RU2730935C1 - Method for non-invasive detection of labyrinth hydrop in patients with mixed form of hearing loss - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, particularly to otorhinolaryngology. Bone conductivity (BC) and air conduction (AC), air-bone gap (ABG) are determined by audiological examination of each ear. Lateralization of sound is determined in the audiometric experience of Weber by establishing a bone conduction sensor on the sagittal line in the center of the forehead, thus determining a better or normally hearing ear. That is followed by camouflaging a better hearing ear with narrow-band noise of +40 dB above the AC threshold, and re-determining thresholds AC, BC and ABG for the worse hearing ear. That is followed by determining an audible threshold of an ultrasonic signal (US) common for both ears, for which the US emitter is placed on the forehead of the patient on a sagittal line of the head near a hair growth boundary with preliminary application of Vaseline oil on the skin surface. US signal is transmitted at frequency of 100 kHz and the US audibility threshold is determined, and the US signal is lateralized at the threshold of audibility of US and at louder sound – by 5–7 dB more than the threshold of audibility US (over-threshold lateralization). When combined: increasing the thresholds of the BC worse hearing ear and reducing its ABG values after disguising a better/normally hearing ear, lateralization of audible sounds in the Weber experience in the direction of a worse hearing ear or its absence (in the center of the forehead), avoiding lateralization of threshold and above-threshold US or presence of lateralization of US towards better/normally hearing ear – detecting presence of cochlear component on worse hearing ear. In this case, diagnosed thereon is mixed hearing loss without pronounced phenomena of the phenomenon of accelerated sound volume increase (PASVI). When combined: higher thresholds of BC thresholds of hearing ear and reduced values of its ABG after camouflage of better/normally hearing ear, lateralization of audible sounds in Weber's experience towards worse hearing ear, presence of lateralization of threshold and over-threshold US towards worse hearing ear – presence of a cochlear component on a worse-hearing ear is diagnosed, and mixed-based hearing loss is diagnosed on the cochlear component with manifested PASVI (labyrinth hydrop).

EFFECT: method enables detecting the manifested PASVI phenomena in a worse-hearing ear with unilateral or bilateral mixed hearing changes in the patient, confirming or refuting the labyrinth hydrop signs, that can influence prospects of hearing improvement in postoperative period and occurrence of remote postoperative changes in dynamics.

1 cl, 3 ex

Description

The invention relates to medicine, namely to otorhinolaryngology.

As you know, the hydrops of the labyrinth (GL) is a special condition of the inner ear, which is characterized by an increase in pressure in the endolymphatic system of the inner ear, accompanied by a complex of signs, including the patient's complaints of a feeling of congestion in one or both ears, the irritating effect of loud sounds; fluctuation and hearing loss, predominantly asymmetric and, according to tonal threshold audiometry (TPA), predominantly of a neurosensory nature with a small, up to 15 dB, bone-air interval (CVI) in the low-frequency spectrum (0.125-0.5 kHz) - the so-called "Hydropic curve". The characteristic features of GL, or rather the phenomenon of accelerated increase in loudness (FUNG), which is the audiological hallmark of GL, are also the data of suprathreshold tests-differential threshold of sound power (DPSZ) according to Luscher - 0.2-0.5 dB at a rate of 0, 8-1.0 dB, SiSi-test data - 90-100% at a rate of 0-30%, the phenomenon of lateralization of ultrasound (USW) towards the hearing impairment with unilateral and bilateral, mainly sensorineural hearing loss [1, 2, 3, 4 ], with normal (up to 15 dB) thresholds, and with speech audiometry - the presence of recruitment, a paradoxical drop in speech intelligibility (SPR) with amplification of the speech signal.

Most authors believe that the cause of the development of endolymphatic hydrops is, on the one hand, an increase in the production of endolymph by the vascular stripe of the cochlear organ of the cochlea, and on the other hand, a violation of the process of its resorption in the endolymphatic duct and sac [5, 6].

Idiopathic endolymphatic hydrops of the labyrinth underlies the pathogenesis of Meniere's disease, but its symptoms can also be observed in a number of other diseases: in chronic suppurative otitis media (CHS), otosclerosis (OS), labyrinth trauma (TL), acute sensorineural hearing loss (ONST), syphilitic damage to the temporal bone (SL), with vertebral-basilar insufficiency (VBI) - the so-called "secondary endolymphatic hydrops" [7].

