Hearing loss (bradyacus or hypoacusia) is a hearing impairment of varying severity (from minor to deep) that occurs suddenly or develops gradually, and is caused by a disruption in the functioning of sound-perceiving or sound-conducting structures of the auditory analyzer (ear). When hearing loss a person has poor hearing of various sounds, including speech, as a result, normal communication and any communication with other people is hampered, which leads to its desocialization.
Deafness It is a kind of final stage of hearing loss and represents an almost complete loss of the ability to hear various sounds. When deafness a person does not hear even very loud sounds, which normally cause pain in the ears.
Deafness and hearing loss can affect only one or both ears. Moreover, the hearing loss of different ears may have varying degrees of severity. That is, a person can hear with one ear better, and worse with others.
Deafness and hearing loss – a brief description
Hearing loss and deafness are variants of a hearing disorder in which a person loses the ability to hear various sounds. Depending on the severity of hearing loss, a person can hear a greater or lesser range of sounds, and in case of deafness there is a complete inability to hear any sounds. In general, deafness can be considered as the last stage of hearing loss, in which there is complete hearing loss. Under the term "hearing loss" usually impairment of hearing of varying severity, in which a person can hear at least very loud speech. And deafness is a condition in which a person is no longer able to hear even very loud speech.
Hearing loss or deafness can affect one or both ears, and its severity may be different on the right and left ear. Since the development mechanisms, causes, and methods for treating hearing loss and deafness are the same, they are combined into one nosology, considering the successive stages of a pathological process of hearing loss by a person.
Hearing loss or deafness may be caused by damage to the sound-conducting structures (organs of the middle and outer ear) or sound-perceiving apparatus (organs of the inner ear and brain structure). In some cases, hearing loss or deafness may be due to the simultaneous damage to both the sound-conducting structures and the sound-perceiving apparatus of the auditory analyzer. In order to have a clear idea of what the defeat of one or another hearing aid analyzer means, it is necessary to know its structure and functions.
So, the auditory analyzer consists of the ear, the auditory nerve and the auditory cortex. With the help of ears, a person perceives sounds, which are transmitted along the auditory nerve in a coded form to the brain, where the received signal is processed and "recognition" sound. Due to the complex structure of the ear not only catches the sounds, but also produces them "recoding" into the nerve impulses that are transmitted to the brain via the auditory nerve. Perception of sounds and their "recoding" The nerve impulses are produced by various structures of the ear.
Thus, the structures of the external and middle ear, such as the eardrum and the auditory ossicles (malleus, incus and stapes), are responsible for the perception of sounds. It is these parts of the ear that perceive the sound and guide it to the structures of the inner ear (the cochlea, the vestibule and the semicircular canals). And in the inner ear, the structures of which are located in the temporal bone of the skull, occurs "recoding" sound waves into electrical nerve impulses, subsequently transmitted to the brain via the corresponding nerve fibers. In the brain, there is a processing and "recognition" sounds.
Accordingly, the structures of the outer and middle ear belong to the conductive, and the organs of the inner ear, the auditory nerve and the cerebral cortex to the sound-receiving. Therefore, the whole set of options for hearing loss is divided into two large groups – associated with the defeat of the sound-conducting structures of the ear or the sound-perceiving apparatus of the auditory analyzer.
Hearing loss or deafness can be acquired or congenital, and depending on the time of onset, early or late. Early hearing loss is considered to be acquired before the child reaches the age of 3–5 years. If the hearing loss or deafness appeared after 5 years of age, then it refers to the late.
Acquired hearing loss or deafness is usually associated with the negative effects of various external factors, such as ear injuries, previous infections, complicated by damage to the auditory analyzer, constant noise exposure, etc. Separately, hearing loss due to age-related changes in the structure of the auditory analyzer should be noted. not associated with any negative effects on the organ of hearing. Congenital hearing loss is usually caused by malformations, genetic abnormalities of the fetus or some infectious diseases (rubella, syphilis, etc.) carried by the mother during pregnancy.
The specific causal factor of hearing loss is determined during a special otoscopic examination carried out by an ENT doctor, an audiologist, or a neuropathologist. In order to find the optimal method of treatment of reduced hearing, it is necessary to find out what caused the hearing loss – the defeat of the sound-conducting or sound-perceiving apparatus.
