Method for diagnosing contusional damage to hearing organ in adult patients without perforation of eardrum in at least one ear

Abstract

FIELD: otolaryngology; audiology.SUBSTANCE: examination is carried out in two stages. At the first stage, tonal threshold audiometry is performed to determine the thresholds of sound perception on both sides. In the event of bilateral conductive hearing impairment, or conductive hearing impairment on the side without perforation of the eardrum in the presence of any type of hearing impairment on the side where there is perforation of the eardrum, then the absence of a causal relationship between the hearing impairment and contusional temporary damage to the organ of hearing is established. If there is no hearing impairment on the side without perforation of the eardrum, or there is hearing impairment of a non-conductive type, and in the presence of any type of hearing impairment on the opposite side, where there is or is not perforation of the eardrum, then the examination is continued. In this case, at the second stage, low-frequency acoustic impedance analysis with acoustic reflexometry is carried out on the side where there is no perforation of the eardrum, including tympanometry; if type A tympanogram is registered, the study is continued. Then, ipsilateral acoustic reflexes are recorded. In this case, if bilateral hearing loss is determined based on the results of tonal threshold audiometry and there is no perforation of both eardrums, and there is no registration of the ipsilateral acoustic reflex on both sides at frequencies of 500, 1000, 2000 and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive for three days from the moment of exposure to the blast wave, then a causal relationship with the contusion etiology of hearing loss is established. If a unilateral decrease in sound perception thresholds is noted and on this side the ipsilateral acoustic reflex is not recorded at frequencies of 500, 1000, 2000 and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive for three days and for one day from the moment of exposure to a blast wave on the opposite side, where the average sound perception thresholds according to tonal threshold audiometry correspond to the norm, then a causal relationship with the contusional etiology of hearing loss is also established. If there is a unilateral perforation of the eardrum, and bilateral hearing loss is determined based on the results of pure tone threshold audiometry, and on the side where there is no perforation of the eardrum, the ipsilateral acoustic reflex is not recorded at frequencies of 500, 1000, 2000 and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive within three days from the moment of exposure to the blast wave, then a causal relationship with the contusion etiology of hearing loss is established. If there is a unilateral perforation of the eardrum, and unilateral hearing loss is determined based on the results of tonal threshold audiometry on the side of the perforation of the eardrum, and at the same time, an ipsilateral acoustic reflex is not recorded at frequencies of 500, 1000, 2000 and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive within one day from the moment of exposure to a blast wave on the opposite side, where the average thresholds of sound perception according to tonal threshold audiometry correspond to the norm, then a causal relationship with the contusion etiology of hearing loss is also established. If there is a unilateral perforation of the eardrum, and unilateral hearing loss is determined based on the results of pure tone threshold audiometry on the side without perforation of the eardrum, and at the same time, no ipsilateral acoustic reflex is recorded on it at frequencies of 500, 1000, 2000 and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive within three days from the moment of exposure to the blast wave, then a causal relationship with the contusion etiology of hearing loss is also established.EFFECT: method allows for the relatively quick and inexpensive diagnosis of contusional damage to the hearing organ.1 cl, 8 dwg, 2 ex

Description

[0001] Description of the invention patent

[0002] The invention relates to the field of medicine, in particular to otolaryngology and surdology, and can be used to establish the fact of contusional damage to the hearing organ.

[0003] Explosion is a rapid release of a large amount of energy in a limited volume, leading to a strong increase in pressure in it and the formation of sound and blast waves [1, 2].

[0004] Damage to the hearing organ as a result of an explosion is possible both in peacetime and in a combat zone. In peacetime, as a result of industrial accidents - mine injuries or as a result of terrorist acts [3, 4]. In a combat zone, as a result of mine-explosive impact [5, 6, 7, 8]. As in the first and second cases, establishing the etiologic factor affects the therapy. For example, with acubarotrauma, damage occurs not only to the structures of the middle, but also the inner ear due to the simultaneous impact of a sharp change in environmental pressure and high-intensity sound [6, 7, 8, 9]. In this case, in addition to the therapy indicated for acute otitis, a course of hearing stabilization therapy is carried out [6]. In the study, the authors used the classification of acubarotrauma according to the principles of military field surgery as modified by Chechko A.N., Belicheva E.G. [5].In addition to the need for timely etiotropic treatment, questions of insurance payments (industrial / military injuries) also arise, including establishing a causal relationship with the mine-explosive etiology. The latter is particularly relevant for acoustic trauma—specific damage to the hearing organ caused by sounds of excessive intensity or duration [5, 9, 10].

