In otorhinolaryngology, a disease such as neuritis is often encountered. auditory nerve. This pathology manifests itself as hearing loss. With this disease, a person cannot perceive sounds normally. This reduces the quality of life.

Auditory nerve damage

The activity of all organs is controlled by the central nervous system. The auditory nerve is connected to the structures of the brain. Its main function is to transmit information from the analyzer to other departments. This is the VIII pair of cranial nerves. More than 70% of cases of hearing loss in adults are caused by sensorineural hearing loss.

The disease is characterized by unilateral lesions. Cochlear neuritis almost always manifests itself as tinnitus. The risk group includes elderly and young people working in hazardous working conditions. Hearing loss is an occupationally induced disease. Most often it develops in people who work in noisy environments.

Acute acoustic neuritis is a non-infectious inflammatory disease, which is accompanied by hearing loss and noise. The prevalence of this pathology reaches 5%. Men get sick more often than women. According to statistics, neuritis is most often diagnosed in people over 55 years of age. In ICD-10 this pathology is referred to as sensorineural hearing loss.

What is neuritis like?

There are several types of cochlear neuritis of the auditory nerve. It can be congenital and acquired, unilateral and bilateral, prelingual and postlingual, central and peripheral, acute, subacute and chronic. Depending on the character pathological changes There are stable, reversible and irreversible neurites.

There is a classification based on main reason inflammation. According to it, the following types of neuritis are distinguished:

• Professional
• Medication
• Toxic
• Infectious
• Ischemic
• Ray
• Traumatic
• Allergic

Most often, the development of the disease is observed in old age. The congenital form is diagnosed very rarely. It may be caused by fetal developmental abnormalities. The prelingual form develops in young children before they can speak. Acquired neuritis can be acute, subacute and chronic. It is based on how long ago the disease occurred.

Inflammation auricular nerve called acute if the first symptoms appeared no more than a month ago. Under acute neuritis characterized by the duration of the onset of the first symptoms from 1 to 3 months. If this period is more than 12 weeks, then the inflammation is called chronic. The loudness of any sound is measured in decibels (dB). With neuritis, hearing loss develops. This is a condition in which the hearing threshold increases.

Depending on this, 4 degrees of hearing loss are distinguished against the background of inflammation of the vestibular cochlear nerve. Neuritis mild degree characterized threshold values perceived sounds from 26 to 40 dB. If this indicator increases to 41–55 dB, this indicates moderate hearing loss. The severe form is characterized by an increase in the threshold to 56–70 dB. An increase in this indicator to 71–90 dB indicates an extreme degree of hearing loss. Such patients practically do not perceive surrounding sounds. As neuritis and hearing loss progress, complete deafness develops.

Main etiological factors

Inflammation of the auditory nerve is a polyetiological disease. The following factors play an important role in the development of acquired neuritis:

• Viral diseases (measles, rubella, influenza, ARVI, herpes)
• Bacterial infections (syphilis, scarlet fever)
• Irrational treatment with ototoxic drugs (aminoglycosides, sulfonamides, diuretics, salicylates)
• Poisoning with chemicals (arsenic, mercury, cadmium, phosphorus)
• Harmful occupational factors
• Vascular pathology
• Internal otitis
• Mechanical injuries
• Operations
• Barotrauma; sudden changes in atmospheric pressure
• Allergic reactions
• Brain tumors
• Paget's disease
• Exposure to ionizing radiation
• Sickle cell anemia

In older people, the aging processes of the body are of great importance in the development of this pathology. Common reason lesions of the VIII pair of cranial nerves - impact physical factors. These include noise and vibration. The risk group includes people who long time work in hazardous conditions. In this case, the disease develops gradually.

Often such people become disabled. Most often, neuritis and hearing loss develop when working in hot shops, in the engineering and metallurgical industries. WITH similar problem bell ringers collide. Almost all of them are deaf due to constant exposure to loud noise.

The condition of the ear largely depends on blood circulation. Causes of nerve damage include vascular disorders. These include atherosclerosis, thrombosis, arterial hypertension, spicy and chronic disorder cerebral circulation. Very often, the auditory nerve becomes inflamed after a stroke. Sometimes a congenital form of the disease is detected.

It is caused by genetic factors and trauma during childbirth. Cochlear neuritis develops with Stickler, Usher, Pendred, Alport and Waandenburg syndromes. In the presence of this pathology, hearing loss is combined with other disorders. Possible causes of the development of the disease include prolonged labor, fetal hypoxia, improper management of pregnancy, and trauma to the child during passage through the birth canal.