Treatment for hearing loss and deafness is performed by various methods, among which are both conservative and operational. Conservative methods are usually used to restore sharply deteriorated hearing against the background of a known causative factor (for example, in case of hearing loss after taking antibiotics, after a head injury, etc.). In such cases, with timely treatment, hearing can be restored by 90%. If conservative therapy was not carried out as soon as possible after hearing impairment, then its effectiveness is extremely low. In such situations, conservative methods of treatment are considered and used exclusively as auxiliary.
Surgical treatment methods are variable and allow you to return the person hearing in the vast majority of cases. Most of the operational methods for treating hearing loss are associated with the selection, installation and adjustment of hearing aids, which allow a person to perceive sounds, hear speech and interact normally with others. Another large group of methods for the operative treatment of hearing loss is to perform very complex operations on the installation of cochlear implants, which make it possible to restore the ability to perceive sounds to people who cannot use hearing aids.
The problem of hearing loss and deafness is very important, because a person who is hard of hearing is isolated from society, his employment and self-realization opportunities are severely limited, which, of course, leaves a negative imprint on the entire life of the hearing impaired. The effects of hearing loss in children are most severe, since they have poor hearing can lead to dumbness. After all, the child has not mastered the speech very well, he needs constant practice and further development of the speech apparatus, which are achieved only with the help of constant perception of new revolutions, words, etc., and so on. And when the child does not hear the speech, he can completely lose even the ability to speak, becoming not just hard of hearing, but mute.
It must be remembered that about 50% of cases of hearing loss can be prevented with proper adherence to preventive measures. Thus, vaccination of children, adolescents and women of childbearing age against dangerous infections, such as measles, rubella, meningitis, mumps, whooping cough, etc., which can cause complications such as otitis and other ear diseases, is an effective preventive measure. Also effective preventive measures for hearing loss are high-quality obstetric care for pregnant women and women in childbirth, proper hygiene of the ears, timely and adequate treatment of diseases of the upper respiratory tract, avoiding the use of drugs that are toxic to the auditory analyzer, and minimizing noise exposure to ears , when working in noisy areas, wear earplugs, noise-canceling headphones, etc.).
Deafness and dumbness
Deafness and dumbness are often combined, the latter being a consequence of the former. The fact is that a person masters and then constantly supports the ability to speak, to pronounce articulate sounds only on condition that he constantly hears those from other people as well as from himself. When a person ceases to hear sounds and speech, it becomes difficult for him to speak, as a result of which the speech skill is reduced (worsens). A pronounced reduction in speech skills eventually leads to dumbness.
Children who have become deaf at the age of less than 5 years are especially susceptible to secondary development. These children gradually lose their already learned speech skills, and they become dumb due to not hearing the speech. Children who are deaf from birth are almost always dumb, since they cannot master the speech without simply hearing it. After all, the child learns to speak, listening to other people and trying to independently pronounce imitating sounds. And a deaf child does not hear sounds, as a result of which he simply cannot even try to say something himself, imitating others. It is because of the inability to hear deaf from birth children remain dumb.
Adults who have acquired hearing loss, in very rare cases, become mute, because their speech skills are well developed and are lost very slowly. A deaf or deaf adult can speak strangely, stretching words or pronouncing them very loudly, but almost completely the ability to reproduce speech is never lost.
Deafness in one ear
Deafness in one ear in terms of developmental mechanisms, causes and methods of treatment is no different from any variant of acquired hearing loss.
In congenital deafness, the pathological process usually affects both ears, since it is associated with systemic impairments in the work of the entire auditory analyzer.
Consider the various forms and types of hearing loss and deafness, which are allocated, depending on one or another leading feature underlying the classification. Since there are several leading signs and characteristics of hearing loss and deafness, there is more than one type of disease identified on their basis.
Depending on what structure of the auditory analyzer is affected – conductive or sound-perceiving, the whole set of different variants of hearing loss and deafness is divided into three large groups:
one. Sensorineural (sensorineural) hearing loss or deafness.
2 Conductive hearing loss or deafness.
3 Mixed hearing loss or deafness.
Sensorineural (sensorineural) hearing loss and deafness
Sensorineural is called hearing loss or deafness, due to the defeat of the sound-perceiving apparatus of the hearing analyzer. With neurosensory hearing loss, a person picks up sounds, but the brain does not perceive them and does not recognize them, as a result of which there is a decrease in hearing in practice.
