deaf
Introduction
Introduction to deafness It is generally believed that the average listening threshold of language frequency (0.5, 1.2 Hz) is above 26 dB, that is, hearing impairment, hearing loss within 70 dB is called hearing, and those above 70 dB are , clinically known as deafness. Various acute infectious diseases, bacterial or viral infections, such as epidemic encephalitis, mumps, purulent meningitis, measles, scarlet fever, influenza, herpes zoster, typhoid, etc. can damage the inner ear And cause different light and different sensorineural hearing loss. basic knowledge Sickness ratio: 1%-5% Susceptible people: most of the elderly Mode of infection: non-infectious Complications: psychological disorders
Cause
Deafness
Infectious pathogenic sputum (10%):
Various acute infectious diseases, bacterial or viral infections, such as epidemic encephalitis, mumps, purulent meningitis, measles, scarlet fever, influenza, herpes zoster, typhoid, etc. can damage the inner ear And cause different light and different sensorineural hearing loss.
Drug toxicity (10%):
More common in aminoglycoside antibiotics, such as gentamicin, kanamycin, polymyxin, dihydrostreptomycin, neomycin, etc., other drugs such as quinine, salicylic acid, cisplatin, etc. Both can cause sensorineural hearing loss, ear drug poisoning is closely related to the susceptibility of the body. The toxicity of the drug is bilateral, with tinnitus and vestibular function. The long-term use of such drugs in the middle ear is also It should be infiltrated into the inner ear through the snail window and should be noted.
Senile sputum (25%):
Due to senile vascular sclerosis, hyperosteogeny, the blood supply to the spiral hair cells and spiral ganglion is insufficient, degenerative lesions occur, or the central nervous system declines, leading to hearing loss.
Traumatic spasm (5%):
Craniocerebral trauma and humeral fractures damage the structure of the inner ear, resulting in inner ear hemorrhage, or damage to the inner ear caused by strong shock, can cause sensorineural hearing loss, sometimes with tinnitus, dizziness, light can recover, ear surgery can also damage the inner ear structure Causes deafness.
According to the different classification of deafness, the reasons are also different:
(1) Conductive
1. Congenital: Common congenital malformations, including external ear, middle ear malformation, such as congenital external auditory canal atresia or tympanic membrane, ossicular, snail window, vestibular window hypoplasia.
2. Acquired: obstruction of the external auditory canal, such as embolism, osteophytes, foreign bodies, tumors, inflammation, etc., middle ear purulent or non-suppurative inflammation causes middle ear sound transmission mechanism obstacles, or ear trauma causes the ossicular chain to be damaged , middle ear benign, malignant tumor or otosclerosis.
(2) Sensorineural hearing loss
1. Congenital: often caused by hypoplasia of the inner ear, or caused by viral infection or ototoxic drugs during pregnancy, or injury during childbirth.
2. Acquired: There are several reasons:
(1) Sudden sputum: It is a sudden and unexplained sensorineural hearing loss. At present, it is believed that acute vascular occlusion and viral infection are common causes of this disease. The lesion may involve the auger, or even the vestibular membrane. The snail window membrane is ruptured, and the deafness can appear in an instant. It can also reach a peak quickly in a few hours and several days. Most of them are unilateral, and there are also diseases in both ears, accompanied by tinnitus, and some may be accompanied by vertigo. Early treatment can be better. effect.
(2) Knocking sputum: The acute injury of the hearing device caused by the sudden strong pressure wave and strong impulse noise. The tympanic membrane and the cochlea are the most vulnerable parts of the hearing. When the person is exposed to noise above 90dB (A) Cochlear injury can occur, if the intensity exceeds 120dB, it can cause permanent paralysis. The tympanic membrane damage is related to the pressure wave intensity, which is characterized by tympanic membrane congestion or tympanic membrane perforation, degree of deafness and noise intensity, number of exposures and peak value of pressure wave. , pulse width, spectrum, individual differences and other factors, the nature of deafness is mostly sensorineural hearing loss or mixed paralysis.