GL is often accompanied by vestibular dysfunction, which can be reflected in the results of vestibular tests and electrophysiological measurements - electrocochleography (ECoG), but in about half of the cases, the results of these tests do not differ from normal values.

With mixed forms of hearing loss observed in patients with CHD, OS, TL, etc., with CVI more than 15 dB, it is more difficult to suspect and identify signs of GL for a number of reasons. Patients with significant hearing loss pay little attention to its additional "+/-" - changes, at best believing that this is due to the pathology of the nose and paranasal sinuses. Such complaints are not the leading ones; they can only be identified by a targeted survey if a patient is suspected of having secondary HF. The shape of the audiometric curves does not have features typical of hydrops. Suprathreshold tests do not give a clear picture of FUNG, and sometimes they are completely impossible due to high hearing thresholds. However, as practice shows, it is important to have information about the presence of signs of hydrops immediately before starting treatment, both conservative and surgical, in order to take them into account when carrying out therapy or change the plan of surgical intervention taking into account these data.

To detect HF in various forms of hearing loss, there is an excellent imaging method - magnetic resonance imaging (MRI) of the temporal bones with contrast, which consists in the intratympanic injection of a contrast agent followed by an MRI study [8]. Using this method, the degree of severity, localization of GL is determined, and the effectiveness of therapy for treating the disease is assessed. However, it itself is costly, and it is not possible to carry it out everywhere. In addition, patients may have allergic reactions to the contrast agent, and finally, complications are possible during the very manipulation of the drug injection into the tympanic cavity, as with any invasive technique.

The prototype of our method can be a method for determining the form of hearing loss using ultrasound, described in the work of B.M. Sagalovich, K.P. Pokryvalova [9], in which lateralization of the threshold USI occurs in the worse hearing ear with conductive ear, in the better hearing ear with sensorineural hearing loss, and USI does not lateralize with normal hearing in both ears and symmetrical bilateral equivalent hearing change.

When performing this test, scrupulous accuracy is required in determining the threshold of perception of ultrasound, since with lateralization of both ultrasound and ordinary sound, the direction of the presented signal can change with an increase in its volume, which is associated with the presence of FUNG when the receptor apparatus of the cochlea is damaged [3, 4, 10, 11, 12].

In addition, in the study of hearing in patients by bone conduction (CB), both during tuning fork tests and TPA and in the study of USV thresholds, sound propagating along the bones of the skull is perceived simultaneously by both ears [9, 13]. It is recommended to use masking of a better hearing ear when the difference in hearing in air conduction (VP) is 35-40 dB [14]. In such conditions, due to the so-called eavesdropping phenomenon, the CP thresholds for both ears may turn out to be equal or slightly different, especially with a smaller hearing difference in EP. CVI in the hearing-impaired ear may be falsely enlarged.

Suprathreshold tests (Weber's experiments, tuning fork and audiometric in combination with lateralization of ultrasonography) in the presence of pronounced FUNG (respectively, GL) may not correspond to the expected results of the study in this patient. In turn, masking of ultrasound is extremely difficult due to the excessive values of the masking tone (over 90 dB) necessary for this [9].

All this disorientates otosurgeons regarding the actual CVI, and also, accordingly, in general, the form of hearing loss in the patient and the level of damage to sensory structures.

To identify pronounced phenomena of FUNG (labyrinth hydrops) in mixed forms of hearing loss, we offer our own non-invasive method of research using a set of audiological tests, including ultrasound.

The achieved technical result is the detection of pronounced FUNG phenomena in a worse hearing ear with unilateral or bilateral mixed hearing changes in a patient, through the use of a combination of hearing research methods in patients, which jointly confirm or deny the presence of signs of HF in the patient, which may affect the prospects for hearing improvement in the postoperative period and the occurrence of distant postoperative changes in dynamics.

