Acute hearing loss

Acute hearing loss is a phenomenon of rapidly increasing incomplete deterioration of hearing function, when a person begins to perceive and understand the surrounding environment, including spoken sounds. This pathological condition can be associated with a variety of causes, it makes it much more difficult to stay in society and is characterized by the loss of the ability to catch and interpret sounds. Several degrees of acute hearing loss are known, in addition to this there are other classification options. Treatment is complex, comprehensive, and depends on the underlying cause of the disorder. [1]

Acute hearing loss is a reversible or permanent impairment of hearing acuity (low-intensity sound perception) and sound volume (reduced frequency range or inability to perceive individual frequencies).

The auditory analyzing apparatus includes the external ear, consisting of the auricle, a catcher and a guide for airborne mechanical waves into the external auditory canal. Sound vibrations are amplified in the canal and then transmitted to the tympanic membrane, which in turn transmits them to the middle ear system. The middle ear is a cavity with the localization of three auditory ossicles: malleus, incus and stapes. The malleus is connected to the membrane, and there are articulations between all the ossicles. Their motorization contributes to the amplification of the wave up to 15 times.

The middle-ear cavity flows into the inner-ear cavity, the auditory mechanism of which is represented by the cochlea, filled with fluid content. As the fluid moves, the plate with its sensory structures moves, transforming mechanical waves into electrical vibrations. The impulse is transmitted through auditory nerve, reaches the temporal lobe of the cerebral cortex, where the received information is analyzed and sound perception is formed. [2]

Sound waves are transmitted not only by air but also by bone tissue. In a normal person analyzes sounds in the frequency range of 16-20 thousand hertz, with the highest sensitivity in the range of 1-4 thousand hertz. In middle age (25-35 years) sound perception is better at wave frequencies of 3 thousand hertz, and in old age it approaches 1 thousand hertz, which is due to age-related changes in inner-ear structures.

Sounds outside of these ranges can be perceived by the auditory mechanism, but they are not transformed into a sensation.

The sound volume perceived by a person is usually in the range of 0-140 decibels (whispered volume is about 30 decibels, spoken volume is about 50 decibels). Sound above 120-130 decibels causes organ overstress and increases the likelihood of auditory traumatism.

The hearing analyzer is able to adapt to different perceived loudnesses by self-regulating its sensitivity threshold. Failure of this regulatory process can lead to auditory fatigue, delayed recovery of the analyzer, which, over time, causes permanent impairment of the organ's function.

Epidemiology

Hearing loss is a pressing global issue as the percentage of people with hearing loss tends to steadily increase. An estimated 1.57 billion people worldwide had hearing loss in 2019, representing one in five people (20.3%), of whom 403.3 million (357.3-449.5) had moderate or greater hearing loss after adjustment for hearing aid use and 430.4 million (381.7-479.6) without adjustment. The largest number of people with moderate to profound hearing loss lived in the Western Pacific region (127-1 million). Of all people with hearing loss, 62-1% (60-2-63-9) were older than 50 years. This estimate is projected to grow to 630 million by 2030 and more than 900 million by 2050. [3] Among people aged 12 years and older in the U.S., nearly one in eight has bilateral hearing loss, and nearly one in five has unilateral or bilateral hearing loss. [4]

Acute hearing loss can also occur in children. Early onset hearing loss is poorly treatable because infants do not yet have the skill to interpret sounds correctly. Late cases of hearing loss are treated more effectively if detected in the early stages of development.

Acute sensorineural hearing loss occurs in about 27 cases per hundred thousand population.

According to disappointing expert forecasts, in 30 years, up to 2.5 billion people in the world will have some form of hearing loss, with around 700 million suffering from one of the main consequences of hearing loss - deafness.

More than a billion people are at risk of developing acute hearing loss every day due to listening to music using excessive volume levels.

Given the current trend, in 20 to 30 years, one in ten people on the planet will have a disabling hearing loss.

Causes of the acute hearing loss

Acute hearing loss can result from infectious inflammatory, neoplastic, neurological, metabolic, otologic, or vascular pathologies. Acute hearing loss can also sometimes result from the use of ototoxic medications.