(3) Noise : It is a slow sensory neuropathic sputum caused by long-term noise stimulation above 85dB(A). It is mainly characterized by tinnitus, deafness, and pure tone audiometry. It is a 4000Hz valley-shaped notch or High-frequency attenuation type can also cause headache, insomnia, irritability and memory loss. The degree of deafness is mainly related to noise intensity and exposure time. Secondly, it has a certain relationship with noise spectrum and individual difference. Some people find that 2000Hz4000Hz Noise is the most likely to cause cochlear damage.
Prevention
Deafness prevention
In order to prevent deafness, the following aspects should be noted:
1. Pay attention to the prevention of congenital deafness, strengthen genetic research, and adopt eugenics measures;
2. Strengthen the health care work of pregnant women, avoid viral infection, syphilis infection, and prevent the abuse of ototoxic antibiotics;
3. Control and treat various infectious diseases that may cause paralysis, such as meningitis, measles, mumps, typhoid fever, scarlet fever, malaria, etc.;
4. Active treatment of chronic catarrhal otitis media, chronic suppurative otitis media and other degenerative ear diseases that may cause paralysis;
5. Early surgical treatment of external auditory canal malformation and middle ear malformation of deaf children, improve hearing, and provide necessary hearing to imitate and learn language;
6. Planned hearing tests for young children and preschool children, early detection of hearing defects;
7. Provide a large amount of iodine-containing foods, such as iodized salt, in areas lacking iodine to correct hypothyroidism.
Conductive sputum conduction loss does not exceed 60 decibels, chronic catarrhal otitis media, chronic suppurative otitis media, otosclerosis and other conductive sputum generally can not cause hoarseness, but in the case of conductive sputum, if there is drug poisoning, shock When the factors are superimposed, it is more likely to cause severe deafness, which makes the deaf children dumb. Therefore, it is extremely important to prevent the above diseases and early treatment.
(1) Prevention and treatment of conductive defects
Early active treatment of acute and chronic suppurative otitis media and secretory otitis media is an important measure to prevent conductive spasm. The construction of the sound structure (tympanoplasty) has a certain effect on improving the hearing of conductive sputum. For example, early tympanic exploration and tympanoplasty can save and restore hearing. For those with more conductive sputum, hearing aids can be worn to improve hearing.
(2) Prevention and treatment of sensorineural hearing loss
The efficacy of sensorineural hearing loss is currently not ideal, so the key is prevention, early treatment after onset.
1. Actively prevent and treat deafness caused by acute infectious diseases, do a good job in the prevention, isolation and treatment of infectious diseases, and enhance the resistance of the body (especially children).
2. For the use of ototoxic drugs, it is necessary to strictly control the indications. If there is poisoning, the drug should be discontinued immediately, and vitamins and blood vessels should be used.
3. Different drugs can be used according to different reasons and different stages of pathological changes, such as drugs that promote neurotrophic and improve microcirculation of the cochlea, various vasodilators, and biological products that promote metabolism.
Complication
Deafness complications Complications
1. Children's mental retardation
Deafness causes the newborn to lose the power of "listening" and "speaking", unable to obtain outside information, and the development of the language system is seriously affected. Hearing loss will delay the normal development of their intelligence and language. Lead to children's mental development is not perfect.
2. Alzheimer's disease
Deafness is often accompanied by tinnitus or re-vibration, which makes the language discrimination and expression ability of the elderly extremely declining, resulting in the lack of interpersonal communication in the elderly, the character becoming lonely and quirky, and may lead to Alzheimer's disease.
3. Suspicion
Once you have deafness, you have obstacles in dealing with people. You can't understand what others are saying. They are always afraid of others looking down, and then feel inferior. The more self-esteem, the more attention is paid to the attitudes of others towards themselves, and the sensitivity is so strong that a series of conjectures will be generated for an inconspicuous movement and gradually become hostile and attacking against others. Experts pointed out: Suspicious suspicion caused by ear hearing problems is a more serious psychological disorder.
4. Loss of language ability
Most of them are due to hearing loss and the ability to learn language, which ultimately leads to the loss of language ability.
Deafness is not only a loss of hearing ability, but the patient loses not only the sound, but also the serious impact on the patient's psychology, leading to a variety of complications, which may lead the patient's world to a world of malformation. Therefore, suffering from deafness must be treated in time.
