Acute acoustic trauma. Causes. Symptoms Diagnostics. Treatment. Acoustic ear injury: symptoms and treatment Consequences of contusion of ENT organs

Arises from short-term or long-term exposure to low-pitched sounds (more than 120 dB) on the organ of hearing. Acute and chronic acoustic trauma are distinguished. Acute trauma is a consequence of short-term exposure to extremely strong and high-pitched sounds (for example, a loud whistle in the ear, etc.).

The intensity of these sounds can be so great that the sensation of sound is usually accompanied by Rot. Histological examination of the cochlea of ​​animals subjected to acoustic trauma reveals hemorrhage in the cochlea, displacement and swelling of the cells of the spiral organ.

In everyday life, chronic acoustic noise injury is more common, the occurrence of which is based on the factor of fatigue due to prolonged exposure to intense sounds on the hearing organ. Hearing impairment caused by exposure to short-term noise is often reversible. On the contrary, prolonged and repeated exposure to sound can even lead to atrophy of the organ of Cortiea. The severity of hearing damage increases sharply with simultaneous and prolonged exposure to noise and vibration (for example, weaving workshops, blacksmithing, etc.).

Diagnosis is based on anamnesis, the patient’s general history and the results of a hearing test. Usually with lk\e tpch

Treatment In the initial stages of the formation of a professional career, it is necessary to resolve the issue of changing profession. Persons working in noisy industries must use specific measures to protect themselves from industrial noise. Treatment for developed occupational hearing loss involves the same measures as for sensorineural hearing loss. General strengthening therapy, sedatives, vitamin therapy (B vitamins, C, A and E), and a rational work and rest regime are prescribed.

Prevention of occupational hearing loss is carried out through a complex of medical and technical measures. It comes to the fore to conduct a thorough professional selection process when enrolling in jobs that involve high levels 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 in summer takes an excessively long time, then such candidates will experience Vibration trauma (vibrotrauma), as the name itself shows, occurs as a result of vibration vibrations (shocks) produced by various mechanisms (tools, vehicles). Studying the results of vibration exposure in an experiment on animals made it possible to detect degenerative changes in the cochlea (in the apical helix and spiral ganglion cells), as well as in the auditory and vestibular nuclei.

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

Treatment is similar to that for acoustic trauma, given their close anatomical relationship. It should also be added that in order to prevent vibration injuries, the following measures are carried out: vibration insulation, vibration damping and singing.

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

The otoscopic picture during barotrauma is characterized by the appearance of hyperemia of the tympanic membrane with hemorrhages in its thickness. Sometimes there are ruptures and complete destruction of the eardrum. In the first 2 days after the first injury, inflammatory changes may not be detected, but then inflammation becomes more noticeable. When there is hemorrhage in the tympanic cavity while the membrane is intact, 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 develops noise and ringing in the ears, decreased hearing, dizziness, and nausea. Sometimes there is loss of consciousness.

The degree of hearing loss due to barotrauma varies depending on which part of the auditory analyzer the changes occur. 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 peritubular ridge.

Treatment. First aid for barotrauma, accompanied by a violation of the integrity of the eardrum, bleeding of the eardrum or hemorrhage into the thickness of the membrane, consists of a thorough but very careful cleaning of the ear canal from clots of debris, possible foreign impurities (an explosion could cause grach.p>) with the help sterile cotton wool, wrapped in a pad. Promyn.shps\chd is strictly prohibited, as this can damage the tympanic cavity. After removing the contents of the ear canal, the skin of the ear canal is carefully washed!

Acoustic ear injury is a common damage to the human hearing system that occurs during long-term or short-term exposure to strong sounds. According to the ICD-10 classification, this disease belongs to the subsection: “Noise effects of the inner ear” (H83.3), which includes the injury itself and hearing loss caused by noise.

The effect of loud noise from steel on the hearing aid began to be noticed back in the century before last, when powerful engines appeared. Over time, scientists have identified two forms of this disease:

1. Chronic, or in other words professional, occurs with constant exposure to sound above 70 dB together with vibration. Such waves provoke the development of irreversible processes in the labyrinth, which are almost impossible to stop.
2. Acute is accompanied by severe hemorrhage and can change the cells in the labyrinth. A single exposure to a loud sound can cause pain and even mechanical damage.

Explosions from mines or other projectiles can cause blast injury. It is characterized by the occurrence of pressure inside the ear, which leads to rupture of the eardrum. With such exposure, a person begins to get lost in space and may lose consciousness.

Causes

The main cause of such hearing aid injury is work associated with constant exposure to very loud noise. It occurs due to prolonged exposure to sounds of 1000-6000 GHz. Mechanical damage to the membrane and membrane can occur in people:

• working with noisy equipment;
• living in places where loud noises are regularly heard;
• visiting shooting ranges;
• those who neglect protection, for example, do not use earplugs.

Hazardous professions in this area include: boilermakers, weavers, nailers. People whose work involves the use of small arms can also suffer chronic injury.

Noise source table

Symptoms and diagnostic methods

The main symptom of acoustic trauma is complete or partial hearing loss. When receiving an acute injury, sharp pain occurs, with the appearance of hearing loss. It can appear on one or both sides.

In this condition, the patient does not hear surrounding sounds. You may feel dizzy. An endoscopy can look for tears in the eardrum.

Tinnitus is a symptom that signals the onset of chronic acoustic trauma. It can be expressed by buzzing, ringing or other unpleasant incessant sound.

