Deafness (congenital and acquired): causes, diagnostics, how to treat. Causes of hearing loss and deafness Human analyzer of a man suffering deafness

Chapter 2. Hearing Analyzer
Hearing - this is a reflection of reality in the form of sound phenomena. The hearing of living organisms developed in the process of their interaction with the environment in order to ensure adequate to survive the perception and analysis of acoustic signals from inanimate and wildlife, signing about what is happening in the environment. Sound information is particularly indispensable where the vision is powerless, which allows you to get reliable information about all living organisms to meet them in advance.

The hearing is implemented through the activities of mechanical, receptor and nerve structures that transform sound oscillations into nerve impulses. These structures are combined hearing analyzer - The second largest sensory analytical system in ensuring adaptive reactions and cognitive activity of man. With the help of hearing, the perception of the world becomes brighter and richer, so the decline or deprivation of hearing in childhood is significantly affected by the cognitive and mental ability of the child, the formation of its intelligence.

The special role of the auditory analyzer in humans is associated with a self-split speech, since the auditory perception is its basis. Any hearing impairment during the formation of the speech lead to a delay in development or deafonex, although the entire articulation apparatus of the child remains not disturbed. In adults who own a speech, a violation of a hearing function does not lead to a speech disorder, although sharply makes it difficult to communicate between people in their labor and social activities.

Hearing analyzerincludes:

- receptor (peripheral) apparatus is an outdoor, secondary and inner ear;

- conduction (medium) apparatus - auditory nerve;

- Central (cortic) apparatus - hearing centers in the temporal fractions of large hemispheres.

2.1. Anatomy of the auditory analyzer

Organ hearing The person (Fig. 7) catches (outdoor ear), enhances (middle ear) and perceives (inner ear) sound oscillations, representing, in fact, the distant analyzer, peripheral (sensory) department of which is located in the pyramid of the temporal bone (snail).

Outdoor Ear It includes the ear shell and the outer hearing pass, which ends with a dense fibrous membrane - a drumpoint, which is the boundary between the outer and middle ear. Own sink serves as a collector of sound waves and the determinant of the direction of the sound source when hearing two ears ( binaural hearing). Both ears perform one job, but are not reported, which contributes to a more complete receipt of information. The auditory pass is not only a conductor of sounds, but also a resonator in the speech frequency range from 2,000 to 2 500 Hz. The sound is enhanced by these frequencies from 5 to 10 dB. The longitudinal fluctuations of air carrying sound cause mechanical oscillations of the eardrum, but in order to be transmitted by the snail window membrane separating the middle ear from the internal, and then the endolymph of the inner ear, these oscillations should be significantly reinforced.

Fig. 7. Ear structure

Outdoor Ear: 1 - ear sink; 2 - a hearing pass; 3 - Drumpotting.

Middle ear: 4 - the cavity of the middle ear; 5 - hearing tube; bones of the middle ear: hammer (a), anvil (b), swipping (B);

Interior Ear: 6 - snail; 7 - Hearing nerve.

Vestibular apparatus: 8 - anticipation with bags; 9 - semicircular channels.
Middle ear - Amplifier of sound oscillations caught ear. The human sounding machine is a very perfect mechanical system. It is capable of responding to minimal air fluctuations and conduct them to a sound-visible system where the primary analysis of the sound wave is carried out. The oscillations of the eardrum transforming air sound waves into mechanical oscillations are transmitted to the middle ear in the cavity, the hearing bones in the cavity - hammer, anvil and rapidly(Fig. 7). This system hearing bones Provides, according to the latest data, the strengthening of the sound coming from the drum membrane is 20-25 times, which allows to overcome the resistance of the oval window membrane, separating the middle ear cavity from the cavity of the internal and transfer the oscillations of the endolymph of the inner ear. The role of the eardrum and auditory bones is reduced to the transformation of air oscillations of large amplitude and relatively low force in the oscillations of ear endolymph with a relatively small amplitude, but large pressure.

With the sounds of large intensity, the system of hearing seeds is acquiring a protective, depreciation. The main way to deliver sounds to the snail - air, the second way is bone. In this case, the sound wave directly acts on the bone of the skull.

One of the important conditions for normal air transmission of sounds is the lack of a pressure difference on both sides of the eardrum, which is ensured by the ventilation capacity of the auditory ("Eustachiyeva") pipe. The latter has a length of 3.5 cm and the width of only 2 mm, and connects the drum cavity in the form of a canal with a nasophal. When swallowing, this pass opens, ventilating the middle ear and the pressure equalization in it with atmospheric occurs.

The most complex structure has interior Ear . Located in the rocky part of the temporal bone, it is a bone maze, inside of which is a membered labyrinth of connective tissue. The membrane labyrinth is inserted into the bone labyrinth and, in general, repeats its shape. Between bone and connecting labyrinths perilimfa, inside the web - endolimf.In the inner ear, three departments distinguish: snail, threshold snail and semicircular channels, but the sensory apparatus of hearing is only snail. Two other formations belong to the system of the vestibular analyzer.

The hearing body is in snail which is a spiral bone channel that spirally curls around the bone rod of the cone-shaped form by 2.5-2.75 curls, and blindly ends in the top of the pyramid.

Fig. 8. Spiral organ in snail

BUT - open snail: 1 - the position of the spiral organ in the snail;

2 - the main membrane; 3 - Hearing nerve.

B - spiral organ: 1 - cover membrane; 2 - Retiewiccated membrane;

3 - external and internal hairsdown cells; 4 - support cells;

5 - fibers of a cochlear nerve (in cross-section);

6 - external and internal pillars; 7 - Cochlear nerve

Spiral snail channel has a length of 28-30 mm. In the diameter in the initial separation, the spiral channel is wide (6 mm), and as the snail approaches the tip is gradually narrows, reaching 2 mm. From the rod, around which this channel passes, in the lumen of the latter, the bone spiral basilar (basic) plate departs, and, heading towards the peripheral wall of the spiral channel, ends, not reaching it, in the middle of the channel diameter. From the free edge of the bone spiral plate to the opposite wall of the snail, a basilar plate is stretched, which is part of a rumbled snail. Thus, the spiral snail channel is longitudinal partitions turns out to be divided into the upper (run-up staircase), the middle (spiral organ) and the lower (drum staircase) parts filled with endolymph. Hearard receptors are located in a basilar plate of the spiral organ located in the middle of the channel (Fig. 8a).

The basilar plate consists of about 20 thousand thin elastic fibers stretched in the form of strings of various lengths between the bone spiral ridge and the outer wall of the snail (like a musical instrument - harp). The initial curl of the snail fiber is shorter and thinner, and the latter is longer and thicker. The tension of the fibers gradually weakens from the base to the top of the snail. The connection between the fibers is very weak, and therefore the isolated oscillation of individual sections of the membrane is possible. Only those hairs are involved in the oscillation that are akin to the frequency of the received signal (by the type of resonance phenomenon). The less fluctuating hairs, and the closer they are located to the Thread window, the lower the sound.

Fig. 9. Hearing analyzer
Dendrites are suitable for auditory hairs hair (bipolar) sensitive cellsincluded in the spiral node located right there in the central part of the snail. The axons of bipolar (hairs) cells of the spiral (snelled) node form an auditory branch of the predver-ulvoy-throat (VIII pair of cranknot and brain nerves), which goes to the hearing analyzer nuclei, located in the bridge (second auditory neuron), subcortical hearing centers in four (Third auditory neuron) and the cortical center of hearing in the temporal proportion of each hemisphere (Fig. 9), where they are formed into the auditory sensations. In total, in a rumor nerve, about 30,000-40,000 afferent fibers. The oscillating hairs cells cause excitation only in strictly defined hearing nerve fibers, and therefore, in strictly certain nerve cells of the cerebral cortex.

Each hemisphere receives information from both ears ( binaural hearing), thereby it becomes possible to determine the sound source and its direction. If the sounding item is on the left, then the impulses from the left ear come to the brain earlier than from the right. This small time difference and allows not only to determine the direction, but also to perceive sound sources from different sections of space. This sound is called volume or stereo.

2.2. Physiology of hearing

For the auditory analyzer, the sound is an adequate stimulus. The main characteristics of each audio tone are the frequency and amplitude of the sound wave. The more frequency, the sound is higher by the tone. The strength of the sound expressed by its volume is proportional to the amplitude and is measured in decibels (dB). The human ear can perceive the sound in the range of 20 Hz to 20,000 Hz (children up to 32,000 Hz). The greatest excitability of the ear has a frequency of 1000 to 4000 Hz. Below 1000 and above 4000 Hz, the ear excitability decreases.

The sound by force of up to 30 dB is heard very weak, from 30 to 50 dB corresponds to a human whistery, from 50 to 65 dB - ordinary speech, from 65 to 100 dB - strong noise, 120 dB - "pain threshold", and 140 dB causes damage Average (rupture of the eardrum) and internal (destruction of the Cortiene organ) ear.

The threshold of speech hearing in children is 6-9 years old - 17-24 dBA, in adults - 7-10 dBA. With the loss of the ability to perceive sounds from 30 to 70 dB, it is difficult to have difficulty conversation, below 30 dB - there is almost a complete deafness.

Various hearing capabilities are evaluated by differential thresholds (DP), i.e., by catching the minimally variable any of the parameters of the sound, for example, its intensity or frequency. A person has a differential intensity threshold equal to 0.3-0.7 dB, frequency of 2-8 Hz.

The bone spends the sound well. With some forms of deafness, when the hearing nerve is not damaged, the sound passes through the bones. The deaf can sometimes dance, listening to music across the floor, perceiving her rhythm legs. Beethoven listened to the game on the piano through the cane, which he relied on the piano, and the other end kept in his teeth. With bone-fabric conduct, you can hear ultrasound - sounds with a frequency of over 50,000 Hz.

With long-term action on the ear of strong sounds (2-3 minutes), the hearing acuity decreases, and in silence - is restored; For this, it is enough 10-15 seconds ( hearing adaptation ).

Temporary reduction of hearing sensitivity with a longer period of recovery of normal hearing acuity, also arising with long-term exposure of intensive sounds, but restored after a short-term recreation, it is called auditory fatigue . The auditory fatigue, which is based on temporary protective braking in the cerebral cortex, is a physiological phenomenon that has a protective nature against the pathological depletion of nerve centers. Not restored after short-term recreation, the auditory fatigue, which is based on persistent proceedable braking in the structures of the brain, is called auditory overwork requiring it to relieve a number of special medical and recreational activities.

Physiology of sound perception. Under the influence of sound waves in the membranes and liquids, the snail occurs complex movements. The study of them is hampered by both the low size of oscillations and too small snail size and its depth of its location in a dense capsule of the labyrinth. It is even more difficult to identify the nature of the physiological processes occurring during the transformation of mechanical energy into the nervous excitation in the receptor, as well as in the nervous conductors and centers. In this regard, there are only a number of hypotheses (assumptions) explaining the processes of sound perception.

