RU2143876C1 - Method for treating the cases of neurosensory hypacusia - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves introducing living human fecal tissues for stimulating sensory members of peripheral area of acoustic analyzer. EFFECT: enhanced effectiveness of treatment. 1 dwg, 1 tbl

Description

 The present invention relates to surgical otorhinolaryngology, namely to the treatment of lesions of the peripheral part of the auditory analyzer, known as sensorineural hearing loss. This disease occurs in all age groups, dominating in people of the most working age from 30 to 50, progresses with time and is considered difficult to treat.

 Among the known conservative methods of treating the disease, the most common methods are based on the etiological and symptomatic principles of therapy. It is known the use of drugs for the treatment of sensorineural hearing loss, improving microcirculation in vessels, antispasmodics (see Palchun V.T., Kunelskaya N.L., Aslamazova V.I., Polyakova T.S. et al. Acute sensorineural hearing loss, clinic, diagnostics treatment and medical examination. - Methodological recommendations. - M., 1987, - S. 21-28), as well as drugs that affect the rheological properties of blood (anticoagulant drugs); drugs that enhance metabolic and energy processes in tissues (see. Kunelskaya N. L. Clinic, diagnosis, treatment and prevention of acute sensorineural hearing loss: Dis. ... Candidate of Medical Sciences. - M., 1985, - P. 252) ; physiotherapy procedures are also used: laser therapy, electrophoresis, phonophoresis, superphonophoresis (see A. Kryukov. Development of pharmacophysical effects on the auditory receptor with sensorineural hearing loss: Dis .... Candidate of Medical Sciences. - M., 1988.).

 Of the surgical methods, cochlear implantation methods are currently used that are aimed at implanting microelectrodes into the inner ear (see Zhurn. Ear nos. And throat bol. - 1995, N 3. - P. 21-29).

 However, all of the above methods for the treatment of sensorineural hearing loss are ineffective.

 The essence of the present invention lies in the fact that an operative way is performed to open the tympanum and through the fibrous ring of the oval window of the vestibule enter drugs stimulating the sensory elements of the peripheral part of the auditory analyzer. As a drug that stimulates the sensory elements of the peripheral part of the auditory analyzer, live human fetal tissues are used, in particular, by directly introducing a suspension of fetal tissues of the cochlea of the human embryo into the cavity of the labyrinth of the inner ear.

 The invention is disclosed in the following example of its implementation in a particular patient.

 Example. Patient S., 25 years old, was admitted to the ENT clinic of the Department of Medicine of the Russian State Medical University in a planned manner after an outpatient examination with a diagnosis of Chronic sensorineural hearing loss, I degree, left. The patient complains of hearing loss in the left ear, the presence of obsessive noise in the left ear, and more recently, the head, irritability, impaired performance, poor sleep. From the anamnesis it is known that the above complaints disturb the patient for about 1.5 years. She underwent treatment and examination three times in a hospital with a temporary insignificant effect.

 The patient underwent an extended examination: an ophthalmologist, a neurologist, clinical blood tests, transcranial dopplerography, a comprehensive audiological examination. On the tonal threshold audiogram, a decrease in the bone and air conduction curve on the left, characteristic for neurosensory hearing loss, was found with a pronounced decrease in high frequencies. During audiometry in an extended frequency range (8-20000 Hz), the bone conduction curve continued to decrease with a “break” of 18 kHz. The thresholds of sensitivity to ultrasound (98000 Hz) were 4V. The consultation, consisting of the department head, department head and neurologist, recommended transplantation of human fetal tissues, to which patient consent was obtained.

 Using a microsurgical technique and a microscope, a patient under local anesthesia with novocaine 1% anesthetized the posterior wall of the auditory meatus. Retreating about 3-4 mm from the eardrum ring, an incision was made in the posterior upper part of the skin of the external auditory meatus. The soft tissues are separated and together with the flap of the tympanic membrane are retracted anteriorly. The tympanic cavity is opened. A narrow chisel brought down the bony canopy of the wall of the ear canal, the area of the vestibule window is exposed. A thin long needle produced microperforation of the foot plate of the stapes, a small amount of remyphy was released, after which the patient subjectively noted slight dizziness, increased noise in the ear. A suspension of fetal tissues containing about 1 million cells of the ear labyrinth alone was introduced into the re-lymph. Next, the meatotympanal flap was carefully laid in place, fixing cotton swabs with hydrocortisone, an aseptic ear patch were introduced.