Symptom
Deafness Symptoms Common Symptoms Central Deafness Hearing Loss Hearing Loss Type Deafness Deafness Hearing Defects Tone Rhythm Abnormal Fluctuation Hearing Loss Pathological Auditory Adaptation Tympanic Scarring
According to the WHO 1980 deafness classification standard, the average speech frequency pure tone hearing threshold is divided into five levels.
Mild sputum: There is no difficulty in listening to general conversation at close range. The audiometer and audio listening threshold of the audiometer are 26~40dB.
Moderate : It is difficult to listen at close distance, listening threshold 41~55dB
Medium, severe : Listening to loud language at close range, the hearing threshold is 56~70dB.
Severe sputum: You can hear it by shouting in your ear, listening threshold 71~91dB.
Full : I can't hear the loud voice shouting in my ear. The pure tone listening and listening threshold is over 91dB.
According to the location and nature of the lesion can be divided into three categories:
(1) Conductive deafness: The external ear, the middle ear sounding mechanism has lesions, and the sound waves are transmitted to the inner ear, such as deafness caused by embolism, otitis media, etc.
(B) sensorineural deafness (neurosensory deafness): refers to the cochlear spiral lesions can not turn the sound waves into nerve excitation or nerve and its central pathway disorders can not be excited into the nerve; or cerebral cortical central lesions can not be distinguished Language, collectively referred to as sensorineural hearing loss, such as Meniere's disease, ear drug poisoning, lost, noise damage, acoustic neuroma and so on.
(C) mixed deafness (mixed deafness): the sound and sensory mechanism at the same time there are lesions, such as long-term chronic suppurative otitis media, early stage of otosclerosis, knocking sputum and so on.
Examine
Deafness check
Check the external auditory canal and tympanic membrane; perform tuning fork examination and pure tone hearing threshold to find out the nature and extent of deafness. For children and uncooperative adults, you can also perform guest observation, such as acoustic impedance measurement, auditory brainstem response. Listen to cochlear electrograms, etc.
There are many methods for hearing and vestibular function tests. In recent years, research and clinical work in this area have made great progress. However, due to the limited conditions, it is impossible for advanced grassroots medical units to have advanced and complicated inspection equipment. Inspection, as a patient and their families, is even more powerless, so simple inspection methods should be used.
Hearing test: You can use the watch sound test to test the hearing with the watch before using the medicine. During the medicine use, the same watch is used to test the hearing. Pay attention to the position of the table, and each time should be placed in the same position, and should not be The watch should be placed close to the ear skin or the upper end of the bone so that the watch has a certain distance from the auricle, so that the sound heard is the sound transmitted through the air, otherwise it is the sound transmitted through the bone, which cannot faithfully reflect the actual situation of the hearing. In the trial, if the hearing loss is found before administration, the possibility of cochlear system poisoning should be considered.
Vestibular function check: The head of the balance function is judged by the observation of the standing position and the gait posture. The stand of standing still first uses the feet to stand together, then the feet stand in front and rear, and finally stand with one foot, the latter difficulty. Maximum, if the balance function is normal, it can be maintained for more than 10 seconds by standing. If the balance is dysfunctional, the standing is difficult to maintain, and it will quickly fall to one side, swing left and right or lean forward, and observe the gait posture. Take the walking test, that is, let the inspected person close their eyes and walk forward in a straight line. The normal person can make the feet reach the two sides of the straight line. If the walking is abnormal, there will be obvious deflection, and the walking is unstable, just like drunkenness. Walking squatting, generally walking ten steps, is enough to tell whether the walking is stable or not. Before conducting this test, you should know whether the examinee has physical defects, sequelae of poliomyelitis, hemiplegia, and patients with poor mental development are not suitable for this kind of examination. Method, when doing vestibular function examination, the inspected person should first stand and walk with a blink of an eye. If the standing posture and walking gait are stable, it is difficult to distinguish. Fixed or not, the patient standing and walking with eyes closed to better understand balance.
Diagnosis
Deafness diagnosis
The medical history should be carefully inspected; the external auditory canal and tympanic membrane should be examined; the tuning fork examination and pure tone hearing threshold can be performed to find out the nature and extent of deafness. For children and uncooperative adults, it is also possible to observe and listen to the audience, such as acoustic impedance measurement and listening. Sexual brainstem response audiometry and cochlear electrograms.
Attention should be paid to the identification of conductive deafness and neurological deafness.
