneous nystagmus is usually central, since peripheral nystagmus disappears 2-3 weeks after injury (10) (Fig. 13-1).

Symmetrical vestibular reactions predominate, predominantly inhibited by nystagmus, often with a simultaneous increase in autonomic and sensory reflexes. The symmetry of the course of vestibular reactions is also noted in those patients in whom the cortical vestibular zone and the peripheral analyzer were unevenly damaged. This is due to compensatory changes in the vestibular apparatus in the late period of traumatic brain injury.

Rice. 11-1. Electronystagmogram of the patient one year after the transverse fissure of the pyramid of the temporal bone on the right. Asymmetric spontaneous nystagmus (right - slow, tonic; left - lively, frequent, clonic)

Much less common is a violation of optokinetic nystagmus. After hemispheric focal damage, it changes in the opposite direction from the lesion. After trauma to the brainstem, optokinetic nystagmus is impaired in all directions. In dynamics, it is often possible to note the restoration of optokinetic nystagmus (4, 10). As a residual stem symptom, a violation of the rhythm of optokinetic nystagmus, detected by electronystagmography, is often noted (Fig. 11-2).

Rice. 11-2. Electronystagmus about a gram in a patient a year after the transverse fissure of the pyramid of the temporal bone. A clear asymmetry of the horizontal optokinetic nystagmus: to the right it is slower, to the left - the rhythm is more frequent. Dysrit-miya nystagmus, multi-toothed tops of teeth.

11.1.2. Hearing disorders

A comprehensive study of hearing with modern electroacoustic methods using various tests (tonal, speech, suprathreshold audiometry) in the long-term period of TBI makes it possible to establish a higher frequency of hearing impairment than in the study with tuning forks, whispering and colloquial speech. Hearing at high frequencies is especially affected, the perception of complex sounds is impaired, speech intelligibility worsens, and there is a dissociation between tonal and speech hearing.

All patients with hearing impairment can be divided into two groups - with and without damage to the pyramid of the temporal bone. The most frequent and significant hearing loss is observed with fissures of the pyramid of the temporal bone due to damage to the peripheral auditory receptor and the auditory nerve.

11.1.3. Transverse fractures

In most cases, patients with transverse fractures of the pyramid of the temporal bone have a high degree of hearing loss or complete deafness on the side of the injury (Fig. 11-3). In this case, vestibular excitability on the side of the lesion also usually falls out, which is due to damage to the inner ear. In some patients, these symptoms are combined with a violation of taste in the anterior 2/3 of the tongue on the side of the lesion. Also in this group of patients, peripheral paresis is quite common. facial nerve on the affected side. With transverse fissures of the pyramid of the temporal bone, taste disturbances in the anterior 2/3 of the tongue and paresis of the facial nerve often proceed more or less in parallel. Such symptoms are obviously due to damage to them in the channel of the internal ear canal, where the taste fibers and fibers of the VIIth nerve pass together (5, 13).

Rice. 11-3. Tonal audiogram of a 37-year-old patient 7 years after a craniocerebral injury with a transverse fracture of the temporal bone pyramid on the left. Deafness on the left. On the right, a slight decrease in air and bone conduction by 15-40 dB, mainly at high tones (4000, 8000 Hz.)

11.1.4. Longitudinal fractures

In patients with a longitudinal fracture of the pyramid of the temporal bone, as a rule, there is no complete loss of auditory function in the residual period. With pure tone audiometry, in some patients with this pathology, hearing loss on the side of the lesion of a mixed type is detected. The conductive nature of hearing impairment is manifested by hearing loss in the range of low and medium frequencies, as well as the presence of a bone-air interval. However, in these same patients, sound perception suffers simultaneously with impaired sound conduction: hearing decreases simultaneously.

specifically and even predominantly in the high frequency range (4000-8000 Hz) with a parallel increase in hearing thresholds for these frequencies, both in air and in bone sound conduction. The main type of audiometric curves in fractures of the pyramid of the temporal bone was still with a predominance of the sensorineural component (5, 9, 24) (Fig. 11-4).

In addition, in patients with previously suffered longitudinal fractures of the temporal bone on the side of the lesion, only high-frequency sensorineural hearing loss can be noted. With complete preservation of bone and air conduction in the zone of low and medium frequencies, a parallel

Clinical Guide to Traumatic Brain Injury

Rice. 11-4. Tonal audiogram of a patient 12 months after a traumatic brain injury with a longitudinal fissure of the pyramid of the temporal bone on the right.

On the right side of the crack, there is a combined hearing loss of a sound-conducting and sound-perceiving type (at frequencies of 125-1000 Hz. There is a pronounced bone o-air gap: with intact bone conduction, air conduction is reduced by 35-45 dB; at high frequencies (2000-8000 Hz .) there is a parallel decrease in bone and air conduction by 60-85 dB.On the left, a slight decrease in hearing at high tones (4000-8000 Hz.)

increased hearing thresholds for air and bone sound conduction in the high frequency range (5).

Consequently, the data of threshold tone audiometry show that in the long-term period after longitudinal cracks in the pyramid of the temporal bone on the side of the injury, damage to the inner ear is observed in almost all cases, which can only be manifested by an audiometrically detectable hearing loss in the high frequency range. Hearing loss associated with impaired sound conduction is subsequently restored in most patients, except in cases where the fracture is accompanied by damage to the ossicular chain.

Unlike transverse fractures of the pyramid of the temporal bone, with longitudinal cracks, taste in the anterior 2/3 of the tongue on the side of the lesion suffers much less frequently and, in addition, isolated taste lesion without damage to the facial nerve predominates. The defeat of the taste fibers with the preservation of the function of the VII nerve indicates that with longitudinal cracks, the taste fibers that go as part of the drum string are more likely to suffer. This is consistent with the fact that with longitudinal cracks, the structures of the middle ear are mainly affected (5).

Application of tonal threshold audiometry allows to identify on the "healthy" side in almost all patients with damage to the pyramid of the temporal bone hearing loss at high frequencies (4000-8000 Hz.), Both with bone and air sound conduction. This is explained both by trauma to the inner ear of the "healthy" side, and damage to the auditory pathways and nuclei in the brain stem. These features highlight the breadth and

prevalence of traumatic brain injury.

With fractures of the pyramid of the temporal bone on the side of the lesion, a parallel decrease in tonal and speech hearing is much more often noted. This is characteristic of a peripheral lesion. On the “healthy” side, on the contrary, dissociation in the perception of speech and pure tones is somewhat more common.

The study of the perception of speech with an increase in its intensity to PO dB. shows that speech intelligibility under these conditions deteriorates both on the affected side and on the “healthy” side (positive speech phenomenon of accelerated volume increase - FUNG). The combination of dissociated hearing loss and positive speech FUNG can be observed both on the affected side and on the healthy side. All of these symptoms are characteristic of central hearing loss (4, 5).

11.1.5. Hearing loss

in the absence of pyramidal fractures

In the second group of patients without damage to the temporal bones with craniocerebral injury, tone audiometry very often reveals bilateral, almost symmetrical hearing loss during air and bone sound conduction in the high frequency range (4000-8000 Hz). This is due to both trauma to the inner ear and damage to the auditory stem structures (Fig. 11-5),

Orthoneurological and otorhinolaryngological consequences of traumatic brain injury

Rice. 11-5. Audiogram a 44-year-old patient 4 years after a craniocerebral injury of the fronto-parietal-temporal localization Decrease in air and bone conduction by 10-50 dB. predominantly in the high frequency range.

In addition, damage to the auditory analyzer can also occur at a higher level, which manifests itself in a particularly sharp violation of speech perception and speech-tonal dissociation.

In the group of patients without damage to the pyramid of the temporal bone within the limits of speech frequencies, tonal hearing is usually preserved in full. At the same time, there is sometimes a violation of speech intelligibility, and there is a clear dissociation between speech and tone audiometry with a predominant deterioration in the perception of spoken speech. The study of speech hearing with increasing volume often reveals a clear violation of speech intelligibility.

