RU2232014C1 - Method for treating sensoneural impaired hearing - Google Patents

Abstract

FIELD: medicine, otorhinolaryngology.

SUBSTANCE: one should inject intravenously perfluorane at the quantity of 2.5-3.0 g/kg patient's body weight. Injection of perfluorane is combined with inhalation of 40-45%-air-oxygen mixture for 10 min before perfluorane injection and repeatedly for 10 min afterwards. The method enables to shorten therapy terms.

EFFECT: higher efficiency of therapy.

1 dwg, 1 ex, 1 tbl

Description

The present invention relates to medicine and will find application in otorhinolaryngological practice for the treatment of patients with sensorineural hearing loss (CHT).

Despite the successes achieved at the present stage of development of medicine, the number of people with hearing impairments remains significant, primarily due to SNT, the treatment of which until now remains one of the urgent problems of otorhinolaryngology. It is known that the number of patients suffering from SNT is constantly increasing. Methods aimed at restoring and improving hearing often turn out to be ineffective. Untimely and inadequate care for patients with a sudden form of SNT leads to irreversible changes in the inner ear.

The defeat of sound-absorbing structures is accompanied by hearing loss, tinnitus, which creates difficulties for patients in communicating with others, their social adaptation is impaired, and the quality of life is reduced.

The condition of the cochlea and cochleovestibular nerve largely depends on the blood circulation of the inner ear and the oxygen content in arterial blood.

The anatomical and physiological characteristics of the circulatory system of the inner ear and brain are determined by a number of points:

- the internal auditory artery (a.auditiva interna or a.labyrinthi) is the only artery that supplies blood to the inner ear; it comes from the vertebrobasilar system, which provides blood supply to the posterior third of the brain;

- the internal auditory artery refers to the terminal arteries, that is, it does not have anastomoses;

- the inner ear is distinguished by the presence in the spiral organ of the vascular strip - a special formation that performs a trophic function in relation to the receptors of the auditory analyzer;

- the absence of anastomoses between the vessels of the middle and inner ears;

- segmentation of the microvasculature of the inner ear (isolation of blood supply to individual sections and elements of the cochlea).

There are reports in the literature that various etiological factors cause vascular changes that lead to hearing loss by the type of impaired sound perception (A.I. Kryukov et al. Features of cerebral hemodynamics in angiogenic cochleovestibulopathies and lipid distress syndrome (message 1 - ultrasound diagnostics) // Vestn., otorinolar. - 2003. - No. 1. - S.12-16).

Studies of cerebral blood circulation revealed that disorders of the main and peripheral circulation of the inner ear are typical in the pathogenesis of acute CHT, regardless of the etiology of the process. Analysis of cerebral hemodynamics in patients with impaired sound perception, according to rheoencephalography, shows that the vascular component of varying severity occupies an important place in the pathogenesis of SNT of various etiologies, being the cause, effect or background of the disease. The spastic state of the vessels, their compression, embolism, thrombosis, hemorrhage, fluctuations in blood pressure and other disorders cause the most unfavorable condition for auditory receptors - hypoxia. Hypoxia and metabolic acidosis are the most important components of the pathogenesis of lesions of the inner ear. A metabolic disorder initially leads to loss of function, and then to the death of hair cells (Linkov V.I. Experimental study of metabolic and functional disorders in the cochlea // Clinical, diagnostic and anatomical and physiological aspects of the peripheral part of the auditory system. Collection of works - SPB. - 1991. - S. 71-79).

Knowledge of the anatomical and physiological features and the indicated aspects of the pathogenesis of SNT determines the possibilities of pathogenetic effects in this pathology.

In the early stages of lesion, the neuroepithelium may be in a state of depression, and the changes are functional in nature. It is at this stage, manifested by vascular spasm, capillary stasis and swelling of the nuclei of the hair cells, that the use of therapy aimed at improving microcirculation and, consequently, at increasing oxygen delivery to the neuroepithelium of the spiral organ is especially effective (Palchun V.T., Petukhova N.A. Hearing changes in quantum hemotherapy of patients with sensorineural hearing loss // West. Otorhinolar. - 2001. - No. 5. - S. 16-19).

