Sudden deafness, also known as idiopathic blast deafness, is a sudden loss of hearing that can reach its peak or even total deafness in 1 to 3 days. Most of them are monaural and are caused by systemic or local factors.
Clinical manifestations
1. Deafness: Sudden and obvious hearing loss (mostly unilateral), most patients have tinnitus, and some patients have stuffiness, fullness and obstruction in the ear.
2. Causes: Most patients have no obvious cause for the onset of the disease, and many of them occur during sleep and feel tinnitus and deafness when they wake up. Some patients have obvious history of exertion, emotional excitement, mental tension and cold, which may be related to the onset of the disease.
3. Vertigo: A small number of patients have deafness and vertigo at the same time, with a spinning sensation, often accompanied by nausea and vomiting, and the vertigo is reduced in about a week after the onset of the disease, and the tinnitus and deafness do not improve, and the hearing loss of those with vertigo is more severe and not easy to recover.
Diagnosis
1.Sudden and obvious hearing loss, unilateral deafness is common, some patients can be accompanied by vertigo, electrical audiometric examination is sensorineural deafness.
2.Differentiation: Simple sudden deafness is easy to diagnose, because of the sudden onset of symptoms, hearing loss is obvious, most of them are monaural, so it is not easy to be mixed with other deafness; but if the patient is accompanied by vertigo, it should be differentiated from many diseases, at this time, you should go to the hospital to ask a specialist for examination in time, because to identify the symptoms of vertigo, you need to use all kinds of instruments, so it is not possible for the patient to do it by himself.
Treatment
The earlier the treatment of sudden deafness, the better the effect. More than 80% of those who start treatment within one week after the onset of the disease can recover or partially recover their hearing, while the effect of treatment after two weeks after the onset of the disease is less effective. Some data show that when the onset of the disease is more than one month, the hearing has already been basically fixed, and the effect of treatment will be greatly reduced. Some patients become permanently deaf because they are not treated in time. Therefore, sudden deafness should be treated as an emergency.
Medications: low molecular dextran, vasodilators (calcium channel blockers, histamine derivatives, herbs for blood circulation), anti-thrombotic and fibrinolytic agents (dongling clotting enzyme, urokinase), vitamins, drugs to improve inner ear metabolism (Ducoxib, etc.), glucocorticoids, etc.; Chinese herbs such as compound salvia. Sedation should be given to patients with tinnitus and vertigo.
Physiotherapy and acupuncture: hyperbaric oxygen, peri-auricular acupuncture point injection, etc.
Surgical treatment: intra-dural drug injection, inner ear nutrition with temporal muscle flap, etc.
Drug-induced deafness
Treatment should be carried out early, mainly with neurotrophic drugs, such as vitamin A, vitamin B complex, ATP, coenzyme A, hyperbaric oxygen, etc. Chinese herbal medicines, such as Atractylodes macrocephala, Radix et Rhizoma atractylodis, Lycium barbarum, etc., also have a certain protective effect on the inner ear. In early stage of mild intoxication, hearing can be restored. For deafness that has been poisoned for a long time, general treatment methods have no obvious effect. In terms of prevention, genetic testing of ototoxic drug-sensitive individuals is feasible to screen ototoxic drug-sensitive people; avoid the use of ototoxic drugs.
Noise Deafness
There is no effective treatment for noise deafness in Western medicine. The application of vasodilators followed by neurotropic drugs and drugs to promote cell metabolism may be helpful, but the effect is generally not obvious. Those with severe hearing impairment can be treated with hearing aids or cochlear implants. The most important thing is to transfer away from the noisy working environment as soon as possible once the diagnosis is confirmed, or to improve the noise pollution in the working environment by wearing anti-noise ear plugs and noise detectors.
Age-related deafness
Hearing aids can be worn, and conservative treatment is based on nourishing the nerves and improving microcirculation. If the hearing is stable, it can be treated according to sensorineural deafness.
Deafness caused by systemic diseases and infectious deafness
We can treat the cause of deafness and maintain the residual hearing by dilating the blood vessels and improving the metabolism of the inner ear.
