[The influence of external factors on the auditory function in the students residing in a megapolis].

The objective of the present study was to estimate the auditory function in the students aged from 20 to 30 years and the noise load associated with the use of mobile phones, listening to music through headphones, attending concerts and youth clubs. The secondary objective was to assess the influence of these factors on the auditory function depending on their type, intensity, and duration. It is shown that the auditory threshold in the frequency range between 125 and 8000 Hz in 97% of the examined students do not exceed 25 dB varying from 5 to 15 dB The main factor influencing the auditory function is the use of players and headphones followed by mobile phones and deafening music in youth clubs.

[The assessment of the ventilation function of the eustachian tubes after shunting of the tympanic cavity].

The objective of the present work was to study specific features of the eustachian tube after the insertion of the shunt into the tympanic membrane and to measure the pressure necessary to ensure passive opening of the tube in the patients presenting with exudative otitis medium (EOM). The study included 87 patients with this pathology who underwent shunting of the tympanic cavity following a course of conservative treatment. Threshold audimetry and acoustic impedancemetry were performed in all the patients to estimate the patency of the eustachian tube with the perforated tympanic membrane. It is concluded that the shunting of the tympanic cavity resulted in markedly disturbed dynamic function of the Eustachian tube in the majority of the patients (59%) regardless of the severity of hearing impairment.

[Catheterization of the Eustachian tube in the combined treatment of exudative otitis].

The objective of the present study was to determine the amount of a medicinal agent entering the tympanic cavity during catheterization of the Eustachian tube in 26 patients presenting with exudative otitis and admitted for its treatment to N.I. Pirogov Clinical Hospital No 1, Moscow. The patients were managed by combined therapy in conjunction with catheterization of the Eustachian tube using radiocontrast matter (the iodine containing (76%) preparation trazograf having viscosity identical with that of dexamethasone). The administration of trazograf was followed by multispiral CT of the temporal bones. It was shown that trazograf penetrated into the tympanic cavity during catheterization of the Eustachian tube and accumulated inside it in 19.2% and 77% of the cases respectively. This finding suggests that the therapeutic effect in the patients presenting with exudative otitis is due not only to the direct action of the pharmaceutical product being used on the site of inflammation but also to the restoration of the draining and aerating functions of the course of Eustachian tube catheterization.

[Exudative otitis media. Modern concepts and the importance of the problem].

The objective of the present work was to analyse current concepts of etiology, pathogenesis, and classification of exudative otitis medium (EOM) in conjunction with the methods for the treatment of this pathology. Views of the problem expressed by different authors (both Russian-speaking and foreign) are discussed. Complications of the disease developing as a result of the untimely or inadequate treatment are described.

[Epidemiological characteristic of the patients presenting with cochleovestibular disorders associated with labyrinthine hydrops]. / Épidemiologicheskaia kharakteristika bol'nykh, stradaiushchikh kokhleovestibuliarnymi narusheniiami pri gidropse labirinta.

A total of 1,067 patients complaining of hearing impairment, dizziness, and tympanophony were admitted for the treatment to the Surdological Department of N.I. Pirogov City Clinical Hospital No 1 during the period from 2000 to 2010. As many as 326 (30.5%) patients were preliminarily diagnosed with Meniere's disease based on their medical histories, clinical condition, and the results of questionnaire studies. All of them were subjected to comprehensive audiologic and vestibulogic examination with the use of up-to-date techniques. The data thus obtained allowed to reveal labyrinthine hydrops in 275 (84%) patients. It is concluded that 101 (9.5%) patients presenting with the typical symptoms of Meniere's disease had labyrinthine hydrops.

[The application of supravascular laser irradiation of blood for the treatment of cochleovestibular disorders].

A total of 165 patients presenting with neurosensory impairement of hearing and Meniere's disease were treated by supravascular (extracorporeal) laser irradiation of blood. The study undertaken to evaluate the efficacy of this treatment confirmed its beneficial effect in patients with acute hearing disorders. It was equally effective as regards elimination of labyrinthine hydropsis in patients presenting with Meniere's disease. The method proved less efficacious for the management of long-standing hearing impairement and chronic loss of hearing, but it can be used to prevent the development of these conditions.