Treatment for SNT is a complex problem. Traditional methods using complex drug therapy, which includes a large number of components, often multidirectional, often prove to be ineffective due to the inability to act on the links of pathogenesis. The search for methods of treatment with the least drug load on the patient’s body and, at the same time, with exposure to the main links of the pathogenesis of SNT is relevant.

Conducted research on the medical-scientific and patent literature identified various methods of treatment of SNT.

The well-known “Method for the treatment of sensorineural hearing loss” proposed by N. Atamanova and I. G. Samoilova (RF patent No. 2108793, BI No. 11, 1998), which consists in the administration of the drug ceruloplasmin after preliminary determination of the content of ceruloplasmin protein and substances with molecular weight of 300-5000 Yes, with a ceruloplasmin content of not more than 65 mg% and an increase in the content of substances with a molecular weight of 300-5000 Yes more than 0.25 units. ceruloplasmin is administered intravenously in an amount of 1.5 mg / kg daily for 5-7 days. The disadvantages of the method are the limitation of the use of the method due to the need for a special examination to determine the indications for the administration of ceruloplasmin, the duration of the course of treatment (5-7 days), a high degree of likelihood of complications for the administration of ceruloplasmin - a blood plasma protein (MD Mashkovsky. Medicines ., vol. II.- 1993. - S. 182), such as urticaria, fever, etc.

The known method described in the article A.A. Gorlina et al. (Hyperbaric oxygenation in the complex treatment of sensorineural hearing loss of vascular origin // Bulletin of otorhinolaryngology. - No. 5. - 1980. - P. 12-14), consisting of complex drug therapy, including the use of vasodilating, antispasmodic drugs, B vitamins, drugs that improve blood supply and metabolic processes of the brain, in combination with hyperbaric oxygenation. The disadvantages of the method are the complexity of the method, which requires the use of special equipment, a number of contraindications that limit the use of the method for hypertension, diseases of the nose and paranasal sinuses, claustrophobia, etc., a long course of treatment is 10-15 sessions.

V.T. Palchun et al. They suggested using the surgical “Method for the treatment of sensorineural hearing loss”, performed by opening the tympanic cavity and introducing medications stimulating the sensory elements of the peripheral section of the auditory analyzer through the fibrous ring of the oval window (RF patent No. 2143876, BI. No. 1. - 2000). The disadvantages of the method are the invasiveness of the intervention, the complexity of the surgical procedure, the risk of post-manipulation complications.

The closest in essence and taken as a prototype is the method proposed by S.O. Shemyakin (The use of plasmapheresis in the treatment of sensorineural hearing loss: Ph.D. dissertation - St. Petersburg. - 2000. - 21 p.), Which carried out by intravenous administration of the active substance, where the patient’s own blood acts as an active substance, processed by plasmapheresis in combination with laser irradiation. The technique is based on the principle of siphon blood sampling and passing it when returning through a membrane plasma filter. During the plasmapheresis procedure, one of the peripheral veins is cannulated to connect to the patient; a 4-5% solution of sodium citrate or systemic heparinization at a dose of up to 150 units / kg body weight is used as an anticoagulant. The total volume of plasmoexfusion is not more than 30% of the volume of circulating blood. Irradiation of blood is carried out during its passage through the system of highways with a helium-neon laser with a wavelength of 0.63-0.64 microns. The course of treatment consists of 2-5 sessions for 2-3 hours, carried out after 1-2 days. The average improvement in hearing thresholds, according to the author, is 11-16 dB - in 57% of patients.

The disadvantages of the prototype include:

1) the complexity of the method, carried out in several stages, using special equipment requiring training of personnel;

2) long stay in a hospital;

3) the risk of complications (infection, hypovolemia, thromboembolism when taking about 1/3 of the blood volume in a person and passing it through a filter);

4) lack of effectiveness of the method.

