Ear contusion from gunshot symptoms. Acoustic ear injury. Hearing recovery after acoustic trauma. Consequences of ear contusion

Acoustic trauma (acutrauma)- damage to the inner ear caused by simultaneous or continuous exposure to excessively loud sound or noise. The main symptoms of acute sound damage are sharply arising and gradually subsiding pain and ringing in the ears. Chronic acutrauma is manifested by a gradual decrease in hearing acuity, discomfort and sensation of tinnitus, sleep disturbance and increased fatigue. The diagnostic program includes the collection of anamnestic data and patient complaints, otoscopy, speech examination and tone audiometry. Treatment includes taking vitamins gr. B, nootropics, darsonvalization and oxygen therapy, hearing aids.

General information

In modern otolaryngology, it is customary to distinguish between acute and chronic (more common) forms of acutrauma. Approximately a quarter of all cases of acquired sensorineural hearing loss are associated with acoustic damage to the inner ear. The bulk of patients are people whose profession is associated with constant noise. People who work in confined spaces and have diseases of the upper respiratory tract, auditory tubes and middle ear. Acutrauma accounts for about 60% of all pathologies caused by exposure to physical factors in production conditions and 23% of all occupational diseases. In this regard, most patients are able-bodied persons aged 30 to 60 years. The disease occurs with equal frequency among men and women. Geographic features of distribution are not noted.

Causes of Acutrauma

Leading etiological factor– Excessively loud noise or sound. The mechanism and rate of development of the lesion, its main manifestations depend on the nature and duration of the sound exposure. Based on this, it is reasonable to single out two main causes of acoustic trauma.

Short-term super-strong sound. Includes any sounds whose volume exceeds 120 dB - whistle near the ear, siren, signal vehicle, explosion, shot of a firearm, etc. As a result, a person develops an acute acutrauma, which is often combined with barotrauma.
Constant intense noise. Regular and prolonged exposure to noise with a loudness of 90 dB or more (with increased sensitivity - from 60 dB) causes the development of chronic acoustic trauma. In the vast majority of cases, pathology develops in people who are faced with occupational hazards - among workers in the field of heavy engineering and shipbuilding, aviation, metallurgy, the textile industry, etc.

Pathogenesis

Acute and chronic (professional) acoustic injuries have different mechanisms of development. A short-term, excessively strong sound causes hemorrhage in the perilymph of the anterior part of the membranous labyrinth of the cochlea - one of the components of the inner ear. In parallel, there is a displacement and swelling of the outer and inner hair cells of the organ of Corti. The latter is the final receptor apparatus, in which the vibrations of the perilymph are converted into a nerve impulse transmitted to the central nervous system. In some cases, there is a detachment of the organ of Corti from the main membrane. The pathogenesis of chronic acutrauma is not fully understood, so there are several possible theories. According to them, constant exposure to loud noises on the hearing aid can cause degenerative changes organ of Corti, metabolic disorders and the phenomenon of fatigue, the formation of pathological foci of excitation in the subcortical centers.

Acoustic Trauma Symptoms

The acute form of the disease is characterized by sharp pain in the ears at the time of sound perception and sudden unilateral or bilateral hearing loss. A person loses the ability to perceive external sounds and hears only a gradually subsiding ringing or squeaking, which can be combined with dizziness, aching or throbbing pain inside the ear. When combined with barotrauma, the clinical picture is supplemented by bleeding from the external auditory canal and nose, and a violation of spatial orientation. The further course depends on the severity of the lesion. acoustic trauma mild degree characterized by a gradual restoration of sound perception to its original level after 5-30 minutes. With moderate and severe degree, during the first 2-3 hours, the patient hears only loud sounds or screams. Then there is a gradual resumption of sound perception to the level of hearing loss. varying degrees expressiveness.

Development clinical picture chronic acoustic injury goes through 4 stages.