Sensorineural hearing loss is not a single disease, but a whole group of various pathologies that lead to impaired functioning of the auditory nerve, the inner ear, or the auditory portion of the cerebral cortex. But since all the data of the pathology affect the sound-sensing apparatus of the auditory analyzer, and therefore have similar pathogenesis, they are combined into one large group of neurosensory hearing loss. Morphologically, neurosensory deafness and deafness can be caused by impaired functioning of the auditory nerve and cerebral cortex, as well as abnormalities of the inner ear (for example, atrophy of the sensory apparatus of the cochlea, changes in the structure of the vascular cavity, spiral ganglion, etc.) caused violations or due to illness and injury.
That is, if hearing loss is associated with impaired functioning of the structures of the inner ear (cochlea, vestibule or semicircular canals), the auditory nerve (VIII pair of cranial nerves) or the cerebral cortex responsible for the perception and recognition of sounds, this is precisely the neurosensory reduction options hearing
By origin, sensorineural hearing loss and deafness may be congenital or acquired. Moreover, congenital cases of sensorineural hearing loss are 20%, and acquired, respectively – 80%.
Cases of congenital hearing loss may be due to either genetic abnormalities in the fetus, or abnormalities in the development of the auditory analyzer, arising from the adverse effects of environmental factors in the period of prenatal development. Genetic disorders of the fetus are initially, that is transmitted from the parents at the time of fertilization of the egg by the sperm. If at the same time the sperm or egg has any genetic abnormalities, then the fetus during the prenatal development will not form a full-fledged auditory analyzer, which will lead to congenital sensorineural hearing loss. But the anomalies of the development of the auditory analyzer in the fetus, which can also cause congenital hearing loss, occur in the period of bearing a child with initially normal genes. That is, the fetus received normal genes from parents, but during the prenatal growth period it was affected by any unfavorable factors (for example, infectious diseases or poisonings suffered by a woman, etc.) that disrupted the course of its normal development, resulting in abnormal formation of the auditory analyzer, manifested congenital hearing loss.
Congenital hearing loss in most cases is one of the symptoms of a genetic disease (for example, Tricher-Collins, Alport, Klippel-Feil, Pendred, etc.) syndromes caused by mutations in the genes. Congenital hearing loss, as the only disorder that is not combined with any other disorders of the functions of various organs and systems and is caused by developmental abnormalities, is relatively rare, no more than in 20% of cases.
Severe infectious diseases (rubella, typhoid, meningitis, etc.) that a woman suffered during pregnancy (especially during 3–4 months of gestation), intrauterine infection of the fetus with various infections (for example, toxoplasmosis, herpes, HIV, etc.), as well as poisoning of the mother by toxic substances (alcohol, drugs, industrial emissions, etc.). The causes of congenital hearing loss due to genetic disorders are the presence of genetic abnormalities in one or both parents, a closely related marriage, etc.
Acquired hearing loss always occurs against the background of initially normal hearing, which is reduced due to the negative impact of any environmental factors. Sensory neural hearing loss of acquired genesis can be triggered by brain damage (traumatic brain injury, hemorrhage, birth trauma in a child, etc.), inner ear diseases (Meniere’s disease, labyrinthitis, complications of mumps, otitis, measles, syphilis, herpes, etc.) e.), a neurinoma of the auditory nerve, prolonged exposure to noise on the ears, and the use of medications that are toxic to the structures of the auditory analyzer (for example, Levomitsetina, Gentamicin, Kanamycin, Furosemide, etc.).
Separately, it is necessary to highlight the option of sensorineural hearing loss, which is called presbyacusis, and is a gradual decrease in hearing as they grow older or older. When presbyacusis hearing is lost slowly, and first the child or adult stops hearing high frequencies (birds singing, squeaking, phone ringing, etc.), but well perceives low tones (hammering, driving a truck, etc.). Gradually, the range of perceived frequencies of sounds narrows due to the increasing impairment of hearing to higher tones, and, ultimately, the person stops hearing altogether.
Conductive hearing loss and deafness
The group of conductive hearing loss and deafness include various conditions and diseases leading to the disruption of the functioning of the sound-conducting system of the auditory analyzer. That is, if hearing loss is associated with any disease affecting the sound-conducting system of the ear (eardrum, external auditory canal, auricle, auditory ossicles), then it belongs to the conductive group.
It is necessary to understand that conductive hearing loss and deafness are not one pathology, but a whole group of various diseases and conditions, united by the fact that they affect the sound-conducting system of the auditory analyzer.
With conductive hearing loss and deafness, the sounds of the surrounding world do not reach the inner ear, where they "recoded" into nerve impulses and from where they enter the brain. Thus, a person does not hear because the sound does not reach the organ that can transmit it to the brain.
