APPLICATION
OF HBO IN COMPLEX TREATING OF ACUTE NEUROSENSORY HYPOACUSIS.
Practical recommendations.
Acute neurosensory hypoacusis (NH) is a broadcasted
disease. The efficiency of its treating directly depends on the time, spent from
the beginning of the disease till the beginning of active therapy. If the
treating is begun in al in a few days, the efficiency is about 40 - 50%; if
later - the success is reducing. Thus the practical healer would recognize and
begin treating of that disease in time.
Etiology and pathogenesis.
NH is a polyetiologic disease. Usually it is caused by
vascular diseases (hypertension; cerebral arteriosclerosis; vascular dystonia;
etc.), violation of hemocirculation of cerebrum. Such violations as vascular
spasm, embolia, thrombosis, vascular suppression, inter vascular stenosis,
improved coagulability; other vasogenal violations, troubling the spiral organ.
The reaction of the internal ear at vascular variations deals with the
particularities of circulation and vascular network here
- it is closely terminated with the cerebral circulation and the reaction
is immediate and sharp at any changes in cerebral circulation. The response is
in the reduction of sensitivity of ear (at any frequency); transgressions of
vestibular abilities and noise in damaged ear.
The NH can be caused by infection. These can arrive by
2 ways: directly (meningitis, parotitis, typhoid, influenza, dysentery) or by
means of middle ear (scarlatina, pox, measles).
An important role in development of NH play industrial
and medicinal toxins. These are aminiglycosidal antibiotics and diuretics
(furocemid and etacrine acid). Everything here depends on individual sensitivity
of body.
Significant changes can be observed for diabetics - the
lipoid-protein compounds can be synthesed in the membrane.
The NH accompanied with kidney diseases is probably
caused by intoxication by nitric residues.
The NH can be caused by mechanical craniocerebral
trauma or acoustical transgression of middle ear. The most dangerous are the
lateral crushes of temporal bone - their usual result is diminishing of cohlear
and vestibular functions on the side of damaging.
Diagnostics.
The camertonal investigation; audiometry; ultrasound
can be applied for the investigation. The camertonal investigation can determine
the worthening of bonal conductivity.
The most informative for diagnostics is tonal
audiometry. This method helps to investigate both bonal and aerial conductivity
at any frequencies. Four degrees of NH are determined. These are:
I degree - losses
in region 20 - 40 dB;
II degree - losses in region 40 - 60 dB;
III degree - losses in region 60 - 80 dB;
IV degree - losses in region above 80 dB (practical
deafness).
The audiometry for topical diagnosis is applied in
broad region: 10 - 20 kHz. The particularity of damaging the middle ear is
worthening of audition at high frequencies sooner than at lower ones.
In pathologically damaged ear the ability to determine
the intensity of sound, comparatively to the normal one, and any audio violation
causes inadequate response (so called recruitment). In case the retrocohlear
violations this phenomena is usually absent.
In differential topic diagnosis a speech audiometry.
The curve of distinctcy at conductive hypoacusis is parallel to normal one. For
neirosensoric hypoacusis the curve is shifted to the right, especially for the
high sensitivity region. Sometimes the values for speech and tonal threshold are
different.
For more exact determination of receptor violations the
impedansometry can be applied. Nevertheless the determination of the levels of
damaging of audition is not sufficiently solved yet, independently of the
abundance of methods for it. Only the complex investigation can give an
approximately sufficient diagnosis.
The treating.
The variety of etiologies of NH need different
approaches in its treating. The process of treating would be selected
individually for every sick on the basis of advanced investigation.
The success of medicamental treating of acute cohlear
neuritis of vascular etiology depends on the time of the beginning of therapy.
Absence of success displays the presence of irreversible degeneration in ear;
otherwise the hypoacusis is caused by functional disorder of
receptors of middle ear. For the success in treating of
NH an early diagnosis and early beginning of therapy are required.
The efficiency of treating can also improve, if done in
clinic: here all the responses at any external violations, including the
treating activities can be determined. The intravenous injection of medicines
for improvement of cerebral circulation are broadly applied (reopolyglucin;
mannitol; hemodes; caviton and trental). They improve the venose conductivity.
