Sensorineural hearing loss. Is there a cure for hearing loss? Degrees of hearing loss: a detailed description Methods of rehabilitation of patients

- Hearing loss due to injury auditory analyzer and manifested by unilateral or bilateral hearing loss, tinnitus, as well as resulting disorders social adaptation. Diagnosis of the disease is based on the study of the anamnesis, physical and instrumental examination data (tuning fork methods, audiometry, MRI, ultrasound of the BCA, etc.). Treatment involves the restoration of reduced auditory function with the help of hearing aids, the use of glucocorticoids, medications with angioprotective and neuroprotective action.

General information

Treatment of sensorineural hearing loss

The main goal of therapeutic measures is the restoration or stabilization of hearing function, elimination of concomitant symptoms (dizziness, tinnitus, balance disorders, neuropsychiatric disorders), return to active life, social contacts.

• Physiotherapy, reflexology. On the initial stages diseases, phonoelectrophoresis, electrical stimulation of the tissues of the inner ear, acupuncture and electropuncture are used, which in some cases makes it possible to reduce the intensity of tinnitus, get rid of dizziness, improve sleep and mood.
• Medical treatment. The effectiveness of drug exposure is highest when treatment is started early. With a sudden onset of hearing loss, hearing is sometimes completely restored by the use of shock doses of glucocorticoid hormones for 5-8 days. Drugs that improve blood circulation, conduction of nerve impulses and microcirculation are widely used: pentoxifylline, piracetam. With concomitant NST dizziness, drugs with a histamine-like effect are prescribed, for example, betahistine. Medicines that have an antihypertensive effect are used in the presence of arterial hypertension, as well as psychotropic drugs in the presence of neuropsychiatric disorders.
• Hearing aid. Indicated for moderate to severe hearing loss. Behind-the-ear, intra-ear and pocket analog and digital devices are used for monoaural or binaural hearing aids.
• Surgical treatment, cochlear implantation. Transtympanic administration of glucocorticoid hormones into the tympanic cavity is practiced. Surgical interventions are performed for tumors of the posterior cranial fossa to reduce the severity of some of the symptoms that accompany vestibular disorders. Cochlear implantation is performed in the complete absence of hearing, provided that the function of the auditory nerve is preserved.

Forecast and prevention

The prognosis in patients with acute neurosensory hearing loss with timely treatment in 50% of cases is relatively favorable. The use of hearing aids and implants for chronic NST usually helps to stabilize hearing. Preventive actions to prevent the loss of hearing function, they include the exclusion of harmful environmental factors (noise and vibration at work and at home), the rejection of alcohol and the use of toxic medications, the prevention of injuries, including acoustic and barotrauma, the timely treatment of infectious and somatic diseases.

Sensorineural hearing loss (sensoneural hearing loss, cochlear neuropathy) is a disease in which there is a progressive decrease in hearing up to its complete loss. The loss of auditory function is associated with damage to any area on the path of sound transmission from the external environment to the analyzer - from the auricle to the temporal cortex of the brain. With sensorineural hearing loss, the main organ of the inner ear - the cochlea - loses the ability to perceive and transmit sound waves to the center of hearing.

Sensorineural hearing loss can be either an independent (not caused by anything) disease, or accompany other diseases, contributing to the aggravation of the patient's condition.

The main sign of the occurrence of sensorineural hearing loss is a decrease in the number of sensitive nerve cells responsible for the transmission of the auditory impulse from the ear to the brain.

Most often, the process begins with sensitive (hair) cells of the cochlea - the structure of the inner ear, which picks up sounds from the external environment, converts them into nerve impulses and transmits them to the temporal cortex (hearing center).

The cause of hearing loss can be damage to the inner ear mechanically (accidental entry of foreign bodies into the ear canal) or due to a sharp drop in high and low atmospheric pressure (for example, when diving quickly to a depth), occupational hazards (working in conditions of constant loud noise in the absence of personal protective equipment).