Clinical manifestations of neuritis

With this disease, the function of only one nerve is most often impaired. The main symptoms are noise and hearing loss. Additional symptoms diseases include dizziness, nausea, imbalance, headache, weakness, pale skin. Often increases blood pressure. Possible visual disturbances in the form of flashing flies.

If inflammation of the nerve in the ear area occurs as a result of infectious diseases (influenza or ARVI), then there may be an increase in body temperature, a cough and general malaise. Occupational neuritis of the auditory nerve develops over a long period of time. Hearing can decrease after 20 or even 30 years from the start of work in hazardous work.

It is impossible to cure such patients. With unilateral inflammation, sound is better perceived by the healthy ear. If both nerves are inflamed, then the person perceives information better from the side that is less affected. The acute form of neuritis develops suddenly within 4–5 hours or several days. The progressive form of the disease is more dangerous, as it often leads to deafness.

At chronic form neuritis general health patients is not significantly disturbed. There are no signs of intoxication. Constant symptom neuritis is ringing (noise) in the ears. It occurs regardless of external factors. Noise can appear even when a person is in absolute silence. The degree of hearing impairment is assessed using audiometry.

Stage 1 disease is characterized by the fact that a person hears whispering at a distance of no more than 3 m, and spoken speech is detected at a distance of 3–6 m. Treatment at this stage of the disease is most effective. Hearing loss of severity 2 is characterized by the perception of information when speaking in a whisper at a distance of 1 m. Speech is audible if the sound source is 1–4 m away.

Neuritis with grade 3 hearing loss is severe. With it, a person does not hear whispers at all. He can distinguish spoken speech at a distance of 1 m. The most dangerous is grade 4 hearing loss. It is given to those people who can at least hear something. Without proper treatment, a person becomes completely deaf.

Patient examination plan

If the auditory nerve is damaged, treatment is carried out after excluding other diseases and comprehensive examination. It is necessary to establish the exact cause of the pathology. Great value has a correctly collected anamnesis. The impact of potentially harmful factors (noise and vibration) must be assessed. If neuritis is suspected, the following studies are performed:

• Audiometry
• Otoscopy
• Auditory evoked potential testing (for children)
• Microotoscopy
• Acoustic impedance measurement
• Vestibulometry
• Stabilography

If necessary, consultation with several specialists is required. Acoustic neuritis should be treated after pure tone threshold audiometry. It allows you to estimate the minimum sound intensity that the patient's ear perceives. This is the most reliable research method. It helps determine the degree of hearing loss.

Very often, neuritis is caused by purulent inflammation of the hearing organ (otitis). It can be identified during the inspection process. This is called otoscopy. Additional tests include MRI or CT scan of the brain, Doppler ultrasound vessels of the head and neck, blood and urine tests. In order to exclude diseases associated with impaired sound conduction, acoustic impedance testing is required. Differential diagnosis is carried out with otosclerosis, Meniere's disease and labyrinthitis.

Therapeutic tactics for neuritis

Every otorhinolaryngologist knows how to treat neuritis. In case of infectious etiology of the disease, it is carried out drug therapy. You must first determine the species of the pathogen and its sensitivity to antibiotics. The following groups apply medicines:

• Neuroprotectors
• Venotonics
• Vasodilators
• Nootropics

Medicines such as Vinpocetine, Trental, Piracetam, Cerebrolysin, Cavinton, Mexidol are often used. If neuritis is infectious, you need to remain calm, drink more fluids and eat well. Additionally, it is recommended to take vitamins. In case of acoustic neuritis, its symptoms and treatment are determined by the doctor.

A remedy such as Betahistine is often used. It allows you to get rid of noise in the ear and dizziness if the neuritis is caused by pathology of the labyrinth located in the internal part of the hearing organ. In case of nerve inflammation due to intoxication, treatment involves the use of specific antidotes, taking symptomatic medications, physiotherapy, and detoxification of the body.

If neuritis is caused by traumatic brain injury, then the main way to cure patients is to eliminate brain edema and inflammation. The most difficult form of inflammation to treat is inflammation of the hearing organ, caused by occupational hazards (noise and vibration). In this case, you need to change your job. Additionally, adaptogens, neuroprotectors, physiotherapy (electrophoresis), and radon baths are prescribed.

Treatment includes several courses with a frequency of 1-2 times a year. When complete deafness develops, prosthetics are required. If neuritis is provoked by acoustic trauma, then painkillers, medications that improve blood circulation, antibiotics and sedatives are prescribed. Treatment of acoustic neuritis folk remedies ineffective. You should consult your doctor before using herbal remedies.