[The importance of psychic personality traits and emotional state for diagnostics and treatment of the patient].

It is very important for a physician to be aware not only of objective changes in the somatic status of the patient but also of his or her subjective emotional experience in connection with a given pathology. In everyday life and work, we frequently encounter people differing in psychic traits and emotional status. In the present paper, we describe certain personality types, their characteristic features and types of behaviour in response to the developing pathology. The most common reaction is the feeling of apprehension. Recommendations are proposed on the application of the methods for reducing manifestations of apprehension with the use of psychotherapeutic modalities and pharmaceuticals.

[Assessment of efficacy and tolerance of tanakan during treatment of sensorineural bradyacuasia and tympanophonia].

The objective of the study was to evaluate efficacy and tolerance of tanakan during treatment of neurosensory hearing loss and subjective tinnitis supposedly of vascular etiology. The secondary purpose was to analyse late results of 3 month courses of therapy and changes in the clinical course of the disease during treatment and within 6 months after its termination. Tanakan was first given at a dose of 40 mg thrice daily for 90 days. Results of the treatment were estimated on days 90, 180, and 240. The second course (40 mg thrice daily for 90 days) was initiated 180 days after the end of the first one. The final outcome was evaluated on day 360. It was shown that monotherapy with tanakan effectively improved the hearing function and had the most pronounced beneficial effect on subjective tinnitus. Results of the treatment remained stable throughout the entire observation period (12 months).

[Assessment of functioning of the internal ear in patients with labyrinthine hydrops and in normal subjects by means of phase audiometry].

A method for the diagnosis of labyrinthine hydrops is proposed that takes advantage of specific physiological features of internal ear functioning. Namely, the basal membrane of the inner ear exposed to a low-frequency tone undergoes synchronous sinusoidal oscillations along its entire length; simultaneously, sensitivity of the organ of Corti changes periodically. Under normal conditions, perception of 1,000 Hz tonal signals at the background of a low-frequency masker varied substantially depending on the phase during which the signal came. In the maximum discharging phase that corresponded to a 270 degree deviation of the basal membrane from its initial position, it was maximally displaced towards the vestibule staircase, and perception of the test tone was most affected. Patients with hydrops of the internal ear exhibited phase-independent constant perception of high-frequency tonal signals against the background test tone. It is concluded that the method of phase audiometry can be used in large research centres for the comprehensive evaluation of cochlear-vestibular function during hydrops formation.

[Acoustic and vestibular analysers in patients with mine explosion trauma].

The aim of the study was examination of the acoustic and vestibular functions in patients with mine explosion trauma. Acoustic and vestibular functions were studied in 27 patients (16 females and 11 males aged 19-66 years, mean age 37.2 +/- 4.12) admitted to the ENT clinic of Moscow city hospital N 1. All the patients had suffered from explosion in closed space. General clinical and complex otoneurological examinations were made including gustatory and olfactory investigations, studies of the facial skin sensitivity, nasal mucosa, corneal reflex, soft palate motility, audiometry and vestibulometry. The findings of the tests suggested the following conclusions: mine explosion damages hearing by impairment of both sound conduction (85.7%) and sound perception (61.2%), the latter suffering primarily at the cochlear level; damage to the cranial nerves V and XIII occurs at the level of the brain stem; mixed affection of the vestibular analyzer is seen primarily at the level of stem nuclei.

[Audiological diagnosis of cochleovestibular disorders caused by internal ear hydrops].

A total of 75 patients with clinical signs of internal ear hydrops (IEH) were examined using dehydration tests and electrocochleography. The patients were divided into groups by the results of pure tone threshold audiometry according to the international classification. Both methods proved highly informative. Positive dehydration tests were obtained in 57% cases, positive electrocochleography evidence was observed in 73% cases. An increased SP/AP amplitude was seen in 65% cases. Both methods allowed IEH detection in 82% cases. In normal hearing and hypoacusis of the first degree electrocochleography is more effective than dehydration tests in detection of IEH, but with hearing loss deterioration this advantage lessens. It is shown that patients can suffer from IEH in normal values of pure tone threshold audiometry. This should be taken into consideration in examination of patients who do not complain of hypoacusis.