[0005] It is worth noting that traumatic changes in the middle ear are not always the result of blast exposure. It should be remembered that such injuries can also occur with household injuries [5]. In such cases, in the absence of a reliable medical history, objective hearing tests are required to confirm the blast / mine-explosive etiology—the impact on the central auditory system analyzer.

[0006] For example, in military neurology, according to the RF Government Resolution No. 855 of July 29, 1998, the diagnosis of "Closed traumatic brain injury. Concussion" is possible only in the first three days after the injury, when general cerebral symptoms persist: fine horizontal nystagmus in the extreme abductions of the eye, mild meningeal symptoms, short-term loss of consciousness, asymmetry of tendon and skin reflexes

[11] . In our study, we also set the task of identifying temporary functional disorders of the hearing organ after an explosive / mine-explosive injury (contusion etiology), which could be diagnosed by instrumental methods.

[0007] A method exists for diagnosing central hearing impairments resulting from contusion etiology. It is based on the presentation of sound stimuli and the detection of the difference between these stimuli based on their rise and fall edges, as described in patent SU730347A1.

[0008] A disadvantage of this method is its use of a purely subjective examination method—essentially a variation of pure tone threshold audiometry. Furthermore, this diagnostic method was developed for persistent, long-term hearing impairments, which makes it impossible to determine the etiological factor: months or years after the injury, atrophy of the hair cells of the organ of Corti occurs. These changes are also characteristic of chronic sensorineural hearing loss of non-traumatic etiology

[10] .

[0009] There are methods for diagnosing hearing damage using objective research methods—recording auditory evoked potentials in the brainstem, such as in patent RU 2440025 C1. This method is also used in cases of traumatic brain injury to diagnose diffuse axonal damage. This means that the presence of brain injury is obvious and does not require confirmation. Another disadvantage of this method is the high cost of equipment for recording auditory evoked potentials and the need for specialized testing, which requires a lengthy period of time.

[0010] Patents RU 2803386 C1 and RU 2759485 C1 also utilize expensive hearing testing methods such as auditory evoked potentials and otoacoustic emission methods. These methods also do not aim to identify the etiology of hearing loss, specifically contusion-related causes.

[0011] The above-mentioned research methods do not allow for the detection of damage to the central auditory analyzer, characteristic of acubarotrauma. To address this issue, acoustic impedance measurement, specifically acoustic reflexometry

[12] , can be used. The latter allows for the assessment of the acoustic reflex and the persistence of it in acubarotrauma and / or acoustic trauma without damage to the ossicular chain or rupture of the stapedius muscle, as in the case of short-term functional changes of central origin associated with concussion.

[0012] The closest, in our opinion, is the method described in the work of S.L. Kovalenko "Study of hearing in preschool children at the present stage" (Russian Otolaryngology, No. 4 (41) 2009, pp. 69-74). It was taken by the authors as a prototype.

[0013] A drawback of this method is that it was used only to screen for the actual hearing loss. This study did not include daily acoustic reflexometry to determine the duration of temporary hearing impairment (i.e., the absence of ipsilateral acoustic reflexes), nor did it assess the frequencies (in Hz) and heights (in dB) of these reflexes, which could provide the basis for establishing a causal relationship with contusion etiology.

[0014] The claimed invention is aimed at solving the problem of developing a portable, low-time, relatively inexpensive (compared to methods using devices for recording auditory evoked potentials, otoacoustic emission) method for diagnosing contusional damage to the hearing organ.

[0015] To achieve the above result, the invention contains the following essential features.

