Treatment of sensorineural (sensorineural) hearing loss

Indications for hospitalization

Indication for emergency hospitalization is acute sensorineural hearing loss, regardless of the etiologic factor, and in some cases, progressive NST.

Objectives of treatment of sensorineural hearing loss

With acute sensorineural hearing loss, the most important goal is the restoration of the auditory function. Achieving this goal is possible only with the beginning of treatment in the shortest possible time. With chronic impairment of the auditory function, the goal of the treatment is to stabilize the decreased auditory function. In addition, the first place for chronic sensorineural hearing loss is the social rehabilitation of people. Individual approach in the treatment of neurosensory hearing loss is very important (the state of mind, age and the presence of concomitant diseases, etc.) are taken into account.

Non-drug treatment of sensorineural hearing loss

Sensorineural hearing loss describes the effect of stimulating therapy in the form of acupuncture, electropuncture, electrostimulation of internal ear structures, endaural phono-electrophoresis of drugs capable of penetrating the hematolabyrin barrier, laser puncture (10 sessions immediately after completion of infusion therapy), and hyperbaric oxygenation.

Non-drug treatment should be aimed at rehabilitating the auditory function. Rehabilitation of the auditory function with neurosensory hearing loss is aimed at restoring social activity and the quality of life of the patient and consists of carrying out hearing and cochlear implantation.

If hearing loss is more than 40 dB, speech communication, as a rule, is difficult and a person needs correction of hearing. In other words, with hearing loss at vowel speech frequencies (500-4000 Hz) by 40 dB or more, a hearing aid is shown. In foreign practice, the patient is recommended hearing aid if the hearing loss on both sides is 30 dB or more. Willingness to wear a hearing aid is largely determined by the patient's social activity and increases with the degree of hearing loss. In children, especially the first years of life, the testimony to hearing aids has significantly expanded. It is proved that hearing loss of more than 25 dB in the range of 1000-4000 Hz leads to a disruption in the child's speech,

When carrying out a hearing aid, one should take into account the fact that sensorineural hearing loss is a complex violation of social adaptation. In addition, that there is a deterioration in the threshold of audibility in the frequency range, important for understanding speech, there is a violation of our final hearing. Despite the variety of causes of sensorineural hearing loss, in most cases external hair cells suffer. They are completely or partially destroyed in the cochlea. Without normally functioning outer hair cells, the inner hair cells begin to respond only to sound that exceeds the normal hearing threshold by 40 -60 dB. In the presence of a typical for neurosensory hearing loss in the patient, the descending audiometric curve first of all, the zone of perception of high-frequency components of speech that are important for understanding consonants is lost. Vowels suffer less in this case. The main acoustic energy of speech is located in the zone of vowels, that is, in the low-frequency range. This explains the fang that when a high-frequency hearing loss is lost, the patient does not perceive the speech more quietly. Because of the limited perception of consonants, it becomes for him "just" fuzzy, more difficult to understand. Given that there are more consonants in the Russian language than vowels, consonants are much more important for understanding the meaning of speech than vowels. The sensation of lowering the volume of speech appears only with hearing impairment and in the low frequency zone. In addition to lowering the thresholds of audibility, that is, the boundary between what is heard and what is not audible, the loss of the outer hair cells causes hearing impairment in the above-threshold hearing zone, the phenomenon of accelerating the increase in loudness, and the narrowing of the dynamic range of hearing appear. Considering that with the sensorineural hearing loss the perception of high frequency sounds is largely lost when low frequency is stored, the greatest amplification in the high frequency region is required, this requires several channels of gain adjustment in the hearing aid to create an adequate sound. The proximity of the location of the microphone and telephone in the hearing aid due to their miniature size can lead to acoustic feedback, which occurs when the amplified sound of the device re-enters the microphone. One of the problems that arises with hearing aids is the effect of "occlusion". It occurs when the body of the in-ear device or the earbud liner blocks the external auditory canal, with an excessive increase in low frequencies, which is not comfortable for the patient.