Among the main reasons:

• head and ear injuries (including barotraumas), ear diseases, and eardrum defects as a consequence of trauma and otitis media;
• Exposure to constant strong noise (at work, listening to music, etc.); [5]
• mechanical obstacles (wax plugs), intra-ear foreign bodies;
• tumor processes, both false (choleastoma) and true (cancer);
• hemorrhaging in the middle ear;
• damage to the articulation between the auditory ossicles (due to trauma, inflammatory diseases);
• taking ototoxic medications;
• industrial intoxication (aniline, benzene, styrene, xylene, etc.); [6]
• infectious processes (viral infections of the upper respiratory tract, [7] meningitis and tick-borne encephalitis, epidparotitis, measles, diphtheria, etc.); [8]
• metabolic and vascular pathologies (hypertension, stroke, diabetes, [9] hypothyroidism).

Risk factors

Acute hearing loss most often occurs in the following conditions:

• Otitis media is an inflammatory process affecting the outer, middle, inner ear. The disease is more often unilateral in nature. The main symptomatology includes earache, deterioration of hearing, fever. Patients with otitis media complain of sensations of "shooting" in the ear, there may be a skewed face when the pathology spreads to the facial nerve. With inflammation of the inner ear, nausea, impaired balance, dizziness are noted.
• Meniere's disease is a pathology that affects the inner ear and is associated with an increase in fluid volume in the spiral organ. The disease occurs with varying degrees of hearing loss, dizziness, nausea, and ear noise.

Some of the most common risk factors for acute hearing loss include:

• hereditary predisposition (diagnosed hearing impairment in close relatives);
• infectious-inflammatory, viral pathologies, both in the patient himself and in his mother during pregnancy;
• Frequent, regular, erratic, prolonged use of ototoxic medications;
• head trauma, injuries to the maxillofacial skeleton;
• hypoxic-ischemic, hemorrhagic lesions of the central nervous system;
• Elevated cholesterol levels in the bloodstream are often associated with the development of hearing loss;
• alcohol abuse leads to malfunctions in the receptor section of the auditory analyzer, negatively affecting sound perception (especially in the high-frequency range);
• acoustic trauma causes damage to the hair cells of the cochlea and disruption of sound transmission to the auditory nerve;
• severe stress, nervous shocks (including chronic ones).

Some infectious processes can lead to acute hearing loss against the background of ongoing treatment, or immediately after its completion. In such situations, the causes are often meningitis of microbial etiology, Lyme disease, viral lesions of the spiral organ. The most common underlying pathologies are epidparotitis and herpesvirus infection.

In some cases, acute hearing loss may be the first symptom of other pathologic processes, such as auditory neuroma, Meniere's disease, cerebellar stroke, or multiple sclerosis.

Cogan syndrome is a rare autoimmune pathology characterized by damage to the cornea and inner ear. In more than half of cases, the disease starts with the onset of acute hearing loss. About 20% of patients have complex systemic vasculitis, including a life-threatening inflammatory process of the aortic wall.

Acute hearing loss is common in hematologic diseases - particularly sickle cell anemia, leukemia, Waldenström's macroglobulinemia.

Pathogenesis

The pathomorphological basis for the development of acute hearing loss of sensorineural etiology lies in the quantitative deficiency of neural elements in different parts of the auditory analyzer, from the spiral cochlea to the central part - the auditory cortex of the temporal lobe of the brain. Damage to the spiral organ leads to perceptual hearing impairment up to hearing loss.

The exact mechanisms of acute hearing loss associated with sound perception impairment are still under investigation. Ongoing research indicates that acute hearing loss patients have high concentrations of pro-inflammatory cytokines in the inner ear. This contributes to the formation of a dystrophic reaction in the hair cells of the peripheral receptors of the auditory analyzer, the cortical organ.

An increase in the number of cytokines can be caused by several etiologic factors: infection, intoxication, vascular disorder, stress, degenerative-dystrophic process in the spine, negative influence of damaging external factors, etc.

The close anatomical and physiologic proximity of the auditory and vestibular apparatuses explains the occurrence of combined impairment of these two systems. Most patients show vestibular signs such as systemic dizziness, static disorders, problems with coordination, gait, and nausea. However, in some patients, the vestibular component is only detected when appropriate diagnostics are performed. Particularly often auditory and vestibular disorders are simultaneously detected against the background of acute circulatory disorders in the basin of the labyrinthine artery or acoustic neurinoma (vestibular schwannoma).