As a rule, all cases of conductive hearing loss are acquired and caused by various diseases and injuries that violate the structure of the outer and middle ear (for example, sulfur plugs, tumors, otitis media, otosclerosis, damage to the eardrum, etc.). Congenital conductive hearing loss is rare and is usually one of the manifestations of a genetic disease caused by gene abnormalities. Congenital hearing loss of the conductive type is always associated with abnormalities of the structure of the outer and middle ear.
Mixed hearing loss and deafness
Mixed hearing loss and deafness represent a hearing loss against the background of a combination of conductive and sensorineural disorders.
Depending on the period in which a person’s hearing has deteriorated, congenital, hereditary and acquired hearing loss or deafness is distinguished.
Hereditary hearing loss and deafness
Hereditary hearing loss and deafness are variants of hearing impairment that occur as a result of existing genetic abnormalities in a person, which are transmitted to him from parents. In other words, with hereditary hearing loss and deafness, a person receives genes from parents, which sooner or later lead to hearing impairment.
Hereditary hearing loss can occur at different ages, i.e. it is not necessarily congenital. Thus, with hereditary hearing loss, only 20% of children are born already deaf, 40% begin to lose their hearing in childhood, and the remaining 40% report a sudden and unreasonable hearing loss only in adulthood.
Hereditary hearing loss is caused by certain genes, which, as a rule, are recessive. This means that a child will have hearing loss only if he receives recessive deafness genes from both parents. If from one of the parents the child receives the dominant gene of normal hearing, and from the second – the recessive gene of deafness, then he will normally hear.
Since the genes of hereditary deafness are recessive, this type of hearing impairment is usually found in closely related marriages, as well as in unions of people whose relatives or they themselves suffered from hereditary hearing loss.
The morphological substrate of hereditary deafness can be various violations of the structure of the inner ear, which are caused by defective genes that are passed on to the child by the parents.
Hereditary deafness, as a rule, is not the only health disorder that exists in a person, and in the vast majority of cases is combined with other pathologies that are also of a genetic nature. That is, usually hereditary deafness is combined with other pathologies, which also developed as a result of anomalies in the genes transferred to the child by the parents. Most often hereditary deafness is one of the symptoms of genetic diseases, which manifest themselves as a whole complex of symptoms.
Currently, hereditary deafness, as one of the symptoms of a genetic abnormality, is found in the following diseases associated with abnormalities in genes:
Genes for deafness
Currently, more than 100 genes have been identified that can lead to hereditary hearing loss. These genes are located in different chromosomes, some of which are associated with genetic syndromes, while others are not. That is, some genes of deafness are an integral part of various genetic diseases that manifest themselves as a whole complex of disorders, and not just a hearing disorder. And other genes cause only isolated deafness, without any other genetic abnormalities.
The most common genes for deafness are as follows:
- OTOF (the gene is on chromosome 2 and if it is present, the person suffers from hearing loss)
- Gjb2 (With a mutation in this gene, called 35 del G, a person has hearing loss).
Mutations in these genes can be identified through genetic screening.
Congenital hearing loss and deafness
These options for hearing loss occur during fetal development of the child when exposed to various adverse factors. In other words, a child is born already with hearing loss, which arose not due to genetic mutations and anomalies, but due to the influence of adverse factors that disrupt the normal formation of the auditory analyzer. It is in the absence of genetic disorders is the fundamental difference between congenital hearing loss and hereditary.
Congenital hearing loss can occur when the following adverse factors affect the body of a pregnant woman:
- Damage to the child’s central nervous system due to birth injury (for example, hypoxia due to entanglement of the umbilical cord, compression of the bones of the skull due to the imposition of obstetric forceps, etc.) or anesthesia. In these situations, hemorrhages occur in the structures of the auditory analyzer, as a result of which the latter is damaged and the child has a hearing loss.
- Infectious diseases suffered by a woman during pregnancy , especially at 3 – 4 months of gestation, which can disturb the normal formation of the fetal hearing aid (for example, influenza, measles, chickenpox, mumps, meningitis, cytomegalovirus infection, rubella, syphilis, herpes, encephalitis, typhoid fever, otitis media, toxoplasmosis, scarlet fever, HIV ). The causative agents of these infections are able to penetrate to the fetus through the placenta and disrupt the normal course of formation of the ear and the auditory nerve, resulting in hearing loss in a newborn baby.
- Hemolytic disease of the newborn. With this pathology, hearing loss arises from the violation of the blood supply to the central nervous system of the fetus.