 The patient underwent a satisfactory operation. Prescribed anti-inflammatory therapy, antihistamines, diuretics, analgesics. On the first day in the postoperative period, the patient complained of moderate headaches, a slight increase in noise in the left ear, and hearing loss. Within 4-5 days, fine spontaneous nystagmus of the first degree is observed on the right. During the first day, the temperature rose to 37.8. Against the background of the therapy, the above complaints were stopped. A daily auditory canal toilet was conducted, application of turundum with osmatol. On the 8th day, the patient's condition stabilized, her health improved, the patient, at her request, was released for outpatient monitoring.

 Within 1 year, the patient was under observation and underwent regular general clinical and audiological control. The most pronounced early positive signs in the patient were detected 3 to 4 weeks after surgery. Subjectively, the patient noted an improvement in hearing in the left ear, a decrease in the feeling of congestion, and a decrease in noise. The most noticeable patient noted a decrease in dizziness. On the tonal threshold audiogram, a decrease in the thresholds of air and bone conduction by high frequencies by 10 dB was noted, the curves of the thresholds of bone conduction in the extended frequency range decreased by 6-10 dB. Ultrasound thresholds remained virtually unchanged. Indicators of impedance audiometry and otoacoustic impedancemetry remained virtually unchanged.

 For clarity, the audiometric indicators in the extended frequency range (RHD) in the dynamics before transplantation and after 4 weeks are compared in FIG. 1, where the “x” marks the thresholds of auditory perception through air and bone, and the Δ marks the same, but after treatment.

 Thus, there was a significant improvement in hearing acuity and the subjective state of the patient.

 Biological material for transplantation was obtained from the laboratory of the Institute of Biological Medicine.

 For transplantation, organs and tissues of non-viable fetuses obtained from the health of women aged 15-40 years were used. The indications for abortion were medical and social reasons.

 For each woman whose abortion material, with her consent, it was planned to use for fetal cell therapy, a special medical record was filed, in which, in addition to passport data, the results of a survey conducted according to a special program to determine the risk of fetal infection (history of chronic viral and bacterial infections) are recorded , miscarriage or other pathology of pregnancy and childbirth). The exclusion of infection of the patient during fetal cell therapy was ensured by a standardized certification scheme for the material used for injection, including examination of the fetal material donor and the abortion material itself.

 Since no enzyme immunoassay system is 100% sensitive and can miss an infection-positive serum, each woman immediately before the abortion was examined for the presence of antibodies against human immunodeficiency virus, hepatitis C, syphilis and hepatitis B virus antigen in the blood systems. The diagnostic kits used for this are presented in the table.

 The method was implemented for the first time, it is not at all obvious to specialists of otorhinolaryngologists of both conservative and surgical directions. The novelty is distinguished by the method of transplant administration, since any intervention in the labyrinth was previously considered dangerous due to the possible progression of sensorineural hearing loss and vestibular disorders.

 Essentially, a method of treating sensorineural hearing loss gives a pronounced result due to the restoration of hair cells of the peripheral section of the human auditory analyzer, which was also not previously known.

 In principle, the method is fully ready for implementation in practice, provided that the surgeon is highly qualified and the presence of live fetal tissue.

Claims (2)

 1. A method for the treatment of sensorineural hearing loss, characterized in that the tympanic cavity is opened by surgery and drugs stimulating the sensory elements of the peripheral part of the auditory analyzer are introduced through the fibrous ring of the oval window of the vestibule.  2. The method according to claim 1, characterized in that as a drug that stimulates the sensory elements of the peripheral part of the auditory analyzer, live human fetal tissues are used.

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