The earliest of them is the theory of Helmholts (1863). According to this theory, there are phenomena of mechanical resonance in the snail, as a result of which sophisticated sounds decompose on simple. Tone Any. frequency It has its limited plot on the main membrane and annoys strictly defined nerve fibers: low sounds cause oscillation at the top of the snail, and high - at its base.

According to the newest hydrodynamic theory of Bekeshi and Fletcher, which is currently considered the main, the current beginning of the auditory perception is not the frequency, but the amplitude of the sound. The amplitude maximum of each frequency in the audibility range corresponds to a specific area of \u200b\u200bthe basilar membrane. Under the influence of sound amplitudes in the lymph of both stairs, the snails occur complex dynamic processes and deformations of membranes, while the place of maximum deformation corresponds to the spatial arrangement of sounds on the main membrane, where the vortex movements of lymphs were observed. Sensory cells are the most excited there, where the amplitude of oscillations is maximal, so different frequencies act on various cells.

In any case, the hair cells leading to oscillation relate to the crumbling membrane and change their form, which leads to the emergence of the excitation potential. Arriving in certain groups of receptor cells, excitation, in the form of nervous pulses, it spreads through the hearing nerve fibers into the core of the brain barrel, subcortical centerslocated in the middle brain, where the information contained in the sound stimulus is repeatedly recoded as it passes through various levels of the auditory path. During this process, neurons of one or another type allocate "their" properties of the stimulus, which ensures a rather specific activation of the neurons of the highest levels. Upon reaching the hearing area of \u200b\u200bthe cortex, localized in the temporal shares (fields 41 - the primary hearing cortex and 42 are secondary, associative hearing bark in Brodman), this multiplely recoded information is transformed into an auditory sensation. At the same time, as a result of crossing the conductive paths, the sound signal from the right and left ear falls simultaneously in both hemispheres of the brain.

Age features of the formation of hearing sensitivity. The development of peripheral and subcortex departments of the auditory analyzer mainly ends at the time of birth, and the auditory analyzer starts to function from the first hours of life of the child. The first response to the sound manifests itself by the child with an expansion of pupils, breathing retention, some movements. Then the child begins to listen to the voice of adults and respond to it, which is already associated with a sufficient degree of development of the cortical departments of the analyzer, although the completion of their development occurs in the rather late stages of ontogenesis. In the second half of the year, the child perceives certain sounding and binds them with certain objects or actions. At the age of 7-9 months, the kid begins to imitate the sounds of speech around others, and by the year he appears the first words.

The newborn perception of the height and volume of sound is reduced, but by 6-7 months. Sound perception reaches the norm of an adult, although the functional development of the auditory analyzer associated with the production of subtle differentiations to hearing stimuli continues until 6-7 years. The greatest acuteness of hearing is characteristic of adolescents and young men (14-19 years old), then gradually decreases.

2.3. Pathology of a hearing analyzer

Hearing impairment is an imperceptible obstacle that far-reaching psychological and social consequences can have. Patients with reduced hearing or suffering in full deafness face significant difficulties. Sliced \u200b\u200bfrom verbal communication, they largely lose touch with loved ones and other people around them and significantly change their behavior. With the tasks, for the decision of which corresponds to the ear, other sensory channels cope with extremely unsatisfactory, so the rumor is the most important of human feelings, and his loss can not be underestimated. It is required not only for understanding the speech of others, but also for the ability to speak himself. The deaf from birth, children do not learn to speak, as they are deprived of hearing incentives, so deafness arising before the acquisition of speech relates to particularly serious problems. The inability to speak leads to universal development in development, reducing the possibility of learning. Therefore, the children from the birth of children should begin to use hearing aids until 18 months of age.

Children with hearing impairment are divided into three categories (classification):

• 
  deaf – These are children with a total loss of hearing, among which are distinguished by the deaf without speech (early deaf) and the deaf, which preserved speech. Children with bilateral resistant irregularities include early rich children. In children with congenital or acquired to speech development, the hearing impairment, later deafness is compensated by other analyzers (visual-visual images, instead of verbally logical). The main form of communication is facial expressions and gestures.

In children who retained speech, due to the lack of auditory control, it is fuzzy, lubricated. Children often have violations of the voice (inadequate height of the voice, falsett, swelling, sharpness, unnaturalness of timbre), also there are violations of speech breathing. In mental terms, children are unstable, inhibit, with large complexes.

• 
  late boilers – children with hearing loss, but with a relatively saved speech. They are trained in special schools on special programs with appropriate TSOs to normalize residual hearing (device for vibration, mechanical protection device). Oral speech is perceived by rumor with distortions, so there are difficulties in training, in the selection of speech perception, in the expression and progress of speech. These children are closed, irritable, own a speech with violations of the lexical and grammatical system of speech.
• 
  wasteless - These children with partial hearing insufficiency, impeding auditory development, but preserved the opportunity to accumulate speech reserve.

In the depth of the hearing impairment, 4 degrees are distinguished:

– easy – perception of a whisper at a distance of 3-6 m, speaking speech 6-8 m;

– moderate - the perception of the whisper is 1-3 m, colloquial speech 4-6 m;

– significant - the perception of the whisper is 1 m, colloquial speech 2-4 m;

– heavy - The perception of the whisper - not Bol. 5-10 cm from ear, colloquial speech - no more than 2 meters.

Reducing hearing acuity due to any pathological processes in any of the hearing analyzer departments ( giPocacusia) Or the loss of hearing is the most frequent consequence of the pathology of the auditory analyzer. More rare forms of hearing impairment are hyperaciawhen even the usual speech causes pain or unpleasant sounds (it can be observed during the damage to the facial nerve); Two sound ( diplakusia), which occurs with the unequal reproduction of the left and right ear of the height of the audio signal; parakusion - Improving hearing acuity in a noisy environment, characteristic of otosclerosis.

The hypoacusia can conditionally be associated with three categories of reasons:

1. Violations of sound. Weakness of hearing due to a mechanical obstacle to the passage of sound waves can be caused accumulation in external hearing aisle ear sulfur . It is released by iron outer auditory passes and performs a protective function, but, accumulating in the outer hearing aisle, forms a sulfur plug, the removal of which completely restores the hearing. Similar effect gives and the presence of foreign tel In a rumor pass, which is especially often celebrated in children. It should be noted that the main danger is not so much the presence of a foreign body in the ear, how much unsuccessful attempts to remove it.

Hearing impairment can be caused breakproken breakpoint When exposed to very strong noise or sounds, for example, an explosive wave. In such cases, it is recommended to open the mouth by the time the explosion occurs. A frequent cause of perforation of the eardrum is a picking in ear studs, matches and other objects, as well as inept attempts to remove foreign bodies from the ear. The disorder of the intake of the eardrum when the remaining departments of the auditory body is preserved, relatively little is reflected on the hearing function (only the perception of low sounds suffers). The main danger is the subsequent infection and the development of purulent inflammation in the drum cavity.

Loss of elasticity of the eardrum When exposed to production noise leads to a gradual loss of hearing acute (professional hearing loss).

Inflammation of the tympanal bone apparatus Reduces its ability to strengthen sound and even with a healthy inner ear, hearing worsens.

Inflammation of the middle ear It is dangerous for auditory perception by their consequences (complications), which are most often noted in the chronic character of inflammation (chronic average otitis). For example, due to the formation of adhesions between the walls of the drum cavity and the membrane, the mobility of the latter decreases, resulting in a worsening of hearing, the noise in the ears. Very frequent complication of both chronic and acute purulent octitis, is the campaign of the eardrum. But the main danger is lurking in a possible transition of inflammation to the inner ear (labyrinthitis), on the brain shells (meningitis, brain abscess), or in the occurrence of general blood infection (sepsis).

In many cases, even with proper and timely treatment, especially chronic Middle Otitis, the recovery of the hearing function is not achieved in full, due to the resulting scar changes to the eardrum, the joints of the auditory bones. With the defeats of the middle ear, as a rule, a resistant decrease in hearing occurs, but the full deafness does not occur, since bone conductivity is preserved. Full deafness after inflammation of the middle ear can only develop as a result of the transition of the purulent process from the middle ear to the internal.

Secondary (secretory) otitis It is a consequence of overlapping hearing pipe Due to inflammatory processes in the nasopharynk or the growth of adenoids. The air of the air is partially absorbed by its mucous membrane and is created negative pressure The air, on the one hand, the limiting mobility of the eardrum (effect is the deterioration of hearing), and on the other hand, it is promoted to peer blood plasma from vessels into the drum cavity. The subsequent organization of the plasma bunch can lead to the development of the adhesive process in the drum cavity.

Special place occupies otosclerosis The sponge fabric consisting in the growth of spongy fabric, most often in the area of \u200b\u200bthe oval window niches, as a result of which hepricted turns out to be closed in an oval window and loses its mobility. Sometimes this growth can be spread to the labyrinth of the inner ear, which leads to a violation of not only the function of sounding, but also sounds perception. It is manifested, as a rule, at a young age (15-16 years), the progressive drop of hearing and noise in the ears, leading to a sharp hearing loss or even a complete deafness.

Since the lesions of the middle ear relate only to sound-conducting formations and do not affect the sound-periming neuroephelial structures caused by them conductive. Conductive hearing loss (except professional) in most patients is quite successfully corrected by microsurgical and hardware.

2. Violations of sound perception. In this case, the hairs cells of the Cortiyev organ are damaged, so that either the signal conversion or the separation of the neurotiator is impaired. As a result, the transfer of information from snail in the central nervous system suffers and develops sensory touginess.

The reason is the impact of external or internal adverse factors: infectious diseases of children's age (measles, scaryttern, epidemic cerebrospinal meningitis, epidemic vapotitis), general infections (flu, rapid and returning typhus, syphilis); Drug (chinin, some antibiotics), household (carbon monoxide, light gas) and industrial (lead, mercury, manganese) intoxication; injuries; intensive effects of industrial noise, vibration; violation of blood supply to the inner ear; Atherosclerosis, age-related changes.

By virtue of its deep location in the bone maze, inflammation of the inner ear (Maze), as a rule, are the nature of complications of inflammatory processes of the middle ear or brain shells, some children's infections (measles, scarletins, epidemic vapotitis). Punchy diffuse maze in the overwhelming majority ends with a complete deafness due to the purulent melting of the Cortiyev organ. The result of a limited purulent labyrinthitis is a partial loss of hearing on certain tones, depending on the place of defeat in the snail.

In some cases, with infectious diseases, the microbes themselves penetrate into the labyrinth, and their toxins. Developing in these cases, dry labyrinthitis flows without purulent inflammation and usually does not lead to the death of the nerve elements of the inner ear. Therefore, the complete deafness does not occur, but often there is a significant decrease in hearing due to the formation of scars and battles in the inner ear.

