RU2381007C1 - Diagnostic technique for sensorineural deafness - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: echocardiography is used in single dose without stress testing and duplex scanning of internal carotid artery with the stress testing of physical nature. It is followed with evaluating a responsiveness index (RY) calculated by determining the peak systolic blood velocity (PSV) prior to and after the stress testing as a relation of after-stress PSV to before-stress PSV. The reduced contractility of left ventricle of heart representing a decreased ejection fraction 55% and lower, and the decreased responsiveness index (RY) 1.25 st.units and lower enables to diagnose sensorineural deafness.

EFFECT: method allows for early diagnostics of depressed function of the acoustic analyser.

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Description

The invention relates to medicine, in particular to cardiology, neurology, ophthalmology, otorhinolaryngology, is used to diagnose sensorineural hearing loss in the early stages of the disease.

The urgency of the problem is that this invention will allow any doctor of a polyclinic or inpatient unit, having the results of an echocardiography study and dopplerography with a stress test of a physical nature, diagnose sensorineural hearing loss and, bypassing the ENT doctor (if absent), refer the patient to a sound doctor for determining the level of damage and a possible correction of sensorineural hearing loss.

A known method for determining vascular reactivity, in which the decrease in intravascular pressure is measured simultaneously with the registration of the pulse wave propagation time until the peripheral pulse disappears, in addition, the reactivity threshold is determined by the value of the decrease in intravascular pressure necessary to increase the pulse wave propagation time by 0.01 s, with this change in vascular reactivity is determined by the deviation of the reactivity threshold in subjects I of the maturity period from -5.99 ± 0.29 mm Hg / 0.01 s and in subjects I I maturity period from -8.05 ± 0.31 mm Hg / 0.01 s. (Patent No. 2122824, RF. Publ. 1998.12.10).

The method is intended for early diagnosis of vascular diseases without prioritizing damage to the analyzers of vision and hearing.

There is a method of detecting sensorineural hearing loss and a risk group for a disease, which consists in recording an audiogram and simultaneously conducting immunological and biochemical blood tests and biochemical analysis of urine. If the audiogram has a slightly descending air threshold curve with an increase in perception thresholds in the zone of 4000-8000 Hz from 15 dB or more and the content of substances in the blood with m.m. 300-5000 D more than 0.250 units, violation of the ratio of helpers / suppressors, and / or inhibition of leukocyte migration with phytohemagglutinin, and / or with concanavalin, and / or with brain antigen, is more or less than normal, or if at least one of the above immunological indicators and in the presence of a positive color sedimentary reaction of urine more than 50% judge the presence of sensorineural hearing loss in the patient or attribute him to the risk group for the disease (Patent No. 2084898, RF. Publ. 1997.07.20).

The method provides early detection of the disease, when there is still no clinical appearance of it, for prophylactic treatment and prevention of hearing loss, but due to the use of immunological equipment for its implementation, it is not available to ordinary multidisciplinary clinics.

A known method for the diagnosis of sensorineural hearing loss (SNT), which provides for the determination in the blood of patients of cholesterol (cholesterol), characterized in that patients also examine other indicators of the lipid spectrum of blood serum, namely, total lipids (OL), triglycerides (TG), β- lipoproteins (LPs), as well as assess the state of free radical oxidation (SRO) by chemiluminescence (CL), and with an increase in the content of cholesterol, as well as OL, TG and LP, in combination with signs of inhibition of the SRO system, accompanied by a decrease in the (S) rate of vnosti spontaneous emission (by 23% or more), consider the changes specific to the pathogenesis of the CNT, which is used as an adjunct in the diagnosis of SNT (Application №2003102399, Russian Federation. Publ. 2004.08.10).

There is a method of determining the functional state of peripheral vessels, in which an electrocardiographic study and rheography of the extremities is performed, the temporal and amplitude parameters of the rheogram are determined according to the generally accepted scheme, and the systolic ejection time K is additionally determined, the W index is calculated according to the formula given in the description text, and at W = 1.309-0.007 the functional state of the peripheral vessels is considered normal, with a change in indicators up to 15% it is defined as a violation, and a change of 15% and b Lee as a pathological condition (№ Patent 2,036,604, Russian Federation. Publ. 1995.06.09).

The method is used in functional diagnostics, but it is not intended to detect a decrease in the function of the auditory analyzer.

The objective of the present invention is the ability to detect a decrease in the function of the auditory analyzer for its early diagnosis of the severity of the violation and the appointment of adequate treatment.