Stage of initial manifestations occurs after 1-2 days of exposure to noise. It is characterized by discomfort and ringing inside the ear. After cessation of exposure external factors these manifestations disappear after a few hours of rest. After 10-15 days, adaptation occurs, the symptoms gradually subside. The total duration of the stage is from 1-2 months to 4-6 years. This is followed by a period of "clinical pause", in which discomfort are absent, but gradually, imperceptibly for the patient, hearing acuity decreases. Its duration varies between 2-7 years.
Increasing stage of symptoms manifested by constant tinnitus and the rapid development of hearing loss. In this case, hearing loss occurs sequentially: first, sound is no longer perceived at high, then at medium and low frequencies. those present clinical manifestations are supplemented nonspecific symptoms: increased fatigue and irritability, impaired attention, loss of appetite and insomnia. The formed hearing loss remains at the same level even when continuing to work in the same conditions from 5 to 15 years.
terminal stage develops in people with hypersensitivity to noise, after 15-20 years of operation under noise exposure. Its symptoms are deterioration in hearing acuity up to the inability to perceive spoken language from a distance of more than 2 meters, unbearable noise in the ears, impaired coordination of movements and balance, constant headache and dizziness.

Complications

The most common complication of acoustic trauma is deafness. The main causes of complete hearing loss are late diagnosis and treatment. Its development is facilitated by non-compliance with the recommendations of the otolaryngologist and the refusal to change profession in the initial stages of chronic acoustic damage. Constant exposure to noise leads to systemic disorders: arterial hypertension, neurocirculatory dystonia, astheno-neurotic and angiospastic syndromes. Any acoustic damage to the hair apparatus of the organ of Corti reduces its resistance to infectious agents, systemic intoxication and the action of ototoxic pharmaceuticals.

Diagnostics

The diagnosis of acoustic trauma is not difficult for an experienced otolaryngologist. For this, anamnestic information, patient complaints and a hearing test are sufficient. Other examinations (MRI of the cerebellopontine angles, acoustic impedancemetry) are used to differentiate from other pathologies.

Anamnestic data. With acutrauma, there are always situations in which the patient is under the influence of a sharp and loud sound or has been in constant noise for a long time.
Otoscopy. In some patients, pathological retraction is visualized eardrum, which is typical for constant tetanic contractions of her muscles. When acute acoustic injury is combined with barotrauma, a large number of blood clots and rupture of the eardrum.
Speech audiometry. Allows you to set the distance at which the patient perceives a cry (80-90 dB), conversational (50-60 dB) and whispered speech (30-35 dB). Normally, a conversation is heard at a distance of up to 20 meters, and a whisper - up to 5 m. With hearing loss, these distances decrease or speech becomes inseparable. In severe injuries, only a cry directly above the ear is perceived.
Tone threshold audiometry. It reflects damage to the sound-perceiving apparatus, which is manifested by a progressive deterioration in air and bone conduction with an increase in the frequency of generated sounds.

Differential diagnosis of acute acoustic trauma is performed with sudden (acute) sensorineural hearing loss. The second pathology may be the result allergic reaction or acute violation cerebral circulation. Chronic acutrauma requires differentiation from Meniere's disease, presbycusis, and tumors cerebellopontine angle. With padalexia, unilateral hearing loss occurs, and there may be a spontaneous worsening or regression of symptoms. Presbycusis occurs over the age of 70, and hearing loss is not accompanied by external noise. Tumors of the cerebellopontine angle, in addition to hearing loss, are also manifested by lesions of the facial and trigeminal nerve.

Acoustic Trauma Treatment

Therapeutic measures, depending on the form of pathology, can be aimed at maximizing the restoration of sound perception or preventing further development of hearing loss. In acute acutrauma, complete rest is shown, vitamins gr. B, calcium and bromine preparations. In some patients, hearing acuity recovers on its own after a few hours. If hearing loss develops after exposure to a short sharp sound, treatment is carried out by analogy with chronic acoustic trauma.

In chronic acutrama, treatment is most effective at the stages of initial manifestations and "clinical pause". With modern treatment, in some patients it is possible to achieve regression of symptoms. Later therapy is aimed at preventing further hearing loss. The therapeutic program includes the following drugs and activities:

Change of profession. Eliminating the impact of strong noise on the sound-receiving apparatus prevents further development hearing loss.
Nootropics. Preparations of this series improve sound perception and other cognitive functions of a person, activate the work of the brain as a whole.
B vitamins. They improve the metabolism of the central nervous system, increase its resistance to excessive impulses of the middle ear, tone up the work of the auditory nerve.
Antihypoxants. They normalize the function of damaged hairs of the organ of Corti by improving metabolism in conditions of insufficient supply of oxygen and nutrients.
Darsonvalization. Impact of impulse currents on the area mastoid process stimulates the inner ear. The technique allows you to deal with third-party tinnitus.
Hyperbaric oxygen therapy (HBO). Under conditions of increased oxygen pressure, it improves cerebral circulation and reparative processes in the inner ear.
Hearing aid. Usage hearing aids makes it possible to improve the quality of hearing with severe hearing loss.