The phenomenon of an accelerated increase in volume, which makes it possible to differentiate hearing damage in the cochlea and retrocochlear (with cochlear damage, this phenomenon is often positive, and with retrocochlear - negative) is sharply negative in the acute period of TBI. In the long term, FUNG normalizes. With fractures of the pyramids of the temporal bone, it is often positive, but this also occurs with frontal and parietal lesions. This indicates that the positive FUN G may have a central origin. Especially sharply after an injury, hearing decreases in patients older than 50 years, as well as in patients who have undergone neuritis of the VIII nerve in the past and inflammatory processes in the middle ear (5).

11.1.6. Perception of ultrasound

allows you to more accurately localize the level of damage to the auditory analyzer in traumatic brain injury and differentiate the nature of the damage to the receptor structures of the inner ear. This has important practical and prognostic significance for hearing restoration.

So, with the same tonal audiograms of the neuritic type with hearing loss mainly at high frequencies, an increase in the thresholds for the perception of ultrasound indicates damage to the nerve elements in the inner ear, the root of the auditory nerve or in the brain stem, while more low thresholds the perception of ultrasound with a similar decrease in tonal hearing is noted with damage to the sound-conducting media of the inner ear (post-traumatic hydrons), which is prognostically considered more favorable.

Somewhat more often, auditory sensitivity to ultrasound suffers in patients with fissures of the pyramid of the temporal bone and, to a lesser extent, in patients after a craniocerebral injury that occurs without fissures of the pyramid. Violations of the perception of ultrasound occur with the same frequency in the acute and late periods of injury and indicate irreversible impairment of sound perception in the inner ear, auditory nerve and brain stem. In the study of the lateralization of ultrasound much more often and more clearly than in the study of the lateralization of the sounds of the audible part of the spectrum in Weber's experiment, the lateralization of ultrasound towards the better hearing ear is detected and, thus, even slight disturbances in sound perception in the inner ear and root VIII are detected nerve as a result of injury. Lateralization of sound in Weber's experiment with a mixed nature of hearing loss more often than ultrasound reveals sound conduction disturbances.

Clinical Guide to Traumatic Brain Injury

According to the ratio of sound lateralization in the Weber experiment and ultrasound, taking into account the nature of tonal audiograms, it is possible to clarify the level of damage to the auditory pathways and differentiate damage to the hair cells of the cochlea and root VIII nerve in the central sections, which is important for the prognosis of auditory disorders and the course of the disease.

In some cases, there is a progressive hearing loss due to damage to the inner ear even after a slight concussion of the labyrinth (24, 38). So, a number of authors emphasize that in the long term the state of hearing is not stable, in some patients it is subject to fluctuations. This pattern is observed in relation not only to auditory, but also to vestibular disorders. This can be explained by dynamic disorders of blood and liquor circulation, exacerbation of post-traumatic arachnoencephalitis due to cooling or infectious diseases, and the presence of post-traumatic perilymphatic fistulas. (44, 57, 58).

11.1.7. Olfactory disorders

Olfactory disturbances occur with fractures or hemorrhages in the basal-medial sections of the anterior and middle cranial fossae, as well as with foci of contusion softening in the basal-temporal sections of the brain. At the same time, delicate olfactory filaments, olfactory triangles and tracts in the frontal-medial-basal regions, as well as cortical olfactory formations in the temporomedio-basal regions due to their bruises are most often damaged. Often, olfactory disorders are observed in fractures of the cranial vault and occipital bone due to counter-strike. In the remote period, various olfactory disorders occur in almost half of the patients. Can be found as complete loss sense of smell, and its decrease varying degrees. There is also impaired odor recognition and olfactory hallucinations (4, 5).

The importance of otonserological symptoms in the residual period is determined by their high frequency, they occur in 94% of cases. Vestibular disorders in the vast majority of observations in the residual period are compensated, hearing improves.

The reduction of compensatory possibilities in the restoration of hearing and vestibular function is facilitated by previously transferred neuritis of the VIII nerve, elderly age patients with the addition of vascular disorders, very severe neo-

fraternal damages of these analyzers at

11.1.8. Treatment

post-traumatic dizziness, subjective tinnitus and sensorineural hearing loss.

Comprehensive rehabilitation of patients with post-traumatic sensorineural hearing loss, subjective tinnitus, hyperacusis and vestibular disorders is based on a combination of pharmacotherapy, physiotherapy, psychotherapy, reflexology, intravascular detoxification therapy.

Drug treatment is aimed at improving microcirculation and activation of metabolic processes in the affected areas of the vestibular and auditory analyzers, dehydration, and relief of inflammation. For this purpose, drugs are used:

A) improving the supply of oxygen to tissues, reducing the aggregation of blood elements and its viscosity (trental i/v 0.1 g, cavinton i/v 10-20 mg per 250-500 ml of rheopolyglucin or isotonic solution; xanthinol nicotinate i/m or i/v 2.0 ml)

B) improving the permeability of cell membranes, in particular vascular wall and activating redox and reparative processes (vitamin C intravenously up to 100 mg/day, cocarboxylase 100-200 mg intravenously, phosphobion 2- 4 ml intravenously, vitamins of group "B" and "E" intramuscularly, methiol, mexidol)

B) neuroprotective therapy (nootropil, glycine, gliatilin 1 capsule 3 times a day, cerebrolysin up to 5.0 ml/day intravenously or intramuscularly)

D) dehydration agents (manitol 250-400 IV, 40% glucose solution 20 ml IV, diacarb 0.25 g, triampur 0.1 g orally every other day for 3-5 days.)

E) sedatives (valerian root, motherwort), tranquilizers (relanium, phenazepam, tazepam orally up to 20 mg/day)

In addition, small doses of corticosteroid drugs are administered (prednisolone IV 30-60 mg for 3 days), which have anti-inflammatory, desensitizing and antiexudative effects. According to the indications, antibiotic therapy is carried out (abaktal, 1 tab. 2 r / day) and antihistamines (Telfast, 1 tab. / day).

Orthoneurological and otorhinolaryngological consequences of traumatic brain injury

With dizziness, atropine drugs, torekan, and also betaserk are prescribed. Betahistine hydrochloride - Betaserc - is a drug that promotes the accumulation and release of histamine in the neuronal synapses of the central and peripheral nervous system. The drug Betaserc has a prohistamine effect on the postsynaptic membrane. Dizziness is blocked due to the agonistic effects of Betaserc on the central and peripheral HI receptors. On the periphery, Betaserc increases microcirculation in the inner ear, improves cochlear blood flow. Central histamine receptors under the influence of Betaserc get the opportunity to compensate and accelerate vestibular adaptation.

During an acute attack of dizziness, it is advisable to prescribe 2-3 tablets - 24 mg of Betaserc once, which stop the attacks of dizziness after 30-45 minutes. Drug therapy is prescribed in courses of 1-2 months and goes well with taking betaserc, the course of which is 1-2 tablets 3 times a day.

Medical therapy also needs to be supplemented therapeutic gymnastics, massage of the cervical-collar zone, which improves blood circulation in the affected area, electrophoresis with aminophylline on the cervical-collar zone No. 10.

In the treatment of sensorineural hearing loss and subjective tinnitus, the method of treatment with fluctuating currents is used. Fluctuorization is a method of exposure with a therapeutic purpose of aperiodic alternating current of low strength and low voltage, randomly changing in amplitude and frequency within 100-2000 Hz. The effect of fluctuating current, depending on the method of its application, dose and disease, is transformed to a greater extent through the central and autonomic nervous system. This action is based on the ability of fluctuating currents to activate tissue trophism, enzymatic activity and the process of resorption of toxic substances of tissue decay as a result of short-term hyperemia. The course of treatment is 10 daily procedures. The duration of each ranges from 10 to 20 minutes.