In some cases, hearing loss may be the first manifestation of a benign or malignant tumor of the auditory nerve, when there is a difficulty in conducting a nerve impulse to the brain.

There are several risk factors for developing sensorineural hearing loss in adults:

• viral infections (influenza, mumps, measles, endemic encephalitis transmitted through tick bites);
• bacterial infections (meningitis, scarlet fever, typhoid fever, diphtheria);
• the influence of substances toxic to the organ of hearing (industrial products, ototoxic chemicals, some antibiotics - Streptomycin, Kanamycin, Gentamicin, non-steroidal anti-inflammatory drugs, chemotherapy drugs for the treatment of cancer);
• diseases of the cardiovascular system, which can lead to thickening of the blood and a decrease in blood flow through the arteries of the brain ( hypertonic disease, stroke, angina);
• degenerative diseases of the spine involving the nerve roots of the cervical region, which prevent the normal conduction of a nerve impulse to the brain.

In adults, deafness is more often bilateral, since all risk factors affect the entire body. As a first-line therapy in adults, a behind-the-ear blockade with a solution of "Lidocaine" or "Prozerin" can be used to relieve symptoms.

Causes of sensorineural hearing loss in children can be divided into two groups: hereditary and non-hereditary.

Hereditary causes include mutations in genes encoding structural proteins of the inner ear. Defective cells appear that cannot perform their function. The result of these mutations is congenital deafness.

In addition, auditory function may be affected by hypoxic conditions at birth (eg, prolonged labor, premature rupture of amniotic fluid, cord entanglement), hyperbilirubinemia, prematurity (birth before 32 weeks weighing less than 1500 g).

Congenital deafness in children can be in both ears (bilateral) or in one ear (left-sided, right-sided).

Classification of the disease

Depending on the affected organ, hearing loss is classified into sensorineural, conductive and mixed.

Depending on the time of occurrence, sensorineural hearing loss can be acquired as a result of any exposure or congenital. Acquired differentiates into several types with different clinical manifestations: sudden, acute, subacute and chronic.

On the side of the lesion, unilateral and bilateral (symmetric and asymmetric) hearing loss are distinguished.

sudden

With this form, the disease develops abruptly, within 12 hours. The cochlear receptor apparatus quickly loses its function. When the exact cause of the complaints cannot be determined, idiopathic hearing loss is diagnosed.

A sudden decrease in hearing in one or both ears is characteristic, it becomes difficult for the patient to make out the speech of the interlocutor and the sounds of the environment, sometimes complete deafness may occur. Subjective tinnitus of a permanent nature, nausea, dizziness, excessive sweating, tachycardia may accompany hearing loss.

mixed

Mixed hearing loss is a disease of both the cochlear prescription apparatus and the outer ear, that is, a combination of sensorineural hearing loss with conductive hearing loss.

Conductive

Conductive hearing loss is a hearing impairment in the presence of a pathology in the outer, middle or inner ear, in which the conduction of sound vibrations to the cochlea is disturbed. in the external auditory canal or. Such mild to moderate hearing loss responds well to medical and surgical treatment.

Neurosensory

Sensorineural deafness is caused by the pathology of the sensitive apparatus of the cochlea (hair cells). In this case, there is a violation of sensory and neural functions: the sound is not perceived and is not transmitted to the analyzer - the cortex of the temporal lobe of the brain.

Acute

In the acute form, hearing loss occurs quickly, in 1-3 days. The disease is reversible: hearing returns to normal within 1 month. The acute form has a favorable prognosis - more than 90% of patients are completely cured.