Traumatic deafness
Traumatic deafness is mostly conductive deafness, and surgical treatment is available to restore and reconstruct the sound conduction system as much as possible.
Autoimmune deafness
Immunosuppressants such as cyclophosphamide and prednisolone are effective, but they can relapse after stopping the medication. Re-medication remains effective.
Cochlear implantation
Treatment of sensorineural deafness
Pharmacological treatment: Because the causes of sensorineural deafness are many and the mechanisms and pathological changes are different, there is no simple and effective drug and treatment method that can be applied to all cases. At present, it is advisable to use vasodilators, drugs that reduce blood viscosity, B vitamins, energy preparations and, if necessary, steroid hormones for a certain period of time while excluding or treating etiologic diseases. Such vasodilators as poppy bases, heparin, 654-2, hydroergot alkaloids, dibazol, chuanxiongzine, and geranium flavonoid are taken orally or injected. Vitamin B1, B6, B12, adenosine triphosphate, coenzyme A, cytochrome C, low molecular dextrose, sodium bicarbonate, hyperbaric oxygen and other treatments. Those who are ineffective in medication can be fitted with hearing aids.
Hearing aid: It is a sound amplification device that helps deaf people to hear sound. It is mainly composed of miniature sound transmitter, amplifier and earphone, earmould, power supply and so on. There are many types of hearing aids, such as air-conduction and bone-conduction, cassette and ear-level (including glasses, behind-the-ear and in-the-ear), monaural and binaural hearing aids, etc. They can only be used properly after detailed examination by otologists or audiologists. Generally speaking, people with an average hearing loss of 35-85dB in speech frequency can use them. If the difference in hearing loss between the two ears is large, but not more than 50 dB, it is appropriate to use the hearing aid for the poorer ear; if the hearing loss in one ear is more than 50 dB, the hearing aid should be used for the better ear. In addition, the characteristics of the hearing impairment should be considered. For example, hearing aids should be used for ears with high speech recognition, flat hearing curve, large bone and air conduction gap or wide dynamic hearing range. Both air- and bone-conduction hearing aids can be used for sensorineural deafness. Only bone-conduction hearing aids should be used for patients with narrow external auditory canals or inflammatory conditions. Patients with sensorineural deafness are more likely to use air-conduction hearing aids. Hearing aids with automatic gain control or automatic resonance control devices are required for those with resonance.
Cochlear implant: also known as electronic cochlear implant. It is suitable for young and middle-aged people who are extremely deaf bilaterally, who have no active lesions in the ear, who have normal inner ear structures as evidenced by X-ray tomography or CT examination, who have no cochlear electrogram response, and who can induce brainstem response by electrical stimulation of the drum head or round window.
Treatment of congenital deafness
Congenital deafness can be divided into two categories: hereditary and non-hereditary. It can also be divided into three categories: conductive, sensorineural and mixed.
Congenital middle ear malformations should be treated surgically, preferably at the age of 15 years or older;
2. Congenital sensorineural deafness is irreversible and there is no effective drug or surgical treatment;
(1) Early detection and diagnosis of congenital deafness should be achieved;
②Deaf children, regardless of age, should wear hearing aids and undergo hearing and speech rehabilitation as soon as possible once they are diagnosed and have residual hearing.
③If possible, cochlear implantation should be done for children with extreme bilateral deafness.
Conductive deafness
Also known as conductive deafness, it can be caused by lesions from the pinna to the middle ear or even the inner ear, and common diseases include
1. (Common conductive deafness): caused by lesions from the auricle to the middle ear
① Malformation or absence of the ossicles
②Blocking of the external auditory canal
③Perforation of the tympanic membrane
④Drum chamber lesions: fluid and pus accumulation outside the drum chamber, adhesions and sclerosis of the auditory chain, fracture of the auditory chain, etc.
Most of the common conductive deafness can be treated surgically, such as removing foreign bodies from the external canal, reconstruction of the auditory chain, vibrating sound bridge, tympanic membrane repair, and auricular reimplantation, etc. The purpose is to restore the normal sound conduction pathway, which can lead to partial or complete recovery of hearing. With the advent of various hearing aids, those who are not suitable for surgery can choose to wear hearing aids.
