RU2675203C1 - Method of determining form of hearing loss in patients with unilateral 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 with a unilateral change in the hearing of the patient. For this purpose, determine the bone (BC) and air conduction (AC), 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 with a louder sound – 5–7 dB more than the threshold of hearing of US (suprathreshold lateralization), determine a normally hearing, healthy ear. Next, a healthy ear is masked with narrow-band noise +40 dB above the air conduction (AC) of this ear and the thresholds of AC, bone conduction (BC) and BAI are redefined for worse hearing ear. When combined: lateralization of audible sounds and ultrasound in the direction of a worse hearing ear, the lack of differences in BC thresholds on a worse hearing ear before and after masking a healthy ear, preserving the same BAI on a worse hearing ear before and after masking a normal hearing ear – diagnose conductive hearing loss on a worse hearing ear. In combination: 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 lateral US in the direction of a healthy ear, increased BC thresholds of worse hearing ear and decreased BAI thereof after masking a normal 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 an accurate determination of the form of hearing loss in patients at the expense of a specific set of studies, which allows confirming or refuting the presence of a cochlear component.1 cl, 3 ex

Description

The invention relates to medicine, namely to otorhinolaryngology.

As is known, conductive hearing loss according to tonal threshold audiometry (TPA) is characterized by the presence of a patient's hearing change in air sound conduction (VP) through the headphones, and the absence of such in bone conduction sound (CP), which is detected using a bone telephone mounted on the mastoid process of the temporal bones of the affected ear [1-4]. If the measurement of VP through headphones is carried out in isolation for each ear-patient and healthy, then the study of CP - simultaneously for both ears, regardless of the side of the study. Under such conditions, CP thresholds may coincide or slightly differ due to the phenomena of “listening” from the side of a better hearing person, that is, a healthy ear with rare exceptions [4, 5].

Fork tests for the affected (worse hearing) ear demonstrate the predominance of sound conduction over the duration of the CP sound compared with the EP (negative experiments of Rinne and Lewis-Federichi), according to the tonal audiometry, a bone-air interval (CVI) is detected, measured in the area of speech frequencies - ZRCH (0.5-2 kHz), expressed to varying degrees. Sound in the tuning fork and audiometric experiment of Weber is lateralized (directed) mainly towards the worse than the hearing ear [1-5]. According to various authors, masking a healthy ear with noise should be used when the difference between the ears in the EP 30-40 dB [1-5]. With a smaller difference in VP, thus, it is possible to miss the presence of changes in the CP of the affected ear.

It is known that hearing thresholds according to ultrasound studies are normal in the absence of hearing impairment and with conductive hearing loss. Lateralization of the threshold ultrasound with normal hearing in both ears is absent, with unilateral sensorineural hearing loss is directed towards the healthy ear, with unilateral conductive hearing loss - towards the patient [6-8].

The level of bone sound conduction (CP) is very important especially for otosurgeons, since research data on CP and CAP in patients determine the bone-air interval (CVI), or otherwise - the cochlear reserve of the cochlea - this is the number of decibels that can theoretically be calculated when performing a hearing-improving surgical intervention. In addition, the condition of the CP should be clarified for various acute inflammatory conditions of the middle ear in order to determine treatment tactics.

To clarify the condition of the CP in the affected ear, we offer our own research method.

Prototype. As a prototype, we have chosen the method for determining the form of hearing loss, described in the work of Sagalovich B.M., Pokryvalova K.P. [6], according to which the lateralization of the threshold ultrasound occurs in the better hearing ear with neurosensory, in the worse hearing - with conductive hearing loss, and the ultrasound does not lateralize the “norm” in both ears when hearing is heard and the bilateral hearing is symmetrically equivalent. However, the application of this research technique does not take into account the fact that the lateralization of both ordinary sound and ultrasound can change with an increase in the volume of the presented signal, which is associated with the presence of perceptual damage in the cochlear area, which is characterized by the presence of a more or less pronounced accelerated rise phenomenon volume (FUNG) [7, 8, 9].