Symptoms of the acute hearing loss

The main clinical symptom of acute hearing loss is a rapid deterioration of hearing over several days (usually 2-3 days to one week). The first signs are noticed almost immediately:

• the person starts to ask to repeat what has been said;
• increases the volume while watching TV;
• his speech is getting louder than usual;
• when needing to concentrate on sounds, the bangs get tired quickly and become irritable.

In general, the clinical picture varies, depending on the stage of the pathological process. Thus, at stage 1, there are problems with the perception of whispered speech and quiet conversations. Stage 2 is already characterized by the appearance of problems with the perception of normal speech: the interlocutor has to speak louder than usual to be heard and understood.

The third stage is characterized by a rather severe impairment of auditory function. The patient stops responding even to relatively loud conversations and noise. At stage 4, there is no sensitivity even to strong sounds.

The final clinical stage is complete deafness.

In childhood (especially early childhood), acute hearing loss is defined by the following signs:

• A child over 4-5 months of age does not turn toward sound sources;
• no response to his own name;
• reaction to other people appears only when visual contact with them is established;
• No speech activity at 1 year of age or more.

The first sign of acute sensorineural hearing loss is an increase in the pain threshold of sound perception. The patient begins to react painfully even to not very loud sounds.

Perilymphatic fistulas may form between the middle and inner ear in the event of intense ambient pressure changes or physical overload. Perilymphatic fistulas can be congenital, but acute hearing loss can occur after trauma or sudden pressure changes.

Against the background of taking ototoxic drugs, acute hearing loss can occur within 1-2 days, which is especially common in the case of overdose of such drugs. There are descriptions of a rare genetic pathology, which is characterized by a more intense effect of aminoglycosides.

Stages

Grade 1 acute hearing loss is characterized by hearing impairment in which a person cannot perceive speech sounds of about 26-40 decibels in a normal environment.

Grade 2 acute hearing loss is a hearing impairment where a person can no longer perceive speech sounds of moderate volume - about 41-55 decibels.

Grade 3 acute hearing loss indicates impaired sound perception in the range of most sounds - about 56-70 decibels. Communication becomes problematic, as any conversation will require considerable effort on the part of the patient.

Acute hearing loss of the 4th degree is characterized by the fact that the patient hears only very loud sounds (71-90 decibels). It is almost impossible to communicate with such a person without the use of a hearing aid.

In even more complex cases, when the patient cannot hear speech sounds in the range of more than 90 decibels, the diagnosis is not hearing loss, but total deafness. [10]

Forms

People who have lost the ability to hear normally (with a hearing threshold of 20 decibels or less in both ears) suffer from hearing loss. The degree of hearing loss can be slight (mild), moderate, severe or profound. Acute hearing loss can occur in one or both ears, making sound perception much more difficult.

The term acute hearing loss applies to patients with acute hearing loss ranging from mild to severe. Typically, hard of hearing people use hearing aids, cochlear prostheses and other devices to improve their hearing, and turn on subtitles when watching programs.

Classification of acute hearing loss takes into account the degree of impairment and its level. The following variants of pathology are considered to be the main ones:

• Acute sensorineural hearing loss is otherwise known as sensorineural hearing loss. The level of the inner ear converts mechanical vibrations into electrical impulses. This process is impaired if the hair cells die, resulting in impaired and distorted sound perception. Acute sensorineural hearing loss is accompanied by a decrease in the pain threshold of sound perception. Normally, this threshold is about 100 decibels, but in patients with sensorineural hearing loss, sound-perceiving pain appears even if the hearing threshold is slightly exceeded. The problem often develops in disorders of microcirculation in the inner ear, with increased fluid pressure in the inner ear (Meniere's disease), in diseases of the auditory nerve, etc. The problem can also be caused by infectious diseases. It can also be caused by infectious-inflammatory processes (epidparotitis, meningitis, measles, human immunodeficiency syndrome), much less often by autoimmune pathologies (in particular, Wegener's granulomatosis). [11]
• Acute bilateral hearing loss is a complex problem that can occur either due to an infection or trauma, or due to certain medications. For example, hearing loss may follow antibiotic therapy with aminoglycosides (monomycin, gentamicin, kanamycin or neomycin). Reversible bilateral hearing loss appears against the background of treatment with certain diuretics, macrolides, non-steroidal anti-inflammatory drugs. In addition, systematic exposure to excessive noise, chronic intoxication (lead, mercury, carbon monoxide compounds) are often the causes.
• Acute right-sided hearing loss is a unilateral hearing impairment, as is acute left-sided hearing loss. The problem is most often caused by trauma and diseases of the ear and the formation of a wax plug. The probability of a plug especially increases with improper hygiene, when patients do not clean the wax from the ear canals, but push it inside, compressing and gradually blocking the left or right passage. A less common cause of unilateral lesions is considered to be a tumor process.
• Acute mixed hearing loss results from the combined effects of factors that can cause conductive and sensorineural hearing loss. This pathology requires a special therapeutic approach and the use of sophisticated hearing aids.
• Acute conductive hearing loss is caused by an obstacle in the direction of sound conduction and amplification. Obstructions can occur in the outer ear, for example, wax plugs, tumors, otitis externa, or developmental defects. If the problem occurs in the middle ear, it can be trauma to the auditory ossicles and/or eardrum, otitis media or adhesive otitis media, otosclerosis, tubo-otitis.

Complications and consequences

If acute hearing loss is not treated in a timely manner, the problem can develop into total deafness and can also negatively affect many aspects of life, such as communication, cognitive ability, education and employment.

Children with this problem face difficulties in obtaining education, socializing with peers. Among adults with hearing loss there is a relatively high rate of unemployment; many patients are forced to move to less skilled labor, which negatively affects social conditions.

Severe hearing loss significantly increases the risk of developing depressive states, regardless of the age and medical history of the person. [12] According to statistics, more than 10% of patients with severe pathology suffer from depression in the future, while in people with normal hearing function they are diagnosed in only 5% of cases.

Panic attacks are also characteristic of patients with even mild hearing loss (in 30-59% of patients). Over the years, when acute hearing loss becomes chronic, this indicator increases significantly. In addition, the risk of developing hallucinations, psychosis, paranoid states increases.

Late effects include loneliness, social isolation.

Problems appearing in identifying the sources of sounds, or in identifying incomprehensible sounds, can provoke hallucinations.

In the presence of constant ear noise or ringing, a state of clinical depression often develops, as the constant sound depresses and suppresses the emotional state. Most patients complain of excessive sound sensitivity and insomnia followed by daytime sleepiness.

Older hearing-impaired people often suffer from dementia. [13] There is a proven link between senile hearing problems and cognitive decline and the development of dementia (the risks increase 2-5 times, depending on the degree of pathology). [14]

Hearing loss in adults is in many cases associated with a general deterioration of health. This is not a direct consequence, but an indirect one, caused by changes in the psycho-emotional state of the patient: chronic stress, fear, depression. As a result, somatic pathologies develop and aggravate - in particular, hypertension, diabetes mellitus.

Diagnostics of the acute hearing loss

If a person is suspected of acute hearing loss, he is prescribed a number of complex examinations, during which the doctor finds out the possible cause of the disorder, assesses the extent of pathological changes.

As part of the initial diagnostic measures, the specialist reproduces spoken and whispered speech and finds out how the patient hears it.

The history should include an indication of acute onset of hearing loss, which is necessary to exclude chronic pathology. It is also necessary to determine whether the process is unilateral or bilateral, and to find out the previous event that may have caused the development of the disorder (trauma, infection, etc.). Acute hearing loss may be characterized by an ear clinical picture (e.g. Discharge from the ear), vestibular picture (dizziness, spatial disorientation), neurological symptoms (pain in the head, distorted taste, etc.).

Further examinations determine the presence or absence of other potentially implicated factors such as syphilis and HIV, ototoxic medications, and other somatic pathologies.

Special attention is paid to the evaluation of the auditory mechanism, as well as to the neurological examination. The tympanic membrane is examined for perforations, discharge, and other damage. The cranial nerves, cerebellum and vestibular apparatus are examined during the neurological examination.

Among the suspicious signs to look out for (other than acute hearing loss itself) are:

• impaired function of the cranial nerves;
• Asymmetry of sound perception of the right and left ears;
• neurological symptoms (motor weakness, Horner's sign, aphasia, sensory disorders, impaired thermosensitivity).

