RU2675196C1 - Method for determining form of hearing loss in patients with bilateral change of hearing - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to otolaryngology, and can be used in determining the form of hearing loss in patients with bilateral hearing changes. For this purpose, determine the bone (BC) and air conduction (AC), as well as bone-air interval (BAI) by audiological examination of each ear. In addition, a threshold of audibility of an ultrasound (US) signal common to both ears is determined, for which an ultrasonic emitter is placed on the patient's forehead along the sagittal line of the head at the border of hair growth with preliminary application of vaseline oil on the skin surface. US signal is applied at a frequency of 100 kHz and the threshold of hearing of ultrasonic signals and lateralization of the US signal at the threshold of hearing of US signals are determined, and at a louder sound – by 5–7 dB more than the threshold of hearing of US (suprathreshold lateralization), better hearing ear is determined. Next, masking a better hearing ear with narrow-band noise +40 dB is performed over air conduction (AC) of better hearing ear, and the thresholds of AC, bone conduction (BC) and BAI is re-determined for a worse hearing ear. With a combination of lateralization of audible sounds and US in the direction of a worse hearing ear, there is no difference in BC thresholds on a worse hearing ear before and after masking a better hearing ear, maintaining the same BAI on a worse hearing ear before and after masking a better hearing ear diagnose conductive hearing loss on a worse hearing ear. With a combination of lateralization of audible sounds in the direction of a worse hearing ear, the lack of lateralization of the threshold and above-threshold US or the presence of lateralization of US towards a better hearing ear, increased BC thresholds of worse hearing ear and decreased BAI thereof after masking a better hearing ear reveal the presence of a hidden cochlear component in the worse hearing ear and, accordingly, diagnose mixed hearing loss on it.EFFECT: method provides the most accurate determination of the form of hearing loss in patients with a bilateral hearing change due to a specific hearing test complex, which allows confirming or disproving the presence of a latent cochlear component.1 cl, 3 ex

Description

The invention relates to medicine, namely to otorhinolaryngology.

If the sound signal transmission to the perceiving structures of the inner ear is disturbed for various reasons, patients experience conductive hearing loss, which is manifested on the audiogram by the presence of high sound thresholds measured through the air (air conduction - VP) through headphones (impaired sound conduction) at normal bone thresholds (CP ) characterizing the parameters of its perception. In such conditions, a more or less pronounced bone-air interval (CVI) occurs on the tonal threshold audiometry (TPA) graph.

In the case of bilateral conductive lesion, tuning tests on both ears reveal negative Rinne and Lewis-Federichi experiments (the predominance of bone conduction over the air over the duration of sounding), and Weber's tuning fork and audiometric experiments demonstrate the absence of lateralization (directional in any direction) of sound with equal hearing loss in both ears or lateralization of sound into a worse hearing ear with asymmetric bilateral conductive hearing loss [1-4].

Ultrasound at the threshold (minimum) value with such hearing loss is directed towards the worse hearing ear (heard in the worse hearing ear), its thresholds do not differ from normal ones [5].

However, if the EP is studied for each ear through an earphone in isolation, then when conducting a CP study, sound propagating through the bones of the skull is perceived simultaneously by both ears [6]. In addition, masking better than the hearing ear is recommended for use with a hearing difference in the EP of 35-40 dB [4]. Under such conditions, in connection with the so-called phenomenon of eavesdropping, thresholds of CP in both ears may turn out to be equal or slightly different, especially with a smaller difference in hearing in the EP. The CVI on the hearing ear that is worse hearing can turn out to be falsely enlarged, which disorientates the otosurgeons relative to the actual CVI, or otherwise, the snail reserve, for hearing enhancement.

To identify the hidden sensorineural (cochlear) component with bilateral “conductive” hearing loss, as well as to clarify the actual CVI required to calculate the estimated hearing gain after hearing-improving surgery, we offer our research method.

The prototype can be a method for determining the form of hearing loss using ultrasound (ultrasound), presented in the work of B.M. Sagalovich, K.P. Prychalova [5], in which the lateralization of the threshold ultrasound occurs in the hearing ear worse with conductive, in the better hearing - with sensorineural hearing loss, and the ultrasound does not lateralize with normal hearing in both ears and symmetrical bilateral hearing change. However, this technique does not take into account that lateralization of both ordinary sound and ultrasound can change with an increase in the volume of the presented signal, which is associated with the reaction of the sensor system in the cochlear area, which is characterized by the presence of the phenomenon of accelerated increase in volume (FUNG) [7, 8, 9].