- Severe somatic diseases of a pregnant woman, accompanied by vascular damage (for example, diabetes, nephritis, thyrotoxicosis, cardiovascular diseases). In these diseases, hearing loss occurs due to insufficient blood supply to the fetus during pregnancy.
- Smoking and drinking during pregnancy.
- Permanent effects on the body of a pregnant woman of various industrial poisons and toxic substances (for example, when living in a region with unfavorable environmental conditions or working in hazardous industries).
- Use during pregnancy of drugs that are toxic to the auditory analyzer (for example, Streptomycin, Gentamicin, Monomitsin, Neomycin, Kanamycin, Levomycetin, Furosemide, Tobramycin, Cisplastin, Endoxan, Quinine, Lasix, Uregit, Aspirin, ethacrynic acid, etc.).
Acquired hearing loss and deafness
Acquired hearing loss and deafness occur in people of different ages during life under the influence of various adverse factors that interfere with the work of the auditory analyzer. This means that acquired hearing loss can occur at any time under the influence of a possible causative factor.
Thus, the possible causes of acquired hearing loss or deafness are any factors that lead to a violation of the structure of the ear, the auditory nerve or the cerebral cortex. Such factors include severe or chronic diseases of the upper respiratory tract, complications of infections (for example, meningitis, typhoid, herpes, mumps, toxoplasmosis, etc.), head injuries, contusion (for example, a kiss or a loud cry right in the ear), tumors and inflammation of the auditory nerve, prolonged exposure to noise, impaired blood circulation in the vertebrobasilar basin (eg, strokes, hematomas, etc.), as well as the administration of drugs that are toxic to the auditory analyzer.
By the nature and duration of the pathological process, hearing loss is divided into acute, subacute and chronic.
Acute hearing loss
Acute hearing loss is a significant impairment of hearing for a short period of time lasting no more than 1 month. In other words, if the hearing loss occurred within a maximum of a month, then it is a question of acute hearing loss.
Acute hearing loss develops not simultaneously, but gradually, and at the initial stage a person feels stuffy in the ear or tinnitus, and not hearing impairment. A feeling of congestion or tinnitus can periodically appear and disappear, being preliminary signs of the onset of hearing loss. And only some time after the appearance of a feeling of congestion or noise in the ears of a person, a persistent hearing loss occurs.
The causes of acute hearing loss are various factors that damage the structures of the ear and the area of the cerebral cortex responsible for the recognition of sounds. Acute hearing loss can occur after a head injury, after an infectious disease (for example, otitis, measles, rubella, mumps, etc.), after hemorrhages or circulatory disorders in the structures of the inner ear or brain, and after taking toxic to the ear. drugs (eg, furosemide, quinine, gentamicin), etc.
Acute hearing loss is amenable to conservative therapy, and the success of treatment depends on how quickly it is started relative to the appearance of the first signs of the disease. That is, the earlier the treatment of hearing loss is started, the greater the likelihood of normalization of hearing. It must be remembered that the successful cure of acute hearing loss is most likely when starting therapy during the first month after hearing loss. If more than a month has passed since the loss of hearing, then conservative therapy, as a rule, is ineffective and only allows you to maintain hearing at the current level, preventing it from deteriorating even more.
Among the cases of acute hearing loss in a separate group, sudden deafness is also distinguished, in which a person has a sharp hearing impairment within 12 hours. Sudden deafness appears abruptly, without any preliminary signs, against the background of complete well-being, when a person simply stops hearing sounds.
As a rule, sudden deafness is one-sided, that is, the ability to hear sounds is reduced only in one ear, while in the second one it remains normal. In addition, severe hearing loss is characteristic of sudden deafness. This form of hearing loss is due to viral infections, and therefore prognostically more favorable compared to other types of deafness. Sudden hearing loss responds well to conservative treatment, through which you can completely restore hearing in more than 95% of cases.
Subacute hearing loss
Chronic hearing loss
In this form, hearing loss occurs gradually, over a long period of time lasting more than 3 months. That is, for several months or years, a person faces a steady but slow deterioration in hearing. When the hearing ceases to deteriorate and begins to remain at the same level for six months, hearing loss is considered fully formed.
In chronic hearing loss, hearing loss is combined with constant noise or ringing in the ears, which is not audible to others, but is very difficult for the person to suffer.
Deafness and hearing loss in a child
Children of different ages can suffer from any kinds and forms of hearing loss or deafness. Most often in children there are cases of congenital and genetic hearing loss, acquired deafness develops less frequently. Among the cases of acquired deafness, most are due to the intake of toxic drugs for the ear and the complications of infectious diseases.