[0016] The audiological examination is conducted in two stages. In the first stage, pure-tone threshold audiometry is performed to determine sound perception thresholds bilaterally. We used the Amplivox model 240 (Amplivox, UK). The examination continues if there is no bilateral conductive hearing loss, or no conductive hearing loss on the side without a perforated eardrum and no hearing loss on the side with a perforated eardrum. These factors must be considered to determine the feasibility of the next stage of the examination. If conductive hearing loss is detected on the side without a perforated eardrum, this may affect the interpretation of the acoustic reflexometry results.In other words, the absence of an ipsilateral acoustic reflex on the side without a perforated eardrum may be due to a rupture of the ossicular chain, chronic inflammation in the middle ear, or otosclerosis, rather than to a temporary contusional hearing loss. If conductive hearing loss is noted on the side with a perforated eardrum, and mixed or sensorineural hearing loss is noted on the opposite side without a perforated eardrum, the examination is also continued. In the second stage, low-frequency acoustic impedance analysis with acoustic reflex analysis is performed on the side without a perforated eardrum. For this purpose, we used the Amplivox Otowave 302 (Amplivox, UK). Tympanograms are recorded at a frequency of 226 Hz; if a type A tympanogram is recorded, the examination is continued.This feature is also important for excluding the aforementioned causes of sound conduction impairment, as in conductive hearing loss. Then, ipsilateral acoustic reflexes are recorded at frequencies of 500, 1000, 2000, and 4000 Hz with a sound level from 80 to 95 dB inclusive. The study was not performed above the 95 dB threshold to exclude repeated acoustic trauma. Moreover, if bilateral hearing loss is determined by the results of pure-tone threshold audiometry and there is no perforation of both eardrums, and there is no registration of the ipsilateral acoustic reflex on both sides at frequencies of 500, 1000, 2000, and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive for three days after exposure to the blast wave, a causal relationship with the contusion etiology of hearing loss is established.If a unilateral decrease in sound perception thresholds is noted and on this side the ipsilateral acoustic reflex is not recorded at frequencies of 500, 1000, 2000 and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive for three days and for one day from the moment of exposure to a blast wave on the opposite side, where the average sound perception thresholds according to tonal threshold audiometry correspond to the norm, then a causal relationship with the contusional etiology of hearing loss is also established.In the case where there is a unilateral perforation of the eardrum and bilateral hearing loss is determined based on the results of pure tone threshold audiometry and also on the side where there is no perforation of the eardrum, the ipsilateral acoustic reflex is not recorded at frequencies of 500, 1000, 2000 and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive for three days from the moment of exposure to the blast wave, then a causal relationship with the contusion etiology of hearing loss is established.In the event that there is a unilateral perforation of the eardrum and unilateral hearing loss is determined based on the results of tonal threshold audiometry on the side of the perforation of the eardrum, and at the same time, no ipsilateral acoustic reflex is recorded at frequencies of 500, 1000, 2000 and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive within one day from the moment of exposure to a blast wave on the opposite side, where the average thresholds of sound perception according to tonal threshold audiometry correspond to the norm, then a causal relationship with the contusion etiology of hearing loss is also established.When there is a unilateral perforation of the eardrum and unilateral hearing loss is determined based on the results of tonal threshold audiometry on the side without perforation of the eardrum and at the same time, the ipsilateral acoustic reflex is not recorded on it at frequencies of 500, 1000, 2000 and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive for three days from the moment of exposure to a blast wave, then a causal relationship with the contusion etiology of hearing loss is also established.