To diagnose acoustic trauma, the doctor will conduct a survey to find out what noise the patient was exposed to. Special equipment is also used for audiometry.

When the ear is exposed to sounds of varying volumes and frequencies, it is determined which of them the patient hears and which ones he does not. This diagnostic method allows you to determine the severity and neglect of the disease.

Treatment

If you receive an acute acoustic injury, treatment may not be required. After short-term exposure to strong sound, almost all symptoms that appear can be reversible. The same cannot be said for chronic injury. It requires mandatory treatment.

Medical

The first signs of chronic acoustic trauma are a signal for urgent treatment at a medical facility. First of all, the doctor recommends eliminating the cause of the disease.

That is, a person needs to change his profession. If this is not done, the disease will only progress and it will no longer be possible to stop the changes.

During drug therapy, calcium and bromine preparations are used to help get rid of tinnitus. In addition, the doctor will prescribe sedatives and restorative drugs, nootropic drugs, as well as vitamin therapy.

Additionally, medications that improve blood microcirculation may be prescribed. Steroid medications may be prescribed.

Often, patient reviews of this treatment can be negative. If treatment of the disease began too late, it may be impossible to restore hearing loss, since degenerative changes in the nerve endings of the hearing aid have already occurred.

Therefore, the most important point in treatment is early diagnosis.

The sooner the patient consults a doctor and eliminates the causes that led to the injury, the greater the effectiveness of the medications.

Folk remedies

Treatment of acoustic trauma with folk remedies comes down to additional measures that improve blood circulation and relieve unpleasant background sounds. These can be pine and hydrogen sulfide baths.

You can also use folk sedatives. This could be lemon balm, currant or lilac leaves. Tea made from such herbs has a calming and relaxing effect. Dandelion can help with tinnitus; a syrup can be prepared from it and taken 3 times a day.

If drug treatment is ineffective, the doctor will recommend technological assistance. This can be a specially selected hearing aid or a cochlear implant.

Consequences

Consequences after acoustic trauma may vary depending on the extent of the injury. In mild cases, hearing quickly returns to its original level after additional treatment.

With moderate severity, even after proper and intensive treatment, they may remain

manifestations of hearing loss

In case of severe injury, hearing restoration is almost impossible. Technological assistance is used for these purposes.

Prevention

Prevention of chronic acoustic injury involves reducing exposure of the damaged inner ear to loud noise. To achieve this, it is recommended that production facilities use every opportunity to enhance the sound insulation of walls and ceilings.

Additionally, a person must use physical protective measures: wear headphones and earplugs.

Before you get a job in a production facility where background noise is constantly increased, you must pass an ear fatigue test.

If, during the diagnosis, normal hearing is restored very slowly, then the person is considered to be highly susceptible to loud sounds and should not work in such an industry.

Acoustic trauma is damage to the structures of the inner ear, which occurs due to immediate or regular exposure to intense sounds or noise.

The pathology is fraught with hearing impairment - up to the need for hearing aids (use of a hearing aid). It has become especially relevant in the age of loud music, deafening parties and working in noisy environments.

Total information

Acoustic trauma is a very common phenomenon in the 21st century. The chronic form of this pathology is more often observed, and the acute form is much less common. The disease is the cause of sensorineural hearing loss in 25% of all clinical cases of its occurrence.

The vast majority of people affected by acoustic trauma are the working population in the age category from 30 to 60 years. This is explained by the fact that in the vast majority of cases, acoustic trauma is caused by loud sounds due to the specifics of a particular profession. It has been revealed that those people who most often suffer are those who:

• work in closed premises;
• have various diseases of the upper respiratory tract, middle ear, and auditory tubes (most often chronic).

According to statistics, acoustic trauma accounts for about 60% of all diseases and pathological conditions that develop due to the negative influence of physical factors in a particular workplace. In general, acoustic trauma accounts for about a quarter of absolutely all occupational diseases known to medicine.

Men and women get sick with the same frequency. Children are more sensitive to the strength of sound exposure - they can develop acoustic trauma at a sound threshold that does not have any significance for the adult hearing system.

The incidence in different geographical regions is practically the same - be it developed countries or those with a low level of economic development.

Causes

The immediate cause of acoustic trauma is extremely intense sound or noise. How and how quickly ear damage develops depends, first of all, on such characteristics of sound exposure as:

• character;
• duration.

Based on this, there are two main causes of acoustic traumatic damage to ear structures:

• brief (may last less than a second) extremely loud sound;
• constant sound or noise of high or moderate intensity.

Short-term super-strong sounds are those whose volume (intensity) exceeds 120 dB (decibels). It can be:

• a whistling, piercing sound heard at a short distance from the ear;
• a loud human scream or an animal's roar just in the ear (at a distance of literally a few centimeters);
• the sound of a car horn (more often) or another vehicle, for example, a train (less often) under the ear itself;
• a piercing siren sounded not far from a person - indicating a combat alarm, the passage of an ambulance or a police car;
• shot from a firearm (often even a small caliber);
• explosion

note

The resulting acoustic trauma can be combined with barotrauma - physical damage to the structures of the inner ear, which was caused due to the difference in pressure from the external environment and the internal cavities of the ear.