Chronic

Hearing loss persists for more than 3 months. At the same time, hearing loss can be stable (the hearing level remains constant, without any dynamics), progressive (with gradual deterioration up to complete deafness), fluctuating (with periods of improvement). The chronic form is not amenable to conservative treatment, it can only be eliminated with the help of cochlear implantation (complete replacement of the cochlea).

subacute

Subacute form of hearing loss means hearing loss in the interval from 1 to 3 months. With adequate therapy, full recovery of hearing is possible in the future. In some patients, this form becomes chronic. The subacute form is treated in 30-40% of patients.

Degrees of hearing loss

Based on the results of audiography and the determination of the average hearing threshold (decibel), the doctor can differentiate the stage of the disease, which will determine the further tactics of the patient. Post-traumatic secondary hearing loss (damage to the organ of hearing after acoustic, vibration and barotrauma) also requires determining the degree of damage to objectify the diagnosis.

1

At degree 1 (26-40 dB), a person does not distinguish between quiet sounds, does not hear speech in a noisy environment. He understands words of standard volume from a distance of less than 6 meters, and a whisper - from 1-3 m. With a slight decrease in hearing, the patient does not always go to the doctor, so the disease begins to progress. younger age is difficult to identify.

2

At grade 2 (40-55 dB), conversational speech is perceived at a distance of 4 m, a whisper is distinguishable only at the very ear. Parents may notice that the child does not respond to his name, does not turn his head towards the source of the sound.

3

With hearing impairment up to degree 3 (55-70 dB), conversational speech is perceived only at a distance of less than 1 m from the speaker, a whisper is not distinguishable. Only at this stage, most patients turn to a specialist.

4

Grade 4 (70-90 dB) is the most severe form of hearing loss and borders on total deafness. The patient hears only loud sounds uttered at the auricle itself.

Symptoms of the disease

The first manifestation of sensorineural hearing loss is hearing loss, gradual and progressive, sometimes reaching complete deafness. The second typical symptom is the appearance of tinnitus. The noise is constant, subjective, high-frequency, can be described by the patient as a whistle, rustle, gnashing in the ears. to see a doctor.

In children

In young children, hearing loss manifests itself as an absence or dubious response to sounds, according to parents. The older the child becomes, the more pronounced the delay in mental and speech development, the more difficult it is to teach. Attentive parents may notice changes in the behavior of a child with hearing loss as early as infancy.

In adults

Symptoms in adults may appear suddenly or may progress over several months or years. Hearing loss is accompanied by the appearance of constant high-frequency noise in the ears. Vegetative symptoms are possible: increase and decrease blood pressure, increased heart rate, increased sweating, nystagmus (twitching of the pupils of the eyes).

Diagnostic methods

Sensorineural hearing loss in adults is diagnosed based on the following research methods:

1. History taking (suddenness of hearing impairment that preceded the disease, the presence of risk factors).
2. Otoscopy (examination of the outer ear is carried out using an instrument - an otoscope).
3. Acumetry (in a special noise-absorbing room, the doctor pronounces words at different volumes).
4. Audiometry (assessment of the conduction of sound through the air and through temporal bone skulls).
5. Magnetic resonance imaging of the bones and ligaments of the hearing organs, the brain.
6. Laboratory blood tests, consultations of specialized specialists if necessary.

In children, the detection of hearing impairment is carried out in a sound-absorbing room. The doctor pronounces sounds that are interesting for the child at different volumes (for example, the name of the child) and observes the reaction.

Treatment

Treatment of sensorineural hearing loss is quite complicated. It should be comprehensive, consistent, start as early as possible, preferably at the first stage of hearing loss.

With a sudden onset of sensorineural hearing loss, emergency hospitalization is indicated, protective mode (exclude all loud noises and sounds). Subacute and chronic forms are treated on an outpatient basis (under the supervision of a polyclinic doctor).

With all forms of hearing loss, physiotherapy is considered effective. Electrophoresis is applied to the collar zone with "No-shpa", nicotinic acid, "Eufillin", magnesium, "Dimedrol". Physiotherapy helps to improve blood circulation in the brain and activate the nerve cells of the cervical spinal cord.