The course, mechanisms of development 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 greater importance than in adults, because for a given age group hearing is crucial for mastering and maintaining speech skills, without which the child will become not only deaf, but also dumb. Otherwise, there are no fundamental differences in the course, causes and treatment of hearing loss in children and adults.
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 effects on a pregnant woman, which, in turn, lead to disruption of the normal growth and development of the fetus. Therefore, the causes of congenital hearing loss are factors that affect not so much the fetus itself, but rather a pregnant woman. So, Possible causes of congenital and genetic hearing loss are the following factors:
Signs (symptoms) of deafness and hearing loss
The main sign of hearing loss is the deterioration of the ability to hear, perceive and distinguish between a variety of sounds. A person with hearing loss does not hear a part of the sounds that normally a person picks up well. The lower the severity of hearing loss, the greater the range of sounds a person continues to hear. Accordingly, the heavier the hearing loss, the greater the number of sounds a person, on the contrary, does not hear.
You need to know that when hearing loss of various degrees of severity a person loses the ability to perceive certain spectra of sounds. Thus, with mild hearing loss, the ability to hear high and quiet sounds, such as a whisper, a squeak, a phone call, a bird singing, is lost. When the hearing loss is weighted, the ability to hear the next in height tones of the sound spectra disappears, that is, quiet speech, wind rustling, etc. As hearing loss progresses, the ability to hear sounds belonging to the upper spectrum of perceived tones disappears, and the distinction between low sound vibrations, such like a truck rumble, 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 is why To identify hearing loss, consider the following indirect signs of this pathology:
- Frequent questioning
- The absolute lack of response to the sounds of high tones (for example, the trilling of birds, the peep of a call or telephone, etc.)
- Monotone speech, improper stress setting
- Too loud speech
- Shuffling gait
- Difficulties in maintaining balance (noted with sensorineural hearing loss due to partial lesion of the vestibular apparatus)
- Lack of reaction to sounds, voices, music, etc. (normally, a person instinctively turns towards the source of the sound)
- Complaints of discomfort, noise or ringing in the ears
- The complete absence of any emitted sounds in infants (with congenital hearing loss).
Deafness (hearing loss)
How to determine deafness?
At the initial examination stage, a simple method is used to diagnose hearing loss and deafness, during which the doctor says the words in a whisper, and the patient must repeat them. If a person does not hear whisper speech, then hearing loss is diagnosed and further specialized examination is carried out, aimed at identifying the type of pathology and finding out its possible cause, which is important for the subsequent selection of the most effective treatment.
The following methods are used to determine the type, degree and specific characteristics of hearing loss:
- Audiometry (a person’s ability to hear sounds of different heights is being investigated)
- Tympanometry (bone and air conduction of the middle ear is examined)
- Weber test (allows you to identify one or both ears involved in the pathological process)
- Tuning fork – Schwabach test (allows you to identify the type of hearing loss – conductive or neurosensory)
- Impedancemetry (allows you to identify the localization of the pathological process that led to hearing loss)
- Otoscopy (examination of ear structures with special tools in order to identify defects in the structure of the eardrum, external auditory canal, etc.)
- MRI or CT (the cause of hearing loss is detected).
In each case, a different number of examinations may be needed to confirm hearing loss and ascertaining the degree of its severity. For example, one person will have enough audiometry, and another will have, in addition to this examination, to pass other tests.
The greatest problem is the detection of hearing loss in infants, since, in principle, they do not yet speak. In relation to infants, they use an adapted audiometry, the essence of which is that the child must respond to the sounds with head turns, various movements, etc. If the baby does not respond to the sounds, then he suffers from hearing loss. In addition to audiometry, impedancemetry, tympanometry and otoscopy are used to identify hearing loss in young children.
General principles of therapy
The treatment of hearing loss and deafness is complex and consists of taking therapeutic measures aimed at eliminating the causative factor (if possible), normalizing the ear structures, detoxifying, and also improving blood circulation in the structures of the auditory analyzer. To achieve all the goals of hearing loss therapy, various methods are used, such as:
- Drug therapy (used to detoxify, improve blood circulation of the brain and ear structures, eliminate the causative factor)
- Physiotherapeutic methods (used to improve hearing, detoxification)
- Hearing exercises (used to maintain hearing and improve speech skills)
- Surgical treatment (surgery to restore the normal structure of the middle and outer ear, as well as the installation of a hearing aid or a cochlear implant).