Conservative treatment is effective for early stages diseases. With bilateral hearing loss and a threshold of 40 dB, prosthetics are performed. Surgical treatment involves cochlear or stem implantation. In cases of complete deafness and grade 4 hearing loss, operations on the cochlea can be performed.

Methods for preventing neuritis

Cochlear neuritis can be prevented. To do this, you must follow the following recommendations:

• Treat hearing diseases in a timely manner, respiratory tract and heads
• Avoid contact with toxic substances
• Don't listen to loud music on headphones
• Avoid long-term use of ototoxic drugs
• Treat cardiovascular diseases (atherosclerosis, hypertension)
• Quit smoking and alcohol
• Avoid head injury

For acoustic neuritis, treatment with folk remedies does not give good results. Often a hearing aid is required. To avoid this, you need to be in a quiet environment more often and avoid exposure to sharp and loud sounds on your hearing. Prevention of occupational neuritis is of greater importance. It assumes:

• Application of sound-absorbing building materials
• The use of special structures that dissipate noise
• Application of silencers
• Timely repair of broken equipment and its replacement with new ones
• Using earplugs or headphones

Noise has an adverse effect on a person if it is combined with vibration and a cold microclimate. Sources of loud noise can be ventilation, presses, jackhammers and other equipment. It is necessary to influence both the source of noise and the path of its propagation. Cochlear neuritis is a common disease. At early diagnosis hearing is restored in half of the patients. Chronic (occupational) neuritis leads to irreversible consequences. Such people become completely deaf. In this case, prosthetics are required.

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IN major cities As a result of exposure to strong background noise on the hearing aid, many people are diagnosed with acoustic neuritis, which leads to atrophic and degenerative changes cells of the sound-receiving apparatus, and, as a result, to hearing loss, the appearance of imaginary tinnitus, and speech unintelligibility. This phenomenon occurs in 6% of cases worldwide, most often affecting men over 55 years of age. But older people usually do not go to the doctor, because they believe that this is a consequence age characteristics body. But neuritis often leads to complete loss hearing loss, which significantly reduces the patient’s quality of life.

Description of the pathology

Acoustic neuritis is a disease in which the nerve that provides hearing function develops inflammatory process. The auditory nerve is located in the inner ear, it transmits sound impulses to the brain and signals that come from vestibular apparatus, also localized in the inner ear. Damage to the nerve leads to hearing loss, dizziness, nausea, and spatial disorientation.

The auditory nerve originates from fibrous cells, which are antennas that capture sound vibrations, convert their electrical signals and transmit them to the nerve itself. Therefore, auditory neuritis also affects hair cells and nerve centers in the brain. Treatment, which has good reviews from doctors if the patient contacts the doctor in a timely manner medical institution, must be aimed at stopping pathological process, since when hair cells die, they are never restored, so hearing acuity is significantly reduced. Without treatment, the disease provokes the development of complete deafness. This pathology can affect either one or both ears.

Causes of the disease

The causes of acoustic neuritis can be different. Often the disease can be triggered by any infection in the head and neck area. Often the pathology develops due to influenza, ARVI, meningitis, mumps, as well as rubella.

Also, the causes of the development of the disease are:

1. Long-term exposure to the auditory nerve of toxins and harmful substances, medications, alcohol and nicotine, mercury, heavy metals. Such substances contribute to the development of inflammation of the auditory nerve.
2. Injuries and injuries to the head, which contribute to poor circulation, the development of swelling, and microscopic hemorrhages from the cerebral arteries. When the vessels that supply the nerve are damaged, neuritis develops. Also, the auditory nerve can become inflamed due to damage from inert debris or infection during injury.
3. Age-related changes. In this case, the development of the disease is associated with hypertension, circulatory disorders in the brain, changes in the hearing aid, as well as suffered a stroke.
4. Professional activities. Acoustic neuritis often develops in people who are constantly exposed to increased noise and vibration. Often the disease appears as a result acoustic trauma(impact of loud sound on the organs of hearing), for example, with a whistle, gunshot.
5. Allergic reactions, sharp drop pressure.
6. Benign or malignant tumors.

Symptoms and signs of the disease

Usually, with neuritis of the auditory nerve, symptoms do not appear immediately, since it is characterized by a slow course. The main signs of the disease include:

1. Hearing loss due to inflammation of the auditory nerve. This phenomenon can have varying degrees of manifestation, in some cases there is complete loss of hearing. Hearing loss occurs gradually, so if you consult a doctor in a timely manner, you can prevent the development of negative consequences.
2. The presence of noise or ringing in the ears, regardless of external factors. This phenomenon occurs in humans all the time, but with complete hearing loss it disappears.
3. Severe pain in the ears due to mechanical damage as a result of injury.
4. Increase blood pressure, the appearance of dots before the eyes indicates a violation of the blood vessels of the brain.
5. Nausea, lack of coordination of movements, dizziness, and headache appear when the cochlear nerve, which transmits signals to the brain from the vestibular apparatus, is involved in the pathological process.
6. Weakness and discoloration of the skin develop during acute intoxication.
7. Cough, increased body temperature with infectious diseases.
8. Decreased speech intelligibility, feeling of fullness in the ear.