Hearing disorders arise due to an increase in endolymph pressure on sensitive cells of the inner ear, which is observed when meniere disease. Despite the fact that the increase in pressure is increasing in nature, the decline in hearing progresses not only during the exacerbations of the disease, but also during the intergreacy period.

3. Retrochlear violations - Internal and secondary ear, healthy, but violated either the transfer of nerve pulses for a rumor nervous nervous area of \u200b\u200bthe bark of large hemispheres, or the activity itself of cortical centers (for example, with a brain tumor).

The lesions of the conductor department of the auditory analyzer may occur on any of its segment. Most frequent are neurutians of auditory nerve Such under which the inflammatory defeat is not only the trunk of the auditory nerve, but also the damage to the nerve cells that are part of the spiral nervous knot, located in the snail.

Nervous fabric is very sensitive to any toxic effects. Therefore, a very frequent consequence of the impact of some medicinal (chinin, arsenic, streptomycin, salicylic drugs, antibiotics of aminoglycoside groups and diuretic products) and toxic (lead, mercury, nicotine, alcohol, carbon monoxide, etc.) substances, bacterium toxins are the death of the nerve ganglia of the spiral node, which leads to a secondary descending degeneration of Cortiyev's bodies and ascending degeneration of nervous cells Hearing nerve fibers, with the formation of a complete or partial loss of the hearing function. Moreover, quinine and arsenic have the same affinity for the nerve elements of the auditory body, like methyl (woody) alcohol - to the nerve endings in the eye. Reducing hearing acuteness in such cases can achieve considerable severity, up to deafness, and treatment is usually not effective. In these cases, the rehabilitation of patients occurs with the help of training and using auditory devices.

The diseases of the hearing nerve barrel occur due to the transition of inflammatory processes from the brain shells on the nerve shell during meningitis.

Conductive hearing paths in the brain can suffer from congenital anomalies and in various diseases and damage to the brain. These are primarily hemorrhages, tumors, inflammatory processes of the brain (encephalitis) during meningitis, syphilis, etc. In all cases, such lesions are usually not isolated, but are accompanied by other brain disorders.

If the process develops in one half of the brain and captures the auditory paths before their crossroads - the rumor to the corresponding ear is completely or partially disturbed; Above the crossroads - there comes a bilateral decrease in hearing, more pronounced on the side, opposite to the defeat, but the full loss of hearing does not occur, since the part of the pulses goes on the preserved conductive paths of the opposite side.

Damage to the temporal fractions of the brain, where the auditory cortex is located, can occur with hemorrhages in the brain, tumors, encephalitis. Comprehension of speech, spatial localization of the sound source and identification of its temporal characteristics. However, such lesions do not affect the ability to distinguish the frequency and power of sound. One-sided bark lesions lead to a decrease in rumor on both ears, more - on the opposite side. Bilateral lesions of conductive paths and the central end of the auditory analyzer are practically not observed.

Defects of hearing organs:

1. Allozia – Congenital complete absence or underdevelopment (for example, lack of cortiene organ) of the inner ear.

2. Atresia - infection of the outdoor auditory pass; With an innate character, it is usually combined with the underdevelopment of the ear shell or its fullest. Acquired atresia can be a consequence long inflammation The skin of the ears (with chronic threading from the ear), or scar changes after injuries. In all cases, only a complete incigepse of the auditory pass is to a significant and resistant decrease in hearing. In case of incomplete infections, when there is at least a minimum gap in a rumor passage, hearing is usually not suffering.

3. Thumbed ear sinks combined with increasing their size - macro or small sink sinks – micro . In view of the fact that the functional value of the ear shell is small, all its diseases, damage and anomalies of development, up to the complete absence, do not entail a significant impairment of hearing and have mostly cosmetic significance.

4. Congenital fistula – the incoming of the gill slit, open on the front surface of the ear shell, a little above the goat. The hole is minor and there is a damaging, transparent yellow liquid.

5. Congenital A. nomalions of the middle ear – accompanies violations of the development of outdoor and inner ear (filling the drum cavity with bone tissue, the absence of auditory bones, splicing them).

The cause of congenital ear defects is most often lied in disorders of the development of the embryo. Such factors belongs to the pathological impact on the embryo from the body of the mother (intoxication, infection, injury to the fetus). The well-known role is played by hereditary predisposition.

From congenital development defects should be distinguished by damage to the hearing body arising during the generic act. For example, even the injuries of the inner ear may be due to the compression of the fetus head with narrow generic paths or the consequences of the imposition of obstetric tongs during pathological gods.

Congenital deafness or headup - either hereditary violation of the embryological development of the peripheral part of the auditory analyzer or its individual elements (outdoor, secondary ear, bone capsule of the labyrinth, cortiyev organ); or hearing impairment related to viral infectionstransferred to pregnant in early terms (up to 3 months) pregnancy (measles, influenza, vapotitis); Either the consequences of the admission to the body of pregnant toxic substances (chinin, salicylic preparations, alcohol). An innate reduction in hearing is found already in the first year of the child's life: it does not move from the "coming" to the pronouncement of syllables or simple words, but, on the contrary, gradually fell completely silent. In addition, at the most later, by the middle of the second year, a normal child learns to turn towards the sound incentive.

The role of the hereditary (genetic) factor as the cause of congenital hearing disorders in previous years was somewhat exaggerated. However, this factor undoubtedly has a certain meaning, since, it is known that the deaf parents have children with a congenital defect of hearing are more often born than those who have hearing.

Subjective reactions to noise. In addition to sound injury, that is, objectively observed damage to hearing, a long stay in an environment, "contaminated" excess sounds ("sound noise"), leads to an increase in irritability, worsening sleep, headaches, an increase in blood pressure. The discomfort caused by noise largely depends on the psychological attitude of the subject to the sound source. For example, the tenants of the house can annoy the game on the piano with two floors above, although the volume level objectively is small and other residents do not arise complaints.

The value of hearing in a person's life is difficult to overestimate. Noted that during the period of intensive development little child The rumor carries up to 80% of information about objects, phenomena, events of the surrounding world, the characters of nearby people. The ear allows you to significantly expand the information field, greatly facilitates socialization, allows a person to more freely navigate in space. It is important, the presence of hearing and for the more successful aesthetic development of the individual (music). One of the most significant hearing functions for the child is a prerequisite for successful speech formation. In the absence of hearing, it is not developing without additional stimulation and attract additional funds.

Deaf: Hearing is completely absent or there is residual hearing, on the basis of which independent formation of speech is impossible.

In this group of people you can allocate two subgroups

1. Winged (people who have lost his rumor up to 3 years, i.e. during the period of active formation of speech).

4 deafness groups (neutiman):

• people hearing non-hearing sounds (125 -250 oscillations);
• people who hearing speech sounds (500 oscillations per second) are low vowels;
• people who perceive 1000 oscillations per second - vowels and some consonants, on the basis of which the independent appearance in the speech of individual syllables and words;
• people who perceive up to 2000 oscillations per second are familiar short words and suggestions;

In early people, it is not developing in independently developing, but can be formed by special learning.

2. Late items (people who have lost his hearing after 3 years)

Speech condition, depending on the loss of hearing, is different. Hearing loss in 3 years can lead to a complete loss of success of speech.

Weigh-drying: There is a decrease in hearing of varying degrees, on the basis of which self-development is possible.

This group of people is also conditionally divided into two subgroups.

- People with a slight decrease in hearing and the best development of speech

- People with a significant decrease in hearing and severe speech underdevelopment

Weigh-drying people hear speech, but difficulty perceive individual complex phrases. Self speech is not fully formed, which can be expressed in the poor vocabulary, losing individual syllables, sound-proof disorders, characteristics of phrases. The conclusion is obvious - the better the rumor, the better it is. However, we will not forget that the loss or reduction of hearing in the child should be considered otherwise than in an adult. An adult person is easier to preserve the already existing speech, while the children have independent formation is extremely difficult or impossible, but even an adult person who has lost her rumor, having listened to the risk of decay of the already existing speech due to the lack of auditory control.

Types of irregularities of hearing

Censorineral disorders of hearing

Sensorium hearing disorders - violations under which the process of sound perception suffers. Problems with the latter occur when there is damage, dysfunction, underdevelopment and other pathological changes in snail, the fibers of the auditory nerve and the centers of the nervous system responsible for analyzing sound signals. Those. Anatomical substrate of sensorineral hearing impairments is usually located not at the levels of the outer and middle ear, but in the inner ear and the brain.

Compared with the conductive hearing loss, the sensorine hearing impairment is a more serious medical and social problem:

they are more often conducted

• sensorineral disorders are the main cause of deafness and heavy degrees of hearing loss - i.e. As a rule, it is heavier than conductive. The contribution of sensorineral hearing disorders into the disability of the children's population (deafness, difficulties in training, social adaptation) is incomparable with those for conductive hearing disorders. The possibilities of medical care in the sensorineral type of hearing disorders are quite limited.
• possible medical and rebirth assistance to people with such hearing impairments belongs to the category of very expensive.

All this served as a serious motive for intensive scientific study of sensorineral hearing impairments - today they are the object of close attention of hesitations, genetics, epidemiologists, pharmacologists, embryos, etc.

Sensorium hearing impairments may occur at any age, but a significant part of them is already manifested in the earlier childhood (usually - by the time of birth). Among the reasons for this type of hearing disorders, many genetic and external factors mean. For example, it is well known that more than half (about 60%) of all cases of congenital sensorineral hearing loss and deafness are purely hereditary causes. The remainder of the cases falls on the share of adverse exemplary influences revealed to the hearing organs of the embryo or already born man.

For example, the cause of sensorineral irregularities of hearing may be mutations (breakdowns) in individual human genes encoding protein molecules, important for the normal operation of the auditory analyzer. Such proteins include Connexin-26, myozin -7a and others. In addition, non-mental defects of snail development, diseases of the inner ear and nervous system (tumors, can also lead to sensorine deafness and hearing loss. inflammatory diseases, degeneration, injuries), toxic influences of some chemicals (including medicines), noise injury, etc. Below are the risk factors of sensory hearing disorders depending on the age of a person. If there is some of those such (or at once), "healthy" alertness regarding the rumor of a child or an adult will be quite justified.