Constant intense noise causes acoustic trauma, often if its intensity is 90 dB or higher. In people with increased tissue sensitivity, as well as those whose inner ear has been compromised by injury, acute or chronic diseases, or tissue pathology, acoustic injury can develop when exposed to sound with an intensity of 60 dB. In the greatest majority of cases, the disease develops in people who, due to their duty, are forced to regularly be in an environment with loud sounds and noises. This:

• heavy engineering workers;
• shipbuilding workers;
• employees involved in the aviation sector;
• metallurgists (especially with experience - those who began their careers in rather unsuitable conditions, with a low level of labor protection);
• textile industry workers;
• builders involved in servicing a pile driver - a construction machine designed to drive a construction pile into the ground;
• teachers and social workers who have worked for many years with numerous noisy children's groups (especially if they have hyperactive children who like to scream and make noise);
• musicians - especially those who perform musical compositions in the style of rock, metal and their “narrow” varieties;
• sound engineers and editors who have been forced to work with sound through headphones for many years;
• employees who serve animals in zoos or circuses that regularly produce loud screams. For example, there is evidence of chronic exposure to the hearing of employees (and subsequent acoustic trauma) to the sounds produced by noisy monkeys, which these employees have served for many years

and others.

Outside of professional influence, the following categories of people are at risk of acoustic injury due to chronic exposure to loud sounds:

• those who like to attend large concerts - these are mainly performances of rock musicians that take place in closed spaces and from which, moreover, it is impossible to leave prematurely due to large crowds of people;
• those who abuse listening to music or other sounds (for example, when watching movies) on headphones. If such abuse is observed over many years, then the intensity of the sound load may not play a role - even moderately intense sounds can cause acoustic trauma in a person after several years of using headphones.

There are also a number of factors that do not directly lead to acoustic injury, but contribute to its development. This:

• Previously occurring compromise of the hearing aid is various diseases of the inner ear (inflammatory, tumor and other nature) and/or its traumatic damage. Both previously suffered pathologies and those diagnosed at the time of the occurrence of acoustic trauma are important;
• endocrinological disorders - first of all, diabetes mellitus (impaired carbohydrate metabolism associated with a lack of the hormone insulin), hyperthyroidism (increased production of thyroid hormones), hypothyroidism (reduced production of thyroid hormones). These diseases are important in the sense that they worsen chemical processes in tissues and their regeneration - in particular, in the tissues of the inner ear;
• malformations of the structures of the hearing aid;
• poor nutrition - in particular, consuming insufficient amounts of proteins, fats, carbohydrates, vitamins, microelements, which negatively affects the regenerative (restorative) properties of hearing aid tissues damaged due to acoustic trauma.

Development of the disease

Depending on the causative factors, acoustic trauma can develop in two forms:

• acute (with simultaneous exposure to strong sounds on the inner ear);
• chronic (due to prolonged, regular exposure to sounds and noise of increased intensity on the organ of hearing).

Acute and chronic types of acoustic trauma differ not only in causative factors, but also in that they have different development mechanisms.

If an acoustic injury occurs due to a short-term but intense sound, then the following pathological changes develop in the organ of hearing:

• hemorrhage occurs in the perilymph (liquid contents) of the membranous labyrinth of the cochlea - and it is one of the main elements of the inner ear;
• swelling of the hair cells of the organ of Corti - the receptive part of the auditory analyzer;
• due to swelling - displacement of these cells.

The nerve impulse signaling the sounds of the external environment is formed precisely as a result of the movement of the fluid filling the organ of Corti, therefore, when its cells swell and shift, the sound is distorted. Under the influence of a strong sound, the organ of Corti can even be torn away from its attachment site.

The mechanisms of chronic acoustic trauma are not as well studied as acute ones. But there is evidence that regular exposure to loud noises can cause the organ of Corti to degenerate. In addition, the pathology is aggravated, since against the background of regular intense sounds, the subcortical centers of the brain, which are responsible for the perception of sounds from the external environment, suffer - pathological phenomena such as:

• metabolic disorders (metabolism in tissues);
• phenomena of fatigue of individual nervous structures;
• the formation of so-called pathological foci of excitation, which leads to hearing impairment.

Symptoms acoustic ear injury

The development of the clinical picture of acoustic trauma depends on whether it is acute or chronic.

In the acute form of the described pathology, at the moment of occurrence and perception of a strong sound, the following symptoms are observed:

• severe acute pain in the ears;
• sudden hearing loss (one- or two-sided - this depends on the circumstances of the occurrence of a strong sound, in particular, on the location of its source in relation to the ears).

The following develops further:

• the ability to perceive sounds from the external environment is lost;
• sounds are heard only in the form of a gradually fading ringing or a characteristic squeak;
• against the background of such sounds, dizziness and pain inside the ear (aching or throbbing) occur.

If, in addition to acoustic trauma, barotrauma occurs, then the described symptoms are joined by:

• bleeding from the external auditory canal, and often from the nose;
• violation of orientation in space.

• light;
• moderate severity;
• heavy.

For acoustic trauma mild degree sound perception is restored to the original level within 5-30 minutes after the impact of sound on the hearing aid.

For acoustic trauma moderate During the first 1-2 hours, the victim hears only loud sounds or screams; in severe cases, for 2-3 hours. After this, sound perception resumes, but hearing loss of varying severity develops.

With chronic acoustic trauma, its clinical picture develops in the form of 4 stages:

• stage of initial manifestations;
• clinical pause stage;
• stage of increasing symptoms;
• terminal stage.