Other signs of the disease will depend on the course of inflammatory and degenerative processes.

Degree of development of pathology

In medicine, acoustic neuritis has several degrees of development:

1. The first degree, in which a person can hear whispers at a distance of three meters, and spoken speech at a distance of six meters.
2. The second degree, in which a person can hear whispers at a distance of one meter, and spoken speech at a distance of four meters.
3. Third degree, when a person cannot hear a whisper, but can hear spoken speech at a distance of one meter.
4. The fourth degree of pathology, when a person can distinguish only some sounds.
5. The fifth degree is characterized by complete deafness.

Diagnostic measures

Before prescribing treatment for acoustic neuritis, the doctor must conduct a diagnosis and make an accurate diagnosis. Research should be aimed at establishing the causes of the disease and determining the degree of hearing impairment. To do this, the doctor prescribes the following diagnostic methods:

1. Otoscopic examination to examine the organ of hearing using an endoscope, which is inserted into the ear cavity.
2. Rinne test to determine conductive or sensorineural deafness.
3. Whisper test colloquial speech to determine the degree of development of the disease.
4. Weber's test to differentiate hearing loss due to damage to the sound-conducting or sound-receiving apparatus.
5. Schwabach and Jelle test to determine hearing impairment using tuning forks.

An otolaryngologist also differentiates neuritis from a disease such as otosclerosis.

Thus, to make a final diagnosis, audiological studies are carried out to determine the nature of hearing damage and determine the threshold of hearing sounds of different frequencies.

Pathology therapy

Typically, treatment for acoustic neuritis involves a comprehensive treatment, which will depend on the cause of the disease. In the presence of bacterial and viral diseases that lead to hearing loss, antibacterial drugs are prescribed. Their choice depends on the results of bacterial culture, which will show the presence of bacterial sensitivity to antibiotics. To reduce the effect of toxins on the auditory nerve, the doctor prescribes vitamin complexes, appoints drinking plenty of fluids and peace, good nutrition.

In case of chronic intoxication with various substances, treatment of auditory neuritis requires long-term treatment. The doctor prescribes special antidotes that will remove toxins from the body, drugs aimed at eliminating the symptoms of poisoning, as well as physiotherapy, mud therapy, mineral baths and so on.

If the patient has been diagnosed acute poisoning, he is given first aid, and then sent to a hospital, where antidotes, symptomatic therapy, and vitamins are prescribed. In severe cases, resuscitation measures may be required.

In case of injuries and damage to the skull, it is necessary to urgently contact a medical institution in order to prevent the development of neuritis and other complications. Before treating acoustic neuritis, the doctor performs an X-ray of the skull and encephalography. Then painkillers, medications are prescribed that help normalize blood circulation in the brain, diuretics to relieve swelling, vitamin and mineral complexes.

When the auditory nerve is damaged as a result professional activities it is necessary to exclude the cause of the development of pathology. In this case, the person must change the situation. As therapy, the doctor prescribes adaptogens and vitamins. Physiotherapy is also prescribed, in particular electrophoresis, balneotherapy, mud therapy and radon baths to eliminate inflammation in nerve fibers, magnetic therapy and acupuncture to relieve pain. Such patients should undergo therapy twice a year. In cases of complete hearing loss, prosthetics are performed.

If the acoustic neuritis, the symptoms and treatment of which are now being considered, arose as a result of acoustic trauma, the patient is prescribed painkillers and sedatives, antibiotics and antiseptics to eliminate infection in the ear, vitamins, adaptogens, as well as medications that normalize blood circulation in small vessels and functionality nervous system.

At age-related changes neuritis is difficult to treat. In this case, the patient is prescribed medications that he will have to take for the rest of his life. These include medications to normalize blood pressure, reduce the concentration of glucose and cholesterol in the blood, as well as blood clotting, normalize blood flow in the vessels of the brain, vitamins and biological supplements. Also, such patients are recommended to undergo spa treatment and physiotherapy.

Acute neuritis of the auditory nerve (reviews about this pathological process without treatment from doctors are only negative) can lead to fatal outcome. In this case, the person must be urgently hospitalized. He is prescribed drugs aimed at improving blood circulation and metabolism in the brain, diuretics, anticonvulsants and detoxification agents. The patient must comply special diet which involves limiting fluid intake.