Newborn period (1 month of life):

• the presence in the family history of cases of sensorineral irregularities of hearing in the blood relatives of the child
• disease rubella or even just contact with Krasnuha patients who had a woman during pregnancy in these kid
• the acute disease of the woman during pregnancy (or exacerbation of chronically current infections) is of particular importance to the toxoplasmosis, cytomegalovirus and other herpes infection, syphilis treatment of women during pregnancy antibiotics from the aminoglycoside group (streptomycin, kanamycin, neomycin, gentamicin, etc.), especially In combination with diuretic means of the type of Lazix.
• the birth of a child in asphyxia (score on the apart scale in the 1st minute - 0-4 points, or 0-6 points in the 5th minute). This data can be found in the newborn exchange card.
• premature childbirth (the birth of a premature baby with a body weight of less than 1500 grams)
• high levels of bilirubin in a child who demanded operations of replaced blood transfusion (the usual cause of this is a rhesus conflict or other immunological incompatibility of the mother and the fetus)
• severe diseases of the newborn, demanding long (more than 5 days) artificial ventilation of its lungs ("hardware breathing")
• generic injury (especially - including fractures of bones of skull and hemorrhage in the brain)
• treatment of infectious diseases in a newborn baby aminoglycosidic antibiotics, especially if the recent were prescribed in combination with certain diuretics (see above) bacterial meningitis
• congenital malformations in the child, especially the defects of the outer ear, skull and face

In the age period 1 month - 2 years Risk factors are as follows:

• the presence of a child's blood relatives of sensory hearing impairments that appeared in early childhood
• infectious diseases dangerous in terms of sensory hearing disorders - bacterial meningitis, etc.
• card and brain injuries with loss of consciousness or fracture of bones of the skull.
• treatment of aminoglycosidic antibiotics in combination with diuretics of the type of lazix or stacrific acid. The same applies to some chemotherapy appointed for the treatment of leukemia and other malignant tumors.
• the presence of a child of congenital defects or small anomalies of development associated with hearing impairments (there are quite a lot of such vices;

Adequately assess their possible "conjugacy" with hearing impairments should a specialist who properly owning the methodologies of the phenotype and syndromological analysis - is usually such a genetic physician)

In older children and adults, some of the above factors retain their relevance and others are added - the effects on the hearing of chronic infectious, endocrine and other diseases, oncological pathology, noise injury ...

As you approach the elderly, the role of an unpleasant biological process, known as aging - in general, as you can see, the risk factors for the development of sensorineneral hearing loss and deafness are quite a lot and the time range of their action covers almost all human life.

Diagnosis of sensorineural hearing impairments is carried out by the same principle as the diagnosis of conductive hearing loss and deafness.

It also holds ENT or otologist. Evaluation of complaints, inspection of the region of external ear, auditory passage, eardrum, then an audiometry, data that allows you to establish a sensorineral nature of hearing disorders and their severity. Considering the fact that with the sensorineural nature of hearing disorders early diagnosis It is extremely important, in some cases, other, more "fast" methods of audiological examination are applied - an open-coastal emission and a study of the auditory caused of the brain trunk potentials.

Usually, these methods are used to evaluate hearing in kids who, due to the age characteristics of the psyche, cannot undergo audiometry (the latter requires a fully conscious relationship from the test person). The same methods allow you to evaluate the rumor in people with intellectual deviations that are not able to implement the instructions of the audioologist given before the start of the audiometric procedure.

Unfortunately, today there are practically no effective methods for the treatment of sensorineral hearing impairments - in the overwhelming majority.

The reason for this is an extremely complex device of a person's sound and "fine" character of damage or defects in it.

It is impossible, for example, to make an effective replacement of dead Snail cells with new ones - at least modern medicine It is not under power. However, progress in the field of biotechnology and applied electronics can have been able to change the insufficient situation in the very near future with the treatment of sensorine hearing disorders.

In the meantime, patients with this type of deafness and hearing loss remains to be assumed to help the audience - i.e. The use of special devices, to one extent compensating or reduced natural hearing functions.

Over the past decades, the audition has made a powerful jerk forward - from primitive mechanical devices (drawing on the left) prior to the development of programmable digital hearing aids (drawing on the right) and high-tech cochlear implants.

Different modifications of these devices help a person with sensorineral hearing impairments better adapt in society - however, in some cases, in addition to the audience, the professional assistance of specialists in the field of lugbying abbreviation (or parents who have passed the appropriate training are also required. The laboriousness and high financial cost of such an ability in combination with a sufficiently large prevalence of sensorine hearing disorders causes the health systems of advanced countries to look for ways to prevent this pathology.

Warning of sensorineral hearing impairments - the matter is not easy: too much the number of various factors need to be taken into account a person who has become "on defense" of his own hearing and rumor of its descendants.

However, all these physical, moral and financial efforts will always be justified.

If only because a good ear is simply impossible to evaluate in monetary terms - the people who, unfortunately lost, have lost themselves.

Conductive impaired hearing

Conductive hearing impairments - disorders under which the process of conducting sound waves from the external environment to the Ear structures transforming these waves into electrical signals is suffering.

And since the process of sound perception is already begins with the level of the inner ear, the substrate of conductive hearing disorders is always damage, dysfunction or underdevelopment of structures of only outdoor and middle ear. those. - ear shells, outdoor auditory passage, eardrum and auditory bones.

Problems with the above formations may be different. For example, under a number of hereditary syndromes or adverse exemplary effects on developing fruits, a person is born with the defects of the development of the outer ear - the lack of or rude underdevelopment of the oars.

Quite often, this problem is combined with the so-called complete atresia of the auditory passage - in this case, a person has no outer opening of the auditory channel.

The outer hearing pass can also be significantly narrowed (this is called stenosis) - in general, in all these cases, the possibility of "delivery" of mechanical sound oscillations "deep into" the auditory analyzer is sharply reduced, where, in fact, the process of "hears" itself proceeds.

The aforementioned atresia and / or stenosis of an auditory passage can be symptoms of more than 100 (!) Inheritance syndromes. There are few less often malformations of the structures of the middle ear; They also lead to conductive hearing loss.

Much more often than hereditably conditioned or simply congenital defects for the formation of a sound vehicle, its acquired dysfunctions are found.

The most significant - inflammatory lesions of the middle ear - the so-called medium otitis.

Especially often occurs this disease in early childhood. It is the average otitis that is the main cause of conductive hearing loss in children. The reason for this is "Prejudice»Anatomical and physiological features of the body of kids.

However, "does not forget" otitis and adults: some bacteria, his causing, the age of man is not particularly important. Otitis can lead to a violation of the integrity of the eardrum, partial destruction of the auditory bones - in general, to damage the normally formed sound conductive apparatus of the ear.

Acute variants of this pathology are quite well amenable to therapy and with due efforts of doctors and patients with serious hearing impairments are rarely complicated.

The chronic forms are a problem more complicated - in terms of decline in hearing, including.

That is why the treatment of acute average otitis should always be treated seriously: the treated "KOTO -KA", this disease is associated with a launched general "sanitary" nasopharynx state, can play an important role in the development of chronic inflammation of the middle ear.

In addition to medium and external, exudative, acute and chronic otites, conductive hearing impairment may be due to problems with more prose-sulfur traffic jams located in the lumen of external hearing aisters.

Ear sulfur secrets constantly and different people Under different conditions, its viscosity can vary greatly.

In addition, this substance is capable of adsorbing dust particles, broken epithelium cells, etc. Sometimes it leads to education in the loss of a hearing passage of a dense conglomerate, "interfering with" sound waves to reach a drumpatch. Or is even a few limiting mobility of the latter. As a result, the conductive hearing loss occurs.

The same consequences leads to the outer hearing passage of foreign bodies. Most often, the latter are there as a result of the "experiments" that are so like to conduct young children.

It is hardly possible to you can demonstrate peculiar "collections" from foreign objects extracted by doctors from the hearing aisters of unlucky juvenile "Naturalists».

It can be buttons, beads, bones from fruit, crushing ... It is noteworthy that the baby, "Shaking" in his own ear "plug", is not always in a hurry to complain to parents to reduce hearing or other discomfort; There are no cases when the foreign body was removed from the auditory pass of a child after hitting there.

And even to the conductive hearing loss, injuries of the eardrum (or, much less often - the structures of the middle ear) can be solved.

Although the drummeal and has quite effective natural mechanisms for protection against excessively strong effects, it should be recognized that humanity has greatly succeeded in the development of species of these very influences: in nature there are no such either at all, or they are found very and very rare. Because the hoddows often have to deal with the treatment of a injured eardrum - and not only in wartime, unfortunately.

Speaking about the diagnosis of conductive hearing impairments, it should be started with the fact that the "causing" ear must be carefully examined by a competent specialist.

After hearing the patient's complaint and clarify the necessary information, the doctor examines the ears of the sink, the outer hearing passage and the eardrum (for the latter, special tools are usually used - the otoscopes and ear funnels).

Already at this stage it is possible to determine the conductive nature of the hearing impairment. If the inspection data was not informative enough, the specialist resortes to additional research methods - it can be x-ray or computed tomography of temporal bone, as well as audiological tests.

Tympanometry, for example, quite effectively allows you to confirm or eliminate the presence of some serious problems in the drum cavity (inflammatory Exudate, in particular, etc.). The data obtained in audiometry makes it possible to evaluate not only the type of hearing impairment (conductive or sensorineural), but also determine the degree of hearing loss, as well as the "affected" frequencies.

Sometimes other, more narrowly specific methods for studying the function of the auditory analyzer may be required.

There are many methods of medical care to patients with conductive hearing impairment.

If the latter are caused by foreign bodies or sulfur plug, then the treatment is quite simple - these "extra" objects are simply deleted. After that, the rumor is usually completely restored. If we are talking about the active inflammation of the hearing organs, the doctors are struggling with it, applying various drugs and surgical techniques. If we are talking about impaired integrity and "Workability»Drumping membrane and auditory bones, then surgical interventions are most often required. It is known a large number of occasional operations - starting from the so-called tympanoplasty and ending with the prosthetics of hearing bones. Many of these operations are extremely complex in technical plan, require special equipment, but still these operations are carried out in most countries of the world and over the past decades have reinstantly returned the hearing a huge number of patients suffering from conductive hearing impairments. In general, with the treatment of this type of hearing loss, the situation is still more optimistic than that with the treatment of hearing loss and deafness sensorinery.

It is only necessary to always remember that the timely appeal to the specialist largely determines the success in the treatment of conductive hearing violations.

Hereditary impaired hearing

Hereditary (genetic) hearing impairment - violations that are able to be transmitted from ancestors to descendants.

To implement such a program it is not at all necessary that the biological parents of the child themselves have deafness and hearing loss - unfortunately, quite often it happens that the father and the mother of the baby, suffering from the hereditary deafness, have impeccable hearing.

The auditory analyzer of man (as well as all other living beings on the planet) is laid and formed in the intrauterine period of development.

This happens, of course, not chaotic, but through a clear and phased implementation of instructions stored in the genes received from parents. Since the device of our auditory analyzer is quite complex, the number of genes, one way or another participating in its formation, is huge - perhaps it is calculated by thousands. Of course, the contribution of each particular gene is individual: there are genes extremely important for "construction" and the subsequent functioning of the auditory analyzer, there are less significant.