Traumatic injuries, the fact of taking ototoxic medications, infectious processes are detected at the stage of clinical examination. A perilymphatic fistula is typically characterized by a preceding explosive sound at the time of perforation, as well as subsequent weakness, dizziness, and ear noise.

The unfavorable signs of acute hearing loss include focal neurological symptoms: impaired facial sensitivity, impaired mandibular function as a possible lesion of the fifth pair of cranial nerves, as well as facial hemiparesis, perversion or loss of taste, which is observed when the seventh pair of nerves is affected.

Fluctuating unilateral hearing loss combined with a feeling of congestion and tinnitus, dizziness indicates possible Meniere's syndrome. If there are symptoms of an inflammatory reaction (fever, rashes, joint pain), it is possible to suspect an underlying infectious or autoimmune pathology.

Instrumental diagnosis includes audiometry, magnetic resonance imaging or computed tomography.

Patients undergo audiography, often magnetic resonance imaging with contrast, which is especially relevant for unilateral acute hearing loss.

If there is an indication of recent trauma, MRI is also actively used. Computed tomography of the temporal bones is appropriate for evaluating the bony characteristics of the inner ear and detecting congenital defects, fractures, erosive processes.

If necessary, serologic tests for HIV infection or syphilis, general blood tests and tests for the quality of the blood coagulation system, antinuclear antibody tests are performed.

Additional investigations may include:

• duplex scanning of brachiocephalic arteries with color Doppler blood flow mapping (to assess the quality of blood flow in carotid and vertebral arterial vessels);
• X-ray of the cervical spine (to visualize the condition of the vertebrae);
• MRI of the pituitary gland.

Differential diagnosis

A distinction must be made between acute hearing loss and deafness. Deafness is characterized by the preservation of speech perception and reproduction, while a deaf person can no longer recognize speech even at close range.

Complete deafness, in which the patient loses the ability to perceive any sounds, is rarely diagnosed. In order to determine the degree of pathological process, auditory function is evaluated at conversational frequencies with air conduction. The threshold of hearing in patients with hearing loss is 26-90 decibels. If the threshold of hearing is more than 91 decibels, deafness is diagnosed.

As we have already mentioned above, there is conductive hearing loss with damage to the sound-receiving and sound-conducting parts, which leads to impaired transportation of air waves. The pathology reveals itself by deterioration of hearing acuity, there may be a feeling of ear stuffiness, but the preservation of bone conduction is noted.

Neurosensory acute hearing loss develops in the receptor mechanism, auditory nerve, conductive apparatus, cortical and subcortical regions. The acuity of auditory function and its volume are impaired, and bone conduction is affected. The clinical picture may include varying degrees of deterioration of sound perception, ear noise, auditory hallucinations (the patient allegedly hears non-existent words, melodies, etc.).

In addition, acute hearing loss is differentiated from sudden hearing loss, which occurs abruptly and lasts up to 12 hours.

Treatment of the acute hearing loss

Treatment of acute hearing loss includes conservative and, if indicated, surgical measures. Conservative therapy is carried out both on an outpatient and inpatient basis, depending on the severity of the pathology.

Medication is appropriate in the acute period of the inflammatory process affecting the outer, middle, inner ear. The patient undergoes ear sanation - sometimes just remove the wax plug. Prescribe anti-inflammatory, antiviral, antibacterial agents, which are selected based on the likely causative agent of the disease. After the acute process is eliminated, physiotherapy may be used.

If the patient suffers from chronic vascular pathologies, a course of neurometabolic treatment is prescribed.

Surgical intervention consists of plasty of the external auditory canal, eardrum, and auditory ossicles.

In severe cases, cochlear implantation is indicated, which involves placing a device that captures and converts sounds into an electrical impulse.

In general, treatment is aimed at restoring hearing function and, among other things, preserving speech capabilities. There are many different therapeutic options for patients with acute hearing loss:

• antiaggregant and vascular treatment;
• ion therapy and plasmapheresis;
• vitamin therapy, oxygen therapy;
• acupuncture, reflexology.

When acute hearing loss develops, it is important to make a correct diagnosis and direct all efforts to treat the causative pathology.