2. (Very common conductive deafness): caused by inner ear pathology
Ménière’s disease, superior hemispheric canal cleft syndrome
Otosclerosis
Otosclerosis is an autosomal dominant disorder that occurs in women between the ages of 20 and 40 and can be exacerbated in pregnant women.
The typical pathological histological changes are primary focal spongy degeneration of the bone vagus, followed by bone resorption or sclerosis.
Clinical manifestations.
1.Progressive hearing loss in both ears
2. Low-pitched tinnitus
3.Willis mishearing
4.Vertigo
5.Family history
6, Audiological features: early conduction deafness, late mixed or sensorineural deafness may appear; Gelle test () suggests pedal sclerosis fixation; Cahart’s cut may appear at 2KHz.
Typing
w According to the involvement of the lesion
1. Stapedial otosclerosis: the lesion is located in the vestibular window, and the focal areas are the anterior area of the vestibular window and the edge of the round window
2. Cochlear otosclerosis: the lesion is located in the vestibular window, causing lesions in the auditory receptors or auditory nerve.
According to the extent of lesion involvement: Portmann 4 types
Type 1: Early stage of otosclerosis, with sclerosis of the anterior stapes ligament only
Type 2: Anterior region of the vestibular window
Type 3: Other areas of the vestibular window
Type 4: Sclerosis of the entire floor plate or obstructive type
According to whether clinical symptoms appear or not
1.Clinical otosclerosis: clinical symptoms appear due to fixation of the stapes
2.Histological otosclerosis: no lifelong conscious symptoms, only seen in autopsy pathology, 8-10% of whites, while clinical otosclerosis only accounts for 12% of them
By imaging (CT) performance
1. Window type: involving the oval window and round window, CT shows that the oval window disappears and sclerotic bone replaces it
2.Posterior window type: involving the bony vagus including the cochlea, vestibule and semicircular canal, CT shows a low density halo around the cochlea
Treatment
(1) Drug treatment
Sodium fluoride inhibits hydrolase and protease activity in the spongiotic lesion, reduces osteoclast resorption, promotes osteoblast formation, and slows down or terminates progressive hearing loss in otosclerosis. Studies have shown that sodium fluoride 45 mg/d or less does not increase bone formation, but only involves enzyme activity. It is believed that moderate amounts of sodium fluoride (15-45 mg/d) can prevent cochlear degeneration without aggravating stapes fixation.
1. In adults with severe cochlea or proven positive Schwartze’s sign, sodium fluoride 45mg/d, 5d/w, for 6-8m
2.Sodium fluoride 20mg/d for 2y for those who have been operated and have progressive cochlear symptoms.
(2)Surgical treatment
1.Simple window surgery
2.Stirrup shaking surgery
3.Stirrup lift surgery
4.Stirrup footplate windowing (LFT) is a full stapedectomy: the footplate is completely cut or the resection range is greater than 1/2 of the footplate, which is mostly used for Portmann type 1 and 4. Type 1 is the early stage of otosclerosis, and only the ligament in front of the stapes is sclerotic. Therefore, a small hole must be drilled first, and then the window hole must be enlarged by picking the sclerotic foci outward with a small crochet, which may also result in a large hole in the floor.
Portmann 2 and 3 have moderate degree of sclerosis, and it is not easy to rupture the floor plate when drilling, so it is easy to maintain the state of small hole.
6.Laser footplate resection
7.Minimally invasive stapedioplasty without pseudoprosthesis
Vibroacoustic bridge implantation
Indications.
Patients with moderate to moderate sensorineural deafness
Patients with conductive or mixed deafness
Patients with external or middle ear deformities (e.g. microtia, external canal atresia, middle ear hypoplasia, etc.)
Patients who have had multiple middle ear surgeries and still have little improvement in hearing
Patients with hearing loss due to otitis media
Surgery.
Patients with sensorineural deafness, anvil osseous osculoplasty conductive sound can also provide amplification gain to the damaged inner ear
For mixed deafness, stapedioplasty or oval window or round window vibroplasty may be performed, depending on the circumstances.