The mechanism of gene control over the process of laying, the formation and subsequent normal operation of the human auditory analyzer is universal.

Almost all genes store information about the chemical structure of protein molecules designed to perform certain tasks. Some genes encode proteins that are catalysts of biochemical reactions (T.e. enzymes or enzymes), some are the so-called structural proteins (unique building materials from which the most important "details" of our cells are collected).

For example, the Mozin-VIIA gene encodes the protein, an extremely important for normal operation of the cells of the inner ear and retina. Connexin26 gene stores information on the chemical formula and protein structure, which is a special channel, with which cells (including - and hairs) are exchanged by ions and other "signal" molecules.

Unfortunately, the main "repository" of our hereditary information is the DNA molecule - does not always turn out to be sufficiently resistant to malicious chemical and physical environmental impacts. As a result of such "attacks", the molecular structure of DNA often undergoes changes called mutations. The breakdown (or, as already mentioned above - mutations) in genes responsible for the formation and normal operation of the auditory analyzer, lead to the distortion of the chemical structure of the proteins encoded by them. In this regard, the latners cannot normally perform their functions in the body, which ultimately leads to hearing impairment.

Such mutations may accidentally occur in DNA of single eggs or sperm of healthy parents who are not carriers of deafness genes. In this case, mutations are called "de novo", i.e. "First have arisen."

In other cases, the gene breakdowns can be transmitted to man "by inheritance" from the ancestors - at the same time, in most cases, a normal hearing person does not suspect that at least half of its eggs (or spermatozoa) contains a mutant gene, capable of incuring hearing impairment under certain conditions. His children. The manifestations of the defective gene in the human body can be the most different.

If the gene belongs to the category "Top specialized"(T .e. Controls only some particular part of the structure or function of the auditory analyzer), then the carriage of the mutation can be manifested only with deafness (hearing loss).

An example of such a gene can serve as repeatedly mentioned Connexin26, responsible for the hereditary hearing loss of various degrees.

Similar hearing impairments in medicine are called non-indemn. If the gene has a broader "competence" (t .e. It is responsible for the formation or operation of not only hearing organs, but also others), then the deafness or hearing loss caused by the syndromic (or syndromic).

For example, breakdowns in the Mozin7a gene lead to the development of the Usher's syndrome, which can manifest itself not only by hearing impairment, but also serious vision issues.

Another diverse manifestation of mutations in the genes responsible for the syndromes of Vaardenburg, Alport or Pendodred is: among the carriers of such mutations, in addition to a hearing analyzer, a pigment exchange, kidney and thyroid gland can affect the hearing analyzer, respectively.

If the number of known medicine varieties of non-indemnome hereditary hearing disorders is still measured in tens, then the number of hereditary syndromes, accompanied by hearing loss and deafness higher by the whole order: such has long exceeded four hundred names.

Unfortunately, the prevalence of such mutations among the population of the planet is quite significant - this is evidenced by the frequent occurrence of hereditary hearing impairments from representatives of different races and nationalities.

(bradyiacusia or giPocacusia) It is a deterioration in hearing of varying degrees of severity (from insignificant to deeply), which arises suddenly or developing gradually, and caused by the disorder of the functioning of sound surprising or sound conducting structures of the auditory analyzer (EH). In case of hearing loss, the person does not hear various sounds, including the speech, as a result of which normal communication and any communications with other people are difficult, which leads to its desocialization.

Deafness It is a kind of end stage of the hearing loss and is an almost complete loss of the ability to hear different sounds. With a deafness, a person does not hear even very loud sounds, which normally cause ear pain.

Deafness and hearing loss can affect only one or immediately both ear. Moreover, the hearing loss of different ears can have a different severity. That is, one ear can hear better, and the other worse.

Deafness and Headup - Quick Feature

Headupiness and deafness are options for a hearing disorder, in which a person loses the ability to hear different sounds. Depending on the severity of the hearing loss, a person can hear a larger or smaller spectrum of sounds, and with deafness marks the complete inability to hear any sounds. In general, deafness can be viewed as the last stage of the hearing loss, which takes place a complete hearing loss. Under the term "touginess" usually imply a deterioration in the hearing of varying degrees of severity, in which a person can hear at least a very loud speech. And the deafness is called a condition at which a person is no longer able to hear even a very long speech.

Headowing or deafness can affect one or both ear, and the degree of its severity may be different on the right and left ear. Since development mechanisms, reasons, as well as methods of therapy of hearing loss and deafness are the same, they are combined into one nosology, considering them as consecutive stages of one pathological process of human hearing.

Headowness or deafness can be due to the lesion of sound-conducting structures (organs of the middle and outdoor ear) or a sound-visible apparatus (internal ear and structure organs brain). In some cases, hearing loss or deafness may be due to simultaneous lesion and sound-conducting structures, and the audio analysis of the auditory analyzer. To clearly imagine, which means the defeat of a particular apparatus of the auditory analyzer, it is necessary to know its structure and functions.

So, the auditory analyzer consists of ear, auditory nerve and hearing cortex of the brain. With the help of the ears, a person perceives the sounds that further in a rumor nerve are transmitted in the encoded form in the brain where the resulting signal and the "recognition" of sound occurs. Due to the complex structure, the ear not only captures the sounds, but also produces their "transcoding" into the nerve impulses, which are transmitted to the brain in the auditory nerve. The perception of sounds and their "transcoding" into nerve impulses are made by various ear structures.

Thus, the perception of sounds correspond to the structure of the outer and middle ear, such as the drum membrane and hearing bones (hammer, anvil and rapidly). It is these parts of the ear to perceive the sound and conduct it to the structures of the inner ear (snail, intense and semicircular channels). And in the inner ear, the structure of which is located in the temporal bone of the skull, occurs "transcoding" of sound waves into electrical nerve impulses, in the future transmitted to the brain according to the corresponding nerve fibers. The brain has a processing and "recognition" of sounds.

Accordingly, the structure of the outer and middle ear belongs to the sound conducting, and the internal ear organs, the auditory nerve and the cortex of the brain are to soundly observing. Therefore, the entire set of rumor reduction options is divided into two large groups - associated with the damage to the sound-conducting structures of the ear or the audio-visible apparatus of the auditory analyzer.

Headowness or deafness can be acquired or congenital, and depending on the time of occurrence - early or late. The earlyness is considered tortured, acquired before reaching the child of the age of 3 - 5 years. If the hearing loss or deafness appeared after 5 years of age, then it refers to late.

Acquired hearing loss or deafness is usually associated with the negative impact of various external factors, such as injuries Ear, transferred infection , complicated by damage to the auditory analyzer, constant noise effect, etc. Separately, it should be noted the acquired hearing loss due to age-related changes in the structure of the auditory analyzer, which are not associated with any negative impacts on the hearing body. Congenital hearing loss is usually due to developmental deposits, fetal genetic anomalies or transferred mothers during pregnancy Some infectious diseases ( rubella , syphilis etc.).

A specific causal hearing reduction factor is determined in the course of a special composite examination conducted by the ENT-doctor, a sorpse of or neuropathologist . In order to choose the optimal method of reduced hearing therapy, it is necessary to find out what caused the hearing loss - the lesion of the sound-conducting or sound-visible apparatus.

Treatment of hearing loss and deafness is made by various methods, among which there are both conservative and operational. Conservative methods are usually used to restore a sharp deteriorating hearing against the background of a known causal factor (for example, with hearing loss after taking antibiotics , after the cranial injury, etc.). In such cases, with timely therapy, the hearing can be restored by 90%. If conservative therapy was not conducted as soon as possible after the deterioration of hearing, its effectiveness is extremely low. In such situations, conservative treatment techniques are considered and used exclusively as auxiliary.

Operational treatment methods are variable and allow us to return to human hearing overwhelmingly. Most of the operational methods for treating hearing thugs are associated with the selection, installation and adjustment of hearing aids that allow a person to perceive sounds, hear speech and interact normally with others. Another large group of methods of operational treatment of hearing lies is to carry out very complex operations on the installation of cochlear implants, allowing you to return the ability to perceive sounds to people who cannot use hearing aids.

The problem of hearing loss and deafness is very important, since poorly hearing person turns out to be isolated from society, he has sharply limited the possibilities of employment and self-realization, which, of course, imposes a negative imprint for the whole life of the hearing impaired. The most difficult are the consequences of hearing loss in children, since they have a bad hearing to lead to gentle. After all, the child has not yet mastered the speech very well, he needs a permanent practice and further development of the speech apparatus, which are achieved only with the help of a constant perception of new revolutions, words, etc. And when a child does not hear speech, he can completely lose even Available ability to speak, becoming not just a taguhim, but also dumb.

It must be remembered that about 50% of cases of hearing thugs can be prevented in properly compliance with prevention measures. So, effective preventive measures is an vaccination children, adolescents and women of childbearing age against dangerous infections, such as measles , rubella, meningitis , piggy , whooping cough et al. which can cause complications in the form otitov and other diseases of the ear. Also effective prophylactic measures of the warning of hearing loss are high-quality obstetric care for pregnant women and women in labor, correct hygiene Own shells, timely and adequate therapy of ENT diseases, avoiding the use of toxic drugs for the hearing analyzer of drugs, as well as minimizing the noise effect on the ears in industrial and other rooms (for example, when working in noisy premises, it is necessary to wear earnings, noise-canceling headphones and so on .).

Deafness and notch

Deafness and notch are often combined, and the second is a consequence of the first. The fact is that a person is mastering and then constantly supports the ability to speak, to pronounce the self-consistent sounds only if they constantly hear those from other people and from themselves. When a person ceases to hear sounds and speech, it becomes difficult to speak, as a result of which the speech skill is reduced (worsen). The pronounced reduction of speech skills leads to the general.

Particularly susceptible to the secondary development of the little children who have become taguhi under the age of 5 years. Such children gradually lose already learned speech skills, and they become dumb due to the fact that they do not hear. Children, deaf from birth, almost always dumb, as they cannot master the speech, simply do not hear her. After all, the child learns to speak, listening to other people and trying to pronounce self-imitating sounds. And the deaf toddler does not hear sounds, as a result of which he simply cannot even try to say something, imitating others. It is because of the inability to hear the deaf from the birth of children remain dumb.

Adults who acquired hearing loss, in very rare cases become dumb, because speech skills are well developed and lost very slowly. A deaf or a taguhih adult can weird talking, stretching words or pronouncing them very loudly, but completely the ability to play speech is not lost almost never.