Achievable technical result is an increase in the accuracy of determining the form of hearing loss in patients with bilateral hearing loss, through the use of a set of methods for examining patients’ hearing, which together confirm or deny the presence of a hidden cochlear component of hearing loss in a patient, which can affect the prospects for hearing improvement in the postoperative period.

The technical result is achieved due to the following set of essential features:

- determine bone (CP) and air conduction (VP), bone-air interval (CVI) by audiological examination of each ear,

- additionally determine the common threshold for audibility of the ultrasound (UZV) signal for both ears, for which an ultrasonic emitter is installed on the patient’s forehead along the sagittal line of the head at the hair growth border with preliminary application of petroleum jelly on the skin surface,

- provide an ultrasonic signal with a frequency of 100 kHz and determine the hearing threshold of the ultrasonic ultrasound and the lateralization of the ultrasonic signal at the hearing threshold of the ultrasound and with a louder sound - 5-7 dB more than the hearing threshold of the ultrasound (suprathreshold lateralization), determining as a result of all studies better hearing an ear,

- then they mask better than the hearing ear with a narrowband noise of + 40dB above air conduction (VP) better than the hearing ear and re-determine the thresholds of VP, bone conduction (CP) and CVI for the worse hearing ear;

- when combined:

- lateralization of audible sounds and ultrasound in the direction worse than the hearing ear,

- the absence of differences in thresholds of CP on the worse hearing ear before and after masking better than the hearing ear,

- maintaining the same CVI on the worse hearing ear before and after disguising a better hearing ear,

diagnosed with conductive hearing loss in the hearing ear worse;

- when combined:

- lateralization of audible sounds in the direction worse than the hearing ear,

- the absence of lateralization of the threshold and suprathous ultrasound, or the presence of lateralization of the ultrasound in the direction of a better hearing ear,

- an increase in CP thresholds worse than the hearing ear and a decrease in its CVI after masking a better hearing ear,

detect the presence of a hidden cochlear component on the hearing ear that is worse, and, accordingly, they diagnose mixed hearing loss on it.

The method is as follows:

1. Conduct an audiological examination.

This examination includes tuning fork tests (Rinne, Lewis-Federichi, Weber experiments), tonal threshold audiometry with Weber audiometric experience.

Carrying out an audiological examination allows you to determine if the patient has a bilateral "conductive disorder". This violation is usually characterized by the negative results of the Rinne and Lewis-Federici experiments, the presence of a more or less pronounced CVI in both ears, the lateralization of sound in Weber's tuning fork and audiometric experiments mainly in the hearing impaired or in the center, with equal hearing loss in both ears.

2. Conduct a study of the threshold of perception and lateralization of the threshold and suprathreshold ultrasound.

First, the hearing threshold of the ultrasonic signal is determined. For this, an ultrasonic emitter is installed on the patient's forehead along the sagittal (middle) line of the head at the border of hair growth. For a tighter contact with the surface, a small amount of liquid paraffin is preliminarily applied to it,

Using the emitter, an ultrasonic signal with a frequency of 100 kHz is supplied (for example, “Ehotest-02”, Hyperion, RF). The ultrasound threshold of the ultrasound is determined, which usually does not differ from normal (normally up to 15 dB), and then the signal is lateralized at the threshold of audibility and louder sound (plus 5-7 dB above the threshold). By the totality of the results of all studies, a better hearing ear is determined.

3. Mask the best hearing ear with a narrow-band noise of + 40dB above the VP better than the hearing ear [10] and determine the thresholds of the VP, CP and CVI on the worse hearing ear.

4. Determine the form of hearing loss with bilateral hearing loss.

4.1. If all the parameters obtained during the audiological examination and the study of the threshold of perception and lateralization of the threshold and above-threshold ultrasound ultrasound do not differ from the characteristic ones: the presence of CVI, the lateralization of audible sounds and ultrasound in the direction worse than the hearing ear, and after masking better than the hearing ear, CP thresholds (bone conduction thresholds ) on the worse hearing ear do not differ from thresholds of CP before disguise and CVI on it remains the same, then conductive hearing loss on this ear is diagnosed as well as better hearing.

