The aim of the research was to study the effect of nasopharyngeal pathology on hearing in elderly and senile patients. The results of the examination of 139 patients who consulted an audiologist are presented. Group 1 included 62 young and middle-aged people (45,2±11 years), group 2 included 77 elderly and senile people (68,4±6,2 years). All patients underwent video endoscopy of the nasal cavity and nasopharynx, along with the collection of complaints and medical history, an ENT examination and an audiological examination, including pure tone audiometry in the standard frequency range and impedancemetry. The study showed a high incidence of diseases of the nasal cavity and nasopharynx, contributing to hearing impairment, in patients of different ages. It was found that in elderly and senile patients, along with sensorineural hearing loss, conductive/mixed forms of hearing loss were diagnosed in 19,5% of cases, exacerbating hearing loss and reducing the quality of life. Significant correlations between the state of hearing and the presence of occlusion/patulous of the Eustachian tube were revealed. Timely detection of nasopharyngeal pathology leading to dysfunction of the Eustachian tubes and hearing impairment, followed by correction of the identified disorders, can be an effective addition to the rehabilitation program for patients with presbyacusis.
Selenium (Se) is an essential metalloid, possessing not only antioxidant but also anti-inflammatory effects. Recent studies have shown that the latter may be mediated by modulation of NLRP3 inflammasome activation, although the exact mechanisms have yet to be fully characterized. Therefore, the objective of this review is to discuss the molecular mechanisms by which Se modulates NLRP3 inflammasome activation and to examine the downstream effects on NLRP3-mediated inflammation and pyroptotic cell death. The selenoproteins S, O, M, W, and especially glutathione peroxidase (GPX) and thioredoxin reductase (TXNRD) are involved in regulation of the NLRP3 inflammasome machinery through modulation of redox homeostasis. In contrast, Se deficiency has been shown to aggravate NLRP3 inflammasome activation induced by lipopolysaccharide (LPS) treatment or exposure to organic pollutant bisphenol A (BPA). In addition to increased reactive oxygen species (ROS) generation, Se deficiency contributes to NLRP3-mediated inflammation and pyroptosis through modulation of non-coding RNA expression. In turn, Se supplementation mitigates NLRP3 inflammasome activation in liver, heart, kidneys, intestine, brain, and certain other tissues induced by LPS exposure, ischemia/reperfusion (I/R), and various xenobiotics including heavy metals and organic pollutants. This effect appears to be mediated by modulation of various components of Toll-like receptor (TLR)/nuclear factor κB (NF-κB)/NRLP3, nuclear factor erythroid 2-related factor 2 (Nrf2)/ROS/NLRP3, thioredoxin-interacting protein (TXNIP)/NLRP3 pathways, and several other mechanisms including modulation of gut microbiota with subsequent reduction of circulating LPS levels. Collectively, these findings demonstrate that the anti-inflammatory and cytoprotective effects of Se supplementation may be mediated by modulation of NLRP3 inflammasome activation.
Cochlear implantation is a highly technological method of rehabilitation for patients with profound sensorineural hearing loss. In most cases, cochlear implantation follows a standard technique, but there are cases that require meticulous attention in the selection of tactics. Recently, chronic otitis media was considered as a contraindication for cochlear implantation due to the risk of developing a number of complications. Despite these potential problems, cochlear implantation is the only solution to help patients with chronic otitis media and stage IV sensorineural hearing loss. There are various methods for managing the above-mentioned group of patients. Some authors describe performance of cochlear implantation with middle ear surgery in one stage, while other authors, in several stages. The issue of cochlear implantation in patients suffering from chronic suppurative otitis media has always aroused discussions among otosurgeons. In this article, we analyzed a series of clinical cases (10 patients) with chronic otitis media who underwent middle ear sanation surgery and cochlear implantation. In our opinion, a single-stage cochlear implantation together with a sanation intervention on the middle ear can be considered as a technique that allows to accelerate the auditory-speech rehabilitation of patients with stage IV sensorineural hearing loss and epitympanitis. This is especially important for patients with acquired pathology of the inner ear and the risk of ossification of the cochlea spiral canal.
Introduction. Videolaryngoscopy and videolaryngostroboscopy are the “gold standard” for the diagnosis of laryngeal diseases. During a videolaryngoscopy, an anatomical and functional assessment of the state of the larynx is performed. Videolaryngostroboscopy visualizes the vibratory cycle of the vocal folds in order to provide a more detailed functional assessment. Videostrobokymography allows to perform a qualitative and quantitative analysis of the vibratory cycle.Aim. To evaluate the indicators of videostrobokymography in functional and organic dysphonia.Materials and methods. 9 patients were examined. In one case, there was no pathology of the larynx. Among the functional disorders, two cases of hypofunctional and one of hyperfunctional dysphonia are presented. Organic diseases: chronic catarrhal laryngitis, Reinke’s edema, vocal fold nodules, vocal fold polyp, vocal fold injury after phonosurgery. Videolaryngoscopy, videolaryngostroboscopy, and videostrobokymography were performed. The strobokimograms were evaluated qualitatively by the presence of periodic oscillations of the vocal folds, phase and amplitude symmetry, mucous wave, the shape of lateral and medial peaks, and the shape of the gap in the opening phase. For the quantitative analysis, the opening quotient (OQ) was determined, which objectively reflected the duration of the opening phase.Results. Normally, phase and amplitude symmetry were preserved, the mucous wave was visualized, lateral and medial peaks of vibrations were pronounced, the gap in the opening phase was in the shape of a rhomb, OQ was 0.5. Pathological changes included: a decrease in the amplitude of vibrations, an increase or decrease in the mucous wave, phase and amplitude asymmetry, a change in the shape of lateral and medial peaks, a change in the shape of the gap in the opening phase. The OQ index varied from 0.42 to 1 depending on the duration of the opening phase in various diseases of the larynx.Conclusions. Videostrobokymography makes it possible to assess the indicators of the vibratory cycle in more detail, conduct a graphical analysis, compare the picture at different levels of the glottis, and obtain objective data. The method can be used in the in-depth diagnosis and evaluation of the results of treatment of diseases of the larynx in addition to videolaryngostroboscopy.
Tinnitus is a significant clinical problem that has a significant impact on the quality of life of patients. Despite the development of conservative and invasive treatment methods, chronic tinnitus often persists, especially in neurogenic and idiopathic etiologies. In recent years, the attention of researchers has been drawn to the involvement of the autonomic nervous system in the pathogenesis of tinnitus, in particular, the potential for modulating central auditory activity through the vagus nerve. The aim of our study was to evaluate the effectiveness of transcutaneous stimulation of the left cervical branch of the vagus nerve in the complex therapy of tinnitus as a method of neuromodulation in order to reduce the severity of tinnitus and correct autonomic imbalance. The method was evaluated using the example of treating a patient with chronic tinnitus, who, after an acoustic injury, underwent a course of combination therapy: daily 20-minute transcutaneous stimulation of the vagus nerve using the Neurostim device in combination with individually selected sound therapy. Efficacy was assessed using THI, VAS and analysis of autonomic regulation indices (LF/HF). After a 20-day course of therapy, the noise intensity on the THI scale decreased from 58 to 34 points (from severe to mild), the LF/HF index decreased from 4.45 to 3.42, indicating a decrease in sympathicotonia. The patient noted improved sleep and general well-being, a decrease in subjective noise intensity to 3 points on the VAS scale. Transcutaneous vagus nerve stimulation in combination with sound therapy can be considered a promising direction in neuroregulatory therapy for tinnitus. The method is well tolerated and has the potential for wide clinical application, but requires further research to standardize stimulation parameters and select patients.