The scheme of reception is:
Trental - 100 mg dissolved in 250 ml of physiologic
salt solution (I day); 200 mg -II day; 300 mg - later; 7 - 10 days in sum.
Caviton - 10 mg dissolved in 250 ml of physiologic salt solution (I day); 20 mg
-II day; 30 - later on; 7 - 10 days. Simultaneously carboxylasa (50ml) and
vitamin B6 (5%, 1 ml) can be injected intramuscularly.
If NH is caused by infection and intoxication, the
hemodes and mannitol are applicable. Mannitol is an effective diuretic;
sequentially it is applicable if NH is accompanied by hypertension.
Reopolyglucin can't be changed by polyglucin:
polyglucin has a large molecular mass (about 60 000 Dalton) and it can't master
the hematobarrier.
Vasodilatives (papaverin; no-spa and its derivatives;
galidor; complamin; stugeron; eufillin) are applied if angiospasm causes the NH.
Papaverin and no-spa are lessening the venose conductivity; complamin improves
the capillary circulation and tissue metabolism. Stugeron inhibits
vasoconstrictive activities and vascular constriction, caused by delay of
potassum.
The cerebral inflation and inter-cranial pressure would
be urgently reduced with diuretics (mannitol; brinaldix; verospiron; hypotyasad;
diacarb); application of furocemid and etacrin acid is contraindicated for their
ototoxic activity.
Anticoagulants
are applicable (if needed): phenyl; pelentan; sincumar. Doses of medicines would
lessen the protrombinal index to 50 - 60%. The control investigation would be
done once in 3 - 4 days during all the course.
Hyposensibilisators and tranquillisators can be
applied. For the improvement of tissue metabolism the vitamins of B-group;
adenosine triphosphoric acid; cocarboxilasa; ascorbic acid.
In pathology of NH the hypoxia of middle ear is of
prominent importance. Reduction of hypoxia becomes a prominent therapeutic task.
Here HBO can be applied. The physiological essence of HBO is in saturation of
blood and tissue with oxygen; change of tissue metabolism and strengthening of
medicinal activity.
Change of cerebral circulation depends generally on the
concentration of carbon dioxide in blood. HBO suppresses the excitation of
chemireceptors of aorta; that suppresses the respiratory center. The
concentration of CO2 in arterial blood; the cerebral vasodilation takes place.
But the saturation is happening for a short period of time and, sequentially it
isn't dangerous.
The procedures in chamber "Oka-MT" were
persued with saturation of 0,7 - 1,0 AT; exposition - 30 min.; compression - 10
- 15 min.; decompression - 10 min.; 10 - 12 procedures in course.
Before the first procedure the patient would acquaint
with the chamber. For the improvement of respiratoral conductivity the 3% drops
of ephedrine solution would be applied. Permanent care would be taken of the
patient during the procedure.
Before and after the procedure the tension of blood and
pulse index would be measured. This is to determine the oxygental intoxication,
if any.
The dress would be made from cotton; no synthetic; no
silk; no wool is applicable. To exclude the charges of static electricity the
patient would be terminated with special metal plate.
The treatment of NH with horizontal type of audio
metric curves is the most effective one.
The HBO is desirable to be advanced with medicinal
therapy; in particular, vasodilative medicines would be used to avoid
vasoconstictoral effect of oxygen. If no bettering is observed after 5 - 6
procedures, the HBO can be interrupted with the continuation of medicinal
therapy. If the advanced medicinal therapy positively influences the audition,
the HBO is desirable for the application; if not - HBO is also in vain. If the
audition is completely restored, no repetitive courses arerequired; otherwise
the repetitive course would be persued in 3 - 6 months. Absence of bettering of
audition after the course can be the indication for rejecting of the repetitive
course of HBO.
The complete deafness is also irresponsible to the HBO.
The contraindications for application of HBO are:
epilepsy and other convulsions; caverns in lung; hard hypertension; deep
violations of respiratoral conductivity; claustrophobia; improved sensitivity to
oxygen.