In addition, a pulsed low-frequency electromagnetic field is used, which has an analgesic and sedative effect, which has a positive effect on neurodynamics and microcirculation. The course of treatment is 10 sessions lasting 9 minutes. Applied pulse

low-frequency physiotherapy device "INFITO".

Also in the treatment of subjective ear noise, transcutaneous electrical stimulation is used. This technique using direct current is based on the depolarizing effect on the structures of the inner ear. The course of treatment includes 10 sessions of 20 minutes each.

As a psychocorrective agent in the treatment of subjective ear noise, special "tinnitus maskers" can be used, generating noise in the range of 1000 - 25000 Hz and representing a behind-the-ear device in the form of a hearing aid. The positive effect is that as a result of regular use of the masker (from 2 weeks to several months), the patient develops the ability to not notice the previously disturbing subjective tinnitus, which is regarded as a decrease in this symptom.

11.2. Damage to the structures of the middle and inner ear in traumatic brain injury

Combined injuries of the facial skeleton, the walls of the paranasal sinuses, which are closely associated with the base of the skull, and the structures of the middle and inner ear are not uncommon in traumatic brain injury. In the acute period of TBI, they are often hidden by cerebral and focal neurological symptoms, manifesting itself more strongly in the remote period.

11.2.1. Etiology

Traumatic damage to the structures of the ear can occur when exposed to a variety of damaging (exogenous and endogenous) factors. Ear injury can occur as a result of changes in pressure in the external auditory canal and / or tympanic cavity, when solid objects are introduced into the external auditory canal, during thermal exposure, lightning strikes, and also as a result of traumatic brain injury.

Ear injuries are a very common comorbidity with blast injuries, accounting for about 32% of all terrorist bombing accidents in peacetime (19). In modern local wars, ear injuries account for 83.3% of all explosive injuries to ENT organs (14). Such damage as a result of a momentary change in ambient pressure can lead to extensive

K-Tnicheskoe Guidance on Traumatic Brain Injury

damage to the structures of the middle and inner ear. The degree of tissue destruction directly depends on the strength of the shock wave per unit area, and in the case of an explosion, on the distance between the person and the epicenter of the explosion.

11.2.2. Pathogenesis

With a longitudinal fracture of the pyramid of the temporal bone, as a rule, damage to the skin of the auditory canal and tympanic membrane occurs, sometimes accompanied by severe bleeding from the auditory canal and hemorrhage into the tympanic cavity. In this case, dislocation or rupture of the joints of the auditory ossicles may occur (24). The following possible mechanisms of this type of damage are considered (38):

strong concussion on impact, causing a fracture of the bones of the skull, can be the cause of separation and weakening at the points of connection of the auditory ossicles;

the inertial movement of the chain of auditory ossicles during a blow to the head can cause damage to it as a result of sharp acceleration or deceleration;

at the time of the head injury, spastic contracture of the intratympanic muscles can occur, causing a sudden change in the axis of rotation and displacement or damage to them as a result of this "twisting" action.

Facial nerve injuries occur in approximately 20% of this type of injury (13).

With fractures of the temporal bone, in addition to direct mechanical damage, often

there is a contusion of the inner ear, concussion of intralabyrinthine fluids as a result of a bruise, secondary compression of tissue structures due to edema or hemorrhage in the cochlea (2). This is confirmed by histopathological findings in the study of temporal bones with various types of fractures. In some cases, even if the fracture line did not pass through the inner ear. the authors found the presence of blood in the cochlea, damage to the integumentary and Reissner membranes, cells of the organ of Corti, and degeneration of ganglion cells. With any fracture of the pyramid of the temporal bone, ear liquorrhea is possible both with a damaged and with an intact tympanic membrane (57) (Fig. 11-6).

With a closed TBI that is not accompanied by a fracture of the temporal bone, auditory and vestibular disorders may also occur as a result of concussion of the labyrinth. According to the literature, damage to the peripheral labyrinth often occurs when hitting a fixed, motionless head. The shock wave in such injuries propagates along the bones of the base of the skull, causing excessive mixing of the base of the stirrup as a result of strong inertia in the ossicular chain. Changes in the cochlea associated with this mechanism of injury have been described (52). Damage to the organ of Corti has been noted to be similar to damage resulting from acoustic trauma. A blow to the head can cause high-frequency hearing loss, more pronounced around 4 kHz.

In case of head injuries, accompanied by strong acceleration or deceleration, damage

Rice. 11-6. KG of the temporal bone in the axial projection. Cut thickness 1mm.

A longitudinal fracture of the pyramid of the temporal bone is determined, as well as a fracture of the mastoid process. The mixing of the auditory ossicles in the anterior-superior direction. Diastasis between the head of the malleus and the body of the anvil up to 1.5 mm.

Orthoneurological and otorhinolaryngological consequences of traumatic brain injury

are often central. K.Makishima et al. (44) in the experiment on guinea pigs showed that this type of injury causes hemorrhages in the auditory nerve and its ruptures, as well as hemorrhages in the brain tissue. At the same time, degenerative changes were found in cochlear and vestibular neurons and blood in the scala tympani. Changes in the maze were insignificant and physiological tests confirmed the partial preservation of cochlear function. Whiplashes to the head and neck will cause damage to the central nervous system as well as to the vascular structures of the neck, leading to ischemia of the inner ear and brain (56). With a closed head injury, the membranes of the labyrinthine windows can rupture with the formation of an imphatic fistula railing, both as a result of an increase in intracranial pressure and due to excessive displacement of the base of the stirrup during the passage of a shock wave along the ossicular chain.

11.2.3. traumatic

railing imphatic fistula

In the literature, special attention is paid to the mechanism of development of traumatic perilymphatic fistulas. In addition to mechanical damage to the bone capsule of the inner ear as a result of a fracture of the pyramid of the temporal bone or fragmentation of the base of the stapes in the vestibule window, a perilymphatic fistula may occur in the vestibule window or cochlear window due to damage to the membranes (Fig. 11-7).

Since the late 1960s, otologists who have studied auditory and vestibular disorders resulting from various injuries have noted that the reason for this may be the outflow of perilymph into the middle ear through a fistula in the stapedovestibular ligament or the secondary membrane of the cochlear window. According to a number of authors, labyrinth fistulas accompany traumatic perforations of the tympanic membrane in more than half of the cases (27, 29). Traumatic fistulas of labyrinthine fenestrae are also possible in a third of patients with an intact tympanic membrane, detected only during diagnostic tympanotomy (46). According to the literature, traumatic fistulas occur more frequently in the vestibule window than in the cochlear window. However, J.Farmer (28) noted that only fistulas of the cochlear window occur in barotrauma.

Rice. 11-7. Variants of localization of traumatic fistulas of the tympanic cavity

There are two main mechanisms for fistula formation of the cochlear fenestra and vestibule (34). In the first, explosive mechanism, a rupture of the secondary membrane (less often, the annular ligament) occurs from the side of the inner ear as a result of an increase in the pressure of the intralabyrinthine fluid, which, in turn, occurs with an increase in intracranial pressure. The latter can occur with intense physical stress, straining, especially with obstructed venous outflow or after taking large doses of alcohol, etc. A sharp increase in the pressure of the cerebrospinal fluid is transmitted through the cochlear aqueduct to the perilymphatic system and through the scala tympani to the secondary membrane, damaging it. In addition, the pressure of the perilymph through the basilar membrane extends to the median scala, and through the Reissner membrane to the scala vestibule and the base of the stirrup, leading to rupture of the annular ligament. High blood pressure CSF can also be transmitted to the intralabyrinthine fluid through the internal auditory canal through the sieve plate into the vestibule, also leading to rupture of the anular ligament. The second, impiosive, mechanism of fistula formation is associated with an increase in pressure in the tympanic cavity and rupture of membranes from the tympanic cavity. Such damage can occur when the pressure in the external

Clinical Guide to Traumatic Brain Injury

ear canal, often accompanied by perforation of the eardrum. When the target of the auditory ossicles is displaced and the base of the stirrup is immersed, the stapedoves-tibular ligament is also torn. In TBI, a combination of both mechanisms is possible in the formation of perilymphatic fistulas.