The essence of the method is achieved by the fact that in the method for the diagnosis of sensorineural hearing loss, echocardiography is performed once without the use of a stress test and a duplex scan of the internal carotid artery with a stress test of a physical nature and determination of the reactivity index (RY), which is calculated by determining the peak systolic blood flow velocity (PSV) up to and after a stress test as the ratio of PSV after loading to PSV before loading, and with a decrease in the contractility of the left ventricle of the heart in the form underreporting ejection fraction lower than 55%, while reducing the reactivity index (RY) is less than 1.25 USD they diagnose sensorineural hearing loss.

A method for diagnosing sensorineural hearing loss is illustrated with detailed graphic material.

Figure 1 shows an ultrasonogram of the patient’s internal carotid artery, before a stress test, where 1 is the peak systolic blood flow velocity PSV, cm / s, 2 is the peak diastolic blood flow velocity EDV, cm / s.

Figure 2 shows an ultrasonogram of the patient's internal carotid artery, after a stress test, where 1 is the peak systolic blood flow velocity PSV, cm / s, 2 is the peak diastolic blood flow velocity EDV, cm / s.

The method is as follows.

The patient undergoes one-time one-dimensional echocardiography (M-mode), two-dimensional echocardiography (B-mode) and dopplerography in a continuous pulse mode, without the use of a load test. The study is carried out in the position of the patient lying on his back with the head end raised by 30 degrees or in the position on the left side, using standard approaches. Measure the size of the cavities of the heart by the final diastolic size (CRC, cm) and the final systolic size (CRC, cm). End-systolic volume (CSR, ml), end-diastolic volume (BWW, ml) of the left ventricle (LV), stroke volume ml (UO), ejection fraction (EF,%), degree of shortening of the anteroposterior size of the LV (% + Δ. S,%), minute volume, l / min (MO).

An adequate assessment of cerebrovascular reserves of the main hemodynamics is carried out in a patient during a stress test of a physical nature. For this, a hemodynamic indicator is recorded - the peak systolic blood flow velocity, before a stress test, which is performed by raising the legs of the legs bent at the knees up to 90 degrees. Then carry out re-registration of this hemodynamic indicator after 2 minutes and calculate the reactivity index according to the formula:

RY cu = PSV after loading / PSV before loading,

where RY is the reactivity index in cu;

PSV is the peak systolic velocity in cm / s.

A duplex scan of the extracranial part of the internal carotid artery (ICA) is performed. In this case, the ICA study is carried out by the Toshiba-270 apparatus, a 2.5 MHz convex sensor. Before him, in at least 6 hours, the patient does not receive vasoactive drugs or physiotherapeutic procedures. The first measurement of PSV - peak systolic velocity - is carried out in the position of the patient lying on his back. The sensor is placed in the cranial direction at an angle of about 60 degrees to the blood flow line in the vessel during transverse examination of the vessel and parallel to the vessel, in longitudinal examination of the vessel. ICA is located under the edge of the lower jaw. Then the patient is asked to raise the legs bent at the knees up to 90 degrees and after 2 minutes they re-register this hemodynamic indicator, after which the reactivity index is calculated by the formula:

RY cu = PSV after load / PSV before load,

where RY is the reactivity index in cu;

PSV is the peak systolic velocity in cm / s.

Upon receipt of the ejection fraction less than 55% and with RY less than 1.25 cu, the patient is diagnosed with sensorineural hearing loss - a disease of the sound-sensing apparatus.

Examples of practical use of the proposed method.

Data ejection fraction and reactivity index are presented in the studied groups in table 1.

Indicators of the ejection fraction and reactivity index (PV%, RY cu, M ± m)

Table 1 Indicator SPZN N = 110 patients BSPZN N = 98 patients PV% 49.6 ± 4.35 46.24 ± 6.86 RY cu 0.97 ± 0.04 1.23 ± 0.03

In 173 patients there were complaints of hearing loss and the ENT was diagnosed by the doctor as sensorineural hearing loss. 35 patients had no complaints of hearing loss, but were sent by an ophthalmologist to an ENT doctor with suspicion of sensorineural hearing loss, the diagnosis was confirmed, and patients were referred to a doctor by an audiologist, where this diagnosis was made.

The study by an ophthalmologist was conducted in 208 patients, of which 110 patients with vascular pathology of the optic nerve (SPZN) and 98 patients without vascular pathology of the optic nerve (BSPZN) in the period from 1996 to 2007. All patients showed a decrease in cardiac output of less than 55%, as well as a decrease in the reactivity index RY cu less than 1.25.

Example 1. K.P.L., 75 years old. Outpatient card number 73/85. On February 18, 2000, when contacting an optometrist, it was registered:

Vis - 0.5 + 1.0 Diopria (D) = 0.7 / 0.5 + 1, OD = 0.7 IOP - 18 mmHg / 18 mmHg No complaints at the time of the inspection.

