Labyrinthopathy

The term considered in this article includes a fairly large number of pathologies united by one aspect - the localization of diseases - this is the human inner ear. Labyrinthopathy is a violation of the normal functioning of the auricle, which is caused by vasomotor (disruption of neuroreflex mechanisms) and trophic (change in biochemical processes in tissues) characteristics. Mostly, such changes are already chronic.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]

Causes of Labyrinthopathy

Any disease does not appear out of nowhere. It has its source and favorable conditions for development. The causes of labyrinthopathy are quite extensive and diverse. When changes affect the vestibular apparatus, doctors talk about vestibulopathy. If negative disorders affect only the sound receptor itself, then we are talking about cochleopathy. When both changes are detected together, we can already talk about labyrinthopathy.

Negative transformations in the organ of Corti begin to develop mainly from the fibers of the spiral ganglion, nerve cells or hair cells. Gradually, the cellular structures of the supporting apparatus begin to be involved in the process of dystrophy, which gradually leads to complete degradation of the area of Corti.

The following may lead to such a deviation in the functioning of the hearing organ:

• Mechanical damage to the sound receptor is chronic noise trauma.
• The toxic form of pathology is provoked by endogenous or exogenous poisons. These can be: methyl alcohol, quinine, gasoline, aniline, sulfuric acid, nicotine, fluorine, salicylates, arsenic and many other chemical compounds burdened with similar properties.
• Spoiled meat of animals, poultry or fish can also lead to similar intoxication.
• No less dangerous are the toxins produced during the course of such diseases as typhoid, scarlet fever, diphtheria, influenza, diabetes, malaria, measles, as well as during toxicosis caused by pregnancy, in the case of progressive nephritis, intestinal dyspepsia, epidemic mumps, epidemic goiter and many other pathologies.
• Sometimes it is impossible to identify the cause of hearing loss. For example, such a picture can develop in adolescence. Much less often, its initial development is observed in middle-aged people.
• Under the epidermis, a small cystic formation can often form, developing from the remnants of the mucous membrane and surrounded by an area of inflamed bone tissue.
• This problem is also diagnosed as an aging process of the body. That is, senile hearing loss.
• There are known cases where hearing degeneration occurred due to severe hypovitaminosis of the body, or as a result of prolonged starvation (forced or deliberate adherence to a strict diet).
• Consequences of radical surgery.
• Disruption of metabolic processes.
• Vascular disorders.
• Climax.

[ 7 ]

Symptoms of Labyrinthopathy

Almost any disease (with rare exceptions) is accompanied by the appearance and growth of intensity of discomfort symptoms. The main symptoms of labyrinthopathy are a gradual decrease in auditory sound perception. Often, such deterioration is accompanied by background noise, which begins to sound in the ears almost constantly.

The intensity of symptoms largely depends on the cause of the development of pathological hearing loss. Some forms of the disease show a gradual but irreversible decrease in hearing, while a number of cases depend on the factor of speed and effectiveness of the therapeutic measures taken. For example, getting toxic poisoning in the light of professional activity.

There are cases of rapid onset of deafness caused by high intoxication of the body. For example, due to quinine poisoning. Gradually, such a process becomes chronic.

Along with hearing loss, the patient may experience:

• Dizziness, which is especially activated by turning the head sharply.
• Vestibular disorder (impaired stability) with a rapid change in body position.
• The problem of moving around in transport is motion sickness.
• Weak spontaneous nystagmus may be observed - a complex type of oculomotor deviation manifested by frequent involuntary oscillatory movements of the eyeballs.

Diagnosis of labyrinthopathy

In order for the patient to receive high-quality and timely treatment, it is necessary to establish the correct diagnosis as early as possible and, preferably, the cause of the pathology.

Labyrinthopathy diagnostics is mainly based on the patient's medical history. The specialist always tries to get as complete a picture of the disorder as possible, its intensity and localization. The level of hearing loss is determined, which is typical in the case of changes affecting the sound receptor. The question is clarified whether the hearing loss affects both auditory organs or only one.