11.2.4. Treatment

Treatment of patients with injuries of the middle and inner ear includes surgical intervention(with rare exceptions, for example, in case of deafness or "purely" neurosensory hearing loss, when the integrity of the eardrum is not broken) and conservative treatment - preoperative (ear cleaning, anti-inflammatory and dehydration therapy, if necessary - biostimulants, physiotherapy, etc.) and postoperative ( antibiotics, dehydration therapy, drugs that improve blood flow and microcirculation, physiotherapy, etc.).

11.2.5. Indications for surgery

Indications for surgery are: isolated perforations of the tympanic membrane that do not tend to self-heal, as well as conductive hearing loss without damage to the membrane, which may indicate damage to the ossicular chain. If a traumatic fistula of the labyrinthine windows is suspected, regardless of the condition of the tympanic membrane, it is necessary to perform tympanotomy with revision of the labyrinthine windows, since in most cases only during the operation it is possible to reliably determine the presence of a fistula and simultaneously perform its plastic surgery. Thus, surgical treatment should be performed in all patients with a history of trauma, who, according to the examination, have damage to the ossicular chain and/or a combination of at least two of the listed signs of traumatic perilymphatic fistula: increased hearing thresholds for bone and air sound conduction, dizziness (permanent or episodic) after injury or unsteady walking, high-frequency or mixed tinnitus, hearing fluctuation, positive fistula symptom. Surgery also performed with transverse fissures of the pyramid of the temporal bone, passing through medial wall tympanic cavity (according to CT data), since with

In this type of traumatic injury, a long-term existence of a perilymphatic fistula is also possible, requiring surgical closure.

11.2.6. Types of surgical treatment

Depending on the amount of damage, the operation includes myringoplasty, ossiculoplasty, plastic closure of the fistula. All these stages are carried out sequentially using auto-canes - fascia, cartilage, bone, perichondria; sponges are sometimes used drug to prevent displacement of the formed membrane and the reconstructed ossicular chain.

11.2.7. Forecast

In traumatic perilymphatic fistulas, the best prognosis for improvement in auditory function is in those patients (provided that the fistula closes early) in which fistula formation is not accompanied by significant damage to the structures of the inner ear. Basically, these are patients with a rupture of the secondary membrane as a result of barotrauma or with a rupture of the annular ligament, not accompanied by a significant displacement of the stirrup with direct mechanical trauma. With a long-term perilymphatic fistula (regardless of the type of injury), there is a gradual increase in bone sound conduction thresholds and persistent hearing loss even after fistula closure. With indirect mechanical injuries, the most severe functional disorders occur with transverse fractures, when the fracture line passes through the cochlea or the internal auditory meatus. More often, with this type of injury, irreversible deafness or a high degree of hearing loss occurs as a result of mechanical damage to the structures of the inner ear, concussion, or hemorrhage. Therefore, a reconstructive hearing-improving operation does not make sense. However, after surgical closure of perilymphatic fistulas of the cochlea, there is a decrease in tinnitus and dizziness, as well as a decrease in the risk of infectious complications. A good prognosis for hearing restoration is in patients with longitudinal fractures of the temporal bone, accompanied by damage to the ossicular chain, but

Orthoneurological and otorhinolaryngological consequences of traumatic brain injury

without damage to the base of the stirrup, regardless of the time of the hearing-improving surgery. At the same time, if the stirrup is suspected to be immersed, it is necessary to perform the operation as soon as possible. early dates, since due to the formation of adhesions in the vestibule with a late reposition of the base of the stapes, additional surgical trauma can lead to the final death of already damaged structures of the inner ear.

Thus, a variety of pathogenetic factors leads to various damage to the structures of the ear and their combinations, which explains a wide range of clinical symptoms. In some cases, according to the mechanism of injury, it is possible to assume the nature of damage to the structures of the ear.

24645 0

Occupational diseases of the ear are one of the main objects of study of occupational pathology. These diseases occur in workers in industries where the main occupational hazards are noise and vibration. In addition, the hearing organ can be adversely affected by accelerations, chemical factors, electromagnetic waves, and combinations of these factors.

The effect of noise on the organ of hearing

Under industrial noise understand a chaotic combination of sounds that differ in intensity, frequency and temporal parameters, merged into a discordant sound that usually interferes or irritates a person (Kosarev V.V., Eremina N.V., 1998). The harmful effect of noise is determined by several factors: intensity, frequency, duration, nature (stable, impulsive, unstable).

According to the spectral composition, the noise is divided into low-, medium- and high-frequency. Noises whose maximum sound energy is in the range below 300 Hz are classified as low frequency. Such noises are generated by low-speed non-impact units. They penetrate well through soundproof barriers. midrange noises are considered to have the highest intensity in the frequency range from 300 to 800 Hz. These noises occur during the operation of most machines, machine tools and non-impact units. high frequency noises are characterized by the highest intensity level in the frequency zone above 800 Hz. They are generated by impact units, high-speed machines, strong air and gas flows. In addition to sound waves in the audible frequency range, industrial noise may include infrasounds(less than 16 Hz) and ultrasounds(above 20 thousand Hz), which are usually not perceived by the human ear as sound signals, but are not indifferent to the auditory analyzer and the body as a whole.

According to sanitary standards, noise at workplaces, in the premises of residential, public buildings and on the territory of residential development are divided into the following categories:

1) by the nature of the spectrum:

• broadband noise with a continuous spectrum with a width of more than 1 octave;
• tonal noise, in the spectrum of which there are pronounced tones, the excess of which in one band over the neighboring ones is at least 10 dB;

2) according to time characteristics:

• constant noise, the sound level of which changes by no more than 5 dBA during a work shift;
• intermittent noise, the level of which changes by more than 5 dBA during a work shift.

Intermittent noises are divided into:

1) fluctuating, the intensity of which is continuously changing;

2) intermittent noise, the sound level of which changes stepwise (by 5 dBA or more), and the duration of the intervals during which the noise level remains constant is 1 s or more;

3) impulse noise, consisting of one or more sound signals, each with a duration of less than 1 s, while the sound levels of these noises differ from the background sound by at least 7 dB.

As permissible levels of industrial noise, depending on its frequency in our country, the following are accepted:

• for low-frequency noise (from 31.5 to 250 Hz) - 85-100 dB;
• for mid-frequency noise (more than 250 Hz and up to 1000 Hz) - 80-90 dB;
• for high-frequency (more than 1000 Hz) - 75-80 dB.

Occupational noise levels exceeding the MPC by 10-15 dBA are the most unfavorable prognostic in relation to the development of occupational hearing loss. Even a short stay in areas with sound pressure levels above 135 dB in any octave band is prohibited.

Noise sources

Almost all mechanisms and machines that have moving parts that cause vibration or aerodynamic disturbances can be sources of noise. Some production processes of the modern engineering industry are characterized by noise with a maximum of sound energy at frequencies in the range of 250-4000 Hz, exceeding the permissible levels by 20-25 dBA, and in some areas - by 25-40 dB. The most noisy works are carried out in cold heading shops (noise reaches 101-105 dB A), in nailing (104-110 dB A), forging and stamping (115 dB A), polishing (115-118 dB A) shops. The use of pneumatic tools is accompanied by noise, the level of which reaches: when cutting - 118-130 dB A, when grinding - 110-118, when ramming - 102 dBA (Kosarev V.V., Eremina N.V., 1998). High levels of industrial noise accompany routine tests of engines.