With conductive hearing loss, as a rule, surgical treatment is optimal, as a result of which the normal structure of the middle or outer ear is restored, after which the hearing returns completely. At present, a wide range of operations (for example, myringoplasty, tympanoplasty, etc.) is carried out to eliminate conductive hearing loss, among which in each particular case the optimal intervention is chosen to completely eliminate the problem that causes hearing loss or deafness. The operation makes it possible to return hearing even with complete conductive deafness in the overwhelming majority of cases, as a result of which this type of hearing loss is considered prognostically favorable and relatively simple in terms of treatment.
Sensorineural hearing loss is much more difficult to treat, and therefore all possible methods and their combinations are used to treat it. Moreover, there are some differences in the tactics of treatment of acute and chronic neurosensory hearing loss. Thus, in the event of acute hearing loss, a person should be hospitalized as soon as possible in the hospital’s specialized department and should be given medical treatment and physiotherapy in order to restore the normal structure of the inner ear and thereby regain hearing. Specific treatment methods are chosen depending on the nature of the causative factor (viral infection, intoxication, etc.) of acute sensorineural hearing loss. In chronic hearing loss, a person periodically undergoes treatment courses aimed at maintaining the existing level of perception of sounds and preventing possible hearing impairment. That is, in acute hearing loss, treatment is aimed at restoring hearing, and in chronic, at maintaining the existing level of sound recognition and at preventing hearing loss.
Therapy of acute hearing loss is carried out depending on the nature of the causative factor that provoked it. So, today there are four types of acute sensorineural hearing loss, depending on the nature of the causative factor:
- Vascular hearing loss – provoked by impaired blood circulation in the vessels of the skull (as a rule, these disorders are associated with vertebro-basilar insufficiency, hypertension, strokes, atherosclerosis of cerebral vessels, diabetes, diseases of the cervical spine)
- Viral hearing loss – provoked by viral infections (the infection causes inflammatory processes in the region of the inner ear, the auditory nerve, the cerebral cortex, etc.)
- Toxic hearing loss – provoked by poisoning with various toxic substances (alcohol, industrial emissions, etc.)
- Traumatic hearing loss – provoked by injuries of the skull.
Depending on the nature of the causal factor of acute hearing loss, the best medicines are selected for its treatment. If the nature of the causative factor could not be established precisely, then by default acute hearing loss is referred to as vascular.
When vascular deafness essential drugs used to treat are drugs improving cerebral circulation (Cavinton, stugeron, Vazobral, Cinnarizine, Eufillin, papaverine, nikoshpan, komplamin, Aprenal et al.) And enhancing the blood supply to the inner ear (Trental, Plental, Pentoxifylline and others). In addition, neuroprotectors that reduce the negative effects of hypoxia on nerve cells (Preductal, Mildronat, etc.), and drugs that improve metabolism in brain tissues (for example, Solcoseryl, Nootropil, Cerebrolysin, Pantokalcin, etc.) are used. In addition to these drugs for the treatment of acute hearing loss of vascular origin, agents are used to normalize blood pressure, as well as blood glucose and cholesterol levels.
For viral and toxic hearing loss, detoxification drugs (Hemodez, Reopolyglukine) and corticosteroid drugs (Dexamethasone, Prednisolone) are used for 3 to 4 days. Additionally, anti-inflammatory drugs (for example, Ibuprofen, Nimesulide, etc.) are also used for viral hearing loss for 3–4 days. After the completion of detoxification and anti-inflammatory therapy, microcirculation and cerebral circulation improvers, such as Ascorbic Acid, Cocarboxylase, Solcoseryl, Cinnarizin, Trental, etc., begin to be applied.
When traumatic hearing loss is used drugs that normalize cerebral circulation (Cavinton, Stugeron, Vazobral, Cinnarizine, Eufillin, Papaverin, Nikoshpan, Komplamin, Aprenal etc.) and improve metabolism in the central nervous system (Solcoseril, Nootropil, Pantocalcin and etc.). also preventing the inflammatory process in the brain tissue.
Chronic neurosensory hearing loss is treated comprehensively, periodically conducting courses of drug and physiotherapy. If conservative methods are ineffective, and hearing loss has reached III-V degree, then surgical treatment is performed, which consists in installing a hearing aid or a cochlear implant. Of the medications for the treatment of chronic neurosensory hearing loss, B vitamins are used (Milgamma, Neuromultivitis, etc.), aloe extract, as well as agents that improve the metabolism in the brain tissues (Solcoseril, Actovegin, Preductal, Riboxin, Nootropil, Cerebrolysin, Pantocalcin and others. ). Periodically, in addition to these drugs, Prozerin and Galantamine are used to treat chronic hearing loss and deafness, as well as homeopathic remedies (for example, Cerebrum Compositum, Spasuprel, etc.).