4.2. If the results of an audiological examination demonstrate the presence of CVI, the lateralization of audible sounds in Weber’s tuning forks and audiological experiments is predominantly worse than the hearing ear, and the results of a study of the threshold for perception and lateralization of a threshold and suprathreshold ultrasound scan reveal either a lack of lateralization or lateralization towards a better hearing ear, and after masking, the threshold values of CP increase and CVI decreases, then determine the presence of a hidden cochlear component on the hearing ear that is worse, and, accordingly, mixed hearing loss is diagnosed on it.

The method was applied in 3900 patients with various diseases of the middle ear examined in the GBUZ NIKIO them. L.I. Sverzhevsky DZM for the period 2013-2017

Example 1. Patient C, 46 years old. Diagnosis: Otosclerosis.

Complained of bilateral hearing loss, more on the left ear.

Fork tests showed negative results in both ears (CP> CAP) with lateralization in Weber’s experience in the worse hearing left ear. With TPA in the right ear, the EP thresholds at frequencies of 125-8000 Hz were 30, 30, 30, 35, 45, 50, 40 dB and KP - 10, 10, 10, 15, 15, 10, 15 dB, respectively. The CVI in the area of speech frequencies (RFL) from 500 to 4000 Hz was 27.5 dB. Auditory thresholds for the EP in the left (worse hearing) ear for the same frequencies were 45, 45, 40, 50, 55, 60, 60 dB, for the CP - 5, 0, 0, 5, 10, 10, 15 dB, respectively . CVI in the area of speech (500-4000 Hz) frequencies was 45 dB. The difference in auditory thresholds between the ears in the EP in the ROC is 17.5 dB. Sound in Weber’s audiometric experience was lateralized mainly towards the worse left ear.

When the intensity of the ultrasonic signal with a frequency of 100 kHz equal to 13 dB, the patient perceived it in the left ear (lateralization in the worst ear). With an increase in the ultrasound intensity to 20 dB, its lateralization did not change.

After masking, it is better to hear the right ear, according to the generally accepted technique, the thresholds for KP and VP of the left ear have not changed and amounted to - 50, 50, 45, 55, 55, 60, 55 dB and, 5, 5, 5, 5, 5, 10, 15, 20 dB, respectively, and KVI - 45 dB.

Thus, after masking, the specified thresholds for CP did not deteriorate, CVI remained the same, which indicates the patient has conductive hearing loss on the left ear.

The patient underwent surgery on the left ear-stapedoplasty auto-cartilage on a vein with a good functional result. 3 months after the operation, the auditory thresholds for EP on the operated left ear were 10, 10, 5, 10, 10, 15, 30 dB and for CP, respectively, 5, 5, 5, 5, 5, 5, 10, 20 dB. KVI - 3.8 dB. KVI is fully implemented. Hearing improved by 41.2 dB, and on the right, not operated ear remained the same.

Example 2. Patient A., 48 years old. Diagnosis: Bilateral chronic otitis media.

Concerned about hearing loss in both ears, approximately equally.

According to the tuning fork examination, the patient revealed negative samples of Rinne and Lewis-Federichi on both sides (CP> VP). Sound lateralization in Weber's experiment was absent (in the center). With TPA, the auditory thresholds in the right ear in the ROC with VC were 45, 40, 30, 25, 40, 45, 50 dB, and CP - 10, 5, 5, 5, 10, 5, 15 dB, respectively. CVI amounted to 28.8 dB in the area of speech frequencies. In the left ear, the EP thresholds were 50, 50, 35, 25, 40, 45, 55 dB, and the CP thresholds were 10, 5, 0, 5, 5, 5, 10 dB in the same frequency range. CVI on the left ear in the ROC - 32.5 dB. The lateralization of sound in Weber's audiometric experience was also centered. The difference in auditory thresholds between the ears in the EP in the ROC is 5 dB.

When the intensity of the ultrasound with a frequency of 100 kHz, equal to 13 dB, the patient perceived it in the right ear. With an increase in the intensity of the ultrasound to 20 dB, the patient was also perceived by the patient on the right.

Thus, the right ear was the best.

When masking the right ear in the left ear, the thresholds along the EP in the zone of speech frequencies were 55, 50, 40, 35, 45, 50, 60 dB, according to the CP - 20, 15, 15, 15, 35, 35, 40 dB, respectively. CVI was 17.5 dB.

Refined thresholds for KP, thus, turned out to be higher than the original, and the CVI is less than before masking. The patient has mixed hearing loss on her left ear.