Characteristics of the stage of initial manifestations:

• develops after 1-2 days of exposure to noise;
• discomfort and ringing in the ear occur;
• if external factors stop influencing, then the clinic disappears literally a few hours after the so-called acoustic rest - staying in silence;
• after 10-15 days adaptation occurs, the described symptoms gradually regress (develop in the reverse order);
• The stage lasts on average from 1-2 months to 4-6 years.

Characteristics of the clinical pause stage:

• unpleasant subjective sensations are not observed;
• hearing acuity gradually decreases;
• Duration of the stage is 2-7 years.

Characteristics of the stage of increasing symptoms:

• there is a constant noise in the ears;
• Hearing loss develops quite quickly. Its development is characteristic: first, the perception of sounds at high frequencies deteriorates, then at medium and low frequencies;
• in addition to the described ENT symptoms, general disorders also develop - increased fatigue, irritability, impaired attention, deterioration of appetite and sleep (even insomnia);
• hearing loss is observed at the same stable level even if the person continues to work under the same conditions for the next 5-15 years.

Characteristics of the terminal stage:

• is formed in people who have increased sensitivity to noise after 15-20 years of working with aggravated noise conditions;
• There is tinnitus (often unbearable), as well as a decrease in hearing acuity. It can even reach such a level that the patient cannot perceive spoken speech at a distance of more than 2 meters;
• In addition to the described hearing impairments, there is deterioration in coordination and balance, regular headaches and periodic dizziness.

Diagnostics

If the patient has reported exposure to sound and its characteristic consequences, the diagnosis of acoustic trauma is easy to make. Additional instrumental examination methods will help to detail the disorders that have arisen as a result of this pathology. In particular, methods such as:

Differential Diagnosis

Differential (distinctive) diagnosis of acute acoustic trauma is carried out with sudden onset (acute) sensorineural hearing loss, which can develop as a result of:

• allergic reaction;
• acutely formed cerebrovascular accident.

Differential diagnosis of chronic acoustic trauma is carried out with such pathologies as:

• Meniere's disease is a non-inflammatory lesion of the inner ear, in which the amount of fluid increases in it;
• presbycusis – deterioration in the perception of sounds, which develops due to age-related atrophic changes in the inner ear;
• tumors of the cerebellopontine angle.

Complications

The most common complications of acoustic trauma are:

• deafness;
• arterial hypertension;
• neurocirculatory dystonia (old name - vegetative-vascular dystonia) - disorders associated with chaotic narrowing and dilatation of blood vessels;
• astheno-neurotic syndrome – nervous exhaustion;
• angiospastic syndrome is a periodic narrowing of blood vessels with all the ensuing consequences due to impaired blood supply to tissues.

The last four pathologies are not disorders of the hearing organ, but often accompany acoustic trauma.

It should also be noted that due to acoustic damage to the organ of Corti, a decrease in its resistance to:

• infectious agents;
• intoxication of the body;
• exposure to pharmacological drugs that are ototoxic (initially “poisoning” the hearing organ).

Treatment of acoustic ear injury

Treatment of acoustic trauma is conservative.

The basis for the treatment of acute types of this pathology are the following:

• complete peace - in particular, sound;
• vitamin therapy – B vitamins are especially effective;
• calcium preparations.

Note: If the acoustic injury was not too severe, in some patients hearing returns to its original level within a few hours after the injury.

If hearing loss has developed, it is treated in the same way as hearing loss that develops as a result of chronic acoustic trauma.

In the case of chronic acoustic trauma, treatment is effective at the stages of initial manifestations and clinical pause. If treatment is started in a timely manner, it is possible to achieve an improvement in the level of hearing, but in the later stages they fight to prevent hearing loss from progressing. The treatment of chronic acoustic trauma is based on the following:

• change of profession or type of activity;
• refusal to attend concerts with loud sounds;
• refusal to use headphones at home;
• nootropic drugs - they improve the perception of sounds, as well as brain activity, the state of which also plays a role in the complex perception of sounds by a person;
• B vitamins - with their help, they improve metabolic processes in the nervous structures of the hearing aid, increase its ability to resist excessive impulses that spread from the middle ear, and also increase the tone of the auditory nerve;
• antihypoxants - in case of insufficient oxygen supply and literal starvation of the organ of Corti, they normalize its function, as they improve metabolic processes in its tissues;
• Darsonvalization is one of the methods of physiotherapy. The mastoid area is exposed to pulsed currents, which improves the functioning of the inner ear. The method is effective in combating extraneous noise in the ear;
• hyperbaric oxygenation - the patient is in a chamber with increased oxygen pressure. Thanks to this, regenerative (restorative) processes in the inner ear, as well as cerebral circulation, are improved;
• hearing aid – the use of a hearing aid is indicated to improve hearing with significant hearing loss.

Prevention

Acoustic injury is prevented by any measures that prevent the impact of intense sound or noise on the hearing organ. Such activities include the following:

• compliance with safety regulations in conditions that are fraught with loud noise;
• work in premises that provide full sound insulation and sound absorption;
• if necessary, work in conditions of loud sounds - use special headphones;
• periodic preventive examinations to record acoustic injury and improve working conditions.

Forecast

The prognosis for acoustic trauma depends on its type, as well as timely detection and treatment.

In the case of acute acoustic trauma of mild severity, hearing acuity is restored almost to the previous level.

If severe acute or chronic acoustic injury is diagnosed, irreversible hearing loss develops, the degree of which may vary.