[0017] The following cause-and-effect relationship exists between the essential features and the outcome. The authors conducted a prospective cohort study involving patients with a preliminary diagnosis of acubarotrauma and / or acoustic trauma during medical care in a combat zone. The study divided the patients into two groups: a study group and a comparison group. The study group included all patients with a confirmed history of blast / mine-explosive exposure, while the comparison group included patients for whom the available documentation clearly established the absence of blast / mine-explosive exposure. Supporting documents included: primary medical documentation (Form 50 / 100), the results of the military unit investigation into the injury and / or an extract from the combat diary, as well as the presence of an accompanying shrapnel wound to soft tissue.The time from the time of the suspected injury ranged from 1 hour to 5 days inclusive. This interval is due to the fact that, according to the results of our study, on the 6th day from the time of the suspected injury, over 90% of the wounded and injured with acubarotrauma and / or acoustic trauma recorded an acoustic ipsilateral reflex both on the side of the injury where there was no perforation of the eardrum and on the opposite side. When comparing the results of acoustic reflexometry in the groups, the following statistically significant differences were revealed (p < 0.05). The absence of recording of an ipsilateral acoustic reflex on the side of the lesion where there was a hearing impairment of the mixed or sensorineural type in the first three days from exposure to the blast wave (p = 0.041, the method used: Pearson Chi-square).The absence of registration of the ipsilateral acoustic reflex on the side opposite to the acubarotrauma, where there was no perforation of the eardrum and the thresholds of sound perception according to pure tone threshold audiometry were within the norm in the first three days after exposure to the blast wave (p = 0.018, the method used: Pearson's chi-square). At the same time, the conducted correlation analysis of the day from the moment of exposure to the blast wave and the absence of registration of the ipsilateral acoustic reflex showed a moderate association only with the first three days on the side of the lesion - hearing impairment of the mixed or sensorineural type (Cramer's V = 0.388, p = 0.041) and only with the first one day on the opposite side, where there was no perforation of the eardrum and the average thresholds of sound perception according to pure tone threshold audiometry were within the norm (Cramer's V = 0.426, p = 0.018).

[0018] Research conducted on patent and scientific and technical sources of information showed that the proposed method is not known and does not follow clearly from the studied prior art, i.e. it meets the criteria of “novelty” and “inventive step”.

[0019] The invention can be repeatedly used in medicine, in particular in otolaryngology and audiology for diagnosing contusion etiology of damage to the hearing organ in adult patients without perforation of the eardrum in at least one ear, which allows us to conclude that the invention meets the criterion of "industrial applicability".

[0020] The essential features and advantages that can be provided by the present invention are illustrated by the following clinical examples:

[0021] Clinical example 1.

[0022] Patient R., 25 years old, was admitted to the medical care stage (at a multidisciplinary military hospital of the 3rd level) in the combat zone on the first day after receiving an injury with a preliminary diagnosis in Form 100: “MVD from **.**.****. Acubarotrauma on both sides, traumatic perforation of the right eardrum. Blind shrapnel wound of soft tissues of the right forearm.” On the same day, he was examined by an otolaryngologist and instrumental examinations were performed. Otoscopy: AD - external auditory canal is wide, free; tympanic membrane - perforations (2) with thin, sharp edges in the anterior and posterior quadrants, hemorrhage along the handle of the malleus, no chronic changes (granulations, polyps) in the visible part of the tympanic cavity through the perforations (Fig. 1).AS - the external auditory canal is wide and free; the eardrum - in the area of ​​the navel around it there are areas of hemorrhage in the thickness of the eardrum, perforations of the eardrum are not visualized (Fig. 2). When conducting pure tone threshold audiometry on the first day after the injury, the following results were obtained: left ear - the thresholds of sound perception by air and bone conduction are increased at frequencies from 2000 to 8000 Hz from 40 to 85 dB, the average thresholds of sound perception are 42.5 dB (grade II hearing loss), mixed hearing impairment; right ear - sound perception thresholds by air conduction are increased at all frequencies from 30 to 95 dB, by bone conduction at frequencies from 2000 to 8000 Hz from 40 to 80 dB, average sound perception thresholds are 42.5 dB (grade II hearing loss), mixed type hearing impairment (Fig. 3).When conducting low-frequency acoustic impedance analysis with acoustic reflexometry on the first day after the moment of exposure to the blast wave on the side where there is no perforation of the eardrum and the average thresholds of sound perception according to pure tone threshold audiometry corresponded to the second degree of hearing loss with a hearing impairment of the mixed type, type A tympanogram was registered; during acoustic reflexometry, there was no registration of the ipsilateral acoustic reflex at frequencies of 500, 1000, 2000 and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive (Fig. 4). When conducting low-frequency acoustic impedance analysis with acoustic reflexometry on the second and third days after exposure to the blast wave on the side where there is no perforation of the eardrum - no changes.On the 4th day, a type A tympanogram was recorded on the left ear; acoustic reflexometry revealed the recording of an ipsilateral acoustic reflex at a frequency of 500, 1000, 2000 and 4000 Hz in response to sound stimuli of 90, 90, 85 and 80 dB, respectively (Fig. 5).