Considering all this, for a comfortable hearing aid hearing aids should:

• selectively compensate for the violation of perception of loudness and frequency of sounds;
• ensure high intelligibility and naturalness of speech perception (and silence, in a noisy environment, in a group conversation):
• automatically maintain a comfortable volume level:
• adapt to different acoustic situations:
• to ensure the absence of feedback acoustic coupling ("whistle"). Such modern requirements are best met by modern multi-channel digital devices with compression in a wide range of frequencies. In addition, recently there are digital hearing aids for open prosthetics, which, in addition, provide no "occlusion" effect.

The method of signal processing in the amplifier distinguishes between analog and digital hearing aids. In analog processing of a sound signal by means of analogue electronic amplifiers, they transform a stimulus with full preservation of the waveform. In a digital hearing aid, the incoming signals are converted to binary code and processed with a high speed in the processor.

The hearing aid can be mono-aural, when one is prosthetically inspected, as a rule, the hearing ear is better, and binaural, when both ears are tested with two hearing aids. Binaural prosthetics has the following main advantages:

• binaural hearing has a lowered volume (by 4-7 dB, which leads to the expansion of the useful dynamic range;
• the localization of the source of sound is approaching the physiological norm, which makes it much easier to focus on a certain interlocutor.

In the place of wearing, the following types of hearing aids are distinguished:

• BTE hearing aids are placed behind the ear and must be supplemented with an individually manufactured intra-ear liner. Modern BTE hearing aids have great opportunities in prosthetics, high reliability and miniaturization. Recently, miniature BTE hearing aids have appeared for open prosthetics, which allow the patient to adjust high-frequency neurosensory hearing loss comfortably.
• In-ear hearing aids are placed in the ear canal and are manufactured individually according to the shape of the patient's ear canal, the miniature of the device also depends on the degree of hearing loss. With the same capabilities as the BTE, they are less noticeable, provide greater comfort when wearing and a more natural sound. However, in-ear devices have disadvantages: they do not allow to repair greater hearing loss, more expensive to operate and maintain.
• Pocket hearing aids are becoming less and less useful and can be recommended for patients with limited fine motor skills. A large hearing loss can be compensated for by the handheld device, since a significant removal of the telephone and microphone from each other avoids the appearance of acoustic feedback.

To date, the technical capabilities of modern hearing aids allow in most cases to correct even complex forms of sensorineural hearing loss. The effectiveness of hearing answering is determined by the degree to which the individual features of the patient's hearing correspond to the technical capabilities of the hearing aid and the settings. Properly selected hearing aids can improve communication for 90% of people with hearing impairment.

Now there is a real opportunity to provide effective assistance to patients with complete loss of auditory function in cases where deafness is caused by destruction of the spiral organ with a preserved function of the auditory nerve. The rehabilitation of hearing by the method of cochlear implantation of electrodes into the cochlea for the purpose of stimulating the fibers of the auditory nerve is becoming more widespread. In addition, the system of stem cochlear implantation is actively developing at the bilateral damage of the auditory nerve (for example, in tumorous diseases of the auditory nerve). One of the important conditions for successful cochlear implantation is a strict selection of candidates for this operation. To do this, a comprehensive study of the state of the auditory function of the patient, using data subjective and objective audiometry, promontorial test. More details of cochlear implantation are discussed in the relevant section.

Patients who have neurosensory hearing loss combined with a violation of the vestibular system require rehabilitation of the vestibular function with the use of an adequate system of vestibular exercises.

Medicamentous treatment of sensorineural hearing loss

It is important to remember that the outcome of acute sensorineural hearing loss directly depends on how quickly the treatment is started. The later treatment is started, the less hope for hearing restoration.

The approach to the choice of treatment tactics should be based on an analysis of clinical, laboratory and instrumental data obtained before the start of treatment. In the process of it, also after the completion of the course of treatment activities. The treatment plan is individual for each patient, will be determined taking into account the etiology, pathogenesis and duration of the disease, the presence of concomitant pathology, intoxication and allergy in the patient. However, there are general rules that must always be observed strictly:

• conducting in the shortest possible time a multidisciplinary examination of the patient;
• the treatment of the patient with neurosensory hypoacusis in a specialized hospital;
• immediate start of treatment after diagnosis of neurosensory hearing loss;
• observance of the protective regime and sparing diet.