Kovtonyuk Oksana Vladimirovna, medical observer, surgeon, consultant doctor

Among the different types of hearing damage, acoustic trauma is considered the most common. It is diagnosed after prolonged or short-term exposure to noise on the ears and causes dysfunction of the hearing aid, up to complete hearing loss.

What are the symptoms of acoustic trauma? What types of hearing loss are there? How is acoustic trauma treated?

Symptoms of Acoustic Trauma

The symptoms of acoustic ear injury directly depend on the circumstances of its occurrence. Experts distinguish between an acute form - which arose after short-term exposure to strong sound - and a chronic form, which appeared due to prolonged exposure to noise and vibration.

Sudden acute acoustic trauma is accompanied by the following symptoms:

• The patient experiences sharp pain inside the organ of hearing, behind the ear and in the temporal areas;
• there is hearing loss in the affected organ;
• Dizziness and loss of coordination may occur;
• When examined with an endoscope, the otolaryngologist will note ruptures in the membrane of the eardrum.

Acute acoustic trauma can affect both ears or be unilateral.

Chronic acoustic injury, sometimes occurring over several years, is almost painless. Patients may feel slight discomfort from the constant noise surrounding them in production or other work associated with loud sounds and vibration. Symptoms of chronic ear injury are:

• The appearance of incessant subjective tinnitus - buzzing, ringing and whistling;
• significant deterioration in the quality of sound perception in both ears.

When examining the outer ear, the otolaryngologist will note a pathological retraction of the eardrum. She takes this position due to the constant exposure to strong sound waves.

Causes

Acoustic trauma of any kind is caused by the impact of sound on the hearing organ. Its strength may vary:

1. In the acute form of the pathology, the functionality of the ears is negatively affected by loud, sharp, intense sound.
2. With chronic injury, the sound may be relatively quiet, but it affects the hearing organ for a long time, leading to the death of the villi lining the cochlea of ​​the inner ear.

In general, both types of acoustic trauma can result from:

• Working on noisy equipment;
• living in areas with loud sounds (near railways or surface metro lines, near airports and airfields);
• visiting shooting ranges, shooting ranges and training grounds;
• neglect of earplugs when working and staying in noisy objects;
• short-term exposure to loud (more than 120 dB) sound on the ear.

Types of Acoustic Trauma

As mentioned above, there are two types of acoustic injuries - acute and chronic. What is the mechanism of their occurrence?

Acute trauma

This form of hearing damage occurs when the ears are briefly exposed to loud or high-frequency sounds. Symptoms of injury may appear after a sharp whistle directly near the ear canal, a locomotive whistle, a shot or an explosion near the victim. A sudden impact of a strong sound leads to rupture of the eardrum, hemorrhage in the inner ear, and sometimes to displacement of the auditory ossicles lying in the tympanic cavity.

The resulting damage to the eardrum and hemorrhage in the cochlear cavity temporarily impairs the functionality of the hearing organ.

The membrane ceases to properly respond to sound vibrations and transmit them in the required quality further to the middle section, and the villi lining the cochlea, in turn, are not able to accept the resulting movement and process them into a nerve signal.

Chronic injury

Chronic acoustic ear injury occurs after prolonged exposure to noise, sometimes extending over several years. Loud sounds that constantly surround a person have a tiring effect on the internal parts of the hearing organ and significantly stretch the eardrum. Constant exposure to sound waves on the receiving cilia lining the cochlea of ​​the inner ear leads to their nervous fatigue and death.

If the consequences of acute acoustic trauma to the ear are completely reversible - the bruise and hematoma resolve over time, and the ruptures in the eardrum are scarred - then long-term noise exposure is irreversible. The dead villi of the inner ear are not restored, and the resulting hearing loss is not cured.

Diagnosis and treatment

Diagnosis of acoustic ear injury is based on collecting anamnesis and clarifying the circumstances that caused the impairment of the functionality of the hearing organs. Based on what kind of noise affected the patient’s ears, as well as on the basis of the duration of their influence, the otolaryngologist will determine the type of damage and build a program for rehabilitation, treatment or support for the functionality of the remaining villi in the cochlea.

To diagnose an acoustic injury and determine the method of its treatment, the specialist will also conduct audiometric measurements aimed at identifying sounds of what volume and frequency the patient can hear, and which sounds the patient is no longer able to detect with the hearing organ. Based on this study, the otolaryngologist will judge the severity of the disease, because the very first to die in the inner ear are the hairs responsible for receiving, processing and nerve transmission of high frequencies to the brain.

Treatment tactics for acoustic ear injury are based on its type. The acute form, as a rule, does not require any therapy. If a patient is diagnosed with chronic acoustic ear injury, treatment is mandatory. Without taking certain medications, the disease is guaranteed to lead to irreversible deafness.

To stop the progression of the disease, medications alone are not enough. The specialist recommends that you change your occupation or place of residence (depending on what circumstances led to the acoustic trauma of the ear) in order to remove the factor that provokes the death of the sound-receiving villi.

The complex of drug therapy usually consists of the following drugs:

• Calcium and bromine preparations help get rid of the unpleasant accompanying symptoms - noise in the ear;
• the vitamin complex will strengthen the body’s defenses and improve metabolic processes;
• nootropic drugs also help increase metabolism in tissues;
• if there is a risk of developing inflammatory processes and to relieve tissue swelling, steroid drugs are used;
• sedatives will provide the nerve conductors with temporary rest, necessary to relieve the “fatigue” syndrome and stop the degenerative process.