[Psychosomatic status of patients with cochleovestibular disorders. Correction methods].

Psychosomatic status was studied in 106 patients aged 18-65 years with acute and chronic cochleovestibular disorders. Hearing problems, noise in the ears and vestibular disorders have a negative psychogenic effect in patients with cochleovestibulopathy. The majority of the patients need psychological and psychopharmacological care to relieve anxiety and form adequate attitude to the disease. Correction of psychosomatic disorders raises efficacy of the treatment of cochleovestibular diseases.

[Evoked otoacoustic emission in conduction of dehydration tests in patients with Meniere's disease]. / Ispol'zovanie vyzvannoi otoakusticheskoi émissii pri provedenii degidratatsionnykh prob u bol'nykh bolezn'iu Men'era.

We studied potentiality of the test of evoked otoacoustic emission (EOAE) for monitoring of dynamic changes in the internal ear in conduction of dehydration tests. In parallel to registration of tonal hearing thresholds and speech intelligibility in conduction of dehydration tests we registered two classes of EOAE: delayed EOAE (DEOAE) and distortion product otoacoustic emission (DPOAE). Of 36 examinees, we registered DEOAE prior to dehydration in 22 patients. By audiometry, these patients had hearing under 40 dB lower the hearing threshold at frequencies 250-4000 Hz. In registration of DEOAE in dynamics a maximal amplitude increase was seen 2 hours after intake of glycerin. A mean amplitude increase was 7.0+/-2.3 dB. Before dehydration DEOAE was recorded in 26 of 36 patients. Two hours laser otoacoustic response was registered in 29 patients. Hearing loss was not more than 60 dB at frequencies 250-4000 Hz. A maximal amplitude increase was seen in 2 hours. A mean amplitude increase in dehydration was 7.3+/-3.7 dB.

[Erespal effectiveness in exudative otitis media]. / Effektivnost' érespala pri ékssudativnom srednem otite.

Standard conservative treatment of exudative otitis media (EOM) was performed in 82 patients, but 44 of them received adjuvant fenspiride (erespal) in a dose 80 mg per os 3 times a day for 10 days. Dynamic pure tone audiometry, tympanometry and subjective response demonstrated higher treatment efficiency in the erespal group. Therefore, it is recommended to include erespal in combined conventional therapy of EOM.

[Age-related aspects of pure tone threshold in extended band by air]. / Tonal'naia porogovaia audiometriia v rasshirennom diapazone chastot po vozdukhu v vozrastnom aspekte.

In addition to registration of pure tone threshold audiometry in the standard frequency band and acoustic impedance audiometry, tone hearing thresholds were registered conventionally in extended frequency band (9-20 kHz) by air. A total of 103 otologically healthy volunteers (206 ears) aged 14 to 67 years participated in the trial. The results can serve as the standard in examination patients with pure-tone threshold audiometry by air in extended frequency band.

[Dissection of endolymphatic duct in Meniere's disease]. / Rassechenie éndolimfaticheskogo protoka pri bolezni Men'era.

The authors believe that endolymphatic sac (ES) surgery produces the highest and most persistent effect in comparison with all other surgical interventions in Meniere's disease (MD). Conventional views on the mechanisms underlying a beneficial effect of the ES surgery are revised and a new surgical technique is proposed. A positive effect of the operation, according to the authors, depends not on ES decompression but on the ES break taking place in separation of the dura mater from the bone skull in the outlet area of the aqueduct of the vestibule (AV). When the AV is separated from the sac, a rise in endolymphatic pressure is relieved by the endolymph pushing through the AV as it is not connected with the ES. 10 year follow-up has shown that this technique excludes subsequent endolymphatic hydrops.