Deafness for one ear

Deafness on one ear, as a rule, it happens acquired and is found quite often. Such situations usually occur when influencing negative factors only on one ear, as a result of which it ceases to perceive sounds, and the second remains quite normal and fully functional. Deafness on one ear does not necessarily provoke a worsening of hearing from the second ear, moreover, a person can live the rest of his life with the only functioning ear, retaining his hearing in the norm. However, if there is a deafness to one ear, it is necessary to take care of the second organ, because with his defeat, a person will cease to hear at all.

Deafness to one ear in development mechanisms, reasons and methods of treatment are no different from any variant of acquired hearing loss.

With a congenital deafness, the pathological process usually affects both ears, since it is associated with systemic violations of the work of the entire auditory analyzer.

Classification

Consider various forms Both the types of hearing loss and deafness, which allocate depending on the leading feature based on the classification. Since the leading signs and characteristics of hearing loss and deafness are somewhat, then there is also a variety of disease allocated on their basis.

Depending on which the structure of the auditory analyzer is amazed - sound conductive or sound, the entire set of various variants of the hearing loss and deafness is divided into three large groups:
1. Neurosensory (sensuously) hearing loss or deafness.
2. Conductive hearing loss or deafness.
3. Mixed hearing loss or deafness.

Neurosensory (sensuously) hearing loss and deafness

The neurosensory is called hearing loss or deafness due to the lesion of the audio-visible apparatus of the auditory analyzer. With neurosensory hearing loss, a person catches the sounds, but the brain does not perceive them and does not recognize them, as a result of which hearing has a decrease in the practice.

Neurosensory hearing loss is not a single disease, but a whole group of various pathologies, which lead to a violation of the functioning of the hearing nerve, the inner ear or the hearing area of \u200b\u200bthe cerebral cortex. But since all the pathology data affect the sound of the auditory analyzer, and therefore they have a similar pathogenesis, they are combined into one large group of neurosensory touginess. Morphologically neurosensory deafness and hearing loss can be due to the disorder of the functioning of the hearing nerve and the cortex of the brain, as well as the anomalies of the structure of the inner ear (for example, atrophy of the sensory apparatus of the snail, changing the structure of the vascular cavity, spiral ganglium, etc.) arising due to genetic disorders or due to transferred diseases and injuries.

That is, if the hearing loss is associated with the impairment of the functioning of the internal ear structures (snail, the run-up or semicircular channels), the auditory nerve (VIII pair of cranknyh brain nerves) or the cerebral cortex sites responsible for the perception and recognition of sounds, from which it is neurosensory reducing options. hearing.

By origin, neurosensory touginess and deafness can be congenital or acquired. Moreover, congenital cases of gentlenevial \u200b\u200bhearing loss are 20%, and acquired, respectively - 80%.

Cases of congenital hearing loss may be due to either genetic disorders in the fetus, or anomalies for the development of a hearing analyzer arising from the adverse effects of environmental factors during the period of intrauterine development . Genetic disorders in the fetus are originally available, that is, they are transmitted from parents at the time of fertilization of the egg spermatozooid. If at the same time the sperm or egg cells have any genetic anomalies, then the fetal during the period of intrauterine development does not form a full-fledged hearing analyzer, which will lead to congenital sensorsulene hearing loss. But the anomalies for the development of the auditory analyzer in the fetus, which can also cause congenital hearing loss, occur during the period of tooling the child with initially normal genes. That is, the fetus received normal genes from parents, but during the period of intrauterine growth, there were any adverse factors (for example, infectious diseases or poisoning Translated by a woman, etc.), which violated the course of its normal development, which was due to the abnormal formation of the auditory analyzer, manifested by congenital hearing loss.

Congenital hearing loss in most cases is one of symptoms There is a genetic disease (for example, trother-call syndromes, alport, clippel-faila, pendlers, etc.), due to mutations in genes. Congenital hearing loss, as the only violation, which is not combined with any other disorders of the functions of different organs and systems and caused by the anomalies of development, is relatively rare, no more than 20% of cases.

The causes of congenital sensucleular hearing loss, which is emerging as an anomaly of development, may be severe infectious diseases (rubella, typhus, meningitis, etc.), transferred by a woman during pregnancy (especially for 3 months gestation), intrauterine infection of the fetus with various infections (for example, toxoplasmosis , herpes , HIV etc.), as well as the poisoning of the mother toxic substances (alcohol, drugs , industrial emissions, etc.). The causes of the congenital hearing thoughts caused by genetic disorders are the presence of genetic anomalies in one or both parents, a nearby marriage, etc.

Acquired hearing thoughts always occurs against the background of initially normal hearing, which is reduced due to the negative impact of any environmental factors. The sensuous hearing loss of the acquired genesis can be provoked by damage to the brain (cranknogo-brain injury, hemorrhage, generic injury in a child, etc.), diseases of the inner ear ( meniery's disease , labyrinthitis , complications of pigs, otitis, measles, syphilis, herpes, etc.), a non-neuro hearing nerve, long-term exposure to noise on the ears, as well as a reception medications toxic for the structures of the auditory analyzer (for example, Levomycetina , Gentamicina , Kanamycina, Furosemide etc.).

Separately, the variant of neurosensory touginess, which is called presbyhakuzisand lies in the gradual decline in hearing as agreed or aging . With the presbyacuise, the rumor is slowly lost, and first the child or adult ceases to hear high frequencies (bird singing, a peak, phone call, etc.), but the low tones are well perceived (the knock of the hammer passing the truck, etc.). Gradually, the spectrum of perceived frequencies of sounds is narrowed by an increasing deterioration in the hearing at higher tones, and, ultimately, a person ceases to hear at all.

Conductive hearing loss and deafness

The group of conductive hearing loss and deafness includes various states and diseases, leading to the functioning of the sound system of the auditory analyzer. That is, if the hearing lubricants are associated with any disease affecting the audio system of the ear (drummers, an outer hearing pass, ear sink, auditory bones), then it belongs to the conductive group.

It is necessary to understand that the conductive hearing loss and deafness is not one pathology, but a whole group of a variety of diseases and states, united by the fact that they affect the auditory system of the auditory analyzer.

In case of conductive hearing loss and deafness, the sounds of the surrounding world do not reach the inner ear, where they will be "recoded" into the nerve impulses and from where they come to the brain. Thus, a person does not hear because the sound does not reach that organ that can pass it into the brain.

As a rule, all cases of conductive hearing loss are acquired and due to various diseases and injuries that violate the structure of the outer and middle ear (for example, sulfur traffic jams , tumors, otitis, otosclerosis , damage to the eardrum, etc.). Congenital conductive hearing loss is rare and is usually one of the manifestations of any genetic disease due to the anomalies of genes. Constrative type congenital hearing loss is always associated with anomalies of the structure of the exterior and middle ear.

Mixed hearing loss and deafness

Mixed hearing loss and deafness are a decrease in hearing against the background of a combination of conductive and sensuous disorders.

Depending on which the human life has a deterioration in hearing, there is a congenital, hereditary and acquired hearing loss or deafness.

Hereditary hearing loss and deafness

Hereditary hearing loss and deafness are the options of the deterioration of hearing, arising from the available genetic anomalies in the person who were transferred to the parents. In other words, in hereditary hearing loss and a deafness, a person receives genes from parents who sooner or later lead to a deterioration in hearing.

Hereditary hearing loss can manifest itself at different ages, i.e. It is not necessarily congenital. Thus, during hereditary hearing loss, only 20% of children are already born with deaf, 40% begin to lose hearing in childhood and the remaining 40% note the sudden and unfortunate decline in hearing only in adulthood.

Hereditary hearing loss is due to certain genes, which, as a rule, are recessive. This means that the child will have a hearing loss only if it receives the deuchota recessive genes from both parents. If, from one of the parents, the child will receive a dominant gene of normal hearing, and from the second - a recessive deafness gene, it will hear normally.

Since the hereditary deafness genes are recessive, this species Hearing disorders, as a rule, occurs in closely related marriages, as well as during the unions of people whose relatives or they themselves suffered precisely hereditary hearing loss.

The morphological substrate of hereditary deafness can be various violations of the structure of the inner ear, which arise due to defective genes transferred to the child parents.

Hereditary deafness, as a rule, is not the only disorder health A person in the overwhelming majority of cases is combined with other pathologies, also wearing genetic character. That is, the hereditary deafness is usually combined with other pathologies, which also developed due to anomalies in the genes transferred to the child parents. The most often hereditary deafness is one of the symptoms. genetic diseaseswhich are manifested by a whole complex of signs.

Currently, hereditary deafness, as one of the symptoms of the genetic anomaly, is found in the following diseases associated with anomalies in genes:

• Trucher Collins Syndrome (deformation of the bones of the skull);
• Alport syndrome (glomerulonephritis , hearing loss, reduced functional activity of the vestibular apparatus);
• Syndrome Pendredred (Violation of exchange gormons thyroid gland , big head, short hands and legs, increased language, disorder of the vestibular apparatus, deafness and notch);
• Leopard syndrome (cardiovary and pulmonary failure, abnormalities of the structure of the genital organs, freckles and dark spots throughout the body, deafness or hearing loss);
• Cleppel Feil Syndrome (Violation of the structure spine , hands and legs, not fully formed outdoor auditory passage, hearing loss).

Gena deafness

Currently, more than 100 genes were found, which can lead to hereditary hearing loss. These genes are located in various chromosomes, and some of them are associated with genetic syndromes, while others are not. That is, some deafness genes are an integral part of various genetic diseases that manifest themselves a whole complex of disorders, and not just a hearing disorder. And other genes cause only insulated deafness, without any other genetic anomalies.

The most common deafness genes are the following:

• OTOF. (the gene is in 2 chromosome and if it is presented, a person suffers with hearing loss);
• GJB2. (When mutations in this gene, called 35 Del G, a person has heaviness).

Mutations in these genes can be revealed during a genetic survey.

Congenital hearing loss and deafness

These cases of reduction of hearing occur during the intrauterine development of the child when exposed to various adverse factors. In other words, the child is already born with hearing loss, which occurred not due to genetic mutations and anomalies, but due to the impact of adverse factors that violated the normal formation of the auditory analyzer. It is in the absence of genetic disorders that the fundamental difference of congenital hearing loss against hereditary has been listed.