[0023] On the first day, an X-ray of the right forearm was performed: in the soft tissues of the right forearm, in the projection of the middle third of the ulna, a foreign body of metallic density of irregular shape with dimensions of 1.2 × 0.6 × 0.4 cm was determined. Examined by a surgeon: local status - in the area of ​​the posterior surface of the right forearm in its middle third, a wound measuring up to 2.0 cm in diameter was determined, the skin around the wound was moderately hyperemic, palpation was moderately painful, in the projection of the wound upon palpation a foreign body was determined.

[0024] On the 3rd day from the moment of injury, representatives of the military unit where patient R. is serving also provided an extract from the combat log confirming the fact that the said patient R. was injured while performing his official duties in the combat zone during combat operations on **.**.****. The previously made preliminary diagnosis was confirmed.

[0025] From the moment of admission, the patient underwent etiotropic treatment, including a course of hearing stabilization therapy.

[0026] Clinical example 2.

[0027] Patient S., 34, was admitted to a multidisciplinary level 3 military hospital in the combat zone for consultation with an otolaryngologist on the twenty-ninth day after documented exposure to a blast wave. He was diagnosed in Form 100 with "Multiple blind shrapnel wounds of the soft tissues of the lower extremities" on **.**.****. He had previously been treated at a military hospital for the slightly wounded on the second day after exposure to the blast wave / injury under the supervision of a surgeon. On the day of his departure for the consultation with the otolaryngologist, he was discharged to his military unit, where, according to the patient, upon arrival he was caught in a rocket attack. After which he began to complain of pain in his right ear, decreased hearing in his right ear, and on the same day, the command of the military unit sent him for a consultation with an otolaryngologist.

[0028] At the time of examination by an otolaryngologist, on the first day from the presumed moment of impact of the blast wave, reported by patient S., during otoscopy: AD - the external auditory canal is wide, blood clots on the posterosuperior wall; the eardrum - hemorrhage in the anterior quadrants, perforation in the posterior quadrants, its anterior edge is turned inward, the edges of the perforation in the posterior quadrants are scalloped, there are no signs of epithelialization / callus formation of the perforation edges (Fig. 6). AS - The external auditory canal is wide, free. The eardrum is gray, contoured.When conducting pure tone threshold audiometry, the following results were obtained: left ear - sound perception thresholds by air and bone conduction at all frequencies are within normal limits; right ear - sound perception thresholds by air conduction are increased at all frequencies from 40 to 50 dB, by bone conduction at all frequencies are within normal limits, average sound perception thresholds are 43.75 dB (grade II hearing loss), conductive hearing impairment (Fig. 7). When conducting low-frequency acoustic impedance analysis with acoustic reflexometry on the side where there is no perforation of the eardrum and the thresholds of sound perception according to the tonal threshold audiometry corresponded to the norm, type A tympanogram was recorded; during acoustic reflexometry, the registration of the ipsilateral acoustic reflex was noted at frequencies of 1000, 2000 and 4000 Hz in response to sound stimuli of 95, 90 and 85 dB, respectively.The patient was hospitalized with a diagnosis of "Traumatic perforation of the right eardrum of unknown duration. Right-sided conductive hearing loss of grade II."