If the acute hearing loss becomes chronic, some patients are interested in hearing aids. This involves the use of an electronic augmentation device that is placed behind the ear or in the ear canal. The device includes a microphone, a speaker and an amplifier - a chip powered by a small battery. [15]

In the process of selecting a hearing aid, it is important to achieve the best possible intelligibility of sounds and normal perception of their volume. There are many such devices available today that are comfortable, unobtrusive, and have high quality sound reproduction.[16]

The main types of hearing aids available:

• behind-the-ear placement;
• In-the-ear (custom-made using an ear impression).

In bilateral hearing loss, the use of external devices is ineffective, so surgical prosthetics are indicated in such situations.

Medications

Most patients with acute hearing loss are treated with corticosteroids. Most often the drug of choice is prednisolone at a dosage of 40-60 mg per kg of body weight orally daily for 1-2 weeks, with further gradual withdrawal of the drug for 5 days. Glucocorticoids are administered more often orally, less often - transtympanally. Transtympanal administration is more effective and less often accompanied by side effects. In many cases, an integrated approach is used: corticosteroids are administered both orally and by injection into the tympanic cavity.

Antiviral drugs (anti-herpetic drugs: Famciclovir, Valacyclovir) are prescribed when indicated. Salt-free diet, mineral supplements with magnesium and/or zinc, dextran, nifedipine, Pentoxifylline 300 mg or Vinpocetine 50 mg (in 500 ml of isotonic sodium chloride solution, intravenously slowly for 2-3 hours), heparin (or prostaglandin E1), oxygen therapy are recommended.

Given that any damage to the inner ear structures is accompanied by the development of local inflammation, which further adversely affects the restoration of sound-perceiving function, patients are obligatorily prescribed systemic corticosteroid therapy. Steroid drugs have a pronounced anti-inflammatory effect, contribute to the stabilization of electrolyte balance in the inner ear, normalize the endocochlear potential, increase cochlear blood circulation. Nevertheless, there are also "minuses" of steroid therapy, which consist in the increased risk of adverse symptoms, including the development of peptic ulcer disease, pancreatic inflammation, hypertension, metabolic disorders, osteoporosis, cataracts, hyperglycemia, etc., as well as in the development of pancreatic inflammation.

Instead of systemic administration of corticosteroids, intratympanal or transtubar administration is possible.

Transtubar injection is used relatively rarely, which is due to difficulties in dosage of the drug. If the drug solution is injected directly into the tympanic cavity, it leads to a sufficient concentration in the perilymph and does not cause such intense side effects compared to internal administration of corticosteroids.

Thanks to numerous studies, it has been proven that local administration of hormonal drugs is almost equal in effectiveness to their systemic use. And when a long course of treatment is necessary, intratympanal administration is always preferable.

Dexamethasone and methylprednisolone are actively prescribed as part of topical hormonal therapy for acute hearing loss. The anti-inflammatory capacity of dexamethasone is about five times higher than that of methylprednisolone. The optimal single amount of dexamethasone for transtimpanal administration is 1 ml of 2.4% solution. It is possible to use a lower concentration of dexamethasone - up to 0.4%.

It is important to remember that one of the conditions for the effectiveness of transtympanal treatment is the precise transportation of the medication solution to the inner ear structures. This can be achieved by tilting the patient's head at an angle of 45° to the opposite side. It is optimal to stay in this position for up to half an hour. The patient usually lies on the couch during this time.

Another popular drug - Mometasone furoate - is a widespread corticosteroid in medicine, which successfully eliminates the inflammatory process and begins to act as early as 12 hours after the first dose is administered. The drug inhibits the production and release of histamine, pro-inflammatory interleukins, leukotrienes, etc., demonstrates a pronounced anti-allergic and anti-inflammatory activity. Mometasone is prescribed for acute hearing loss caused by seasonal and year-round allergic rhinitis, acute rhinosinusitis, adenoiditis, nasal polyposis. The drug is used intranasally, 1-2 injections into each nasal passage daily (the dose is calculated depending on the age of the patient and the severity of the pathological process). After achieving the necessary therapeutic effect, maintenance therapy is carried out - one injection into each nasal passage in the evening. Mometasone is not prescribed if the patient has hypersensitivity to the components of the medication, as well as in the presence of open wounds in the nasal cavity (for example, associated with trauma). Among the possible side effects: nosebleeds, burning sensation in the nose, pain in the head. The possibility of using the drug during pregnancy is discussed individually with a doctor.