In the shipbuilding industry, a significant part of the production noise is generated by pneumatic tools. Its average level is 85 dB A; individual works are accompanied by noise with an intensity of 120-130 dB A.

On ships, the main source of noise is the main and auxiliary engines. In the engine rooms of ships, the sound pressure level is 30-40 dB higher than in other rooms.

Jet engines of rockets and airplanes are powerful sources of noise and infrasound. Thus, it is known that during the takeoff of turbojet aircraft of the TU-154 type, with a total noise in the cabins of the order of 100 dB A, the infrasound levels are 80 dB.

The noise level in various sections of railway transport exceeds the MPC by 5-30 dB (V. B. Pankova, 2002; T. V. Drozdova, 2006; and others).

In the woodworking industry, power tools are the main source of noise. The noise has a predominantly high-frequency character (1600-3200 Hz), its intensity corresponds to 85-90 dBA.

Noise in the textile industry associated with the operation of the main equipment, in some cases, it exceeds the sanitary standards by 5-30 dB.

A special place is occupied by industries whose technological processes are accompanied by the formation impulse noise. These include the work of pistol fitters, punchers, press workers, blacksmiths, etc. High-intensity impulse noise (100-115 dBA) occurs when firing from firearms, jet and other types of weapons. The energy contribution of the impulse to the total noise load reaches more than 65%. The frequency of noise pulses generated by most presses is 15-60 per minute, peak intensity levels reach 114 and 135 dBA. Impulse acoustic impact is more aggressive, and it is more difficult to adapt to it.

Hearing loss due to action ultrasound, develop faster, they are more pronounced and persistent. The impact of ultrasound on biological structures can be divided into mechanical (tissue micromassage); physical and chemical (acceleration of diffusion processes through biological membranes and change in the rate of biological reactions); thermal and cavitation process (cell destruction).

The pathogenesis of occupational hearing loss

Noise as an adequate stimulus has a direct effect on the peripheral part of the auditory analyzer, causing dystrophic and atrophic changes in it in receptor cells spiral organ of the cochlea and spiral ganglion neurons. Also reacts to strong sounds. auditory cortex large brain, in the cells of which biochemical and histological changes occur, similar to those observed in severe stressful situations.

A certain role in the pathogenesis of hearing impairment of noise etiology is assigned to subcortical hearing centers and their regulatory trophic influence on the structures of the auditory analyzer.

acoustic trauma

It arises as a result of the action on the hearing organ of prolonged or impulse noise, or vibration, exceeding in intensity the permissible hygienic standards or the individual tolerance of the receptor structures of the inner ear to these irritants. Simultaneously with hearing impairment vibroacoustic impact also causes violations of the vestibular function.

Chronic acoustic trauma

Etiology. The cause of chronic acoustic trauma is intense and long-lasting noise during the entire working time.

Pathogenesis is determined by two main factors: noise characteristics (frequency spectrum and intensity) and susceptibility or inverse property - the individual resistance of the hearing organ to the damaging effects of noise. High-frequency components of noise have the most damaging effect. Noise exposure determines the "accumulation" of the damaging effect and is actually a factor in the probation of a given individual in a given production. During exposure to noise, the organ of hearing undergoes three stages of development of occupational hearing loss: a) stage of adaptation, in which there is a slight decrease in auditory sensitivity (by 10-15 dB); the cessation of noise at this stage leads to the restoration of hearing to a normal (initial) level within 10-15 minutes; b) with a longer exposure to noise, fatigue stage(hearing loss of 20-30 dB, the appearance of high-frequency subjective tinnitus; the restoration of auditory function occurs after a few hours of being in a quiet environment); in) stage of organic change in the spiral organ, in which hearing loss becomes significant and irreversible.

pathological anatomy. The impact of noise has a destructive effect on the structures of the spiral organ. The outer hair and supporting cells are the first to suffer, then the inner hair cells are also involved in the degenerative process. Prolonged and intense exposure to sound leads to the total death of the spiral organ, ganglion cells of the nerve spiral node and nerve fibers.

Clinical picture occupational hearing loss consists of specific and nonspecific symptoms. Specific symptoms relate to auditory function, the impairment of which progresses depending on seniority and have a typical perceptual character. Patients complain of subjective high-frequency tinnitus, decreased tonal and speech hearing. Nonspecific symptoms are characterized by general fatigue, increased stress when solving production problems, drowsiness during working hours and sleep disturbance at night, decreased appetite, increased irritability, and increasing signs of vegetative-vascular dystonia.

The mechanism of disorders in the body of persons working with impulse noise is characterized by a more significant and persistent irritating effect and the difficulty of adapting to noise. According to the results of a number of studies, a moderate and significant degree of occupational hearing loss is detected when exposed to impulsive noise 2-5 times more often than in people working in conditions of constant noise exposure.

In table. 1 shows the data of the auditory passport for occupational hearing loss, in fig. 1 - the magnitude of hearing loss in dB for different degrees of occupational hearing loss.

Table 1. Auditory passport of a patient with occupational sensorineural hearing loss of noise genesis

Rice. one. Air conduction audiograms in occupational sensorineural hearing loss (according to N. N. Petrova, A. T. Pakunov, 2009): a — mild hearing loss; 6 - moderate degree; in - a pronounced degree

Treatment complex, multifaceted, including the use of medication, individual and collective prevention, as well as measures for the rehabilitation of hearing impairment. Treatment and other measures to prevent the development of occupational hearing loss are most effective if they are carried out in the early stages of the disease.

Drug treatment of patients includes the use of nootropic drugs (piracetam, nootropil), γ-aminobutyric acid compounds (aminalon, gammalon) in combination with ATP, B vitamins, drugs that improve microcirculation (benciclane, venciclane, trental, cavinton, xanthinol nicotinate), antihypoxants (complexes of vitamins and microelements). Drug treatment should be carried out simultaneously with hyperbaric oxygen therapy. Rehabilitation measures include sanatorium treatment, preventive courses drug treatment on an outpatient basis or in dispensaries. Important are the means of collective (engineering) and individual (the use of protective ear plugs such as "ear plugs") prevention, exclusion of smoking, alcohol abuse.

Acute acoustic trauma

Under the influence of powerful short-term sounds (more than 130 dB), as well as during an explosion, a shot due to a production or emergency production situation, certain changes may occur in the auditory analyzer, qualified as acute sound injury. At the same time, a high intensity of sound pressure is of decisive importance in the mechanism of damage, which significantly distinguishes it in physical parameters from ordinary industrial noise.

In acute acoustic trauma in the inner ear, rupture, displacement, and even destruction of individual elements of the cochlea are determined. Such changes are localized in the main coil of the cochlea, which leads to a decrease in the perception of high sounds (fifth octave). Microcirculation disorders are observed, hemorrhages can be observed in the peri- and endolymphatic spaces, which also creates unfavorable conditions for the functioning of the neuroepithelium. The diffuse nature of the lesion noted at the first time after an acute sound injury causes a significant impairment of the auditory function. As the hemorrhage resolves, auditory thresholds can mosaically recover. When a part of the thrombus is replaced with connective tissue, a separate section of the cochlea with hearing loss at certain frequencies remains persistently affected. Clinical and experimental studies have shown that intense sound exposure, exceeding the pain threshold of the human ear, causes widespread changes, most pronounced in those whorls of the cochlea that correspond to the perception of the spectral composition of the affecting sounds. In the spiral knot, pronounced changes are usually not observed during short-term exposure to strong sound.