Conservative treatment will be characterized by positive dynamics only with early diagnosis of acoustic trauma, but even in this case, pathological changes in the nerve areas of the hearing organ are irreversible. To restore patients' ability to hear, otolaryngologists recommend the use of in-ear hearing aids.

Preventing acoustic injuries

To prevent the hearing organs from losing their functionality due to acute injury, it is important to follow protective preventive measures:

• When working in noisy industries and facilities, use protective earplugs and headphones;
• listen to loud music less often;
• when living in a noisy area, use soundproofing materials during repair, finishing and construction work;
• undergo regular medical examinations with a mandatory visit to the otolaryngologist’s office;
• at the slightest sign of deterioration in hearing quality or the appearance of subjective noise, visit an ENT specialist and undergo audiometric diagnostics.

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

Symptoms and causes

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

There are a huge number of factors that can harm and impair hearing in modern life:

• sounds of transport, especially air;
• production and repair equipment;
• loud music, particularly when played through headphones;
• weapon;
• pyrotechnics;
• other sounds, in particular sharp bangs.

Acoustic trauma may be invisible at the initial stage, which provokes the development of hearing loss. This often occurs 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 on headphones. In adulthood and older age, hearing loss occurs due to an unfavorable work environment. In this case, they talk about occupational hearing loss. An explosion or gunfire can also cause injury.

As a result of injury to the ear, a disruption of its cellular structure occurs. In especially severe cases, the eardrum ruptures and internal hemorrhage occurs. Sometimes blood may leak out of the ear. To increase the chances of hearing restoration, urgent treatment is required, but it is not always effective.

Treatment of injuries of varying degrees

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

• Light. Usually occurs after prolonged exposure to loud sound that does not reach a critical level. Hearing completely recovers on its own after some time.
• Average. A special hearing restoration course is required. However, such acoustic trauma leaves negative consequences that 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 is a chance of partial elimination of hearing loss. If proper treatment is not carried out, the problem progresses, the auditory cochlea loses its sensitivity and complete deafness occurs.

Treatment consists of eliminating the sound irritant to the ear. Next, a course of medication is prescribed: vitamins, sedatives and painkillers, as well as bromine and calcium.

Prevention

To avoid having to undergo intensive treatment or face irreversible consequences, it is important to recognize the negative influence of 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 high noise environments.

It is imperative to limit the effect of vibration on your ears. In case of sudden loud sounds, you should open your mouth to compensate for the pressure on the membrane. If you notice any discomfort or pain, immediately leave the unfavorable environment.

If the ear organs have previously been injured, it is important to undergo a rehabilitation course after completing the main stage of treatment. Here, pine baths, relaxing treatments and visits to sanatorium-resort areas are prescribed.

By taking good care of your hearing, you can avoid problems in the future. If an ear injury does occur to you, treatment must begin immediately, especially if it is moderate to severe.

Ear contusion is a type of acoustic injury that occurs due to a sudden change in air pressure inside the ear canal. This leads to anatomical changes inside the ear, namely rupture of the eardrum and hearing loss.

Often, contusion is short-lived and goes away fairly quickly with qualified treatment and proper medical care. However, more complex cases are possible, leading to deafness in both ears, loss of voice and even speech.

What happens with an ear contusion?

Contusion is a type of ear injury in which internal damage occurs, but the auricle is not deformed. In this case, the integrity of the tissues inside may be compromised and the chain of auditory ossicles may be damaged.

Acoustic ear injury occurs under the influence of a blast wave and the sound stream that comes from it. This causes a sharp change in air pressure inside the ear.

This puts pressure on the eardrum, the ossicles and the nerve endings in the ear. Serious irritation of the sound-receiving apparatus, the organ of Corti, also occurs.

Quite often there is not just a rupture of the eardrum, but its complete destruction. Such an effect on the hearing aid can occur not only when exposed to an explosion, but also when exposed to a loud or harsh sound.

What happens with an ear contusion, look at the photo

Kinds

Medicine officially distinguishes two types of ear contusion - acute and chronic. In each individual case, its own treatment is prescribed and first aid is provided.

Acute injury is characterized by a short-term effect, namely a short and sharp pain that leads to or auditory ossicles.

Thus, a similar effect can be caused by a loud whistle, strong harsh music, or a sharp sound clap. The treatment is gentle, including elimination of the main symptoms in the form of hemorrhage and acute pain.

In severe cases, destruction occurs in all cells. In this case, the nerve fibers are affected, and hemorrhage occurs in the ear canal.

Causes

The main reason for the appearance is the impact of loud sound on the eardrum and other hearing organs. However, there are a huge number of circumstances and factors that provoke injury. Here are just a few of them:

• shot from a firearm;
• explosion;
• exposure to loud music;
• shout.

This is not the entire list of reasons that can lead to disruption of the functioning of the hearing aid. So, regardless of the factor, the hearing organs are primarily exposed to loud sounds, the impulsiveness of which exceeds 160 dB.

It seems incredible, but seemingly temporary things can become the cause. For example, loudly kissing the ear or setting off fireworks can easily stretch and damage the eardrum.

At the same time, the person feels a sharp and oppressive pain inside. The pain subsides fairly quickly, but the discomfort may not go away for some time.

The victim needs to make sure that there is no deafness or blood in the ear. If you detect at least one symptom, you should visit a doctor to rule out the possibility.