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

determine CP, EP and CVI by traditional audiological examination of each ear, revealing as a result of these studies a better hearing or hearing ear;

then, without fail, masking of the better / normally hearing ear is carried out with a narrow-band noise of +40 dB above the threshold of the EP of the better hearing ear to clarify the thresholds of the EP, CP and CVI for the worse hearing ear;

conduct Weber's audiometric experiment (lateralization of audible sounds) over the entire range of audible frequencies (0.125-8 kHz), installing the CP sensor along the sagittal line of the head in the center of the forehead and delivering sound at each of the frequencies +20 dB above the audibility threshold;

additionally, the common for both ears hearing threshold of the ultrasonic signal is determined, for which the ultrasonic emitter is installed on the patient's forehead along the sagittal line of the head at the border of hair growth with preliminary application of vaseline oil to the skin surface;

they send an ultrasonic signal with a frequency of 100 kHz and determine the hearing threshold of the ultrasonic wave and the lateralization of the ultrasonic signal at the hearing threshold of the ultrasonic wave and at louder sound - 5-7 dB more than the hearing threshold of the ultrasonic wave (suprathreshold lateralization)

and when combined:

an increase in the indicators of the thresholds of the CP worse than the hearing ear and a decrease in the indicators of its CVI after masking the better / normally hearing ear,

lateralization of audible sounds in Weber's experience towards a worse hearing ear or its absence (in the center of the forehead),

the absence of lateralization of the threshold and suprathreshold ultrasonic waves or the presence of lateralization of the ultrasonic waves towards the better / normally hearing ear,

reveal the presence of a cochlear component in the worse hearing ear and diagnose mixed hearing loss on it without pronounced FUNG phenomena,

and when combined:

an increase in the indicators of the thresholds of the CP worse than the hearing ear and a decrease in the indicators of its CVI after masking the better / normally hearing ear,

lateralization of audible sounds in Weber's experience towards a worse hearing ear,

presence of lateralization of the threshold and suprathreshold ultrasonic waves towards the worse hearing ear,

reveal the presence of a cochlear component on the worse hearing ear and diagnose mixed hearing loss on it with pronounced FUNG phenomena (hydrops of the labyrinth).

The method is carried out as follows:

1. An audiological examination is performed.

This examination includes carrying out tuning fork tests (experiments of Rinne, Lewis-Federici, Weber), TPA with Weber's audiometric experience.

An audiological examination can determine whether a patient has one or two-sided "conductive impairment", as well as a difference in hearing between the ears, if there is one with bilateral loss. This disorder, as a rule, is characterized by negative results of the Rinne and Lewis-Federici experiments, the presence of more or less pronounced CVI in one or both ears, lateralization of sound in Weber's tuning fork and audiometric experiments mainly in the worse hearing ear or in the center with equal hearing loss in both ear. On the basis of the results of these studies, a better / normally hearing ear is determined.

2. Conduct masking of a better / normally hearing ear with a narrow-band noise of +40 dB above the EP of the better hearing ear [15, 16] and determine the thresholds of EP, CP and CVI on the worse hearing ear.

3. Conduct a study of the threshold of perception and lateralization of the threshold and suprathreshold USV.

First, the threshold of hearing the ultrasonic signal is determined. For this purpose, the USV emitter is placed on the patient's forehead along the sagittal (midline) line of the head at the border of hair growth. For closer contact with the surface, a small amount of petroleum jelly is first applied to it.

Using the emitter, an ultrasonic signal with a frequency of 100 kHz is supplied (for example, "Echotest-02", Hyperion, RF). The hearing threshold of the RAS is determined, which usually does not differ from the normal one (normally - up to 15 dB), and then the lateralization of the signal at the threshold of audibility and at a louder sound (+ 5-7 dB above the threshold).

4. Determine the form of hearing loss and the presence of signs of pronounced FUNG in unilateral or bilateral hearing changes.

4.1. If all the parameters obtained during the audiological examination and study of the threshold of perception and lateralization of the threshold and suprathreshold USV demonstrate the presence of CVI on the worse hearing ear, after masking, the CP thresholds increase, and the CVI decreases, the lateralization of audible sounds in Weber's tuning fork and audiological experiments is mainly directed towards the side of the worse hearing ear, and the results of the study of the threshold of perception and lateralization of the threshold and suprathreshold USV reveal either the absence of lateralization or lateralization towards the better or normally hearing ear, then the presence of a cochlear component on the worse hearing ear and, accordingly, mixed hearing loss with the absence of pronounced FUNG phenomena on it.