Achievable technical result is to increase the accuracy of determining the form of hearing loss in patients through the use of a set of hearing research methods, the combined use of which can confirm or deny the presence of a cochlear component of hearing loss, which determines the final hearing-enhancing effect of surgical intervention.

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 ultrasonic (UZV) signal for both ears, for which an ultrasonic emitter is placed on the patient’s forehead along the sagittal line of the head at the hairline, first applying a small amount of liquid paraffin to the skin surface for closer contact with the skin,

- 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 (healthy) ear

- further, a healthy (normally hearing) ear is masked with a narrow-band noise of +40 dB above the air conduction (VP) of the healthy ear and the thresholds of VP, bone conduction (CP) and CVI for the hearing impaired are re-determined;

- when combined:

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

- the absence of changes in the thresholds of the CP on the worse hearing ear after masking the normally hearing ear,

- maintaining the same CVI on the hearing ear worse than before and after masking the healthy ear, conductive hearing loss is diagnosed on 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 the normally hearing ear,

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

detect 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 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 whether the patient has a unilateral "conductive disturbance." This violation is usually characterized by the negative results of the experiments of Rinne and Lewis-Federichi, the presence of a more or less pronounced CVI in the hearing of the worse ear, lateralization of sound in the tuning fork and audiometric experiments of Weber mainly in the hearing of the ear.

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 more tight contact with the surface, a small amount of petroleum jelly 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). Based on the totality of the results of all previous studies, a better hearing (healthy) ear is determined.

3. Next, a healthy (normally hearing) ear is masked with a narrow-band noise of +40 dB above the healthy ear's EP [10] and the thresholds of EP, CP, and CVI on the hearing ear are determined.

4. Determine the form of hearing loss with unilateral 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 suprathous ultrasound are not different 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 the normally hearing ear, bone conduction thresholds (CP) on the worse hearing ear, they do not differ from thresholds of CP before disguise and CVI on it remains the same, then conductive hearing loss on this ear is also diagnosed.

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 normally hearing ear, and after masking, threshold CP indicators worse than the hearing ear increase, and CVI decreases, then the presence of a hidden cochlear component is determined, and, accordingly, mixed hearing loss is diagnosed on it.

The method was applied in 3900 patients with various forms of otosclerosis and chronic otitis media, examined in GBUZ NIKIO them. L.I. Sverzhevsky DZM for the last 5 years.

Case Studies

Example 1. Patient W., 33 years old. Diagnosis: left-sided chronic purulent otitis media.

The patient complained of hearing loss in his left ear.

Tuning fork tests showed negative results on the left, worse hearing ear (CP> CAP) and positive results on the right (CP <CAP) with lateralization in Weber's experiment in the worse hearing, left ear. With tonal threshold audiometry in the right ear, the auditory thresholds for bone (CP) and air (VP) conductivity at frequencies of 125-8000 Hz were 5 dB. Auditory thresholds for CP in the left (affected) ear for the same frequencies were 5, 0, 0, 5, 10, 10, 15 dB, for EP - 35, 35, 30, 30, 25, 30, 25 dB, respectively. The CVI in the ZRC was 22.5 dB. The difference in auditory thresholds between the ears in the EP in the ROC is 23.8 dB. The sound in Weber's audiometric experiment was lateralized towards the patient, the left ear.

When the intensity of the ultrasonic signal with a frequency of 100 kHz, equal to 11 dB, the patient perceived it in the left ear (lateralization in the patient, worse hearing ear). With an increase in ultrasound intensity to 18 dB, its lateralization did not change: sound was also heard in the worse hearing ear.