Acoustic neuritis: folk remedies

This disease, in the absence of effective and timely treatment leads to complete Doctors recommend immediately contacting a medical facility when the first symptoms of the disease appear. Doctors say that in case of acoustic neuritis, treatment with folk remedies should not be used as the main method. Means traditional medicine can only be used as an additional therapy to reduce the manifestations of the disease. Self-medication in this case is strictly prohibited, so you should consult your doctor about the use of certain medicinal plants. Otherwise, there is a risk of developing complications and negative consequences, which may be irreversible when treatment of acoustic neuritis with folk remedies is used.

Hearing restoration

At long term hearing diseases usually cannot be restored. In this case, it is possible to wear a hearing aid or use cochlear implantation. To prevent further hearing loss, it is recommended to periodically undergo courses of therapy, which includes the use of diaphoretic and diuretic drugs, vitamins, biostimulants, and means to normalize blood circulation.

After audiometry is performed to determine the degree of development of the pathology, the doctor determines the possibility of wearing a hearing aid. An important point in this regard is right choice and setting up the device. They can be behind the ear or in-ear.

At severe violation hearing aid It consists of a chain of electrodes, a receiver, a speech processor and a battery compartment. The doctor performs an operation to install the implant, then the patient is taught how to live with this device and what complications may arise.

Disease prognosis

The prognosis depends on the stage of the disease and how timely treatment was started. With TBI, infections and poisoning, the prognosis is usually favorable; deafness is observed only in the absence of therapy. At chronic pathologies the prognosis is often unfavorable. With age-related changes, it is only possible to stop the pathological process, but it is not possible to completely cure the patient.

Prevention

For the purpose of prevention, it is recommended to eliminate negative factors, which can trigger the development of the disease. Doctors recommend timely treatment of infectious and viral diseases, to exclude bad habits, contact with toxins and harmful substances, do not use antibacterial drugs for a long time, and also periodically undergo examination by an otolaryngologist, especially for people over 55 years of age. Subject to availability harmful conditions labor must use means personal protection. Compliance with all doctor’s recommendations and prescriptions helps reduce the risk of developing serious complications that can cause disability.

Ear disease autonomic ganglion, manifested by paroxysms of vegetalgia, involving the parotid region and ear. During an attack, pain may radiate to the back of the head, lower jaw, neck, shoulder girdle, hand and upper sections chest. Paroxysm is accompanied by hypersalivation, sometimes by clicks in the ear and congestion. Hearing is not impaired. Diagnosis is carried out by a neurologist, but includes consultation with an otolaryngologist, dentist and other specialists depending on the clinical situation. The treatment plan consists of drugs for the relief of painful paroxysms, vascular, decongestant, metabolic drugs, physiotherapeutic procedures and reflexology. The important point is to eliminate the root cause of neuralgia.

General information

The auricular autonomic ganglion is a collection of interneurons of the sympathetic and parasympathetic nerve pathways. The node receives sympathetic preganglionic fibers through the plexus of the middle meningeal artery, and parasympathetic fibers from a branch of the glossopharyngeal nerve. Postganglionic fibers of the auricular ganglion are part of the auriculotemporal nerve, which is a branch trigeminal nerve. They go to the ear gland and vessels of the temporal region, providing their autonomic innervation.

Neuralgia of the ear ganglion is part of the group of vegetative ganglionitis of the head, which also includes neuralgia of the submandibular and sublingual ganglionitis, ganglionitis of the ciliary ganglionitis, ganglionitis of the pterygopalatine ganglion and upper cervical sympathetic node, cervical truncite. Specialists in the field of neurology have collected statistical data indicating that neuralgia of the ear ganglion is most common in middle-aged and young women.

Causes

Etiopathogenetically, neuralgia of the ear node is an irritative disease that develops reflexively in the presence of pathological autonomic impulses coming from chronic infectious foci or when chronic processes in somatic organs. Highest value has a pathology that is localized in the same region as the ear node and is infectious and inflammatory in nature. These include diseases of the parotid gland (mumps, sialadenitis, stones), chronic purulent otitis, chronic tonsillitis, sinusitis (frontal sinusitis, sinusitis, ethmoiditis), dental diseases (chronic periodontitis, stomatitis, gingivitis, periodontitis).

Less common is neuralgia of the ear node, caused by the presence of a distant source of infection (pyelonephritis, urethritis, cystitis), general infectious process(tuberculosis, syphilis, chronic sepsis), metabolic disorders due to endocrine pathology(hyperthyroidism, diabetes mellitus) or somatic disease(liver cirrhosis, cholecystitis, chronic renal failure, chronic gastritis, gastroduodenitis, adnexitis).

