DYNAMICS OF HEARING DISORDERS IN PATIENTS WITH ARTERIAL HYPERTENSION UNDER THE INFLUENCE OF HYPOTENSIVE THERAPY
Hypertension (GB) was identified by Russian scientists as the greatest non-infectious pandemic in the history of mankind. This definition given at the end of the twentieth century retains its significance at the beginning of the twenty-first century, when there is an increase in the trend towards an increase in the incidence of GB. Currently, in the fight against hypertension, not only the reduction in blood pressure, but also the prevention and treatment of organ complications is relevant. As you know, among organ complications, cerebrovascular are life-threatening. In particular, damage to the auditory analyzer significantly reduces the quality of life of patients with GB. Therefore, it is very important to study the state of auditory function in patients with GB, to determine the relationship of this pathology as a whole with discirculatory disorders of the brain. This question in the literature is not sufficiently consecrated; only a few reports discuss individual aspects of this problem.
In view of the foregoing, the aim of this work was to study the state of auditory function in patients with hypertension with pre-stroke cerebrovascular disorders (DECD) and their dynamics during treatment with modern antihypertensive drugs.
Material and research methods. We examined 79 patients with GB who had a disease duration of 1 year to 15 years. Among sick men there were 92, women 18, their age ranged from 31 to 73 years. Patients were distributed according to the structure of revealed DVSC as follows: with initial manifestations of inferiority of the blood supply to the brain (NPNCM) of 20 patients, with hypertensive encephalopathy (HE) -Ist. – 20 people, with GE-II Art. – 20 and GE with episodes of transient disorders of cerebral circulation (PNMK) – 19 patients.
The examination included: examination of somatic (cardiological), neurological and otoneurological status, carrying out rheoencephalography (REG), echoencephaloscopy (EchoES), electroencephalography (EEG), audiometry (AM) and electromagnetogram (ENG) according to generally accepted standard methods. The specified set of examinations was carried out by the patient twice, before and 1 month after treatment. In 40 patients, antihypertensive therapy was carried out with an ACE inhibitor Vazotek (enalopril) at a dose of 5-10 mg / day. 39 patients received antihypertensive therapy with calcium antagonists (Corinfarum up to 30 mg / day or Norwegian 5-10 mg / day). There were no statistically significant differences in the effect on the auditory function indices; therefore, the results are summarized.
The results obtained and their discussion.
The analysis of patients’ complaints showed that out of 79 patients who complained of tinnitus in 28, they were completely regressed, and in 51 partially. When comparing the dynamics of noise with the dynamics of blood pressure, we observed the following picture. Of the 64 patients with DECR with a decrease in blood pressure as a result of treatment, 42 people respectively disappeared or decreased noise (65.6%). And among people with unchanged blood pressure in 63.3% of cases, noise remained unchanged. The dynamics of tinnitus in the context of the structure of DECR was as follows: in patients with NSAIDs, noise decreased or disappeared in 17 out of 20 (85%), in patients with HE-I st. – in 13 of 20 (65%), GE-IIst. – in 10 out of 20 (50%), and in patients with GE with PNMK, the noise disappeared or decreased only in 5 out of 19 (26.3%). According to a study of hearing acuity in speech, after treatment a significant improvement in hearing occurs in the initial stages of the disease, while in later stages, improvement occurs in a smaller percentage of cases. It should also be noted that the perception of colloquial speech improves to a greater extent than whispering.
The results of C128 tuning-forks studies of sound perception through air in patients receiving calcium antagonists showed that positive dynamics occur in 48.7%, and in patients receiving ACE inhibitors in 50%. As you can see, the differences are statistically unreliable. At the same time, the difference in bone conduction is more distinct, making up a positive trend in the group with AK 41.01% and in the ACE inhibitor group 45.0%.
Audiometric studies of auditory function have expanded the understanding of the state of hearing in patients with GB with DTSVR both according to the initial and dynamic data. In particular, audiometric indicators of hearing loss according to the initial data were found in 65 (81.2%) of 79 patients. After a month of antihypertensive therapy, positive audiometric dynamics were found in 36 (55.3%) of 65 patients. The structure and dynamics of audiometric changes were as follows: a) in most patients with an isolated lesion in the perception of high sounds during treatment, some improvements in the perception of these sounds were observed within 10-15 dB, less often 20 dB. b) in some patients with a general increase in thresholds of auditory sensitivity, a decrease in hearing thresholds was observed over the entire frequency range within 10-15 dB., less often -20 dB. c) in several patients with HE-II and HE with PNMK, a mixed change in hearing was observed, consisting mainly in improving the perception of low and worsening perception of high sounds within 10-15 dB, less often 20 dB.