The aim of the invention is to simplify the method, reduce treatment time, prevent complications, the pathogenetic effect of SNT and increase the effectiveness of treatment of patients.

This goal is achieved by intravenous administration of perftoran - a blood substitute with gas transport function (JSC NPF “Perftoran”, Pushchino), which has rheological, diuretic, membrane stabilizing and sorption properties, combined with inhalation of an air-oxygen mixture containing 40-45% oxygen, within 10 minutes before the infusion and 10 minutes after it.

Perftoran is a 10% submicron emulsion based on organofluorine compounds with the function of oxygen transfer and has a multifunctional effect: it increases the oxygen transport function of the blood, improves metabolism and gas exchange at the tissue level, improves blood rheological properties and microcirculation, has a membrane stabilizing effect, cardio and neuroprotective effect, exhibits decongestant effect, has sorption and diuretic properties. The introduction of a blood substitute - perftoran implies the mandatory conduct of a biological test, according to the instructions (Instructions for use of perftoran; registration certificate No. 96/50/10; approved by the Pharmacological Committee 06/24/1999).

Considering the peculiarities of the pathogenesis of SNT, the possibility, through a submicron emulsion - perfluorane, of delivering oxygen to zones inaccessible to red blood cells through spasmodic and narrowed vessels, is promising. Intravenous administration of perftoran helps to reduce hypoxia of the hair cells of the inner ear, restores microcirculation in the vascular strip, improves the rheological properties of blood, and the inhalation of an oxygen-enriched air mixture improves oxygen saturation of the auditory tissue, enhancing the effect of perftoran. In addition, the proposed effect normalizes the redox processes that affect the functioning of the inner ear. In the SNT clinic, these changes are manifested in improved hearing.

The proposed method of treatment is as follows.

An emulsion of perftoran is administered dropwise to a patient with SNT at a rate of 2.5-3.0 ml per kilogram of weight for 1-1.5 hours, on average 100-200 ml of the drug, in combination with inhalation of an air-oxygen mixture for 10 minutes before infusion and 10 minutes after it. The oxygen concentration in the mixture at a flow rate of 5-6 l / min, controlled through a dosimeter, is 40-45%, according to the recommendations of A.V. Blinova, V.Yu. Vasiliev (Oxygen therapy // Anesthesiology and intensive care / Edited by OA Dolina. - 1998. - S. 52).

In the clinic of ENT diseases of the Russian State Medical University, 7 patients with acute SNT were treated according to the described technique.

Patients with SNT underwent a comprehensive examination before and after treatment, including acumetry, tonal threshold audiometry, registration of short-latency auditory evoked potentials (CVEP), a biochemical blood test that allowed us to evaluate the total oxidative activity (OAA), the indicators of which were the content in the blood of patients with malondialdehyde and diene conjugates, and total antioxidant activity (OAA), the indicators of which were the content of catalase and superoxide dismutase.

After treatment, in 6 patients (87%) there was an improvement in hearing of varying degrees, and in all 7 patients there was a decrease or disappearance of subjective tinnitus. The results of tonal threshold audiometry indicated a decrease in sound perception thresholds by 26 ± 3.75 dB in comparison with the initial ones (before applying the method); objective audiometry data confirmed a decrease in auditory perception thresholds by a change in the detection threshold of the V wave and a change in latency of the peaks of the VSWR waves. When analyzing the data of biochemical studies, a change was found in indicators indicating the activity of free radical processes and a high level of antioxidant protection. This confirmed that the proposed mechanism of action of treatment enhances the saturation of the cochlear tissue with oxygen, improves blood circulation to the inner ear and the penetration of microparticles of perftoran emulsion into hard-to-reach parts of the auditory tract, as well as optimization of oxidation-reduction processes in the patient’s body with SNT.