Used to reduce tinnitus massotherapy collar, parotid and occipital zones, modulated currents to the cervical The lymph nodes And carotid arteries. Restoration of damaged nerve fibers is facilitated by electrophoresis with B vitamins, balneotherapy (radon, sodium chloride baths). The ear is directly affected by a vibroacoustic apparatus, which activates the blood and lymph flow.

Physiotherapy is carried out in 3-4 courses with a break of 2 weeks.

This method of treatment is used in severe stage 3-4, when the doctor understands that it is impossible to save auditory receptors with medicines. Instead of the affected cochlea, a special device is implanted that performs all its functions, the patient notes the restoration of hearing.

The cochlear implant consists of two parts: the outer one is attached above the ear and serves as a signal receiver, the inner one is installed directly in the ear and transmits the signal to the auditory nerve. The implantation operation is high-tech and should be performed only in qualified institutions.

For mild or moderate damage to only one ear, hearing aid technology can be used to improve hearing. A special apparatus captures sounds from the external environment, converts them into waves and amplifies the volume, sending them to the middle ear. The hearing aid is attached behind the auricle, if necessary, it can be removed. After turning on the device, the patient begins to hear with both ears equally well.

Medical

With a sudden onset of the disease, intravenous drugs are used in the treatment: glucocorticosteroids, drugs that improve cerebral circulation, antioxidants, vitamins. After discharge from the hospital, the patient can be treated with tablet preparations, which are taken in courses under the regular supervision of an ENT doctor.

At chronic form a course of taking drugs to improve blood circulation 1-2 times a year is enough.

Folk remedies

For the treatment of hearing loss, a decoction of hop cones, bay leaf, instillation of almond oil into the ear canal, garlic and onion therapy were previously used.

but folk methods Treatments for sensorineural hearing loss have not proven effective in restoring hearing. When the first symptoms appear, you should immediately contact a specialist, and not be treated on your own.

Complications

With prolonged course of sensorineural hearing loss, several complications are possible, the most severe of them is complete hearing loss. In this case medications and external hearing prostheses become ineffective. The only treatment for total deafness is cochlear implantation.

To prevent deafness, it is necessary to consult an ENT doctor at the first sign of hearing loss.

Prevention

Audiological screening is used to prevent sensorineural hearing loss in children. In the first years of life, the child is examined at least twice by a pediatrician with an assessment of the reaction to sounds. If parents notice the child's lack of activity in response to interesting sounds and noises, this should also be reported to the pediatrician. If hearing loss is suspected, the child is referred to a specialist consultation - a pediatric otorhinolaryngologist.

For adults, prevention consists in a protective auditory mode: preventing loud and prolonged sounds and timely treatment inflammatory diseases ears. It is necessary to avoid injury to the hearing organs, sudden changes in high and low atmospheric pressure, exposure to intense vibration.

Hearing loss in varying degrees is observed in 3% of the world's population, including even small children. Every year the number of people with varying degrees of deafness is growing, and often the cause of complete hearing loss is untimely treatment.

Disease Definition

This is a violation of sound perception of varying degrees, proceeding, depending on the cause, gradually, or progressing rapidly. The disease affects mainly the elderly and has an age predisposition, but it is also observed in young people and newborns.

There are three types of hearing loss:

• (associated with problems of impaired conduction of sounds through the outer and middle ear into the inner ear);
• (the inner ear, vestibulocochlear nerve, auditory centers of the brain are affected);
• Mixed (combines the symptoms of conductive and).

Hearing loss can range from not hearing a whisper to hearing loss loud sounds at a short distance.