After masking the hearing ear better, according to the generally accepted technique, the thresholds for CP and VP of the left ear practically did not change and amounted to - 5, 5, 5, 5, 10, 15, 15 dB and 40, 40, 35, 30, 30, 30, 25 dB respectively, and CVI - 22.5 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 - revision of the tympanic cavity with tympanoplasty type I with a good functional result. 3 months after the operation, the auditory thresholds for the EP on the operated left ear were 15, 10, 10, 15, 15, 15, 35 dB and CP, respectively - 5, 5, 5, 5, 5, 10, 10, 25 dB. KVI - 6.3 dB. KVI is implemented almost completely. Hearing improved by 16.2 dB, and on the right, healthy ear remained the same.

Example 2. Patient B., 42 years old. Diagnosis: Post-traumatic right-sided chronic otitis media.

Complained of hearing loss in the right ear.

According to tuning-fork research, negative results were found in the Rinne experiment (CP> VP), dubious ones in the Lewis-Federici experiment (CP> VP) on the worse hearing right ear, the sound in the Weber tuning fork was lateralized towards the patient with the right ear. For a healthy ear, tuning fork tests gave a positive result (CP <VP).

With tonal threshold audiometry in the left (healthy) ear, the auditory thresholds for EP and CP in the frequency range from 125 to 8000 kHz of the audiometric tonal scale were 10, 5, 5, 5, 5, 5, 5, and 10 dB. CVI was absent. The auditory thresholds in the right (affected) ear in the same frequency range during bone conduction were 5, 5, 5, 5, 10, 5, and 15 dB, respectively, and airborne, 40, 40, 25, 25, 40, 45, 50 dB. Pre-CVI amounted to 27.5 dB in the area of speech frequencies. The difference in auditory thresholds between the ears in the EP in the ROC is 28.8 dB. The lateralization of sound in Weber's audiometric experience was exclusively in the affected (right) ear.

When the intensity of the ultrasound with a frequency of 100 kHz, equal to 8 dB, the patient perceived it in the center of the forehead. With an increase in the intensity of the ultrasound to 15 dB, the patient was also perceived by the patient in the center.

When masking a healthy ear in the patient, right, and ear, the thresholds for CP were already 15, 15, 15, 10, 30, 35, 40 dB, and for EP, respectively, 50, 40, 30, 30, 45, 50, 50 dB. CVI was 16.3 dB. The refined thresholds for KP thus turned out to be higher than the initial ones, and the CVI turned out to be less than before disguise. The patient has mixed hearing loss on her right ear. It is precisely on this CVI that one can theoretically rely on hearing-enhancing surgical intervention.

The patient was operated on in her right ear. She underwent an operation - an audit of the tympanic cavity with tympanoplasty type I with a good functional result. 3 months after the operation, the auditory thresholds for EP on the operated, right ear were 20, 20, 15, 15, 35, 45, 55 dB and for CP, respectively, 15, 15, 15, 10, 30, 35, 40 dB. KVI - 5 dB. KVI is fully implemented. Hearing on the sore, right ear improved by 11.3 dB, and on the left, healthy ear remained the same.

Example 3. Patient J., 59 years old. Diagnosis: Otosclerosis.

Concerned about the gradual decrease in hearing in the right ear.

According to tuning fork studies, negative results were noted on the right, worse hearing ear (CP> CAP) and positive results on the left (CP <CAP) with lateralization in Weber’s experience in the worse hearing, right ear.

With tonal threshold audiometry on the left ear, the auditory thresholds for bone conduction at frequencies of 125-8000 Hz were 5, 5, 5, 5, 10, 5, 5 dB and air conduction - 15, 10, 10, 15, 10, 15, 15 dB respectively. CVI was 6.3 dB. The auditory thresholds in the right (affected) ear for the same frequencies in terms of CP of 5, 5, 10, 10, 10, 15, and 15 dB, in terms of EP, were 60, 55, 45, 35, 45, 50, 60 dB, respectively. CVI on the affected ear was previously 33.8 dB. The difference in auditory thresholds between the ears in the EP in the ROC is 31.3 dB. The lateralization of sound in Weber's audiometric experience was in the affected (right) ear.