Symptoms of neuralgia of the ear node

Neuralgia of the ear ganglion is manifested by attacks of vegetalgia that occur in front of the opening of the external auditory canal, in the parotid region and in the ear on the affected side. Intense burning or throbbing pain radiates to the lower jaw, behind the ear, to the back of the head, neck and shoulder girdle of the corresponding side. The reflex mechanism of pain irradiation leads to its spread to the upper chest and arm. Pain paroxysms can be provoked by ingestion of hot food or drinks, hypothermia of the face, psycho-emotional stress, excessive physical activity. The duration of an attack of vegetalgia, as a rule, is several minutes, but can be an hour or more.

The dependence of the functioning of the autonomic nervous system on external factors (lighting, barometric pressure, temperature changes, air humidity, etc.) determines the characteristic rhythm of vegetalgia - its occurrence mainly in the evening and at night, exacerbation in the autumn and spring.

In some cases of neuralgia, a paroxysm of pain is accompanied by ear congestion or a sensation of clicking in it. The latter is caused by periodic reflex spasms of the muscles of the auditory tube. Often during an attack, patients note a noticeable increase in salivation, while in the interictal period hypersalivation is not observed. Hearing function is not affected.

Diagnosis of neuralgia of the ear node

Often patients turn to a dentist or otolaryngologist for help, and then receive a referral from them to consult a neurologist. The latter makes a diagnosis based on typical complaints, the presence of sharp pain on palpation of the sclerotomal points of the auriculotemporal, mental and mandibular nerves, Richet's point - the place where the ear ganglion anastomoses with the mandibular nerve. The detection of hyperalgesia in the parotid region also speaks in favor of neuralgia. In a difficult diagnostic situation, they resort to diagnostic novocaine or lidocaine blockade of the ear ganglion.

In the diagnostic process, determining the etiology of neuralgia plays an important role. For this purpose, it is carried out dental examination and ultrasound of the parotid salivary gland, otolaryngological examination (audiometry, otoscopy, rhinoscopy, pharyngoscopy, radiography of the paranasal sinuses). If necessary, consultations with specialized specialists (urologist, gastroenterologist, gynecologist, endocrinologist, etc.) and additional research somatic organs (gastroscopy, ultrasound of the abdominal cavity, ultrasound of the kidneys, study of hormone levels thyroid gland etc.).

Differential diagnosis is carried out with otitis, eustachitis,

Metabolic and vascular therapy: vitamins gr. B, pentoxifylline, nicotinic acid. To reduce swelling, antiallergic drugs (promethazine, chloropyramine, loratadine, desloratadine) are used. If signs of irritation of parasympathetic fibers predominate in the neuralgia clinic, anticholinergic drugs are prescribed: platyphylline, diphenyltropin, etc.

Intolerance to pharmacotherapeutic treatments is an indication for reflexology using acupuncture, magnetic puncture, and laser puncture methods. During the period of convalescence, DDT, amplipulse therapy, and electrophoresis with hyaluronidase are recommended.

Of fundamental importance in treatment is the elimination of the root cause of the disease: rehabilitation oral cavity, treatment of otolaryngological diseases and pathologies of the oral cavity, correction of endocrine disorders, therapy of chronic diseases of somatic organs. According to indications, surgical interventions are performed: removal of tumors and stones of the parotid gland, dissection of adhesions, sanitizing surgery on the middle ear, ethmoidotomy, maxillary sinusotomy, frontotomy, etc.

Update: December 2018

Hearing is one of the sense organs that ensures a normal quality of human life. When it is damaged, a person cannot fully perceive the sounds of the surrounding world: speech, music, industrial noise, and so on. In 73% of cases, hearing impairment is caused by sensorineural hearing loss. In this condition, one portion of the auditory nerve is damaged, often permanently.

To this day, there remains “confusion” with the designation of the diagnosis. On the Internet, medical reports and old monographs you can find the following terms: cochlear neuritis, neuritis/neuropathy of the auditory nerve, perceptual hearing loss. All these are outdated concepts that lost their relevance in 1992 with the release of the 10th edition of the International Classification of Pathologies (ICD-10). These recommendations propose a general concept – “sensorineural hearing loss”.

Anatomical features of the auditory nerve

The auditory nerve is the VIII cranial pair. His way has no clinical significance with this disease, since the level of damage does not affect the symptoms of auditory neuritis. They occur when any area is damaged, from the receptors located in the hair cells of the inner ear to the brain stem (more precisely, its pons).