4.2. If the results of the audiological examination and the study of the threshold of perception and lateralization of the threshold and suprathreshold ultrasonic wavelengths also reveal the presence of CVI on the worse hearing ear, and after masking the better / normally hearing ear, the CP thresholds on the worse hearing ear increase, and the CVI decreases, the lateralization of audible sounds and ultrasound (threshold and suprathreshold) occurs in the direction of the worse hearing ear, then the presence of a cochlear component on the worse hearing ear and, accordingly, mixed hearing loss with the presence of pronounced FUNG phenomena on it is determined.

In addition to the above-mentioned method for visualizing GL using contrast MRI of the temporal bones [8], it can be visualized during surgical operations on the stirrups (with stapedotomy) [17].

Out of 1077 patients with otosclerosis who were observed and underwent surgical treatment in the research department of ear microsurgery at the N.N. L.I. Sverzhevsky DZM for the period 2009 - 2018. 100 patients aged 17 to 72 years with various forms of OS (cochlear - 10%, tympanic - 13%, mixed - 77%) were randomly selected. Of these, 73 were women and 27 were men (2.7: 1).

Taking into account the data of the anamnesis, complaints of patients (with active questioning) about fluctuations in tinnitus / ear, hearing against the background of already reduced (in 81 patients - 81%), instability (48 - 48%), periodic dizziness (13 - 13%) , a special combination of audiological data according to the above research methodology for each patient was suspected of signs of GL in the worst ear in more than half of them (53 patients - 53%) with the following forms of OS - cochlear - 2, tympanic - 1, mixed - 50 At the same time, according to ECoG data available from 18 patients with concomitant vestibular complaints - in 10 of them - signs of HF were not detected, in 2 - signs of HF were revealed in a worse hearing ear (12 in total), and in vestibulometry (VM) - in 8 of 18 patients, no signs of persistent peripheral and central vestibular lesions were found, 1 had a mixed vestibular pathology with a predominance of central disorders, 1 had signs of a central disorder (10 in total). According to Doppler ultrasound of the brachiocephalic arteries (Doppler ultrasound of the BCA), 1 out of 18 showed signs of venous dysfunction with an increase in vascular tone on the side of the worse hearing ear, and another 1 showed signs of hydrocephalus.

In 10 randomly selected out of 32 laser-assisted stapedoplasty planned for surgery, out of 53 patients with signs of the hydrops of the labyrinth during the surgical intervention in order to visualize the hydrops, the footplate of the stirrup was pre-perforated instrumentally, then the stapedoplasty was continued, typically, with laser assistance. The fact is that when exposed to a surgical CO ₂ laser, radiation (power density ≥ 50 kW / cm ² ) is intensively absorbed by tissue water molecules. Under such conditions, the water quickly heats up, and from it the non-aqueous components of the tissue. The consequence of this is the rapid (explosive) evaporation of tissue water (vaporization effect) and the eruption of water vapor together with fragments of cellular and tissue structures outside the tissue with the formation of an ablation crater [18], therefore, the result of visualizing the release of perilymph under pressure when the foot plate is perforated by laser radiation can be nullified.

During the operation, in 8 out of 10 patients, perilymph was delivered under pressure, and in 1 of them it “gushed”. In 2 patients, it was impossible to assess the intake of perilymph due to mobilization of the stapes (in 1) and increased bleeding from the mucous membrane of the tympanic cavity (also in 1).

Later, in the course of postoperative observation of patients with this pathology, the closure of the CVI up to 10 dB was noted over the entire frequency range within a period of up to 6 months. Starting from 3 to 6 months, most patients developed CVI in the low-frequency spectrum of the audiometric curve and it acquired a typical “hydropic” appearance, accompanied by complaints of fluctuating congestion of the operated ear, and occasionally vestibular phenomena (instability, staggering).

Example 1. Patient B., 30 years old. Diagnosis: Otosclerosis, tympanic form.

She complained of hearing loss in the left ear, periodic "ringing" in it.