Explosive ear injury is a complex of injuries caused to the body by impulse mechanical energy, which is released at the time of the explosion and is carried by air or water. In addition to the shock wave, a powerful sound is a constant component of the explosion. However, its action during an explosion is secondary, due to the slower propagation of a sound wave to the organ of hearing than the propagation of a shock wave to it. In an explosion with an intense shock wave, a general contusion damage to the body develops with the involvement of all parts of the sound analyzer in the process. An increase in atmospheric pressure created by an explosion or a shot can lead to significant damage to the sound-conducting apparatus: rupture of the tympanic membrane, ossicular chain, rupture of the secondary membrane of the cochlear window, hemorrhages into the thickness of the tympanic membrane, muscles, mucous membrane tympanic cavity and cells of the mastoid process, a vascular strip. Changes in the inner ear are caused by damage to its sensory elements due to hydrodynamic impact (direct action through the cochlear window when its membrane is ruptured) and vascular disorders caused by the blast wave (indirect effect).

Clinical picture of acute sound injury. Symptoms of acute occupational "cochleoneuritis" are pronounced. With the combined effect of sound and barometric factors, along with damage to the sound-perceiving apparatus, symptoms of middle ear damage are observed. Clinically, acoustic trauma (acute occupational sensorineural hearing loss) can be manifested by temporary stunning, in which there is a sharp increase in hearing thresholds, and a sensation of ringing in the ears. Immediately after the injury, patients report hearing loss, often bilateral, and stuffiness in the ears, accompanied by short-term non-systemic dizziness, unsteady gait, and diffuse headache. The lesion is unilateral and bilateral, depending on the position of the person's head in relation to the sound source.

With the combined effect of sound and barometric factors, conductive hearing loss with an air-bone interval of 20-35 dB is most often diagnosed. The largest air-bone interval (up to 50-60 dB) was observed in patients with ossicular chain rupture. In second place in frequency is mixed hearing loss with maximum increase hearing thresholds for bone conduction at conversational frequencies up to 45 dB, at frequencies of 4-8 kHz - up to 60 dB. In the third most common place, high-frequency sensorineural hearing loss is observed. According to speech audiometry, an increase in speech intelligibility thresholds is detected, which is more pronounced in patients with mixed hearing loss.

Treatment in acute acoustic trauma, it is determined by the degree of general and local signs of damage. With general contusion syndrome - therapeutic measures in accordance with neurological indications. In case of traumatic damage to the middle ear, treatment is aimed at preventing its infection, stopping the pain syndrome.

The effect of vibration on the organ of hearing

Vibration, as well as industrial noise, with prolonged exposure to the body, in addition to various manifestations vibration sickness, characterized by osteoarticular lesions, impaired activity of the nervous system, as well as pathological changes developing in the receptor apparatus of the organ of hearing, its conductor and nuclear-cortical centers.

The pathogenesis of the disease is due to the impact of the energy of mechanical vibrations on the human body when working with various vibration units (hand-held mechanical tools of percussion or rotational action), as well as when staying on vibrating platforms or in mobile vehicles (tractors, combines, rail vehicles, engine compartments, helicopters and etc.).

To assess vibration, the following indicators are used: amplitude, speed, acceleration, frequency. It is assumed that the effect of vibration on the human body is due to the amount of energy transferred to biological tissues. This amount of energy is determined by the resulting shifts in organs, tissues and in the body as a whole.

Vibration in a wide range of frequencies corresponding to 8-10 octave bands acts on a person in production conditions. Vibrations affecting a person are divided into general and local (local, contact). Under the local vibration is understood the application of vibrations to a limited area of ​​the body, and under the general vibration of the body, transmitted from the workplace. The so-called resonant frequencies when the frequency of vibration is close to or coincides with the frequency of natural oscillations of individual parts of the body and human organs. In this regard, the organ of hearing (spiral organ) is most susceptible to the dangerous effects of high-frequency vibrations, in which sensorineural hearing loss develops, similar in pathogenesis to hearing loss of noise genesis.

Etiology. Vibration is a mechanical vibration created or experienced by a body. Its physical characteristics are period, frequency, acceleration and energy. The frequency of vibrational oscillations, as well as sound ones, is expressed in hertz, the energy is in relative units of dB, the amplitude of oscillations is in millimeters. Vibration with a frequency in the range of 30-1000 Hz most often has an adverse effect. For the sanitary and hygienic characteristics of industrial vibration, the spectrum of its constituent frequencies, vibration velocity or vibration acceleration are determined.

Depending on the spectrum, the production vibration is divided into broadband with a continuous spectrum more than one octave wide and sinusoidal, in the spectrum of which one frequency stands out.

By temporal characteristics distinguish:

a) constant vibration, at which the frequency changes no more than 2 times;

b) fluctuating vibration, the frequency of which changes by more than 2 times.

Intermittent vibration is divided into:

• fluctuating in time;
• intermittent;
• impulse.

By way of influencing a person production vibration is divided into local and general.

The general vibration generated by the supporting surfaces of vibrators, platforms, affects the body of a seated or standing man. According to the frequency composition, it is characterized as low frequency(2 and 4 Hz), midrange(8 and 16 Hz), high frequency(31.5 and 63 Hz).

By origin the total vibration is subdivided into transport, transport-technological, technological.

On the vehicles and self-propelled machinery, low-frequency vibration prevails with the highest levels from 1 to 8 Hz. The vibration of workplaces of process equipment operators is characterized by medium and high-frequency nature of the spectrum with a maximum intensity in the range of 20-63 Hz. General vibration is a constant process factor in cement and concrete plants.

At the workplaces of truck drivers, vibration levels exceed the maximum allowable remote control (107 dB, or 1.1 m / s 2) by 4-6 dB, reaching these values ​​​​in the region of 4 Hz - 122 and 8 Hz - 115 dB. Vibration levels on tractors of different classes exceed the permissible values ​​by 6-15 dB within 2-4 Hz, resonant for the human body. The vertical and horizontal vibration of the tram and trolleybus driver's workplaces represents broadband low-frequency processes with a maximum vibration velocity corresponding to 4-8 Hz and an intensity of up to 108 dB. The highest levels of vibration velocity were recorded on the seat of the excavator driver during bucket filling and turning - at a frequency of 4 Hz, it is 16-18 dB higher than the norm and 8 Hz by 3-4 dB. On bucket-wheel excavators, a broadband, predominantly low-frequency vibration is recorded, exceeding the MPC by 28 dB in the 8 Hz region. On construction excavators, the level of vibration velocity on the seats is higher than on the floor, exceeding the norm reaches 18 dB. Vertical vibration on the driver's seats and the cabin floor on the main types of overhead cranes exceeds the standard level within 8-16 Hz up to 16 dB.

Clinical picture. The action of vibration on the organ of hearing leads to sensorineural hearing loss of varying degrees. Since the constant companion of vibration is broadband noise, the harmful factor in this case should be defined as vibronoise effect with mutual potentiation of the harmful effects of both components. Clinical signs under vibronoise exposure, they develop within the limits of vibration disease and are characterized by the rapid development of sensorineural hearing loss, tinnitus, and often symptoms of chronic vestibulopathy.

Treatment provides for the same measures as for general vibration disease and for sensorineural hearing loss of noise and toxic genesis.

Prevention. Patients are subject to transfer to work not related to the impact of the noise-vibration factor. Individual and collective means of protection are assigned, rehabilitation measures in dispensaries and sanatorium treatment.

Otorhinolaryngology. IN AND. Babiak, M.I. Govorun, Ya.A. Nakatis, A.N. Pashchinin

Update: December 2018

Hearing is one of the sense organs that provides a normal quality of human life. With its defeat, a person cannot fully perceive the sounds of the surrounding world: speech, music, industrial noise, and so on. In 73% of cases, hearing loss is caused by sensorineural hearing loss. In this condition, one of the sections of the auditory nerve is damaged, often irreversibly.

To date, there is "confusion" with the designation of the diagnosis. On the Internet, medical reports and old monographs, you can find the following terms: cochlear neuritis, neuritis / neuropathy of the auditory nerve, perceptual hearing loss. All these are outdated concepts that lost their relevance in 1992 along with the release of the 10th edition. International classification pathologies (ICD-10). These recommendations proposed a general concept - "sensorineural hearing loss".