Important features that affect the symptoms of sensorineural hearing loss are the following:

• The fibers of the auditory nerve trunk are distributed heterogeneously. At the periphery (along the edge of the trunk) there is a path for conducting low sounds. Closer to the center there are fibers that conduct higher tones. Therefore, first of all, with this pathology, the perception of low sounds suffers;
• Due to the fact that the vestibular part of the VIII pair goes together with the auditory one, patients often experience: imbalance, and other signs of damage to these fibers;
• Since the conduction of sounds does not suffer in sensorineural hearing loss, and the nerve trunk is affected gradually, complete deafness (anacusia) rarely occurs in the initial period of the disease;
• It is possible to develop atrophy (malnutrition) of the nerve trunk due to its prolonged compression (edema, neoplasm, and so on). In this case, hearing impairment becomes irreversible.

Given that sensorineural hearing loss affects only the nerve trunk (before it enters the brain), lesions most often occur on one side (in one ear). However, the development of a two-way process is possible.

Classification

National recommendations for otolaryngologists suggest classifying sensorineural hearing loss according to three criteria: location of the lesion, rate of development and degree of “deafness.” The disease is also divided into acquired and congenital, but the latter is extremely rare. For example, with congenital syphilis, otosclerosis, progressive hearing loss with damage to the labyrinth.

Depending on the location of the pathological process, the following are distinguished:

• Unilateral (right and left side);
• Double sided:
  • Symmetrical - the disturbance in sound perception is the same on both sides;
  • Asymmetric – hearing function is changed differently on the right and left.

Most often, unilateral hearing loss occurs, since the development of damage on both sides requires some common pathological factor.

There are the following options for the rate of development of “deafness”:

The type of development of deafness depends on the degree of damage to the auditory nerve. If its atrophy develops, as a rule, the disease becomes chronic.

Degrees of sensorineural hearing loss

The degree of sensorineural hearing loss is determined by the patient’s hearing threshold (how loud a person cannot hear the sound). There are five options:

This is the most common classification approved by WHO. The degree of sensorineural hearing loss must be determined in accordance with it.

Reasons

With sensorineural hearing loss, the following negative factors always occur:

• disruption of microcirculation (nutrition) of auditory receptors, which reduces their sound-perceiving function;
• compression of nerve fibers by surrounding tissues (edema, tumor, as a consequence of injury, etc.), which leads to disruption of impulse transmission from receptors to the brain.

These conditions can develop for the following reasons:

The clinical picture does not depend on the cause of the development of sensorineural hearing loss (with the exception of cerebrospinal meningitis), therefore it is taken into account only when diagnosing the disease.

Symptoms

The most significant complaint of patients is hearing loss. Sensorineural hearing loss can manifest itself in only one ear or on both sides at once (see). As can be seen from the classification, it can be varying degrees: from the inability to hear whispered speech to anakusis. First of all, the perception of low sounds (bass speech, low tones in music, etc.) suffers. Subsequently, poor audibility of high-frequency sound occurs.

• - in 92%, a decrease in sound perception ability is accompanied by constant intrusive noise on one or both sides (see. It can have a different timbre, often noise of mixed tonality (high and low sounds blend into each other).
• not typical for sensorineural hearing loss (only at the time of injury).

Since the vestibular fibers pass along with the auditory fibers, patients often experience following symptoms:

• , which intensifies with movement;
• Unsteady gait;
• Loss of coordination (inability to perform precise movements);
• Constant nausea, periodic vomiting.

Other signs of the disease may be present, depending on the cause of hearing loss.

Diagnostics

Sound perception impairment is one of the socially significant problems. Therefore, if sensorineural hearing loss is suspected, the patient must be hospitalized in the ENT department of the hospital, if possible. To suggest this disease it is enough:

• Patient complaints about the above symptoms;
• A history of possible causes that could lead to the disease.

After hospitalization is carried out additional diagnostics, to confirm and clarify the diagnosis.

Speech hearing test

A basic test that does not require any equipment. First of all, the audibility of whispered speech is examined. It is carried out according to the following algorithm:

• The distance between the doctor and the patient should be 6 meters. The patient should turn his ear toward the doctor, while simultaneously closing the other auditory opening;
• The doctor pronounces words mainly with low sounds (hole, sea, window, etc.), then with high ones (thicket, hare, cabbage soup);
• If the patient cannot hear low/high sounds, the distance is reduced by 1 meter.

Normal: low sounds of whispered speech should be clearly distinguishable by patients from a distance of 6 meters, high sounds - 20 meters.

If necessary, a similar study is carried out using spoken language.