Forecast and prevention

The prognosis for recovery from acoustic injury depends on its form. In an acute injury of mild severity, full recovery initial hearing. In severe acute or chronic acutrauma, irreversible hearing loss of varying degrees develops. TO preventive measures includes compliance with safety regulations at work and in life, work in rooms with full sound insulation and sound absorption, the use of individual noise suppressors or special headphones. Important role win back regular professional examinations of persons working under the influence of constant noise.

Arising from short-term or long-term exposure to the hearing organ of multiple sounds (more than 120 dB). There are acute and chronic acoustic trauma. Acute injury is a consequence of the short-term action of super-strong and high sounds (for example, a loud whistle in the ear, etc.).

Intensity: >thn sounds are so great that the sensation of the sound is usually accompanied by Rot. Histological examination of the cochlea of animals subjected to acoustic trauma makes it possible to detect hemorrhage into the cochlea, displacement and swelling of the cells of the spiral organ.

In everyday life, chronic acoustic noise injury is more common, which is based on the fatigue factor due to prolonged exposure to intense sounds on the hearing organ. Hearing disturbances that appear under the action of short-term noise are often reversible. On the contrary, prolonged and repeated exposure to sound can even lead to atrophy of the corti-Ea organ. The severity of hearing damage increases dramatically with simultaneous and prolonged exposure to noise and vibration (for example, weaving workshops, blacksmithing, etc.).

Diagnosis is based on the data of the anamnesis, the general both 1st June stump of the patient and the results of the study of hearing. Usually with lx \ e tph

Treatment In the initial stages of the formation of professional health care, it is necessary to resolve the issue of changing the profession. Persons working in noisy industries should use no 1pin 1ua 1ny measures to protect against industrial noise. Treatment for developed occupational hearing loss involves the same measures as for sensorineural hearing loss. Restorative therapy is prescribed, reception sedatives, vitamin therapy (vitamins B-group, C, A and E), a rational regime of work and rest.

Prevention of occupational hearing loss is carried out by a complex of medical and technical measures. At the forefront is the conduct of a thorough professional selection when enrolling in a job associated with an increased level of noise in production. Special tests are used to assess the degree of fatigue of the auditory analyzer when exposed to strong sounds. If the restoration of normal hearing acuity during LT takes an excessively long time, then such candidates are visually impaired. The study of the results of vibration exposure in an animal experiment made it possible to detect degenerative changes in the cochlea (in the apical curl and cells of the spiral ganglion), as well as in the auditory and vestibular nuclei.

The nature of these changes corresponds to the strength of the vibration and the duration of its impact.

Treatment is carried out similarly to that for acoustic trauma, given their close anatomical relationship. It should be added that in order to prevent vibrotraumas, the following measures are taken for vibro-isolation, vibration dampening, and vibration-control.

Barotrauma occurs when there is a sudden change in the atmospheric phenomenon. The middle and inner ear are most sensitive to this change. There are two types of barotrauma. In the first case, the injury develops when pressure changes only in the external auditory canal, for example, a blow to the ear with the palm of the hand, when using the Siegl pneumatic funnel. The second type of barotrauma is caused by a pressure difference in environment And tympanic cavity, for example, when flying in an airplane, diving with divers, caisson workers, etc. The combination of baro- and acoustic trauma occurs during explosions and shots at close range. Such disturbances are based on an instant increase atmospheric pressure And sudden action sound high intensity, which causes contusion of the organs of the ear and brain varying degrees expressiveness.

The otoscopic picture in barotrauma is characterized by the appearance of hyperemia of the tympanic membrane with hemorrhages in its thickness. Sometimes there are ruptures and mon complete destruction of the eardrum. In the first 2 days after the 1st injury, inflammatory changes may not be detected, after which the inflammation becomes more noticeable. With a hemorrhage into the tympanic cavity with a intact membrane, it acquires a dark blue color.

Barotrauma is also accompanied by a number of functional disorders of the inner ear and central nervous system. The patient has noise and ringing in the ears, hearing loss, dizziness, nausea. Sometimes there is a loss of consciousness.

The degree of hearing impairment in barotrauma varies depending on which part of the auditory analyzer the changes occurred. IN childhood barotrauma sometimes develops during an airplane flight if the patency of the auditory tubes is impaired due to hypertrophy of the pharyngeal tonsil or paratubal ridge.