Tuning fork tests showed positive results on the right ear (CP <EP) and negative results on the left (CP> EP) with lateralization in Weber's experiment in the worse hearing left ear. With TPA in the right ear, the EP thresholds for frequencies of 125 - 8000 Hz were equal to 20, 15, 15, 10, 5, 5, 5 dB and CP - 15, 5, 5, 5, 5, 5, 5 dB, respectively. KVI in the zone of speech frequencies (ZRCH) from 500 to 4000 Hz was equal to 3.75 dB. The hearing thresholds for EP in the left (worse hearing) ear for the same frequencies were equal to 40, 40, 40, 40, 35, 30, 25 dB, for CP - 5, 5, 5, 5, 5, 10, 10 dB, respectively ... CVI in the zone of speech (500-4000 Hz) frequencies was 30 dB. The difference in the auditory thresholds between the ears according to the EP in the ZRCH is 36.5 dB. The sound in Weber's audiometric experiment was lateralized towards the worse, left ear.

After masking the better hearing right ear, according to the generally accepted method, the thresholds for the CP and EP of the left ear were 55, 60, 45, 35, 30, 40, 40 dB and 25, 15, 10, 15, 20, 30, 20 dB, respectively, and KVI - 18.8 dB.

At the intensity of the USW signal with a frequency of 100 kHz, equal to 4 dB, the patient perceived it in the left ear (lateralization to the worse ear). With an increase in the intensity of ultrasound to 11 dB, its lateralization did not change and was also directed to the left.

Thus, after masking, the adjusted CP thresholds worsened, the CVI decreased, which indicates the presence of mixed hearing loss in the patient with pronounced FUNG phenomena on the left ear.

According to the multispiral computed tomography (MSCT) of the temporal bones, the patient was found to have foci of reduced density (+900 HU at a rate of + 2000 to + 2200 HU) in the anterior fissure on both sides. Other structures of the outer, middle, and inner ear are unchanged.

In terms of preoperative preparation, she received 1 three-month course of standard inactivating therapy, including ibandronate, fluoride, calcium, vitamin D in appropriate dosages. She tolerated the course of treatment well.

At the end of the course of treatment, the patient underwent surgery on her left ear - stapedoplasty with a prosthesis for a vein with laser assistance and a good functional result. In the course of stapedoplasty, the foot plate of the stirrup was pre-perforated instrumentally to verify the GL. Perilymph arrived under pressure. The operation was then continued in a typical manner without complications. 2 months after the operation, the auditory thresholds for EP on the operated left ear were 30, 20, 15, 15, 20, 20, 25 dB and for CP, respectively - 20, 15, 10, 15, 5, 10, 20 dB. CVI - 2.5 dB. KVI is fully implemented. Thus, the HAT curve has acquired the typical form of sensorineural hearing loss of the minimum degree. Hearing improved by 16.3 dB, but the right ear, which had not been operated on, remained the same. 6 months after the operation, hearing on the left ear operated on changed, fluctuating congestion appeared in it without signs of inflammatory changes in the upper respiratory tract and normal tympanometry. Hearing thresholds for EP on the operated left ear were 35, 35, 25, 15, 15, 15, 20 dB and for CP, respectively - 15, 10, 10, 15, 15.15, 20 dB. CVI - 3.8 dB. The hearing in the right ear remains the same. USW was lateralized at a threshold intensity of 8 dB and a suprathreshold intensity of 15 dB in the left operated ear. Thus, the audiometric curve for the left ear acquired a typical “hydropic form” of a mixed hearing loss curve with a predominance of the sensorineural component and CVI in the low-frequency region, which was leveled by the appointment of a course of dehydration therapy.

Example 2. Patient A., 33 years old. Diagnosis: Otosclerosis, mixed form.

Hearing is reduced in both ears, more on the left, tinnitus, more on the left.

According to the data of a tuning fork, the patient had negative Rinne and Lewis-Federici tests on both sides (CP> EP). Lateralization of sound in Weber's experiment is directed mainly towards the worse hearing left ear. In HAT, the auditory thresholds in the right ear in EP were 55, 60, 60, 65, 55, 45, 40 dB, and CP - 15, 10, 10, 15, 25, 10, 10 dB, respectively. CVI was 41.3 dB in the speech frequency zone. In the left ear, the thresholds for EP were 70, 75, 70, 70, 75, 60, 65 dB, and for CP - 20, 15, 15, 20, 25, 20, 35 dB in the same frequency range. KVI to the left ear in the ZRCH - 48.8 dB. Lateralization of sound in Weber's audiometric experiment was also to the left. The difference in the auditory thresholds between the ears according to the EP in the ZRCH is 12.5 dB.