Among physiotherapeutic methods for the treatment of chronic hearing loss, the following are used:
- Hyperbaric oxygenation
- Laser irradiation of blood (helium-neon laser)
- Stimulation by fluctuating currents
- Quantum hemotherapy
- Phonoelectrophoresis is endoural.
If, against the background of any type of hearing loss, disorders of the vestibular apparatus appear in a person, then H1-histamine receptor antagonists are used, such as Betaserc, Moreseerk, Tagista, etc.
Surgical treatment of deafness (hearing loss)
Currently, operations are carried out for the treatment of conductive and sensorineural hearing loss and deafness.
Operations for the treatment of conductive deafness consist in the restoration of the normal structure and organs of the middle and outer ear, due to which a person reappears hearing. Depending on what kind of structure is restored, the operations bear the corresponding names. For example, myringoplasty is the operation to restore the eardrum, tympanoplasty is the restoration of the auditory ossicles of the middle ear (stirrup, malleus and incus), etc. After such operations, as a rule, hearing is restored in 100% of cases.
There are only two operations for the treatment of neurosensory deafness – this is installing a hearing aid or cochlear implant. Both options of surgery are made only with the ineffectiveness of conservative therapy and with severe hearing loss, when a person does not hear normal speech, even from close distance.
Installing a hearing aid is a relatively simple operation, but, unfortunately, it will not help return the hearing to those who are affected by the sensitive cells of the cochlea of the inner ear. In such cases, an effective method of hearing restoration is the installation of a cochlear implant. The implant installation operation is technically very difficult, therefore it is performed in a limited number of medical institutions and, accordingly, is expensive, as a result, not everyone is available.
The essence of the cochlear prosthesis is as follows: mini-electrodes are inserted into the structures of the inner ear, which will transcode sounds into nerve impulses and transmit to the auditory nerve. These electrodes are connected to a mini microphone placed in the temporal bone, which picks up the sounds. After installing such a system, the microphone picks up the sounds and transmits them to the electrodes, which, in turn, transcode them into nerve impulses and emit to the auditory nerve, transmitting signals to the brain, where sound recognition occurs. That is, cochlear implantation is, in fact, the formation of new structures that perform the functions of all ear structures.
Hearing aids for hearing loss
Currently, there are two main types of hearing aids – analog and digital.
Analog hearing aids are devices known to many that are visible behind the ear in the elderly. They are quite easy to use, but cumbersome, not very convenient and very rude in providing a sound signal gain. Analog hearing aid can be purchased and started to use independently without special settings from a specialist, since the device has only a few modes of operation, which are switched by a special lever. Thanks to such a lever, a person can independently determine the optimal mode of operation for the hearing aid and use it in the future. However, the analog hearing aid often interferes with, amplifies different frequencies, and not just those that a person does not hear well, as a result of which its use is not very comfortable.
A digital hearing aid, in contrast to an analog one, is tuned exclusively by a hearing care professional, thereby enhancing only those sounds that a person does not hear well. Thanks to the precision of the setting, the digital hearing aid allows the person to hear perfectly without interference and noise, restoring sensitivity to the lost spectrum of sounds and not affecting all other tones. Therefore, in terms of comfort, convenience and accuracy of correction, digital hearing aids are superior to analog ones. Unfortunately, in order to select and configure a digital device, it is necessary to visit the hearing aid center, which is not available to everyone. Currently, there are various models of digital hearing aids, so you can choose the best option for each individual.
More about hearing aids
Deafness treatment with cochlear implantation: device and principle of operation of a cochlear implant, surgeon’s comment – video
Neurosensory hearing loss: causes, symptoms, diagnosis (audiometry), treatment, advice of the otorhinolaryngologist – video
Sensorineural and conductive hearing loss: causes, diagnosis (audiometry, endoscopy), treatment and prevention, hearing aids (opinion of ENT doctor and audiologist) – video
Hearing loss and deafness: how the hearing analyzer is arranged, the causes and symptoms of hearing loss, hearing aids (hearing aids, cochlear implantation in children) – video
Hearing loss and deafness: exercises to improve hearing and eliminate ringing in the ears – video
Author: Nasedkina A.K. Specialist in conducting research on biomedical problems.