Congenital hearing loss may occur when exposed to the body of a pregnant woman of the following adverse factors:

• Damage to the central nervous system of the child due to the generic injury (eg, hypoxia Due to the cordiality pupovina , compression of the bones of the skull due to the imposition of obstetric tongs, etc.) or anesthesia. In these situations, hemorrhages occur in the structure of the auditory analyzer, as a result of which the latter is damaged and the child appears hearing loss.
• Infectious diseasestransferred to the woman during pregnancy , especially for 3-4 months of gestation, capable of violating the normal formation of the hearing aid of the fetus (for example, flu , Cort, chickenpox , pig, meningitis, cytomegalovirus infection , rubella, syphilis, herpes, encephalitis , abdominal typhoid, medium otitis, toxoplasmosis, scarlet fever , HIV). The pathogens of these infections are able to penetrate the fetus through placet and violate the normal course of the formation of the ear and auditory nerve, which will result in the hearing loss newborn Child.
• Hemolytic disease of newborns . With this pathology, hearing thoughts arise due to the violation of the blood supply to the central nervous system of the fetus.
• Severe somatic diseases of the pregnant woman accompanied by damage to vessels (eg, diabetes , jade, thyrotoxicosis , cardiovascular diseases). In these diseases, hearing loss occurs due to lack of blood supply to the fetus during pregnancy.
• Smoking and drinking alcohol during pregnancy.
• Constant impact on the body of a pregnant woman of various industrial poisons and toxic substances (for example, for accommodation in the region with an unfavorable environmental situation or work in harmful production).
• Application during pregnancy drugs toxic for the auditory analyzer (eg, Streptomycin , Gentamicin, Monomicine , Neomycin , Kanamycin, Levomycetin, Furosemid, Tobramycin, Cisplastine, Endocusan, Cinenial, Laziks, Ugitet, Aspirin , Stacrinic acid, etc.).

Acquired hearing loss and deafness

Acquired hearing loss and deafness arise in people of different ages during life under the influence of various adverse factors that violate the work of the auditory analyzer. This means that the acquired hearing loss may occur at any time under the action of a possible caused factor.

So, possible causes of acquired hearing loss or deafness are any factors leading to a violation of the structure of the ear, the auditory nerve or the cerebral cortex. Such factors include heavy or chronic diseases of the ENT organs, complications of infections (for example, meningitis, typhus, herpes, pigs, toxoplasmosis, etc.), head injuries, contusion (for example, a kiss or a loud cry right in the ear), tumors and inflammation of the auditory nerve, the prolonged impact of noise, circulatory disruption in the vertebobasilar pool (for example, stroke , hematoma etc.), as well as the reception of drugs toxic for the auditory analyzer.

According to the nature and duration of the flow of the pathological process, the hearing loss is divided into acute, subacute and chronic.

Acute hearing loss

Acute hearing loss is a significant impairment of hearing over a short period of time for a duration of no more than 1 month. In other words, if the loss of hearing happened during the maximum of the month, then it is about acute hearing loss.

Acute hearing loss is not developing simultaneously, but gradually, and at the initial stage, a person feels constitution in the ear or noise in ears , not a worsening hearing. The feeling of congestion or noise in the ears can periodically appear and disappear, being preliminary signs of the upcoming hearing loss. And only some time after the appearance of the feeling of plow or noise in the ears, a persistent hearing deterioration occurs.

The causes of acute hearing loss are various factors, damaging the structure of the ear and the cerebral cortex section responsible for the recognition of sounds. A sharp decline in hearing may occur after the head injury, after transferring infectious diseases (for example, otites, measles, rubella, pigs, etc.), after hemorrhages or blood circulation disorders in the structures of the inner ear or brain, as well as after receiving toxic for ear drugs (for example, furosemide, quinine, gentamicin), etc.

Acute hearing loss is amenable to conservative therapy, and the success of treatment depends on how quickly it has begun on the emergence of the first signs of the disease. That is, the earlier the treatment of hearing thoughts began, the greater the likelihood of hearing normalization. It must be remembered that the successful seraction of acute hearing loss is most likely at the beginning of therapy during the first month after a decrease in hearing. If more than a month has passed since the loss of hearing, then conservative therapy, as a rule, is ineffective and allows only to support the rumor at the current level, without letting it worsen even stronger.

Among cases of acute hearing loss in a separate group, a sudden deafness is also distinguished, in which a person has a sharp deterioration in hearing for 12 hours. Sudden deafness appears sharply, without any preliminary signs, against the background of complete well-being, when a person simply ceases to hear sounds.

As a rule, a sudden deafness is one-sided, that is, the ability to hear sounds is reduced only by one ear, and the second remains normal. In addition, for a sudden deafness, a strong worsening of hearing is characterized. Such a form of hearing thoughts is due to viral infections, and therefore is prognostically more favorable compared to other species of deafness. Sudden hearing loss is well amenable to conservative treatment, thanks to which it is possible to completely restore the hearing in more than 95% of cases.

Tightening tightness

Prostulating the hearing loss, in fact, is an accurate deafness option, since they have the same causes, development mechanisms, the course and principles of therapy. Therefore, the separation of adhesions of hearing loss in a separate form of the disease does not have a high practical significance. As a result, doctors often share hearing loss to acute and chronic, and subacute options refer to acute. The subacute, from the position of academic knowledge, is considered tortured, the development of which occurs within 1 - 3 months.

Chronic hearing loss

With this form, the deterioration of hearing occurs gradually, for a long period of time, which is ongoing for more than 3 months. That is, for several months or years, a person faces a steady, but slow worsening of hearing. When the hearing ceases to deteriorate and begins to hold on the same level for six months, the hearing loss is considered to be fully formed.

For chronic hearing loss The deterioration of hearing is combined with constant noise or ringing in ears who is not heard others, but very hard tolerate by the person himself.

Deafness and hearing loss in a child

Children of different ages can suffer from any kind and forms of hearing loss or deafness. Most often in children there are cases of congenital and genetic hearing loss, the acquired deafness is developing less often. Among cases of the acquired deafness, most is due to the intake of drugs toxic for the ear and complications of infectious diseases.

The course, development mechanisms and treatment of deafness and hearing loss in children are the same as in adults. However, the treatment of hearing loss in children is given more importance than in adults, since for this age category The rumor is critically important for mastering and maintaining speech skills, without which the child will become not only deaf, but also dumb. Otherwise, any fundamental differences in the course, the causes and treatment of hearing loss in children and adults are not.

The reasons

To avoid confusion, consider separately the causes of congenital and acquired hearing loss and deafness.

The causative factors of congenital hearing loss are various negative impacts on a pregnant woman who lead, in turn, to violating the normal growth and development of the fetal. Therefore, the reasons for congenital hearing loss are factors that affect not so much the fruit as a pregnant woman. So, possible causes of congenital and genetic hearing loss are the following factors:

• Damage to the central nervous system of the child due to the generic injury (for example, hypoxia against the background of the cordness of the umbilicals, compression of the bones of the skull when applying obstetric tongs, etc.);
• Damage to the CNS child with drugs for narcosis introduced a woman during rodov ;
• Infectious diseases transferred to a woman during pregnancy, which can violate the normal formation of the hearing aid of the fetus (for example, influenza, cortex, windmill, pig, meningitis, cytomegalovirus infection, rubella, syphilis, herpes, encephalitis, typhoid fever , medium otitis, toxoplasmosis, scarletin, HIV);
• Hemolytic disease of newborns;
• Pregnancy, leaking against the background of severe somatic diseases in women, accompanied by damage to vessels (for example, diabetes mellitus, nephritis, thyrotoxicosis, cardiovascular diseases);
• Smoking , drink alcohol or narcotic drugs during pregnancy;
• Constant impact on the body of a pregnant woman of various industrial poisons (for example, permanent finding in the region with unfavorable environmental situation or work in harmful industries);
• Use during pregnancy drugs toxic for the auditory analyzer (for example, streptomycin, gentamicin, monomitin, neomycin, kanamycin, levomycetin, furosemide, tobramycin, cycisplastine, endoxan, chinin, lazyx, yekit, aspirin, etcrinic acid, etc.);
• Pathological heredity (the transfer of deafness genes to the child);
• Nearby marriage;
• The birth of a child prematurely or low body weight.

Possible causes of acquired hearing loss in people of any age can be the following factors:

• Generic injury (child during labor can be obtained by the ZNS injury, which will subsequently lead to hearing loss or deafness);
• Hemorrhage or hematoma in the middle or inner ear or in the cerebral cortex;
• Blood impairment in the vertebobasilar basin (combustion of vessels, blood supply to all skull structures);
• Any damage to the central nervous system (for example, cranopy and brain injury, tumors brain, etc.);
• Operations on hearing or brain;
• Complications on the structure of the ear after transferred inflammatory diseases, such as, for example, labyrinthitis, otitis, cortex, scarletin, syphilis, pig, herpes, Menieret's disease, etc.;
• Nevnoma of auditory nerve;
• The long action of noise on the ears (for example, frequent listening to loud music, work in noisy shops, etc.);
• Chronic inflammatory diseases of the ears, throat and nose (for example, sinusitis , otitis, essakhi, etc.);
• Chronic ear pathology (Menieret's disease, Otosclerosis, etc.);
• Hypothyroidism (hormone deficiency thyroid gland in blood);
• Reception of drugs toxic for a hearing analyzer (for example, streptomycin, gentamicin, monomitin, neomycin, kanamycin, levomycetin, furosemide, tobramycin, cisplastine, endoxan, chinin, lazyx, yekit, aspirin, etcrinic acid, etc.);
• Sulfur tubes;
• Damage to drummers;
• Age worsening hearing (presbyacuise) associated with atrophic processes in the body.

Signs (symptoms) deafness and hearing loss

The main sign of hearing loss is the deterioration of the ability to hear, perceive and distinguish between various sounds. Suffering with hearing loss does not hear some of the sounds, which normally catches a person. The smaller the severity of the hearing thoughts, the greater the spectrum of sounds man continues to hear. Accordingly, the harder the hearing loss, the greater the number of sounds of man, on the contrary, does not hear.

It is necessary to know that in the hearing loss of various degrees of gravity, a person loses the ability to perceive certain spectra of sounds. So, at easy hearing loss, the ability to hear high and quiet sounds, such as whisper, squeak, phone call, bird singing. When weighing the hearing loss disappears the ability to hear the sound of the sound spectra, that is, a soft speech, the rustle of the wind, etc. As the hearing thoughts progress, the ability to hear sounds belonging to the upper spectrum of perceived tones are disappeared, and there remains the distinction of low sound oscillations, such as a crash truck, etc.

A person, especially in childhood, does not always understand that he has a hearing loss, since the perception of a large spectrum of sounds remains. That's why to identify hearing, it is necessary to take into account the following indirect signs of this pathology:

• Frequent asking;
• The absolute lack of reaction to the sounds of high tones (for example, trill birds, a peak of a call or phone, etc.);
• Monotonous speech, incorrect staging;
• Too loud speech;
• Scrolling;
• Difficulties in keeping equilibrium (marked with neurosensory hearing loss due to partial lesion of the vestibular apparatus);
• Lack of reaction to sounds, voices, music, etc. (Normally, the person instinctively turns toward the sound source);
• Complaints on the feeling of discomfort, noise or stall in the ears;
• The complete absence of any audio sounds baby (with congenital hearing loss).