Thus, the right ear turned out to be the best.

When masking the right ear in the left ear, the thresholds for EP in the zone of speech frequencies were 80, 90, 80, 70, 80, 60, 70 dB, for CP - 25, 25, 25, 30, 50, 30, 50 dB, respectively. CVI was 38.8 dB.

At an ultrasound intensity with a frequency of 100 kHz, equal to 16 dB, the patient perceived it in the left ear. With an increase in the USW intensity up to 23 dB, it was perceived by the patient also on the left (in the worse hearing ear).

The adjusted thresholds for the CP on the left ear, thus, turned out to be higher than the initial ones, and the CVI was lower than before masking. The patient has a mixed hearing loss on the left ear with pronounced signs of FUNG.

According to MSCT data of the temporal bones, the patient was found to have foci of reduced density (+900 - + 1000HU on the right ear, + 1100- + 1200 HU- on the left ear, with a norm of + 2000- + 2200 HU) in the anterior fissure on both sides, extending to the front leg of the stirrup, the stirrup is thickened. Other structures of the outer, middle, and inner ear are unchanged. Inactivating therapy was not performed before the operation, since the density of otofoci on the left ear planned for surgery was sufficient for surgical intervention.

The patient was operated on on her left ear, she underwent stapedoplasty with a prosthesis on a vein with laser assistance, with a good functional result. During the operation, in spite of the use of a laser, when the footplate of the stapes was perforated, the perilymph was inflowed under pressure. Otherwise, the course of the operation was typical, without complications. Thresholds for EP on the left ear 3 months after surgery were 35, 40, 40, 30, 60, 50, 75 dB, and for CP - 15, 20, 25, 30, 50, 35, 40 dB. KVI, respectively, 10 dB, is almost completely implemented. Hearing improved by 28.8 dB. The noise in the operated ear disappeared. The right ear, which had not been operated on, remained the same.

5 months after the operation, the patient noted the appearance of a feeling of periodic congestion in the operated ear. She did not catch a cold, without signs of inflammatory changes in the upper respiratory tract and tympanometry indicators within normal limits. Hearing in the left, operated ear subjectively became worse. Thresholds for EP on the left ear at the time of the study were 45, 50, 50, 40, 55, 60, 70 dB, and for CP - 20, 25, 25, 35, 50, 35, 50 dB. KVI, respectively, 15 dB. USW was lateralized at a threshold intensity of 15 dB and a suprathreshold intensity of 22 dB in the left ear operated on.

The TPA curve had a typical "hydropic" appearance with a mixed type of hearing impairment with a predominance of the sensorineural component and with CVI predominantly in the low frequency zone (0.125-0.5 kHz) of 25 dB. CVI also decreased during the course of dehydration therapy. The congestion in the operated ear decreased after treatment.

Example 3. Patient K., 39 years old. Diagnosis: Otosclerosis, mixed form.

The patient complained of hearing loss, more pronounced in the right ear, periodic noise in it.

In a tuning fork study, negative experiments by Rinne and Lewis-Federici (CP> EP) were obtained with lateralization of sound in Weber's experiment, predominantly in the right, worse hearing ear. With TPA in the right ear (worse hearing), the auditory thresholds for EP at frequencies of 125 - 8000 Hz were equal to 55, 50, 50, 55, 55, 50.45 dB and for CP - 10, 5, 5, 10, 15.20, 25 dB, respectively. CVI was 41.3 dB. The auditory thresholds in the left ear for the same frequencies for the EP were equal to 45, 40, 40, 30, 20, 25, 30 dB, and for the CP - 10, 5, 5, 15, 15, 20, 20 dB, respectively. CVI in the zone of speech frequencies on this ear was 15 dB. The difference in the auditory thresholds for EP in the ZRCH is 23.8 dB. The lateralization of sound in Weber's audiometric experiment was in the worse hearing (right) ear.

After masking the right ear in the worse hearing, right ear, the thresholds for EP were 60, 60, 55, 65, 60, 50, 50 dB, for CP - 15, 10, 10, 20, 25, 25, 30 dB, respectively. KVI became 37.5 dB.