Symptoms

With any degree of contusion, the symptoms remain approximately the same. In the standard version, after damage to the ear canal, a person feels and observes the following signs of a problem:

• sharp pain in the ear;
• immediate hearing loss - complete deafness;
• disorientation;
• tinnitus;
• bleeding from the ear or nose;
• visual impairment;
• (rarely).

In each individual case, symptoms manifest themselves differently and can be strongly or mildly expressed.

First aid

Providing first and emergency aid for concussion involves a series of prompt and coordinated actions. They look like this:

• The victim should be taken to a safe place where he will not be in danger of repeated exposure to sound;
• The ears should be carefully examined for blood or other fluid that may appear after the explosion;
• If a person has lost consciousness, then he should be brought back to his senses by patting him on the face or using ammonia;
• The affected ear should be isolated with a sterile bandage or a clean piece of cloth. This will protect the damaged ear canal from infection;
• The victim is urgently taken to the hospital.

After a person is in the hospital and sees a doctor, the patient is examined to determine the complexity and extent of the injury.

A detailed diagnosis is carried out. It includes taking an anamnesis, examination and palpation, and examination of the sore ear. If necessary, blood collection is prescribed to detect infection and other special procedures.

Treatment

At the first stages of treatment, the victim must be provided with complete rest, namely, to exclude any possibility of repeated sound trauma.

It is mandatory to eliminate a number of measures to restore auditory function. to the maximum extent possible. In this case, the attending doctor prescribes restorative therapy. It includes taking sedatives and vitamins.

It will not be superfluous to protect yourself from excessive stress on the ear. So, during the treatment period it is better to stop listening to music on headphones and watching TV at high volume.

It is worth avoiding places where the possibility of getting a contusion increases again. Such places include a football stadium, a music concert, and industrial plants.

When an infection occurs, it is prescribed with the addition of. Depending on the patient’s condition, antishock drugs and sedatives are prescribed in the presence of insomnia and increased excitability.

Watch the video on how to provide first aid about shell shock:

Consequences, complications

If treatment is untimely or assistance is delayed for an ear contusion, a person may experience some complications, which, first of all, will leave their mark on the ear. If the eardrum ruptures, significant hearing loss can occur.

Providing qualified medical care allows you to regain the ability to hear within the first weeks after injury.

If this does not happen, the victim may experience serious hearing impairment. The neglect of the infection can develop into and, in which surgical intervention will be inevitable.

Also quite common among complications is one characterized by seasonal manifestations depending on the state of the human immune system and environmental weather conditions. If treatment is not prescribed correctly, a disorder of the central nervous system may occur.

Acoustic trauma (acutetrauma)– damage to the inner ear caused by immediate or continuous exposure to excessive sound or noise. The main symptoms of acute sound damage are sudden onset and gradually subsiding pain and ringing in the ears. Chronic acoustic trauma is manifested by a gradual decrease in hearing acuity, discomfort and a feeling of tinnitus, sleep disturbance and increased fatigue. The diagnostic program includes the collection of anamnestic data and patient complaints, otoscopy, speech testing and pure-tone audiometry. Treatment includes taking vitamins g. B, nootropics, darsonvalization and oxygen therapy, hearing aids.

General information

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

Causes of Acute Trauma

The leading etiological factor is excessively loud noise or sound. The mechanism and rate of development of the lesion, its main manifestations depend on the nature and duration of sound exposure. Based on this, it is advisable to distinguish two main causes of acoustic trauma.

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

Pathogenesis

Acute and chronic (occupational) acoustic injuries have different mechanisms of development. A short-term, excessively strong sound causes hemorrhage into the perilymph of the anterior part of the membranous labyrinth of the cochlea - one of the components of the inner ear. In parallel, displacement and swelling of the outer and inner hair cells of the organ of Corti occur. 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, the organ of Corti detaches from the main membrane. The pathogenesis of chronic acoustic trauma has not been fully studied, so several probable theories have been identified. According to them, constant exposure to loud noises on the hearing aid can cause degenerative changes in the organ of Corti, metabolic disorders and the phenomenon of fatigue, and the formation of pathological foci of excitation in the subcortical centers.

Symptoms of Acoustic Trauma

The acute form of the disease is characterized by severe pain in the ears at the time of perception of sound and sudden one- or two-sided hearing loss. A person is deprived of 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 disturbance of spatial orientation. The further course depends on the severity of the lesion. Mild acoustic trauma is characterized by a gradual restoration of sound perception to the original level after 5-30 minutes. In moderate to severe cases, during the first 2-3 hours the patient hears only loud sounds or screaming. Next, there is a gradual restoration of sound perception to the level of hearing loss of varying degrees of severity.

The development of the clinical picture of chronic acoustic trauma goes through 4 stages.

• Stage of initial manifestations occurs after 1-2 days of exposure to noise. Characterized by discomfort and ringing inside the ear. After the cessation of exposure to external factors, these manifestations disappear after several hours of rest. After 10-15 days, adaptation occurs and 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 there are no unpleasant sensations, but gradually, unnoticed by the patient, hearing acuity decreases. Its duration ranges from 2-7 years.
• Stage of increasing symptoms manifested by constant tinnitus and rapid development of hearing loss. In this case, hearing loss occurs sequentially: first, sound at high frequencies ceases to be perceived, then at medium and low frequencies. The present clinical manifestations are complemented by nonspecific symptoms: increased fatigue and irritability, deterioration of attention, loss of appetite and insomnia. Formed hearing loss remains at the same level even with continued work under the same conditions from 5 to 15 years.
• terminal stage develops in people with increased sensitivity to noise after 15-20 years of working 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 tinnitus, impaired coordination of movements and balance, constant headache and dizziness.