Anatomical features of the auditory nerve

The auditory nerve is the VIII cranial pair. Its pathway is of no clinical significance in this disease, as the level of the lesion does not affect the symptoms of acoustic neuritis. They occur when any area is damaged from the receptors that are located in the hair cells of the inner ear to the brain stem (more precisely, its bridge).

Important features that affect the symptoms of sensorineural hearing loss are as follows:

• The fibers of the auditory nerve trunk are distributed inhomogeneously. On the periphery (along the edge of the trunk) there is a path for conducting low sounds. Closer to the center are fibers that conduct higher tones. Therefore, first of all, with this pathology, the perception of low sounds suffers;
• Due to the fact that the vestibular part of the VIII pair goes along with the auditory one, patients often experience: balance disorders and other signs of damage to these fibers;
• Since the conduction of sounds does not suffer with sensorineural hearing loss, and the nerve trunk is affected gradually, complete deafness (anacusia) rarely occurs in the initial period of the disease;
• Perhaps the development of atrophy (malnutrition) of the nerve trunk, due to its prolonged compression (edema, neoplasm, and so on). In this case, hearing loss becomes irreversible.

Given that sensorineural hearing loss affects only the nerve trunk (before it enters the brain), lesions often occur on one side (in one ear). However, the development of a bilateral process is possible.

Classification

AT national guidelines otolaryngologists, it is proposed to classify sensorineural hearing loss according to three criteria: the location of the lesion, the rate of development and the degree of "deafness". Also, the disease is divided into acquired and congenital, but the latter is extremely rare. For example, with congenital syphilis, otosclerosis, progressive hearing loss with damage to the labyrinth.

Depending on the location of the pathological process, there are:

• Unilateral (right- and left-sided);
• Bilateral:
  • Symmetric - the violation of sound perception is the same on both sides;
  • Asymmetric - the hearing function is changed differently on the right and left.

Most often, unilateral hearing loss occurs, since some common pathological factor is required for the development of a lesion on both sides.

There are the following options for the rate of development of "deafness":

The type of development of deafness depends on the degree of damage to the auditory nerve. If its atrophy develops, as a rule, the disease acquires a chronic course.

Degrees of sensorineural hearing loss

The degree of sensorineural hearing loss is determined by the patient's hearing threshold (how loud a sound a person does not hear). There are five options:

This is the most common classification approved by WHO. The degree of sensorineural hearing loss must necessarily be determined in accordance with it.

The reasons

With neurosensory hearing loss, the following negative factors always take place:

• violation of microcirculation (nutrition) of auditory receptors, due to which their sound-perceiving function decreases;
• compression of nerve fibers by surrounding tissues (edema, tumor, as a consequence of trauma, and so on), which leads to disruption of the transmission of impulses from receptors to the brain.

These conditions can develop for the following reasons:

The clinical picture does not depend on the cause of the development of sensorineural hearing loss (the exception is cerebrospinal meningitis), therefore it is taken into account only in the diagnosis of the disease.

Symptoms

The most significant complaint of patients is hearing loss. Sensorineural hearing loss can occur in only one ear or on both sides at once (see). As can be seen from the classification, it can be of varying degrees: from the inability to hear whispered speech to anacusia. First of all, the perception of low sounds (bass speech, low tones in music, and so on) suffers. In the future, poor audibility of high-frequency sound joins.

• - in 92%, a decrease in the sound-receiving ability is accompanied by a constant obsessive noise from one / two sides (see. It can have a different timbre, often a noise of mixed tonality (high and low sounds pass into each other).
• not typical for sensorineural hearing loss (only at the time of injury).

Since the vestibular fibers pass along with the auditory fibers, the following symptoms are often observed in patients:

• , which increases with movement;
• Unsteady gait;
• Loss of coordination (inability to perform precise movements);
• Constant nausea, occasional vomiting.

It is possible to attach other signs of the disease, depending on the cause of the development of hearing loss.

Diagnostics

Violation of sound perception is one of the socially significant problems. Therefore, if there is a suspicion of sensorineural hearing loss, the patient must be hospitalized in the ENT department of the hospital, if possible. In order to assume this disease is enough:

• Complaints of the patient on the above symptoms;
• The presence in the anamnesis of possible causes that could lead to the disease.

After hospitalization, additional diagnostics are carried out to confirm and clarify the diagnosis.

Speech study of hearing

An elementary test that does not require any equipment. First of all, the audibility of whispered speech is examined. It is carried out according to the following algorithm:

• The distance between the doctor and the patient should be 6 meters. The patient should be turned with his ear to the doctor, while closing the other auditory opening;
• The doctor pronounces words mainly with low sounds (burrow, sea, window, and so on), then with high sounds (thicket, hare, cabbage soup);
• If the patient cannot hear low / high sounds, the distance is reduced by 1 meter.

Norm: low sounds of whispered speech should be clearly distinguished by patients from a distance of 6 meters, high sounds - 20.

If necessary, a similar study is carried out using colloquial speech.

Tuning fork study

The first and most simple method instrumental diagnostics hearing functions. With the help of low-frequency and high-frequency tuning forks, the type of violation is determined (the impossibility of conducting sounds or sensorineural hearing loss).

What is a tuning fork? This is a special instrument that produces a sound of a certain frequency. It consists of a leg (which the doctor holds) and branches (when they are struck, a sound occurs). In medicine, two types of tuning forks are used: C 128 (low frequency) and C 2048 (high frequency).

The following tests are important for diagnosing sensorineural hearing loss:

Determination of signs of sensorineural hearing loss in patients allows us to confidently assume its presence. However, audiometry is required to make a definitive diagnosis.

Audiometry

This examination is carried out using a special sound generator of a certain frequency - an audiometer. There are several methods for using it. Traditionally, threshold audiometry is used to diagnose sensorineural hearing loss.

This is a method for determining the threshold of hearing in decibels (one of the functions of an audiometer), bone and air conduction. After receiving the results, the device automatically builds the patient's curve, which reflects the function of his hearing. Normally it is horizontal. With sensorineural hearing loss, the line becomes sloping, airy and bone conduction decreases in the same way.

To clarify the sound-perceiving function, there are additional modern audiometry techniques:

The above methods are used to clarify the patient's condition, they are rarely used in clinical practice.

Treatment

Medical tactics differ significantly, depending on the form of sensorineural hearing loss, so their treatment is considered separately. One thing remains unchanged - the early treatment of the patient (when the first symptoms appear) significantly improves the prognosis of the pathology.

Treatment of sudden/acute form

If there is a suspicion of acute neuritis of the auditory nerve, the patient should immediately be placed in the ENT / neurological department of the hospital. The patient is shown a "protective" auditory mode, which excludes any loud sounds (loud speech, music, environmental noise, and so on).

• Hormones-glucocorticosteroids intravenously (Dexamethasone). As a rule, it is prescribed for 7-8 days, with a gradual decrease in the dose;
• Drugs to improve blood circulation, including in the nervous tissue (Pentoxifylline / Vinpocetine). Recommended regimen: intravenously for 8-10 days;
• Antioxidants (vitamins C, E; Ethylmethylhydroxypyridine succinate).

If after hospital treatment the need for drugs remains, they are prescribed for further admission, but in the form of tablet forms.

Treatment of subacute/chronic form

In these forms, the pathology acquires a stable or slowly progressive course. In order to slow down the decline in the sound-perceiving function, the following measures are shown to the patient:

1. "Protective" auditory mode;
2. Treatment of other concomitant diseases that could lead to the development of sensorineural hearing loss;
3. Supportive treatment regimen similar to that for sensorineural hearing loss acute form. On average, 2 times a year.

In addition, due attention should be paid to the adaptation of the patient in society with the help of specialized medical equipment.