For an accurate diagnosis, a number of studies are carried out:

• Otoscopy (examination of the outer ear and eardrum with a special device);
• Audiometry (carried out in speech or tone form);
• Tuning fork tests (a study using different-frequency tuning forks makes it possible to differentiate hearing loss of the neurosensory type from conductive);
• Tympanometry (the study allows you to determine the degree of mobility of the eardrum and auditory ossicles, acoustic reflex threshold);
• Computed or magnetic resonance imaging;
• Stabilography (a method for determining the lesions of the vestibular apparatus, which appear in most cases of sensorineural hearing loss);
• Impedancemetry (audiological examination differential diagnosis, including tympanometry and registration of the acoustic reflex).

Causes

Each form of the disease may have a number of causes characteristic of this particular form:

• Conductive. It can occur against the background of the appearance of obstacles to the passage of sounds in the outer and middle ear (, damage, tumors, sulfuric plug);
• Neurosensory. The two main reasons for development are exposure to noise above 90 dB and age-related changes. This form of the disease can occur with some pathologies: Meniere's disease, mumps, maternal rubella during pregnancy, measles, meningitis, parotitis, AIDS.

In addition to the above causes, hearing loss can also occur due to the use of medications or exposure to toxic chemicals. may lead to the development of deafness.

In diabetes, cardiac vascular diseases, high blood pressure, a stroke causes abnormalities that disrupt the blood supply to the brain, which can lead to hearing problems.

Symptoms

To a large extent, the effectiveness of the treatment of hearing loss depends on the timeliness of the treatment started. To do this, it is necessary to distinguish even the slightest signs of the manifestation of the disease.

There are 4 degrees of manifestations of hearing loss:

• Grade 1 is characterized by a slight hearing loss, difficulties arise when recognizing sounds with a volume of 26 - 46 dB. However, in the case of childhood hearing loss, this is a rather alarming sign;
• 2 degree is characterized by the impossibility of recognizing quiet sounds in a noisy environment, while the threshold of sound perception rises to 65 dB;
• 3 degree allows you to distinguish only very loud speech, the threshold of hearing rises to 85 dB. This condition is often referred to as "deafness";
• Grade 4, or deep hearing loss, is characterized by the inability to perceive sounds above 85 dB, and is practically untreatable.

The definition of the disease early stages helps to diagnose and start treatment at an early stage, and this is a good prospect for a complete cure. Early signs of the disease may include:

• Frequent questioning during a conversation;
• Increase the volume on the TV;
• Difficulties in understanding the speech of the interlocutor;
• Conducting a conversation in raised tones;
• Inability to recognize a knock on the door or a phone call.

Of particular danger in terms of progressive hearing loss are manifestations of hearing loss in young children. If the child does not respond to sharp sounds, turns to loved ones only when he sees them, does not start talking by the age of 1, reacts only to some words, be sure to consult a specialist. All of these signs can be symptoms of progressive hearing loss.

Possible Complications

The most severe consequence of untimely or incorrect treatment of the disease is complete deafness. At the same time, the lifestyle of a person, his social status, is significantly changed, disability is assigned.

Not everyone can be sure. The disease is cured completely without the manifestation of any side effects. With timely and correctly performed treatment, the prognosis is favorable in 70-90%. But this only happens during treatment. acute form diseases, so a complete cure again directly depends on the timeliness of the measures taken.

With the transition to the chronic stage, the processes of hearing loss are reversible only in 10-20%, despite all modern techniques. Here, the only means of returning the quality of life to normal is the use of hearing aids or cochlear implants.

Treatment

Seven out of ten cases of hearing loss are mixed. This means that all parts of the ear are affected. In this case, diagnostic measures are of particular importance, allowing to identify the degree of the disease and the specific area of ​​\u200b\u200bdamage.

With a mild degree of the disease, treatment can take place on an outpatient basis. At the same time, physiotherapy procedures are prescribed in combination with medications. The severe course of the disease requires observation in a hospital with a protective regimen. A special diet is selected, bad habits, physical and mental stress are excluded.

If hearing loss is irreversible, hearing aids or cochlear implants are considered. In this case, special electrodes are implanted into the inner ear by surgery.