[0029] On the fourth day from the presumed moment of exposure to the blast wave, the command of the military unit where the patient was serving presented documents: an extract from the combat diary and the investigation materials into the injury sustained by Patient S. According to the presented documents, on that day, Patient S. had indeed been shelled by his unit, but at the same time, Patient S. was located elsewhere and was not exposed to the blast wave. The patient was informed of these facts. He then claimed that he had sustained an injury to his right ear twenty-nine days earlier, along with the injury for which he had been treated at a military hospital for the slightly wounded.The otolaryngologist informed the patient that the medical records provided—form #003 / u from a previous hospitalization, form 100, and a neurologist's examination on the 21st day after documented blast exposure—did not indicate any complaints of hearing loss on the right side or pain in the right ear. There was also a discrepancy between the time since the blast exposure and the presence of recent changes in the right eardrum (there is no epithelialization along the edges of the perforated eardrum, and there are also recent foci of hemorrhage in the eardrum). The changes, according to the pure tone audiometry results, are conductive in nature; there is no damage to the auditory nerve (sensorineural or mixed hearing loss), which would be characteristic of acubarotrauma.The patient then admitted that he had damaged his eardrum with a cotton swab on the day of his visit to an otolaryngologist.

[0030] Based on the above, the fact of a domestic injury was reliably confirmed by the anamnesis and available documentation. Furthermore, the fact of a domestic injury, established during the patient's questioning and the results of our proposed method, revealed the presence of an ipsilateral acoustic reflex at frequencies of 1000, 2000, and 4000 Hz in response to sound stimuli of 95, 90, and 95 dB, respectively, on the side without a perforated eardrum and sound perception thresholds according to pure-tone threshold audiometry within the first 24 hours after the suspected injury (Fig. 8).

[0031] Literature

[0032] 1. The Great Russian Encyclopedia. Vol. 5: The Grand Duke - The Ascending Node of the Orbit. Vol. 5. - 2006 (Moscow: Moscow Textbooks and Kartolithography). - 782 p.: ill., port., color ill.; ISBN 5-85270-334-6.

[0033] 2. Zasosov, R.A. On the effect of detonations, super-powerful sounds, ultrasounds and vibrations on the ear apparatus and the body (manual for doctors and students) [Text] / R.A. Zasosov; Medical-sanitary department of the Navy. Military-maritime medical academy - Leningrad: Military-maritime medical academy, 1945. - 58 p.

[0034] 3. Kichkina M.M. Features of damage to the hearing organ in explosive mine injury: specialty 14.01.03 "Diseases of the ear, throat and nose": abstract of a dissertation for the degree of candidate of medical sciences / Kichkina Marina Mikhailovna - St. Petersburg, 2016. - 22 p.

[0035] 4. Tulupov A.N. Features of the treatment of victims of the terrorist attack in the St. Petersburg metro (03.04.2017) with severe mine-explosive injuries / A.N. Tulupov, I.V. Kazhanov, V.A. Manukovsky, A.V. Nikitin / / Medical, biological and socio-psychological problems of safety in emergency situations. - 2018. - No. 4. - P. 47-58.

[0036] 5. Chechko A.N. Atlas of combat acubarotrauma / A.N. Chechko, E.G. Belicheva. - Moscow: Editus, 2022. - 138 p. - ISBN 978-5-00149-913-8.

[0037] 6. Ear trauma: Clinical guidelines / V.V. Dvoryanchikov, F.A. Syroezhkin, V.I. Egorov [et al.]; National Medical Association of Otolaryngologists. - Moscow: Without publishing house, 2024. - 36 p.

[0038] 7. Military Field Surgery. National Guide / D.V. Trishkin, E.V. Kryukov, D.E. Alekseev [et al.]. - 2nd edition, revised and supplemented. - Moscow: Limited Liability Company Publishing Group "GEOTAR-Media", 2024. - 1056 p. - (National Guide). - ISBN 978-5-9704-8036-6.

[0039] 8. Chechko A.N. Emergency surgery of combat ENT pathology: a guide for doctors / A.N. Chechko, E.G. Belicheva, M.Yu. - Moscow: Editus, 2024. - 279 p. - ISBN 978-5-00217-389-1.