Deductible degree (hearing loss)

The degree of deafness (hearing loss) reflect how much the hearing of a person is degraded. Depending on the ability to perceive the sounds of different volumes, the following segments of hearing loss are isolated:

• I Degree - Easy (Headowness 1) - A person does not hear sounds whose volume is less than 20 - 40 dB. At a given degree of hearing loss, the person hears the whisper from the distance of 1 to 3 meters, and the usual speech is from 4 to 6 meters;
• II degree - average (hearing loss 2) - A person does not hear sounds whose volume is less than 41 - 55 dB. With medium hearing loss, a person hears the speech of normal volume from a distance of 1 to 4 meters, and the whisper is a maximum of 1 meter;
• III degree - heavy (Headowing 3) - A person does not hear sounds whose volume is less than 56 - 70 dB. With medium hearing loss, a person hears the speech of normal volume from a distance of no more than 1 meter, and the whisper is no longer hears at all;
• IV degree - Very heavy (Headowness 4) - A person does not hear sounds whose volume is less than 71 to 90 dB. With medium hearing loss, a person does not hear the speech of normal volume;
• V Degree - deafness (hearing loss 5) - A person does not hear sounds whose volume is less than 91 dB. In this case, a person hears only a loud cry, which in normal can be painful for the ears.

How to determine the deafness?

For diagnostics Headup and deafness at the primary survey stage are used by a simple method, during which the doctor pronounces words in a whisper, and the examiner must repeat them. If a person does not hear a whisper speech, then the hearing loss is diagnosed and a further specialized survey is carried out, aimed at identifying the type of pathology and finding out its possible reason, which is important for the subsequent selection of the most effective treatment.

To determine the form, degree and specific characteristics of hearing loss, the following methods are used:

• Audiometry (The person's ability to hear sounds of different heights is investigated);
• Timpanometry (The bone and air conduction of the middle ear is investigated;
• Test Weber (allows you to identify one or both ears involved in the pathological process);
• Tamblen Sample - Test Schwabach (allows you to identify the type of hearing loss - conductive or neurosensor);
• Impedancemetry (allows you to identify the localization of the pathological process, which led to the hearing loss);
• Otoscopy. (Inspection of the EU structures with special tools in order to identify defects of the structure of the eardrum, external auditory passage, etc.);
• MRI or Kt. (Receives the cause of hearing loss).

In each case, to confirm the hearing loss and finding out the degree of gravity, a different number of surveys may be needed. For example, one person will have enough audiometry, and the other will have to, in addition to this survey, the other tests are also.

The greatest problem is to identify hearing loss in infants, since they, in principle, do not yet own a speech. For children breast-age Using an adapted audiometry, the essence of which is that the child must respond to the sounds of head turns, various movements, etc. If the baby does not respond to sounds, then he suffers with hearing loss. In addition to the audiometry, for the detection of hearing loss in young children, the methods of impedanceometry, tympanometry and otoscopy use.

Treatment

General principles of therapy

Treatment of hearing loss and deafness is comprehensive and is to carry out therapeutic measures aimed at eliminating the causal factor (if possible), the normalization of the structures of the ear, disinfection, as well as to improve blood circulation in the structures of the auditory analyzer. To achieve all the goals of therapy, various methods are used, such as:

• Medical therapy (used for disintellation, improving the blood circulation of the brain and ear structures, eliminating the causal factor);
• Physiotherapeutic methods (apply to improving hearing, disintellation);
• Hearing exercises (apply to maintain hearing levels and improving speech skills);
• Operational treatment (operations to restore the normal structure of the middle and outdoor ear, as well as on the installation of a hearing aid or a cochlear implant).

In case of conductive hearing loss, the optimal, as a rule, is the operational treatment, as a result of which the normal structure of the medium or outdoor ear is restored, after which the hearing is completely returned. Currently, to eliminate the conductive hearing loss wide spectrum Operations (for example, Mirningoplasty, Timpanoplasty, etc.), among which in each specific case optimal intervention is selected, allowing to completely eliminate the problem that causes hearing loss or deafness. The operation allows you to return the hearing even with a complete conductive deafness in the overwhelming majority, as a result of which this type of hearing loss is considered prognostically favorable and relatively simple in terms of treatment.

Neurosensory hearing loss is much more difficult to amenable to therapy, and therefore all possible methods and combinations are used for its treatment. Moreover, there are some differences in tactics treatment of acute and chronic neurosensory touginess. Thus, under acute hearing loss, it is necessary in the shortest possible time to hospitalize in the profile department of the hospital and conduct medication and physiotherapy In order to restore the normal structure of the inner ear and, thereby, returning the rumor. Specific methods of treatment are chosen depending on the nature of the causal factor (viral infection, intoxication etc.) acute neurosensory touginess. In chronic hearing loss, a person periodically takes treatment courses aimed at maintaining the level of perception of sounds and preventing possible hearing deterioration. That is, with acute hearing loss, treatment is aimed at restoring hearing, and when chronic - to maintain the existing level of sound recognition and to prevent hearing deterioration.

Therapy of acute hearing loss is carried out depending on the nature of the provoked caused factor. Thus, today there are four types of acute neurosensory hearing loss depending on the nature of the causal factor:

• Vascular tightness - provoked by a circulatory disorder in a skull vessels (as a rule, these violations are associated with vertebro-basilar insufficiency, hypertensive disease , strokes, atherosclerosis brain vessels diabetes, diseases of the cervical spine);
• Viral touginess - Provoked by viral infections (infection causes inflammatory processes in the field of inner ear, auditory nerve, cerebral cortex, etc.);
• Toxic hearing loss - provoked by poisoning with various poisonous substances (alcohol, industrial emissions, etc.);
• Traumatic hearing loss - Provocosed by the injuries of the skull.

Depending on how the nature of the causative factor of acute hearing loss, the optimal medicines are selected for its treatment. If the nature of the causal factor factor could not be accurately installed, then by default, acute hearing loss is referred to vascular.
pressure Eufillin, Papaverin, Nicoshpan, Compliment, Apron, etc.) and improving metabolism in CNS cells (SalkoSeril, Nootropyl, Pantokalcin et al.), as well as the preventive inflammatory process in brain tissues.

Chronic neurosensory hearing thugs are treated with complex, periodically conducting courses of drug and physiotherapy. If a conservative methods Ineffective, and the hearing thoughts reached III-V degree, then produce operational treatment, which consists in installing a hearing aid or a cochlear implant. From medicines for the treatment of chronic neurosensory hearing loss vitamins Groups in ( Milgamma , Neuromulivitis etc.), extract aloe , as well as funds that improve the metabolism in the tissues of the brain (SOLKOSERIL, Aktovegin , Predict, Riboxin , Nootropyl, cerebrolysin, pantokalcin, etc.). Periodically, in addition to the specified drugs, prozerne and galantamine are used to treat chronic hearing loss and deafness, as well as homeopathic remedies (for example, cerebrum composites, spasquocel, etc.).

Among physiotherapeutic methods for the treatment of chronic hearing loss are as follows:

• Laser irradiation of blood (helium neon laser);
• Stimulation by fluctuating currents;
• Quantum hemotherapy;
• Fouroelectroporesis endoral.

If against the background of any type of hearing loss, the person appears disorders of the vestibular apparatus, the antagonists of H1-histamine receptors are used, such as Betaderk , Maesherk, Tagista, etc.

Operational treatment of deafness (hearing loss)

Currently, operations are carried out for the treatment of conductive and neurosensory hearing loss and deafness.

Operations for the treatment of conductive deafness are to restore the normal structure and organs of the middle and outdoor ear, due to which the person has a rumor again. Depending on which structure is restored, the operations are relevant names. For example, miningoplasty is operations for the restoration of the eardrum, tympanoplasty - the restoration of the hearing bones of the middle ear (Spirit, hammer and anvil), etc. After such operations, as a rule, hearing is restored in 100% of cases.

Operations for the treatment of neurosensory deafness only two are installation of a hearing aid or a cochlear implant. Both options for operational intervention are made only in the ineffectiveness of conservative therapy and during severe hearing loss, when a person does not hear normal speech even from close range.

Installation of a hearing aid is a relatively simple operation, but, unfortunately, it will not help return the hearing those who have the sensitive cells of the snail of the inner ear. In such cases, the effective method of recovery of hearing is the installation of a cochlear implant. The operation on the installation of implant is technically very complex, therefore it is carried out in a limited number of medical institutions and, accordingly, it is expensive, as a result of which not everyone is available.

The essence of cochlearic prosthesis In the following: mini-electrodes that will recode sounds into nerve pulses and transmit to the auditory nerve in the structure of the inner ear. These electrodes are connected to a mini-microphone placed in the temporal bone that catches the sounds. After installing such a system, the microphone captures the sounds and transmits them to the electrodes, which, in turn, recode them into the nerve pulses and are issued to the hearing nerve, transmitting signals into the brain where sounds are recognized. That is, cochlear implantation is, in fact, the formation of new structures that perform the functions of all EH structures.

Hearing machines for the treatment of hearing loss

Currently, there are two main varieties of hearing aids - these are analog and digital.

Analog hearing aids are known to many devices that are visible behind the ear in the elderly. They are pretty simple in circulation, but cumbersome, not very comfortable and very rude in ensuring the amplification of the beep. Analog auditory machine can be purchased and start using independently without special configuration from a specialist, since the device has only several modes of operation, the switching of which is performed by a special lever. Thanks to this lever, a person can independently determine the optimal mode of operation of the auditory apparatus and use it in the future. However, the analog hearing aid often creates interference, reinforces different frequencies, and not just those that a person hears poorly, as a result of which its use is not too comfortable.

The digital auditory apparatus, unlike analog, is configured exclusively by a survival specialist, which increases only those sounds that a person hears poorly. Thanks to the accuracy of the setting, the digital hearing aid allows a person to be perfectly heard without interference and noise, restoring sensitivity to the lost spectrum of sounds and without affecting all other tones. Therefore, from the point of view of comfort, convenience and accuracy of correction, digital hearing aids are superior to analog. Unfortunately, for selection and configuration digital apparatus It is necessary to visit the audit center, which is not available to everyone. Currently, there are various models of digital hearing aids, so you can choose the optimal option for each particular person.

Treatment of deafness by the method of cochlear implantation: the device and principle of operation of the cochlear implant, comment of the doctor-surgeon - video

Neurosensory Touginess: Causes, Symptoms, Diagnostics (Audiometry), Treatment, Soviets-otorinolaryngologist Tips - Video

Neurosensory and conductive hearing loss: reasons, diagnostics (audiometry, endoscopy), treatment and prevention, hearing aids (Opinion of the ENT doctor and Surdian) - Video

Headup and deafness: how the hearing analyzer is arranged, the causes and symptoms of the loss of hearing, the auditory (hearing aids, cochlear implantation in children) - video

Headup and deafness: Exercises for improving hearing and elimination of the stall in the ears - Video

Before use, you must consult with a specialist.