The patient was operated on on her left ear, she underwent surgery tympanoplasty, with a good functional result. Thresholds for EP on the left ear 3 months after surgery were 30, 25, 25, 20, 35, 50, 60 dB, and for CP - 25, 20, 20, 15, 15, 35, 45 dB. KVI, respectively, 11.3 dB, almost completely implemented. Hearing improved by 6.2 dB. On the right, not operated ear remained the same.

Example 3. Patient 3., 21 years old. Diagnosis: Otosclerosis.

The patient complained of hearing loss, more pronounced in the left ear.

During a tuning fork study, negative experiments of Rinne and Lewis-Federichi (CP> VP) with lateralization of sound in Weber's experiment in the left, worse hearing ear were obtained. With TPA in the right ear, the auditory thresholds for EP at frequencies of 125-8000 Hz were 45, 45, 35, 35, 30, 20, 15 dB and for CP - 15, 5, 5, 15, 15, 15, 15, 15 dB, respectively . CVI was 17.5 dB. The auditory thresholds in the left (worse hearing) ear for the same frequencies in the EP were 65, 60, 60, 55, 50, 40, 40 dB, and in the CP - 10, 0, 0, 10, 15, 15, 20 dB, respectively. The CVI in the area of speech frequencies on this ear was 41.3 dB. The difference in auditory thresholds in the EP in the RCS is 20 dB. The lateralization of sound in Weber's audiometric experience was in the worse hearing (left) ear.

When the intensity of the ultrasound signal with a frequency of 100 kHz equal to the threshold value of 9 dB, the patient perceived it in the right ear (lateralization in the better hearing ear). With an increase in intensity of up to 16 dB, the ultrasound also lateralized in the right, better hearing ear.

After masking the right ear in the worse hearing, left, and ear, the thresholds for EP were 70, 65, 65, 55, 55, 55, 50 dB, and for CP - 25, 15, 20, 25, 35, 30, 35 dB, respectively. KVI became 30 dB. The thresholds for KP in this way also turned out to be higher than the initial ones, and the KVI was less than before disguise. The patient’s left ear has a mixed form of hearing loss.

The patient was operated on on her left ear, she underwent stapedoplasty with a prosthesis on a vein with good hearing gain. 3 months after the operation, hearing thresholds for EP on the left ear in the same range were 25, 20, 25, 30, 35, 40, 45, and for CP, respectively, 25, 15, 20, 20, 30, 30, 35 dB . CVI in the postoperative period became 7.5 dB. Hearing, respectively, improved on the left ear by 22.5 dB. KVI is implemented almost completely.

In all the cases presented, the difference in the thresholds for the EP between the ears in the speech zone was less than 35-40 dB, which, according to modern concepts, does not imply the use of muffling (masking) better than the hearing ear. However, the absence of camouflage in such cases can lead to errors in calculating the CVI - the size of possible hearing enhancement after surgery, and the use of the presented methodology for examining patients will allow them to be avoided.

Literature

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Claims (1)

A method for determining the form of hearing loss in a bilateral hearing change in a patient, including determining bone (CP) and air conduction (VP), bone-air interval (CVI) by audiological examination of each ear, characterized in that it further determines the ultrasound hearing threshold common to both ears (UZV) signal, for which an ultrasonic emitter is installed on the patient’s forehead along the sagittal line of the head at the hairline with preliminary application of liquid paraffin on the skin surface, feed U SV signal with a frequency of 100 kHz and determine the threshold of hearing of the ultrasound and the ultrasound of the signal at the threshold of hearing of the ultrasound, and with a louder sound - 5-7 dB more than the threshold of hearing of the ultrasound (suprathreshold lateralization), determining as a result of all studies a better hearing ear , then they mask the best hearing ear with a narrow-band noise of +40 dB above the air conduction (VP) of the better hearing ear and re-determine the thresholds of VP, bone conduction (CP) and CVI for the worse hearing ear, and with a combination of lateralization of audible sounds and ultrasound in the party have worse hearing ear, the lack of difference thresholds KP worse on a hearing ear before and after masking the better hearing ear, maintaining the same KVI at worse a hearing ear before and after masking the better hearing ear diagnose conductive hearing loss at worst a hearing ear; and with a combination of lateralization of audible sounds in the direction of the worse hearing ear, lack of lateralization of the threshold and suprathous ultrasound, or the presence of lateralization of the ultrasound in the direction of the better hearing ear, an increase in the threshold values of CP worse than the hearing ear and a decrease in its CVI after masking a better hearing ear, the presence of a hidden cochlear component on the hearing ear worse and, accordingly, mixed hearing loss is diagnosed on it.