When the intensity of the USV signal with a frequency of 100 kHz, equal to the threshold value of 5 dB, the patient perceived it in the left ear (lateralization in the better hearing ear). With an increase in intensity up to 12 dB, the USW also lateralized into the left ear, which is better hearing.

Thus, the thresholds for CP in the right ear were also higher than the initial ones, and the CVI was less than before masking. The patient has a mixed form of hearing loss on the right ear without pronounced FUNG phenomena.

According to MSCT of the temporal bones, the patient was found to have foci of reduced density (+700 - + 800 HU on the right ear, + 800- + 900 HU on the left ear, with a norm of + 2000- + 2200 HU) in the anterior fissure on both sides, spreading on the anterior sections of the stirrup, the stirrup is thickened. Other structures of the outer, middle, and inner ear are unchanged.

In terms of preoperative preparation, the patient underwent 1 three-month course of standard inactivating therapy, including ibandronate, fluoride, calcium, and vitamin D in appropriate dosages. The course of treatment was well tolerated.

Then the patient was operated on on the right ear, he underwent stapedoplasty with a prosthesis on a vein with good hearing gain. In the course of laser assisted stapedotomy surgery, perilymph delivery was normal. 3 months after the operation, the hearing thresholds for EP in the right ear in the same range were 20, 20, 25, 35, 40, 40, 50, and for CP, respectively, -20, 20, 25, 20, 30, 25, 20 dB ... CVI in the postoperative period became 10 dB. Hearing correspondingly improved in the right ear by 27.5 dB. KVI has been implemented almost completely. When observed in dynamics 6 months after the operation, hearing in the right, operated ear remained stable.

Early detection of pronounced FUNG phenomena (and, accordingly, the hydrops of the labyrinth) in the process of monitoring patients with mixed forms of hearing loss and their preparation for surgical treatment will make it possible to timely adjust the course of therapeutic measures before surgery, tactics of surgical treatment and further observation in order to stabilize hearing in the postoperative period ...

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Claims (12)

A method for non-invasive detection of the hydrops of the labyrinth in patients with mixed hearing loss based on the determination of pronounced signs of the phenomenon of accelerated increase in loudness (FUNG) on the worse hearing ear with one- or two-sided mixed hearing change in a patient, including the determination of bone (CP) and air conduction (EP) , bone-air interval (CVI) by audiological examination of each ear, as well as lateralization of audible sounds in Weber's audiometric experiment, for which a bone sensor is installed along the sagittal line in the center of the forehead, a sound of +20 dB above the audibility threshold is applied at each of the frequencies as a result, a better hearing ear is determined, then masking is performed for a better or normally hearing ear with a narrow-band noise of + 40dB above the threshold of a better or normal hearing ear, and the thresholds of the EP and CP and CWI are specified for the worse hearing ear, then the common for both ears hearing threshold of the ultrasonic (USV) signal is determined, for which the ultrasonic emitter is installed on the patient's forehead along the sagittal line of the head at the border of hair growth with preliminary application of vaseline oil to the skin surface, an ultrasonic signal with a frequency of 100 kHz is applied and the hearing threshold is determined RAS and lateralization of the RAS signal at the hearing threshold of the RAS and at a louder sound - 5-7 dB more than the hearing threshold of the RAS - suprathreshold lateralization and when combined: - an increase in the indicators of the thresholds of the CP worse than the hearing ear and a decrease in the indicators of its CVI after masking a better or normally hearing ear, - lateralization of audible sounds in Weber's experience towards a worse hearing ear or its absence - sound in the center of the forehead, - the absence of lateralization of the threshold and suprathreshold ultrasonic waves or the presence of lateralization of the ultrasonic waves towards a better or normally hearing ear, reveal the presence of a cochlear component on the worse hearing ear and diagnose mixed hearing loss on it without pronounced FUNG phenomena, and when combined: - an increase in the indicators of the thresholds of the CP worse than the hearing ear and a decrease in the indicators of its CVI after masking a better or normally hearing ear, - lateralization of audible sounds in Weber's experience towards a worse hearing ear, - the presence of lateralization of the threshold and suprathreshold USV only towards the worse hearing ear, reveals the presence of a cochlear component on a worse hearing ear and diagnoses it with mixed hearing loss with pronounced symptoms of FUNG - labyrinth hydrops.