When the intensity of the ultrasound signal with a frequency of 100 kHz equal to the threshold value of 14 dB, the patient perceived it in the left ear (lateralization in a healthy ear). With an increase in intensity to 21 dB, the ultrasound also lateralized in the left, better-hearing, healthy ear.

After disguising a healthy ear in the patient, right, and ear, the thresholds for CP were 25, 30, 15, 10, 30, 25, and 45 dB, for EP - 70, 60, 50, 35, 50, 55, 60 dB, respectively. KVI became 26, 3 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 right ear has a mixed form of hearing loss. It is precisely on this CVI that one can theoretically rely on hearing improvement during surgery.

The patient underwent surgery - stapedoplasty with auto-cartilage on a vein in her right ear. Auditory thresholds 3 months after surgery on the operated right ear in the CP were 25, 25, 15, 10, 20, 35, 40 dB, and in the EP, respectively, 30, 25, 15, 15, 25, 40, 55 dB. CVI was 3.8 dB. KVI is fully implemented. Hearing on the patient, the right ear improved by 22.5 dB, and on the left ear remained the same, within the age norm.

As can be seen from all the cases presented, the difference in auditory thresholds between the ears in the EP in the RCS is less than 35-40 dB, which traditionally does not involve masking a better hearing ear. However, the masking technique of a better hearing ear, combined with the use of ultrasound, allows you to clarify the condition of the CP on the operated ear, and thus judge the effectiveness of hearing enhancement of the planned operation.

Bibliography:

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2. Bystshanovska T. Clinical Audiology. - Warsaw, 1965 .-- S. 240.

3. Khechinashvili S.N. Questions of audiology. - Tbilisi, 1978.- S. 63.

4. Altman Ya.A., Tavartkiladze G.A. A Guide to Audiology. M., 2003 .-- S. 360.

5. Guide to Audiology and Hearing Aid. Ed. prof. Lyatkovsky Ya.B. Per. from Polish. Ed. Dayhes N.A. MIA, 2009 - S. 240.

6. Sagalovich B.M., Pokryvalova K.P. “Auditory perception of ultrasounds and its significance for the differential diagnosis of hearing damage” // Vestn. otorhinolar. - 1963. - No. 5. - S. 31-38.

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Claims (1)

A method for determining the form of hearing loss with a one-sided hearing loss in a patient, including determining bone (CP) and air conduction (VP), bone-air interval (CVI) by audiological examination of each ear, characterized in that they additionally determine the total ultrasound auditory threshold for 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 hair growth border with preliminary application of liquid paraffin to the skin surface for pain e close contact with the surface, an ultrasound signal with a frequency of 100 kHz is supplied and the ultrasound threshold of the ultrasound is determined and the ultrasound signal is lateralized at the ultrasound threshold of hearing, and with a louder sound, it is 5-7 dB more than the ultrasound threshold of hearing (above threshold lateralization), determining as a result of all studies a healthy, normally hearing ear, then mask the healthy ear with a narrow-band noise of +40 dB above the air conductivity (VP) of a healthy, normally hearing ear and re-determine the thresholds of VP, bone conduction (CP) and CVI for hearing worse of his ear, and when combined: lateralization of audible sounds and ultrasound in the direction of worse hearing ears, lack of difference in thresholds of CP on the worse hearing ear before and after masking a healthy ear, maintaining the same CVI on the worse hearing ear before and after masking a healthy ear - conductive is diagnosed hearing loss in a worse hearing ear; and when combined: the lateralization of audible sounds in the direction of the worse hearing ear, the lack of lateralization of the threshold and suprathreshold ultrasound, or the presence of lateralization of the ultrasound in the direction of the normally hearing ear, an increase in CP thresholds worse than the hearing ear and a decrease in its CVI after masking a healthy ear, reveal the presence of a hidden cochlear component on the hearing ear worse and, accordingly, diagnosed with mixed hearing loss on it.