[0040] 9. The Great Medical Encyclopedia: [in 30 volumes] / ed. in-chief academician B.V. Petrovsky; [Academy of Medical Sciences of the USSR]. - 3rd ed. - Moscow: Sov. Encyclopedia, 1974-1989. V. 1: A - Antibiosis. V. 1. - 1974. - 576 p.

[0041] 10. Voyachek V.I. Military otolaryngology. - 3rd ed. / V.I. Voyachek. - L.: MEDGIZ, 1946. - 255 p.

[0042] 11. Neurology: national guidelines: in 2 volumes / edited by E.I. Gusev, A.N. Konovalov, V.I. Skvortsova. - 2nd ed., revised and enlarged. - Moscow: GEOTAR-Media, 2022. - V. 1. - 880 p. - (Series "National Guidelines"). - ISBN 978-5-9704-6672-8.

[0043] 12. Otolaryngology: national guidelines / edited by V.T. Palchun. - 2nd ed., revised and enlarged. - M .: GEOTAR-Media, 2020 .-- 1024 p. - (Series "National Guidelines"). - ISBN 978-5-9704-5007-9.

Claims

A method for diagnosing contusional damage to the organ of hearing in adult patients without perforation of the eardrum in at least one ear, including an audiological examination, characterized in that the examination is carried out in two stages, at the first stage, pure tone threshold audiometry is performed to determine the thresholds of sound perception on both sides, in the case of bilateral conductive hearing impairment, or conductive hearing impairment on the side without perforation of the eardrum in the presence of any type of hearing impairment on the side where there is perforation of the eardrum, then the absence of a causal relationship between hearing impairment and contusional temporary damage to the organ of hearing is established, in the case where there is no hearing impairment on the side without perforation of the eardrum, or there is hearing impairment not of the conductive type and in the presence of any type of hearing impairment on the opposite side, where there is or is not perforation of the eardrum,then the study is continued, and at the second stage low-frequency acoustic impedance measurement with acoustic reflexometry is carried out on the side where there is no perforation of the eardrum, including tympanometry, if type A tympanogram is registered, then the study is continued, then ipsilateral acoustic reflexes are recorded, and if bilateral hearing loss is determined based on the results of tonal threshold audiometry and there is no perforation of both eardrums, and also on both sides there is no registration of the ipsilateral acoustic reflex at frequencies of 500, 1000, 2000 and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive within three days from the moment of exposure to the blast wave, then a causal relationship with the contusion etiology of hearing loss is established, and if a unilateral decrease in sound perception thresholds is noted and the ipsilateral acoustic reflex is not recorded on this side at frequencies of 500, 1000,2000 and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive for three days and for one day from the moment of exposure to a blast wave on the opposite side, where the average thresholds of sound perception according to tonal threshold audiometry correspond to the norm, then a causal relationship with the contusion etiology of hearing loss is also established, if there is a unilateral perforation of the eardrum and bilateral hearing loss is determined according to the results of tonal threshold audiometry and on the side where there is no perforation of the eardrum, the ipsilateral acoustic reflex is not recorded at frequencies of 500, 1000, 2000 and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive for three days from the moment of exposure to a blast wave, then a causal relationship with the contusion etiology of hearing loss is established,and if there is a unilateral perforation of the eardrum and unilateral hearing loss is determined based on the results of tonal threshold audiometry on the side of the perforation of the eardrum and at the same time an ipsilateral acoustic reflex is not recorded at frequencies of 500, 1000, 2000 and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive within one day from the moment of exposure to a blast wave on the opposite side, where the average thresholds of sound perception according to tonal threshold audiometry correspond to the norm, then a causal relationship with the contusion etiology of hearing loss is also established, if there is a unilateral perforation of the eardrum and unilateral hearing loss is determined based on the results of tonal threshold audiometry on the side without perforation of the eardrum and at the same time an ipsilateral acoustic reflex is not recorded on it at frequencies of 500, 1000,2000 and 4000 Hz in response to sound stimuli from 80 to 95 dB inclusive within three days from the moment of exposure to a blast wave, then a causal relationship with the contusion etiology of hearing loss is also established.

Images