Treatment. First aid for barotrauma, accompanied by a violation of the integrity of the tympanic membrane, bleeding from tea or hemorrhage into the thickness of the membrane, consists in a thorough, but very careful cleaning of the ear canal from clots of crumbs, possible impurities (during an explosion, grch.p>) can be used sterile cotton wool, wrapped around a doid. Rinse.shps \ chd is strictly prohibited, as it can prp yge GP to ppfptspro your tympanic cavity. After deleting the contents of mdr\meme o ear canal 11.11011, (mi choshy I prgm. and cast lightly powder the wound surface with “smooth sulfanilamide powder. In the external auditory nr

Treatment is necessary if symptoms of severe hearing damage occur:

hearing loss or deafness;
prolonged tinnitus;
retraction of the tympanic membrane during ENT examination.

Types of acoustic ear injury

There are 2 types of acoustic ear injury:

acute. It occurs as a result of short-term exposure to very strong high-frequency sound. For example, with a loud whistle in the ear or a shot from a gun. As a rule, acute acoustic trauma of the ear is accompanied by sharp pain in auditory organ. At histological examination hemorrhage into the cochlea, displacement and swelling of the cells of the canal of Corti is detected;
chronic or noisy. Occurs as a result of the tiring effect of sounds on the organ of hearing. For example, in people who work for a long time in conditions of strong noise.

Hearing impairment in acute acoustic ear injury is almost always reversible, while chronic acoustic injury is often characterized as incurable. Separately, another acoustic ear injury, which is practically not treatable, stands out - age-related hearing loss.

Acoustic Trauma Treatment

If the hearing loss caused the hearing loss, treatment may not be needed at all, since the effects of short-term exposure to strong sound are often reversible. The only thing possible treatment akutrauma in this case - rest.

When the first symptoms of chronic acoustic injury appear, it is recommended to change the profession, because if the working conditions are not changed, the disease will progress. The treatment of an acoustic injury received at work requires the same therapy as in the treatment of other types of hearing loss: sedative and restorative drugs, vitamin therapy, nootropics, compounds of y-aminobutyric acid, drugs that improve microcirculation, antihypoxants.

In the treatment of acoustic trauma, bromine and calcium preparations are used to relieve subjective tinnitus. In order to improve blood circulation in the body, coniferous and hydrogen sulfide baths are recommended. Rehabilitation consists of sanatorium treatment and preventive courses drug therapy in dispensaries. It is necessary to use means of collective (engineering) and individual (headphones, ear plugs) protection against advanced level noise and vibration, which provoke acoustic trauma.

Treatment with pronounced consequences of chronic acoustic trauma is considered ineffective, since hearing loss in this case is caused by degenerative changes in the nervous apparatus of the hearing organ. Therefore very important point considered in treatment early diagnosis acoustic injury.

Only with timely and proper treatment acoustic trauma prognosis of the disease is favorable.

When exposed to noise on the hearing organs, acoustic trauma to the ear can occur. Its treatment is not always successful, and therefore it is desirable to limit the influence of negative factors as much as possible, which, unfortunately, lie in wait for a person even in everyday life.

Symptoms and Causes

Acoustic is an injury to the inside of the ear caused by a loud sound. Especially dangerous is exposure to high frequencies and vibration.

Factors that can harm and impair hearing in modern life there are a lot of:

sounds of transport, especially air;
production and repair equipment;
loud music, in particular, listened to through headphones;
weapon;
pyrotechnics;
other sounds, in particular, sharp pops.

Acoustic trauma may not be noticeable on initial stage which leads to the development of deafness. This is often observed with prolonged exposure to loud sounds on the sensors of the inner ear. In teenagers, the cause may be attending concerts and listening to music with headphones. In adulthood and older age, hearing loss occurs due to an unfavorable working environment. In this case, we speak of professional hearing loss. An explosion of a projectile or shooting can also provoke injury.

As a result of injury to the ear, a violation of its cellular structure occurs. In especially severe cases, the tympanic membrane ruptures and internal hemorrhage occurs. Sometimes blood can leak out of their ear. To increase the chances of hearing restoration, it is required emergency treatment, but it is not always effective.