Complications

The most common complication of acute trauma is deafness. The main causes of complete hearing loss are late diagnosis and treatment. Its development is facilitated by failure to follow the recommendations of the otolaryngologist and 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

Diagnosing 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 impedance measurements) are used to differentiate with other pathologies.

• Anamnestic data. During acute trauma, there are always situations in which the patient is exposed to a sharp and loud sound or has been in conditions of constant noise for a long time.
• Otoscopy. In some patients, pathological retraction of the tympanic membrane is visualized, which is characteristic of constant tetanic contractions of its muscles. When acute acoustic damage is combined with barotrauma, a large number of blood clots and rupture of the eardrum are determined.
• Speech audiometry. Allows you to set the distance at which patients perceive screaming (80-90 dB), spoken (50-60 dB) and whispered speech (30-35 dB). Normally, conversation can be heard at a distance of up to 20 meters, and whispering - up to 5 m. With hearing loss, these distances decrease or speech becomes incomprehensible. In severe cases, only a scream directly above the ear is perceived.
• Pure-tone threshold audiometry. Reflects damage to the sound-receiving apparatus, which is manifested by a progressive deterioration of air and bone conduction with an increase in the frequency of generated sounds.

Differential diagnosis of acute acoustic trauma is carried out with sudden (acute) sensorineural hearing loss. The second pathology may be the result of an allergic reaction or acute cerebrovascular accident. Chronic acoustic trauma requires differentiation from Meniere's disease, presbycusis and tumors of the cerebellopontine angle. With pallexmixia, unilateral hearing loss occurs, and spontaneous worsening or regression of symptoms may occur. Presbycusis occurs over the age of 70 years, and a decrease in hearing acuity is not accompanied by the appearance of extraneous noise. Tumors of the cerebellopontine angle, in addition to hearing loss, also manifest as damage to the facial and trigeminal nerves.

Treatment of acoustic trauma

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 case of acute acute injury, complete rest and vitamins are indicated. 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 short-term acute sound, treatment is similar to chronic acoustic trauma.

With chronic acutram, treatment is most effective at the stages of initial manifestations and “clinical pause”. With modern treatment, some patients 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 of hearing loss.
• Nootropics. Drugs in this series improve sound perception and other cognitive functions of a person, and activate the functioning of the brain as a whole.
• B vitamins. They improve the metabolism of the central nervous system, increase its resistance to excessive impulses from the middle ear, and tone the functioning of the auditory nerve.
• Antihypoxants. They normalize the function of damaged hairs of the organ of Corti by improving metabolism in conditions of insufficient oxygen and nutrients.
• Darsonvalization. The impact of pulsed currents on the mastoid region stimulates the functioning of the inner ear. The technique allows you to combat extraneous tinnitus.
• Hyperbaric oxygen therapy (HBO). Under conditions of increased oxygen pressure, cerebral circulation and reparative processes in the inner ear improve.
• Hearing aids. The use of hearing aids makes it possible to improve the quality of hearing in cases of severe hearing loss.

Forecast and prevention

The prognosis for recovery from acoustic trauma depends on its form. In case of acute injury of mild severity, complete restoration of the original hearing acuity occurs. With severe acute or chronic acoustic trauma, irreversible hearing loss of varying degrees develops. Preventive measures include compliance with safety regulations at work and in life, working in rooms with complete sound insulation and sound absorption, and the use of individual noise protection or special headphones. Regular medical examinations of persons working under the influence of constant noise play an important role.

Treatment is necessary if symptoms of severe hearing damage occur:

• hearing loss or deafness;
• prolonged tinnitus;
• retraction of the eardrum during ENT examination.

Types of acoustic ear injury

There are 2 types of acoustic ear trauma:

• spicy. 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 to the ear is accompanied by severe pain in the auditory organ. Histological examination reveals hemorrhage in the cochlea, displacement and swelling of the cells of the Corti canal;
• chronic or noise. It occurs as a result of the tiring effect of sounds on the hearing organ. For example, in people who work for a long time in conditions of loud noise.

Hearing impairment due to acute acoustic trauma to the ear is almost always reversible, while chronic acoustic trauma is often characterized as incurable. Separately, there is another acoustic ear injury that is practically untreatable - age-related hearing loss.

Treatment of acoustic trauma

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

When the first symptoms of chronic acoustic trauma appear, it is recommended to change profession, since if you do not change working conditions, the disease will progress. Treatment of acoustic trauma received at work requires the same therapy as in the treatment of other types of hearing loss: sedatives and restorative drugs, vitamin therapy, nootropic drugs, γ-aminobutyric acid compounds, 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, pine and hydrogen sulfide baths are recommended. Rehabilitation consists of conducting sanatorium-resort treatment and preventive courses of drug therapy in dispensaries. It is necessary to use means of collective (engineering) and individual (headphones, earplugs) protection from increased levels of noise and vibration, which provoke acoustic trauma.

Treatment for severe consequences of chronic acoustic trauma is considered ineffective, since hearing loss in this case is caused by degenerative changes in the nervous system of the hearing organ. Therefore, early diagnosis of acoustic trauma is considered a very important point in treatment.

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