Physiotherapy treatment

In addition to systemic and local drug therapy, various physiotherapeutic methods are widely used in acute hearing loss. The effective effect of electrophysical factors is explained by energetic optimization of biological processes. The therapeutic activity is determined by physical intra-tissue changes at the cellular and subcellular level, as well as by the general reaction of the organism.

The following physiotherapy methods are most often referred to by specialists:

• medicated electrophoresis;
• application of fluctuating currents that improve tissue trophicity and enzyme activity;
• Amplipulse" device, which involves the use of sinusoidal modulated currents;
• transcranial electrical stimulation;
• physiotherapeutic complex "Audioton", providing exposure to low-frequency pulse current and local low-frequency alternating magnetic field of low induction;
• intravascular irradiation of blood (has a detoxifying, thrombolytic effect, activates tissue repair, increases cellular resistance to pathogens).

Much attention should be paid to the evaluation of the state of the autonomic nervous system. Its dynamic correction is used, which can provide restoration of functionality, regeneration of sensorineural structures of the auditory analyzer (with the help of "Simpatocor-01" device).

Surgical treatment

Surgical treatment consists of plasty of the external auditory canal, tympanic membrane, and auditory ossicles. Air conduction devices are used to optimize the existing but weak air conduction function in the hearing ear. If such devices cannot be used, a middle ear implant is placed.

In mild cases, interventions consist of ear microscopy, removal of wax plugs and foreign bodies from the ear canals. In severe cases, however, cochlear implantation is indicated, which involves placing a device capable of capturing sounds and converting them into electrical impulses.

The most common hearing-improving surgeries:

• Ear tympanoplasty is an intervention performed to restore the position of the ossicles (stapes, malleus and incus). The operation is performed using general anesthesia through the external auditory canal. A microscope is used for the accuracy of manipulation. The intervention is completed with myringoplasty.
• Myringoplasty is a plastic repair of the tympanic membrane, especially for patients with trauma or perforations of the membrane. The damaged area is covered with a skin flap.
• Stapedoplasty is an intervention indicated for patients with otosclerosis. It involves the insertion of a prosthesis to replace the auditory ossicle.

In severe cases with steady progression of the pathological process, the doctor may prescribe cochlear implantation - a variant of hearing aids, which involves the introduction of a system of electrodes into the patient's inner ear to ensure the perception of sounds by electrostimulation of the remaining healthy fibers of the auditory nerve. [17]

The main indications for cochlear implantation:

• progressive bilateral hearing loss with a threshold of at least 90 decibels, which cannot be corrected with a hearing aid;
• absence of severe concomitant somatic pathology and cognitive impairment.

Contraindications:

• marked obliteration of the spiral organ;
• pathology of the auditory nerve (including neurinoma);
• focal diseases in cortical and subcortical brain structures;
• negative promontory test.

During the intervention, the implant is placed under the skin behind the patient's ear. The electrode network coming out of the implant is inserted into the cochlea. The operation can last about two hours, the rehabilitation period is 4-6 weeks. A small behind-the-ear scar remains after the operation. [18]

Prevention

The main measure to prevent acute hearing loss is regular preventive examinations, which are especially important for people who are prone to developing hearing impairment, such as workers in noisy production facilities. Timely detection of pathologies in children is also important, as undiagnosed disorders may cause delays in speech and mental development in the future.

All efforts should be directed toward eliminating factors that could potentially cause acute hearing loss.

Prevention of hearing loss is relevant throughout life, from newborn to old age.

More than half of all cases of acute hearing loss in children and adults can be prevented by taking general measures:

• to support the health of expectant mothers during pregnancy, as well as children from the moment they are born;
• provide genetic counseling, immunizations;
• detect and treat otorhinolaryngologic diseases in a timely manner;
• Protect the auditory organs from the adverse effects of noise and chemical compounds; [19], [20]
• correct use of medications to prevent the development of hearing loss due to ototoxic medications.