Treatment of injuries of varying degrees

The treatment of acoustic trauma largely depends on the extent to which the parts of the ear have undergone changes. There are three varieties:

Light. Usually occurs after prolonged exposure to a loud sound that does not reach a critical level. Hearing fully recovers on its own after a while.
Medium. Requires a special hearing restoration course. However, such acoustic trauma leaves Negative consequences which cannot be eliminated.
heavy. In this case, it is necessary to restore the integrity of the eardrum. Such trauma changes the cells and destroys the receptor part of the ear. It is impossible to completely restore hearing, but there are chances of partial elimination of hearing loss. If proper treatment is not carried out, the problem progresses, the auditory cochlea loses its susceptibility and complete deafness occurs.

Treatment is to eliminate sound stimulus ear. Further, a course of medication is prescribed: vitamins, sedatives and painkillers, as well as bromine and calcium.

Prevention

In order not to have to undergo intensive treatment or face irreversible consequences, it is important to recognize Negative influence external factors and take care of hearing prevention. To prevent the destruction of organ cells and internal hemorrhage, special protective devices are used - headphones and earplugs. These are mandatory protective equipment for people working in noisy environments.

It is imperative to limit the effect of vibration on the ears. With sharp loud sounds to compensate for the pressure on the membrane, the mouth should be opened. If discomfort and pain are detected, immediately leave the unfavorable environment.

If the organs of the ear were previously injured, it is important to undergo a rehabilitation course after the completion of the main stage of treatment. Coniferous baths, relaxing procedures and visits to spa areas are prescribed here.

If you take care of your hearing, you can avoid problems in the future. If, however, an ear injury nevertheless befell you, treatment must begin immediately, especially when it comes to moderate and severe degrees.

Excessively loud sounds or noises. Especially harmful sounds are high (2000 Hz and above) and loud (120 dB or more). Acute acoustic trauma causes hemorrhage into the cochlea and changes in the cells of the organ of Corti. In chronic acoustic trauma (usually occupational) loudness up to 70 dB and above in combination with causes significant degenerative changes in the organ of Corti. It develops first to high-frequency sounds, then to sounds of medium and low frequencies. The coming decrease depends on the duration of the noise, its nature and strength.

Protection against acoustic trauma comes down to proper organization labor, the introduction of new noiseless technology and the use of methods for attenuating noise and vibration. Personal prevention of acoustic trauma is the use of (see)

Acoustic trauma (Greek akoustikos - related to hearing, auditory; trauma - damage) - damage to the organ of hearing caused by the action of sounds of great intensity. Distinguish between acute and chronic acoustic trauma. Acute acoustic trauma can be caused even by short-term exposure to sounds whose intensity exceeds the threshold pain sensation(e.g. jet engine noise). At the same time, the sound pressure reaches such a level that it causes mechanical damage cellular elements of the inner ear. VF Undrits and RA Zasosov observed in the experiment that as a result of the action of super-powerful sounds in the inner ear of experimental animals, hemorrhages occur, damage to the cells of the organ of Corti, and their detachment from the main membrane.

Similar results were obtained by A. I. Aleksandrov, G. M. Komarovich, Z. P. Lebedeva, and R. L. Loit when animals were exposed to superpowerful jet engine noise.

Chronic acoustic trauma is associated with long-term action strong noise, most often in the conditions of some productions, and sometimes leads to occupational hearing loss (see).

Chronic acoustic trauma is characterized by gradually developing degenerative changes in the hair cells of the organ of Corti, which then spread to nerve fibers and on the cells of the spiral ganglion. Typical and early symptom chronic acoustic injury is a drop in auditory sensitivity to high frequency sounds (2048 and 4096 Hz). Subjectively, patients experience hearing loss and often tinnitus.

In the prevention of acoustic injury, the main role is played by labor protection measures in noisy industries: sound insulation and sound absorption, the use of special plugs (see. Antinoise). When applying for a job related to loud noise, carry out tests for fatigue of the organ of hearing. If auditory sensitivity recovers very slowly after exposure to strong sounds, such candidates should be considered low resistance to acoustic trauma.

Treatment with pronounced consequences of acoustic trauma is ineffective, since hearing loss in these cases is most often caused by degenerative, usually irreversible changes nervous apparatus of the organ of hearing. To combat subjective tinnitus, calcium and bromine preparations are recommended. Nux vomica preparations, vitamin B1 have a tonic effect. In acute acoustic trauma - complete rest for the organ of hearing, after the subsidence of acute phenomena - absorbable and tonic agents.