The attending physician examines the sensitivity threshold of the vestibular analyzer, which shows reduced sensory perception. While stimulators of suprathreshold strength provoke an unprecedentedly high response (mainly of a vegetative nature). For the sound analyzer of the diseased ear, such a disproportion in the powerful response to a small irritation causes the strongest volume of sound in response to a slight irritation. Such a picture is typical for disorders of the functionality of the sound receptor.

The patient also undergoes audiometry, as a result of the study, the doctor receives a curve of intelligible speech.

[ 8 ]

Treatment of labyrinthopathy

If hearing loss is a consequence of postoperative intervention, then the main thing in conducting the relief therapy is thorough care of the operated area. This mainly concerns the use of disinfectants: solutions, ointments and powders.

Treatment of labyrinthopathy, regardless of the genesis of the disease, involves prescribing calcium-based medications to the patient (combinations with other elements are often used): calcium lactate, calcium gluconate, calcium lactate gluconate, and others.

Calcium gluconate is prescribed for oral administration, as well as in the form of solutions intravenously and intramuscularly (injections are not prescribed to small patients) use. The quantitative component of the administered pharmacological agent is directly selected based on the age of the person who needs medical care:

• Adult patients are given the drug in doses of one to three grams two to three times a day.
• For infants up to one year of age – 0.5 g twice or three times a day.
• For children aged between two and four years old, take one gram twice or three times a day.
• For children aged five to six years – 1–1.5 g two to three times a day.
• For children from seven to nine years old – 1.5 – 2 g twice or three times a day.
• For teenagers aged 10 to 14 – two to three grams two to three times a day.

Parenterally, the pharmacological preparation under consideration is prescribed to adult patients in an amount of 5 to 10 ml per day. The schedule of administration is determined by the attending physician, and it can be daily or administered every other day or two. For older children - from 1 to 5 ml once every other day or two.

Contraindications to the use of calcium gluconate include hypercalcemia, the patient's tendency to form a blood clot, hypercoagulation, developed atherosclerotic symptoms, and increased sensitivity of the patient's body to the components of the drug.

Iodine preparations are also prescribed: antistrumin, betadine, iox, iodide, iodinol, iodonate, iodopyrone, iodoform, iodognost, microiodine and others.

Iodide is prescribed in tablets and is taken in dosages from 0.1 to 0.2 g per day immediately after meals, together with a sufficient amount of liquid.

It is not recommended to prescribe this drug in case of increased individual sensitivity of the patient's body to iodine, as well as if the patient's medical history includes Duhring-Brock syndrome, autonomous adenoma or adenomatous goiter.

The patient uses bromides: ammonium bromide, potassium bromide, bromoform, sodium bromide.

The drug sodium bromide is taken orally at 0.1 - 1 g of the drug three to four times a day. The drug can also be administered intravenously in a dosage of 5 to 10 ml. Solutions of 5%, 10%, and 20% are used in treatment. The level of concentration used is prescribed by the doctor individually.

Infants under one year of age are given a single injection of 50-100 mg. Toddlers under two years of age - 150 mg once a day. Toddlers under four years of age - 200 mg, children under six years of age - 250 mg. If a child is older than six but under ten years of age, the dosage used is 300 mg per day, teenagers under 14 years of age are given 400-500 mg per day.

Individual intolerance of the patient's body to bromides and their derivatives, severe anemia, hypotension, obvious symptoms of atherosclerotic manifestations, various renal diseases, and decompensation of the cardiovascular system may prevent the administration of the drug.

The patient also takes strychnine-based medications. The pharmacological agent is administered subcutaneously in two or three injections throughout the day: for adult patients - 0.5 - 1 mg, for small patients who are under two years old, the dosage is slightly less and ranges from 0.1 to 0.5 mg (depending on the patient's age). If necessary, the amount of the drug can be increased: one-time - up to 2 mg, during the day - no more than 5 mg (for adult patients).

Doctors consider contraindications for strychnine to include hypersensitivity to the components of the drug, bronchial asthma, thyrotoxicosis, manifestations of angina pectoris, atherosclerotic phenomena, arterial hypertension, hepatitis, a tendency to epileptic seizures, nephritis, and pregnancy in women.

Vitamin complexes based on B vitamins (especially B1) and C are essential.