The operation is possible only for those patients in whom the auditory nerve was not damaged, but the organ of Corti, which is responsible for the perception of sounds with the help of hair cells, has been damaged.

Medical therapy

When prescribing medications for the treatment of hearing loss, first of all, the disease that caused the hearing loss is taken into account, and all efforts are directed to its elimination:

• In the presence of a foreign body, purulent discharge, sulfur plug in the ear, the doctor removes it and rinses it antiseptic solution followed by instillation of antibacterial drops;
• In the presence of a boil, it is opened, the cavity of the outer ear is sanitized, followed by the appointment of antibiotics;
• Tumors in the outer and middle ear are removed surgically;
• At chronic otitis media an operation is performed in the middle ear, during which the middle ear cavity is examined;
• Otitis exudative media and associated hearing impairments are treated by removal of fluid from the middle ear through a puncture in the eardrum or by the introduction of decongestants through the nasopharyngeal mouth of the auditory tube;
• With sensorineural hearing loss, drug therapy involves the use of drugs that improve cerebral circulation and have a stimulating effect on the metabolism in nerve cells. In addition, hormonal agents, diuretics and vitamin complexes group B.

Hearing aids are prescribed to correct hearing loss that cannot be treated. In some cases, there is a partial restoration of hearing with their constant use.

Folk remedies

Of course, serious hearing impairment folk remedies cannot be cured, but it is possible to use them in addition to drug therapy, especially in the presence of inflammatory processes:

• Eleutherococcus extract is taken 20-25 drops twice a day. It has an immunostimulating and anti-inflammatory effect;
• 3-4 drops of almond oil are instilled into the ears alternately: on the left one day, on the right on the second day. The course of treatment is 1 month;
• After suffering a cold, compresses from chopped and heated onions, placed in the ear canal at night, help. The course of treatment is 20 days;
• An infusion of lingonberry leaves (2 tablespoons of dry raw materials per 1 tablespoon of boiling water) is taken twice a day for half a glass;
• Drops from geranium juice are instilled 2 drops 1 time per day. The course of treatment - 10 days;
• An infusion of 4-5 bay leaves is instilled 3 drops into the ear 1 time per day;
• They use turundas with birch tar, before that they carefully lubricate the ear canal with sterile vegetable oil. At the slightest feeling of discomfort, the turundas are removed;
• Within a month, they drink a glass of very hot hop decoction, while at the same time dropping almond oil into their ears;
• Make a tincture of propolis (per 100 ml of alcohol 40 g of crushed purified propolis). Insist in a dark place for 7 days, shaking occasionally. Then it is diluted with olive or corn oil in a ratio of 1: 4. Turunds are made, soaked in the product and inserted for a day, every other day. The course of treatment is 12 procedures.

Alternative recipes, even proven ones, should be used only after consulting a doctor and be a means of additional treatment.

Prevention

• Do not expose the ears to excessive stress (loud music, noise in the workplace, noisy events);
• Timely treat infectious diseases, both related to the ears and of a general nature;
• During pregnancy, undergo preventive examinations in a timely manner, with a cold during this period, try to treat the disease with folk or homeopathic remedies.

One of the significant roles in the prevention of hearing loss is played by the general level of immunity. A weakened body is susceptible to many diseases, and inflammatory processes occur in one place or another. To avoid the transition of inflammation to other organs, the body must have a sufficient margin of safety, the foundations of which are laid at birth. However, throughout life, a person is able to increase his defenses with a healthy lifestyle and good nutrition.

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conclusions

If it does not have a hereditary nature, then the successful disposal of the disease depends only on the timeliness of contacting a doctor. Therefore, monitor your hearing and the hearing of your child and look for the cause at the slightest deviation.

In cases of impossibility of cure by conservative methods modern medicine has a sufficient arsenal to help the patient - the latest hearing aids and implants allow almost all patients not to fall out of society and lead an active daily life.

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