Taking into account the peculiarities of the disease, funds are used, the direction for restoring blood circulation, improvement of rheological parameters of blood, normalization of arterial pressure, improvement of nerve impulse conduction, normalization of microcirculation. Used desintaksikatsionnye drugs, drugs that have angio-and neuroprotective properties. According to randomized studies, when sudden hearing loss (up to 15 hours) is effective in the appointment of glucocorticoids. They are prescribed a shortened course for 6-8 days, starting with a shock dose, then gradually reducing it. In particular, there is a scheme for the use of prednisolone in a dosage of 30 mg / day with a sequential decrease to 5 mg for 8 days.

Numerous scientific researches and clinical experience prove the expediency of carrying out infusion therapy with vasoactive and detoxifying agents from the first day of hospitalization of a patient suffering from acute sensorineural hearing loss. Such drugs as vinpocetine, pentoxifylline, cerebrolysin, pyracetam, ethylmethyl hydroxypyridine succinate (mexidol), are administered parenterally (intravenously drip) for the first 14 days. Later they switch to intramuscular and oral use of drugs. In addition, venotonics and drugs stimulating neuroplasticity are used in complex treatment, in particular, ginkgo bilobate leaf extract is used at a dose of 40 mg three times a day. The drug, in addition, helps to regulate ion exchange in damaged cells, increase central blood flow and improve perfusion in the field of ischemia.

A positive effect on the state of the auditory function upon administration of drugs using the phonoelectrophoresis method (complex use of ultrasound with electrophoresis) is described. In this case, drugs that improve microcirculation and tissue metabolism can be used.

For the treatment of sensorineural hearing loss of various etiologies, accompanied by dizziness, histamine-like drugs that have a specific effect on the microcirculation of the inner ear are used successfully, in particular, beta-histine is used in a dosage of 16-24 mg three times a day. Take the drug should be during or after a meal to prevent possible adverse effects on the gastric mucosa.

It should be emphasized that even adequately selected and timely, fully performed therapy of the patient with sensorineural hearing loss does not exclude the probability of relapse of the disease under the influence of a stressful situation, exacerbation of cardiovascular pathology (eg, hypertensive crisis), acute respiratory viral infection or acoustic trauma.

With chronic progressive hearing loss it is necessary to conduct courses of drug therapy to stabilize the auditory function. The drug complex should be aimed at improving neuronal plasticity and microcirculation in the inner ear area.

Surgical treatment of sensorineural hearing loss

Recently, a number of randomized studies have been shown demonstrating improved hearing in the trans-stampal administration of glucocorticosteroids (dexamethasone) to the tympanum in patients with neurosensory hearing loss in the absence of the effect of conservative therapy. Surgical treatment of neurosensory hearing loss is required for neoplasms in the region of the posterior cranial fossa, Meniere's disease, during cochlear implantation. In addition, surgical treatment as an exception can be used with excruciating ear noise (performs a rehearsal of the tympanic plexus, removal of the stellate node, upper cervical sympathetic unit). Destructive surgery on the cochlea and pre-collar nerve is rarely performed, and only in cases of neurosensory hearing loss of the fourth degree or complete deafness.

Further management

Medicamentous treatment of sensorineural hearing loss is performed with the aim of stabilizing the hearing.

For each specific patient, the period of incapacity for work is determined by the need for conservative treatment, as well as the possibility of conducting a comprehensive survey in an outpatient setting.

Information for the patient

It should be remembered that the acquired sensorineural hearing loss is often the result of non-observance of the rules of labor protection. Reduction of the case is possible during a visit to the disco, during scuba diving and hunting. With the onset of hearing loss, early treatment in a specialized institution for adequate diagnosis and treatment is especially important. Of great importance is the observance of the protective regime and sparing diet, the refusal to smoke and the use of alcoholic beverages.