An example of the implementation of the method is an extract from the medical history No. 31700/1657 of patient S., 30 years old, who was undergoing treatment at the ENT clinic of the Russian State Medical University with a diagnosis of left-sided sensorineural hearing loss of vascular origin. About 3 weeks ago after a stressful situation, the patient suddenly lost hearing in his left ear, subjective noise appeared in it. Only after 3 weeks he sought medical help, and was immediately hospitalized in the ENT clinic for acute sensorineural hearing loss, presumably of vascular origin. The examination confirmed the presence of SNT against the background of neurocirculatory dystonia according to the hypotonic type. The traditional treatment prescribed by the doctor on duty in the admission department - trental, piracetam, hemodesis, electrophoresis with potassium iodide endowally, lasting 8 days, was ineffective - the hearing remained unchanged. In this regard, the patient was treated, which consists in using the proposed method. Within 10 minutes, through the nasal catheter, the patient was inhaled with a 40% air-oxygen mixture, then a biological test for perfluorane was performed. After slow intravenous administration of the first 5 drops of perftoran, the transfusion was stopped for 3 minutes, another 30 drops were introduced and the transfusion was stopped again for 3 minutes, since there was no reaction, the introduction of 200 ml of perftoran was continued, after which the 40% air-oxygen mixture was again inhaled into for 10 minutes. The patient was examined on the day of admission to the hospital, after traditional treatment and a day after treatment with perfluorane. An audiometric study before treatment revealed: on the right, auditory function is normal, on the left, practical deafness: sp. - 0 m, river - 0 m (with disguise). With tonal threshold audiometry (see drawing), a significant decrease in hearing in the left ear is determined by the type of impaired sound, auditory thresholds in the air are increased to 70-100 dB at frequencies of 250-1000 Hz, there is no perception of frequencies 2000-8000 Hz, which corresponds to 4 degrees hearing loss; according to KSVP - the detection threshold on the right is 30 dB (normal), on the left - at a sound intensity of 110 dB, the V wave is not identified. After a course of traditional therapy - auditory function - without dynamics. After treatment with the proposed method using perftoran in combination with inhalation of a 40% air-oxygen mixture, the auditory function in the left ear improved significantly, noise in the ear disappeared, and perception of sounds in the left ear appeared: sp. - 0.2 m, river - 2.5 m (with disguise); on the audiogram (see drawing) there is a decrease in hearing thresholds in air and bone sound conduction, corresponding to 2-3 degrees of hearing loss. When comparing the obtained tonal threshold audiometry data before and after applying the proposed method of treatment, there was a positive dynamics: a decrease in hearing thresholds by 40-50 dB at frequencies of 125-1000 Hz, the appearance of sound perception at frequencies of 2000-6000 Hz through air and bone.

The attached audiogram of patient C. (see drawing) shows curves of hearing thresholds for air and bone conduction before (1) and after (2) treatment.

The results of biochemical studies before and after treatment are presented in the table.

Changes in the biochemical parameters of blood of patients after treatment by the proposed method can be regarded as inhibition of OOA (a 2-fold decrease in DC with MDA stability) and activation of OAA (a 2-fold increase in SOD with relative stability K), which confirms the antioxidant activity of the therapy, which was a favorable moment for Improving the function of the auditory analyzer.

Thus, as a result of the treatment of sensorineural hearing loss by applying the proposed method, subjective ear noise disappeared in patient C., the auditory function significantly improved.

Compared with the prototype, the proposed method has the following advantages:

1) ease of implementation;

2) reduction of treatment time - high efficiency achieved by a single application of the method;

3) method safety - prevention of complications;

4) high efficiency of the method - 87%;

5) the possibility of pathogenetic effects in SNT, due to the ability of penetration of a submicron emulsion of perftoran and oxygen transfer to areas of the hypoxia of the auditory system that are difficult for red blood cells to have.

Claims (1)

A method of treating sensorineural hearing loss by intravenous administration of the active substance, characterized in that the administration of perfluorane is carried out in an amount of 2.5-3.0 ml per 1 kg of the patient’s weight in combination with inhalation of a 40-45% air-oxygen mixture supplied in within 10 minutes before the introduction of perftoran and again within 10 minutes after it.