Tuning fork study

The first and simplest method instrumental diagnostics hearing functions. Using low-frequency and high-frequency tuning forks, the type of impairment is determined (inability to produce sounds or sensorineural hearing loss).

What is a tuning fork? This is a special instrument that produces a sound of a certain frequency. It consists of a leg (which the doctor holds) and branches (when struck, a sound is produced). In medicine, two types of tuning forks are used: C 128 (low frequency) and C 2048 (high frequency).

The following tests are important for diagnosing sensorineural hearing loss:

Determining signs of sensorineural hearing loss in patients allows us to confidently assume its presence. However, audiometry is necessary to make a final diagnosis.

Audiometry

This examination is carried out using a special sound generator of a certain frequency - an audiometer. There are several methods for using it. Traditionally, threshold audiometry is used to diagnose sensorineural hearing loss.

This is a method for determining the hearing threshold in decibels (one of the functions of an audiometer), bone and air conductivity. After receiving the results, the device automatically builds a curve for the patient, which reflects the function of his hearing. Normally it is horizontal. With sensorineural hearing loss, the line becomes inclined, air and bone conduction decreases identically.

To clarify the sound-perceiving function, there are additional modern techniques audiometry:

The methods described above are used to clarify the patient’s condition; they are rarely used in clinical practice.

Treatment

Medical tactics differ significantly depending on the form of sensorineural hearing loss, so their treatment is considered separately. One thing remains unchanged - early treatment of the patient (when the first symptoms appear) significantly improves the prognosis of the pathology.

Treatment of sudden/acute form

If there is a suspicion of acute neuritis of the auditory nerve, the patient should be immediately admitted to the ENT/neurological department of the hospital. The patient is shown a “protective” hearing mode, which excludes any loud sounds (loud speech, music, environmental noise, etc.).

• Glucocorticosteroid hormones intravenously (Dexamethasone). As a rule, it is prescribed for 7-8 days, with a gradual reduction in dose;
• Drugs to improve blood circulation, including in nervous tissue (Pentoxifylline/Vinpocetine). Recommended dosage regimen: intravenously for 8-10 days;
• Antioxidants (vitamins C, E; ethylmethylhydroxypyridine succinate).

If after hospital treatment there is still a need for drugs, they are prescribed for further use, but in the form of tablets.

Treatment of subacute/chronic form

In these forms, the pathology takes on a stable or slowly progressive course. In order to slow down the decline in sound-perceiving function, the patient is advised to take the following measures:

1. “Protective” auditory mode;
2. Treatment of other concomitant diseases that could lead to the development of sensorineural hearing loss;
3. Supportive treatment regimen similar to that for the treatment of sensorineural hearing loss acute form. On average, 2 times a year.

In addition, due attention should be paid to the patient’s adaptation to society with the help of specialized medical equipment.

Methods of rehabilitation of patients

Currently developed effective techniques for adaptation of patients with chronic sensorineural hearing loss. Unfortunately, most of them assume surgery, and only one method is performed with federal funding (at no cost to the patient).

Sensorineural hearing loss – socially significant illness, which reduces the quality of life of patients. That is why, if this diagnosis is suspected, the patient should be immediately hospitalized and treatment should begin to increase the chances of restoring the viability of the nerve. However, in the absence of such an opportunity, rehabilitation methods have been developed that will allow a person to feel comfortable in society.

Frequently asked questions from patients

Are there effective alternative methods for treating sensorineural hearing loss?

No, however, there are physiotherapeutic methods that have proven their effectiveness: endoural administration of certain drugs (Galantamine, Dibazol, Nicotinic acid, and so on), massage of the parotid and collar areas, pulsed currents.

Will my hearing recover after treatment?

This depends on the form of sensorineural hearing loss. In patients with sudden/acute forms, recovery occurs within 1 month in 93% of cases. With subacute and chronic hearing loss, the prognosis is more negative.

Is there an alternative to hearing aids?

Yes, but with less efficiency. A group of scientists in 2011 conducted a study using the following methods: low-frequency vibrosound stimulation, electroreflexotherapy and pedagogical activation of the hearing system. They are aimed at restoring auditory nerve receptors, but are not common in Russia.

Is sensorineural hearing loss inherited from children?

The transmission of hearing loss during syphilis, progressive labyrinthitis and congenital otosclerosis is reliably known. In other pathologies, the role of heredity has not been proven.

How to treat incoordination and dizziness with neuritis?

They are treated according to a similar scheme. It is possible to include nootropics (Cerebrolysin) and anticholinesterase substances (Neuromidin) in the course. Only the treating neurologist can supplement therapy and choose the final tactics.