Abstract for practical lesson
Topic: "Non-purulent diseases of ear. Etiology, classification, clinical
symptoms and treatment"
Otosclerosis is a progressive focal lesion of the internal structures of the ear.
Gradual hearing loss develops due to changes in the bony labyrinth, leading to
fixation of the base of the stirrup in the vestibule window. The otosclerotic focus
envelops the stirrup, which reduces the conduction of sounds. Otosclerosis is
always symmetrical, but most often changes begin to occur first in one ear, and
only after some time in the other.
Diagnosis: diagnosis of otosclerosis is based primarily on the discomfort felt by the
patient himself from hearing loss or speech intelligibility. As a rule, an appeal to an
otorhinolaryngologist occurs when the hearing has already been significantly
affected. The following studies may be prescribed: otoscopy, audiometry,
radiography and CT of the skull, acoustic impedancemetry, evaluation of the
vestibular apparatus.
Treatment of otosclerosis: Treatment measures include surgical removal of
sclerotic and overgrown tissues. In this case, the base of the stirrup is released and
an improvement in sound conductivity is observed. Surgical treatment is effective
in the conductive form of otosclerosis. After treatment, the pathological process
will continue, however, if it is possible to identify negatively influencing factors
and avoid their influence, the operation can give a rather long-term positive effect.
The following surgical methods of treatment are used: stirrup mobilization;
fenestration of the labyrinth; stapedoplasty, hearing aids or the use of a hearing aid.
Cochlear neuritis is a lesion of the auditory nerve, leading to a decrease in hearing
and the appearance of constant noise in the ear.
Causes of hereditary cochlear neuritis: 1. Hereditary hearing loss can occur due to
Waardenburg syndrome, branchio-orenal syndrome, Refsum disease, Alport
syndrome, Stickler syndrome. 2. Diseases transferred by the mother during
pregnancy that can cause cochlear neuritis. Among them are: rubella, meningitis,
syphilis, influenza, otitis media, mumps, herpes, SARS. 3. Problems during
childbirth can cause damage to the auditory nerve. For example, such a disease can
be caused by fetal hypoxia, premature birth, weakness of labor activity or its
discoordination, birth trauma, narrow pelvis of the woman giving birth.
Causes of acquired cochlear neuritis in a third of cases is caused by inflammatory
and infectious diseases. In addition, lesions of the auditory nerve are caused by
drugs, circulatory disorders, injuries, and allergies.
1. Infections and inflammatory processes that can cause cochlear neuritis include:
SARS, influenza, rubella, scarlet fever, mumps, syphilis, typhoid and syphilis.
2. The toxic effect of drugs, such as antibiotics, anti-arrhythmic drugs; medicines
containing heavy metals or phosphorus.
3. Trauma to the skull, tumors that can damage the auditory nerve.
4. Arterial thrombosis, atherosclerotic plaques that impair cerebral circulation and
blood supply to the auditory nerve.
5. Long-term professional activity associated with constant exposure to noisy
environments, exposure to loud sounds or vibrations.
6. Age-related cochlear neuritis associated exclusively with gradual changes in the
auditory nerve.
Symptoms of cochlear neuritis.
Both unilateral and bilateral cochlear neuritis are characterized by two main
symptoms that are constantly present: impaired (decreased) hearing; feeling of
constant noise.
Diagnosis of cochlear neuritis
The degree of damage to the auditory nerve is determined using audiometry or
acoustic impedancemetry. Additionally, the ability of the vestibular apparatus to
respond to stimuli and stress is being studied. To determine the nature of the
disease, various tests and analyzes are carried out, separately, using computed
tomography, X-ray studies or magnetic resonance imaging, the vascular system,
cranial bones, and human brain are studied.
Treatment: Drug treatment is used, vasodilating drugs, venotonics, neuroprotectors
and disaggregants are indicated for administration for two weeks. Then they move
on to another stage of treatment, when the drug can be taken orally or injected
intramuscularly. If hearing impairment was caused by intoxication, first a course of
procedures is carried out that removes harmful substances from the body, such as
heavy metals, arsenic, phosphorus. After the toxic element is eliminated, treatment
is prescribed.
They also stop the symptoms of the disease, eliminating pain, dizziness, nausea,
disorder of the vestibular apparatus, if any. Successfully used procedures such as
electrical stimulation, oxygen barotherapy, electro-, laser-, acupuncture, as well as
phonophoresis.
Hearing aids are indicated not only to facilitate the perception of sounds by
patients, but also to restore speech function. Apply linear, analog, digital-hearing
aids.
Meniere's disease - characterized by an increase in the volume of endolymph
(labyrinth fluid) and an increase in intralabyrinth pressure (endolymphatic
hydrops), resulting in recurrent attacks of progressive deafness (often unilateral),
tinnitus, systemic dizziness, imbalance and autonomic disorders.
Main symptoms: Periodic bouts of systemic dizziness; balance disorder (the patient
cannot walk, stand or even sit); nausea, vomiting; increased sweating; decrease,
rarely increase, blood pressure, blanching of the skin; ringing, noise in the ear(s);
lack of coordination.
Medical prevention of seizures
• Taking diuretics (diuretics) to reduce the accumulation of fluid in the inner ear
(endolymphatic hydrops).
• Betahistine dihydrochloride is a histamine-like drug that acts on cochlear blood
flow, as well as the central and peripheral vestibular apparatus.
• Drugs that improve cerebral circulation (cinnarizine).
• Corticosteroids to reduce inflammation of the inner ear.
Non-drug treatment. Reducing salt intake to reduce the amount of fluid in the inner
ear.
• Limiting the use of alcohol, tobacco smoking and caffeine intake, as well as
stress and any condition that provokes seizures.
• Chemical ablation of the labyrinth - consists in the introduction into the tympanic
cavity of ototoxic antibiotics, such as gentamicin. As a result, the production of
endolymph by the cells of the inner ear and pathological impulses from the
affected labyrinth are reduced.
Sparing surgeries:
• Surgical drainage of the endolymphatic sac:
• sacculotomy - decompressive operation on a spherical sac;
• intersection of the vestibular nerve in order to stop afferent impulses, which
contributes to the disappearance of vestibular disorders.
• laser destruction of the horizontal semicircular canal - allows you to get rid of
vertigo attacks in the near and long term, save hearing and delay the development
of the hydropic process in the other ear with a unilateral process.
With the failure of sparing types of surgical interventions, such destructive
operations are performed as: Labyrinthectomy. Cochleosacculotomy. Vestibular
neurectomy.