Multivitamins are prescribed to small patients over four years of age, one tablet per day. The best time to take them is with food. Children under four years of age are prescribed vitamins in syrup form.

Contraindications to the use of vitamin complexes include only increased hypersensitivity to the components of the drugs.

The patient receives a maintenance dose of glucose intravenously, which is calculated as 4-6 g per kilogram of the patient's weight, which corresponds to approximately 250-450 g per day. In this case, the level of metabolism and its deviations from the norm should be taken into account.

When determining the amount of the drug, the doctor also pays attention to the permissible amount of daily fluid, which has its limitations: for babies weighing up to ten kilograms, the amount of daily fluid is calculated as 100 - 165 mg per kilogram of the little patient's body weight. If the body weight reaches forty kilograms - 45 - 100 mg per kilogram of weight.

Glucose administration to a patient is not allowed if his medical history includes diabetes mellitus, cerebral and pulmonary edema, glucose circulation failure, hyperglycemia, hyperosmolar coma, severe left ventricular dysfunction, hyperhydration, hyperlactacidemia, hyponatremia. In case of senile hearing loss or menopause, drugs developed on the basis of sex hormones give a positive result.

If the cause of the deviation in sound perception is one of the diseases, it is necessary to take measures to stop the underlying disease.

Aeron may be prescribed, which effectively relieves the symptoms of "seasickness".

Aeron is taken by the patient in the amount of one or two tablets half an hour to an hour before the expected "active movement". If necessary, the drug can be administered again - another tablet, but not earlier than six hours after the first dose.

The only contraindication for prescribing this medication may be glaucoma.

The patient takes anticholinergic and ganglionic blocking drugs. These may be pentafen, benzohexonium, diphenin, dipromonium and other chemical compounds and compositions.

Pentafen is prescribed to a specific patient in an individually selected amount, based on the clinical picture of the disease: intramuscularly or intravenously.

The patient is given a single injection of pentafen in a volume ranging from 0.5 to 2 ml. The doctor prescribes two to three such injections per day for his patient. The administration of this drug is mandatory when monitoring blood pressure indicators.

The maximum permissible volumes of the drug used are 3 ml at a time, and up to 9 ml throughout the day.

Contraindications for the administration of the pharmacological drug in question may include closed-angle glaucoma, acute myocardial infarction, individual intolerance by the patient's body to the components of the drug, including azamethonium bromide, severe phase of arterial hypertension, pheochromocytoma, renal and/or liver dysfunction, and the patient being in a state of shock.

Prevention of labyrinthopathy

Every person knows that almost any disease can be either completely prevented or at least slowed down, without bringing it to severe irreversible complications. Prevention of labyrinthopathy consists of following a number of recommendations that will help protect the body from harmful external or internal influences.

• You should stay as far away from toxic substances and volatile poisons as possible. If this cannot be avoided (for example, such contact is related to a person’s professional activity), you should protect yourself as thoroughly as possible using the necessary personal protective equipment.
• Carefully monitor the dosages of the medications taken, avoiding large doses, especially when self-treating a particular disease. Hearing loss and noise can be caused, for example, by such medications as streptomycin, salicylates, quinine.
• Avoid injury.
• Regular preventive examinations should not be ignored.
• When selecting people for work in "noisy workshops", preference should be given to people whose noise threshold is more resistant to sound injuries. This parameter is easily established on the basis of any clinic using sound loads of varying intensity.

Labyrinthopathy prognosis

The answer to this question depends on the etiology and neglect of the pathological process. If irreversible changes have already occurred in the human body and the disease continues to progress, then there is a high probability of the patient becoming completely deaf.

If the processes are reversible and the person seeks help from a qualified specialist in time, then the prognosis for labyrinthopathy is very favorable.

Only a person can protect himself from health-related problems. If the problem concerns young patients, this responsibility is primarily imposed on the child's parents or close relatives. Labyrinthopathy is a very uncomfortable, but not fatal disease. However, losing the sound connection with the outside world is unpleasant. Therefore, at the slightest feeling that the threshold of auditory perception begins to noticeably decrease, it is necessary to immediately consult a doctor - an otolaryngologist, who will conduct the necessary examination and prescribe adequate measures to relieve the problem.

[ 9 ]