The OD field of view from above is 50 degrees, from the fore side - 50 degrees, from below - 55 degrees, from the temporal side - 80 degrees.

OS on top - 50 degrees, on the bow side - 50 degrees, bottom - 55 degrees, on the temporal side - 80 degrees.

Objectively: OU - anterior camara of medium depth, dystrophic changes in the stroma of the iris. Biomicroscopic: nuclear-cortical opacities in the lens. The fundus of the eye: OU - optic nerve discs are pale pink, the borders are clear, the arteries are sclerotic, the veins are full-blooded, in the macular zone of the drusus.

Diagnosis: OU - initial age-related cataract, retinal vascular sclerosis. Central involutional chorioretinal retinal dystrophy. The patient was referred to a therapist. According to the ECG results, a consultation with a cardiologist is recommended. Echo-KG was done, which showed PV = 45.45%; MO-3.6 l / min; UO-48.5 ml; SI-3.6 l / min / m ² ; UI-48.5 ml / l ² . Conclusion: decreased contractility of the left ventricle, diastolic dysfunction of the left ventricle.

Doppler results:

Right side Left-hand side To load after loading to load after loading ICA 0.34-0.18 0.42-0.19 0.31-0.13 0.34-0.12 After the study, we calculate the indices: RY cu RY cu PSV cm / s PSV cm / s ICA 1.1 1,1

A consultation with an ENT doctor was recommended for the patient, although the patient did not actively complain of hearing loss.

The patient was examined by an ENT doctor for a diagnosis of bilateral sensorineural hearing loss.

In this patient, PV is 45.45%; RY - 1.1 cu, on both sides, which is less than the norm on both sides. Based on the study, a decrease in the functions of the auditory and visual analyzer was diagnosed on both sides.

Example 2. V.A.Y., 75 years old. Outpatient card number 479/95.

August 9, 01, Complaints of a sharp decrease in vision in the left eye, hearing loss on the left. Objectively: OU-1,0 / arm movement. Front segment without feature. Biomicroscopic: both eyes are focal changes in the lens. Fundus: Right eye (OD) - DZN - pale pink, clear borders. The left eye (OS) -DZN-pale, fuzzy borders, retinal edema in the posterior pole.

Diagnosis: ischemic opticopathy OS.

The patient was examined by a neurologist - diagnosis: atherosclerotic encephalopathy discirculatory stage II, amniostatic syndrome.

Examined by a cardiologist: according to Echo-KG: PV = 45%; MO - 3.6 l / min; UO - 48.5 ml; SI - 3.6 l / min / m ² ; UI-48.35 ml / l ² . Conclusion: decreased contractility of the left ventricle, diastolic dysfunction of the left ventricle.

Doppler results:

Right side Left-hand side To load after loading to load after loading ICA 0.36-0.10 0.42-0.12 0.27-0.06 0.25-0.05 After the study, we calculate the indices: RY cu RY cu PSV cm / s PSV cm / s ICA 1.2 0.9

The patient was referred to an ENT doctor and diagnosed with sensorineural hearing loss on the left. The diagnosis was examined by an audiologist: sensorineural hearing loss on both sides.

This patient has PV - 45%; RY - 1.2 cu, on the right side, RY - 0.9 cu, on the left side, which is less than the norm on both sides; A decrease in the auditory and visual analyzer was diagnosed on both sides, although the patient complained only of hearing loss on the left side.

Using these examples of these patients, the relationship between the decrease in PV and the decrease in RY for the pathology of the visual and auditory analyzer is clearly visible.

The proposed method allows any doctor of a polyclinic or inpatient unit, having the results of an echocardiography study and dopplerography with a stress test of a physical nature, diagnose sensorineural hearing loss and, bypassing a doctor’s ENT (if absent), send the patient to a doctor by an audiologist to determine the level of lesion and possible correction this pathology. This method is cost-effective and 100% allows you to diagnose sensorineural hearing loss already in the early stages of this disease, which allows for an adequate correction of this pathology.

The proposed method is used in the Tyumen Medical Academy, GU "Kurgan Regional Hospital for War Veterans", GLPU Regional Ophthalmologic Dispensary of Tyumen.

Claims (1)

A method for diagnosing sensorineural hearing loss, characterized in that an echocardiography is performed once without the use of a stress test and a duplex scan of the internal carotid artery with a physical stress test and determination of the reactivity index (RY), which is calculated by determining the peak systolic blood flow velocity (PSV) before and after stress test as the ratio of PSV after loading to PSV before loading, and with a decrease in contractility of the left ventricle of the heart, in the form of a decrease in fra tion discharge below 55%, while reducing the reactivity index (RY) is less than 1.25 USD they diagnose sensorineural hearing loss.

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