Forecast

Early detection of acute hearing loss and triggering factors plays a crucial role in the future prognosis. It is important to conduct systematic screening examinations for the timely detection of otolaryngologic diseases and related hearing impairment, especially among at-risk groups:

• toddlers, preschoolers and school children;
• employees of enterprises whose work is associated with constant noise and toxic effects;
• patients forced to take ototoxic medications;
• the elderly and the elderly.

Diagnosis can be carried out in both inpatient and outpatient settings: when acute hearing loss is detected, the necessary measures should be taken as soon as possible to eliminate the cause and mitigate any adverse effects.

The following measures are taken to improve prognosis in patients with acute hearing loss:

• use of hearing aids, cochlear prosthetics and middle ear implants;
• practicing sign language and other techniques;
• Rehabilitative interventions to optimize communication skills.

A good prognosis for hearing recovery was associated with absence of dizziness, early treatment (first 7 days) and hearing loss less than 50 dB. Age had no influence on the recovery process. [21]

At the first signs of acute hearing loss, it is necessary to consult a doctor as soon as possible: general practitioner, pediatrician, otolaryngologist, family doctor. In general, ear pathologies are dealt with by an otolaryngologist. If the auditory nerve is affected, the help of a neurologist is necessary. There is also a separate specialization - otoneurologist. Rehabilitation measures are carried out with the possible involvement of a surdologist and occupational pathologist. In some cases, the assistance of a traumatologist may be required. In many cases (70-90%) acute hearing loss is reversible if medical help is sought in time - within the first few days. Lack of treatment or improper therapeutic approach is fraught with unfavorable consequences, up to complete deafness.

In viral origin of the disorder as well as in idiopathic acute hearing loss, hearing function is restored in about half of the cases. In the remaining patients, hearing is only partially restored. The average treatment period is 1.5-2 weeks.

The term of recovery after taking ototoxic medications can be different, which depends on the type of drug and the dosage taken. In some cases - for example, in the development of auditory disorders against the background of treatment with acetylsalicylic acid or diuretics - recovery of function occurs within a day. At the same time, long-term use of chemopreparations and antibiotics in high doses leads to the development of acute hearing loss, which gradually develops into a stable chronic form.

List of authoritative books and studies related to the study of acute hearing loss

1. "Otitis Media: State of the Art Concepts and Treatment" - Edited by Samuel Rosenfeld, Year of release: 2018.
2. "Pediatric Otorhinolaryngology: Diagnosis and Treatment" - Author: Richard M. Rosenfeld, Year of publication: 2012.
3. "Otitis Media in Infants and Children" - Editors: Charles D. Bluestone, Jerome O. Klein, Year: 2007. Klein, Year of publication: 2007.
4. "Acute Otitis Media in Children: A Practical Guide for Diagnosis and Management" - Author: Ellen M. Friedman, Year of release: 2016.
5. "Otitis Media: Clinical Practice Guidelines" - Published by the American Society of Otolaryngology - Year: 2016.
6. "Otitis Media: Targeting the Silent Epidemic" - Authors: David M. Baguley, Christopher R.C. Dowrick, Year of release: 2018.
7. "Recent Advances in Otitis Media: Proceedings of the Fifth International Symposium" - Editors: Richard A. Chole, MD, PhD, David D. Lim, MD, et al, Year of release: 2003.

Literature

• Palchun, V. T. Otorhinolaryngology. National manual. Brief edition / Edited by V. V. Т. Palchun. - Moscow : GEOTAR-Media, 2012.
• Palchun V.T., Guseva A.L., Levina Y.V., Chistov S.D. Clinical features of acute sensorineural hearing loss accompanied by vertigo. Otorhinolaryngology Bulletin. 2016; 81(1):8-12.
• Modern approaches and promising directions in the treatment of acute sensorineural hearing loss of acutraumatic genesis. Kuznetsov M.S.*1, Morozova M.V.1, Dvoryanchikov V.V.1, Glaznikov L.A.1, Pastushenkov V.L.1, Hoffman V.R.1 Journal: Bulletin of Otorhinolaryngology. Volume: 85 Number: 5 Year: 2020 Pages: 88-92
• Study of immunologic aspects of the pathogenesis of sensorineural hearing loss. Journal of Russian Otorhinolaryngology, 2007.