Methods of rehabilitation of patients

Currently, effective methods have been developed for the adaptation of patients with chronic sensorineural hearing loss. Unfortunately, most of them involve surgery, and only one is federally funded (at no cost to the patient).

Sensorineural hearing loss is a socially significant disease that reduces the quality of life of patients. That is why, if this diagnosis is suspected, the patient should be immediately hospitalized and treated in order to increase the chances of restoring the viability of the nerve. However, in the absence of such an opportunity, methods of rehabilitation have been developed that will allow a person to feel comfortable in society.

Frequently Asked Questions from Patients

Are there effective methods of alternative treatment of neurosensory hearing loss?

No, however, there are physiotherapeutic methods that have proven their effectiveness: endoural certain drugs (Galantamine, Dibazol, Nicotinic acid, and so on), massage of the parotid and collar areas, impulse currents.

Will my hearing recover after treatment?

It depends on the form of sensorineural hearing loss. In patients with sudden / acute forms, recovery occurs within 1 month in 93% of cases. In subacute and chronic hearing loss, the prognosis is more negative.

Is there an alternative to hearing aids?

Yes, but with less efficiency. A group of scientists in 2011 conducted a study using the following methods: low-frequency vibrosound stimulation, electroreflexotherapy and pedagogical activation of the hearing system. They are aimed at restoring the auditory nerve receptors, but are not common in Russia.

Is sensorineural hearing loss inherited in children?

The transmission of hearing loss in syphilis, progressive labyrinthitis and congenital otosclerosis is reliably known. In other pathologies, the role of heredity has not been proven.

How to treat impaired coordination and dizziness with neuritis?

They are treated in a similar way. It is possible to include nootropics (Cerebrolysin) and anticholinesterase substances (Neuromidin) in the course. Only the attending neurologist can supplement therapy and choose the final tactics.

Acutetrauma(acoustic injury) - damage to the organ of hearing caused by sounds of excessive strength or duration. It is more often observed when the auditory organ is exposed to strong noise (noise trauma).

Exposure to sound exceeding the threshold of pressure and pain in intensity (above 120-130 dB) leads to the development of acute sound injury to the organ of hearing. With a sufficiently long (months, years) exposure to sound of 80-90 dB, a chronic sound injury develops.

It has been established that the resistance to sound pressure of sensitive (hair) cells of the cochlea is different according to the tone scale - at the top of the cochlea, cells that perceive low sounds are more resistant, and cells localized at the base of the cochlea and are responsible for the perception of high tones are less resistant. Therefore permissible hygienic standards for low-frequency noise are 90-100 dB, and for high-frequency noise it is much less - 75-85 dB.

The damaging effect of sound to a certain extent depends on the individual and age characteristics of a person. As a result of chronic acutrauma, a slowly progressive bilateral decrease in hearing acuity (professional hearing loss) develops.

A special position is occupied by hearing loss, which is observed in persons dealing with frequent shots. Here, the action of the sound and barofactor takes place. During detonations (explosions), the main damaging effect is aerodynamic shock, which first causes an aperiodic change in pressure, and then periodic oscillations (vibration and sound).

Symptoms of Acute Acoustic Trauma

Sudden onset of hearing loss of varying degrees (a condition in which all environmental sounds “disappear” instantly);

Earache;

Sudden sensation of ringing in the ears;

Possible dizziness;

If there is a rupture of the membrane, blood flows out of the ear.

Acoustic injury of a mild degree is characterized by a gradual restoration of sound perception to its original level after 5-30 minutes. With moderate and severe degree, during the first 2-3 hours, the patient hears only loud sounds or screams. Then there is a gradual resumption of sound perception to the level of hearing loss of varying severity.

Symptoms of Chronic Acoustic Trauma

Noise in ears;

A significant decrease in hearing acuity or complete deafness;

Retracted form of the membrane (detected by an ENT doctor).

The pathogenesis of acoustic ear injury

Acute and chronic (professional) acoustic injuries have different mechanisms of development. A short, excessively loud sound causes hemorrhage into the perilymph anterior section membranous labyrinth of the cochlea - one of the components of the inner ear. In parallel, there is a displacement and swelling of the outer and inner hair cells of the organ of Corti. The latter is the final receptor apparatus, in which the vibrations of the perilymph are converted into a nerve impulse transmitted to the central nervous system. In some cases, there is a detachment of the organ of Corti from the main membrane.

For the occurrence of chronic acutrauma, the tiring effect of sounds, which causes corresponding physicochemical changes in the auditory organ, is of primary importance. With fatigue, hearing acuity decreases, but after rest it returns to normal. However, prolonged and repeated fatigue can cause degenerative changes in the entire peripheral neuron of the auditory analyzer - the neuro-epithelial elements themselves, nerve fibers and ganglion cells. In severe cases, atrophy of the entire organ of Corti is observed.

Diagnosis of acoustic ear injury

The diagnosis of acoustic injury is based on:

anamnestic data;

Otoscopy;

speech audiometry;

Tonal threshold audiometry.

Differential diagnosis of acute acoustic trauma is performed with sudden (acute) sensorineural hearing loss.

Chronic acutrauma needs to be differentiated from Meniere's disease, presbycusis, and cerebellopontine angle tumors.

Acute trauma treatment

Acute acoustic injury may not require treatment. After short-term exposure to strong sound, almost all of the symptoms that appear can be reversible. The same cannot be said for chronic trauma. It requires mandatory treatment.

The first signs of chronic acoustic trauma are a signal for urgent medical attention. medical institution. First of all, the ENT doctor recommends eliminating the cause of the disease.

That is, a person needs to change his profession. If this is not done, the disease will only progress and it will not be possible to stop the changes.

In drug therapy, calcium and bromine preparations are used to help get rid of tinnitus. In addition, the otolaryngologist will prescribe sedatives and restorative drugs, nootropics, as well as vitamin therapy.

Additionally, medications that improve blood microcirculation can be prescribed. You may be prescribed steroids.

A positive effect can give darsonvalization. The impact of impulse currents on the area of ​​the mastoid process stimulates the work of the inner ear. The technique allows you to deal with third-party tinnitus.

Hyperbaric oxygen therapy is also used. Under conditions of increased oxygen pressure, it improves cerebral circulation and reparative processes in the inner ear.

With severe hearing loss, the use of hearing aids makes it possible to improve the quality of hearing.

Complications of Acutrauma

The most common complication of acoustic trauma is deafness. The main causes of complete hearing loss are late diagnosis and treatment. Its development is facilitated by failure to comply with the recommendations of the otolaryngologist and the refusal to change profession in the initial stages of chronic acoustic damage. Constant exposure to noise leads to systemic disturbances: arterial hypertension, neurocirculatory dystonia, astheno-neurotic and angiospastic syndromes. Any acoustic damage to the hair apparatus of the organ of Corti reduces its resistance to infectious agents, systemic intoxication and the action of ototoxic pharmaceuticals.

Prevention of Acute Trauma

Prevention of chronic acoustic injury is to reduce the impact of strong noise on the damaged inner ear. To do this, it is recommended to use all the possibilities in production to enhance the sound insulation of walls and ceilings.

Additionally, a person should use physical protective measures: wear headphones, earplugs.

Before you get a job in a production where the background noise is constantly increased, you must pass an ear fatigue test.

If during the diagnosis, normal hearing is restored very slowly, then the person is considered highly susceptible to loud sounds and should not work in such a production.

Periodic hearing testing of workers is essential.

Prognosis for acoustic ear injury

If the treatment of the disease began too late, it may not be possible to restore hearing loss, since degenerative changes in the nerve endings of the hearing aid have already occurred.

Therefore, in the treatment important point is early diagnosis.

The sooner the patient turns to the otorhinolaryngologist and eliminates the causes that led to the injury, the more favorable the prognosis will be.