To date, the problem of treating elderly patients with subjective tinnitus is gaining momentum, and there is no single universal approach to its solution. A personalized approach to the patient, including an assessment of the state of tone of the autonomic nervous system, can help identify and correct sympathicotonia in patients as one of the causes of tinnitus. The aim of the study was to evaluate the effectiveness of auricular percutaneous electrical stimulation of the vagus nerve for the treatment of tinnitus in patients of older age groups with sympathicotonia. The study involved 55 people (aged 60 to 85 years), of which 25 patients underwent physiotherapy in combination with drug therapy (main group), and 30 patients, exclusively drug treatment (control group). The assessment of the strength of subjective ear noise, the tone of the autonomic nervous system, the results of the THI (Tinnitus Handicap Inventory) questionnaire, the qualitative characteristics of hearing according to the Russian version of the ESIT-SQ (European School for Interdisciplinary Tinnitus Research Screening Questionnaire) in the study groups showed that patients of the main group were 60% more likely to have a positive effect of treatment according to the studied indicators.

Spatial and speech characteristics of hearing are needed to monitor the rehabilitation of sensorineural hearing loss in patients of older age groups. Using the created «Program for the assessment of speech, spatial and qualitative characteristics of hearing using virtual reality» increases the level of hearing diagnostics using a computerized audiovisual script. The purpose of the study is a comparative analysis of the speech, spatial and qualitative characteristics of hearing before and after using virtual reality in patients of older age groups. The results of the study showed that with good tolerance of virtual reality in 48.3% of patients, the answers to the questions of the SSQrus-12 questionnaire for assessing the spatial and speech characteristics of hearing became more objective. The developed methodology supplemented the group of modern diagnostic methods for spatial and verbal hearing by immersing the patient in a virtual environment in the created audiovisual scenario.

Objective: justifying the possibility of using frequency-based hearing research via the web application ‘Automated System for Initial Hearing Assessment’. Materials and methods. The study was carried out at the Department of Otorhinolaryngology of the Samara State Medical University clinics in October 2019. It involved 91 patients 17 to 73 years old (average age 48±14.6 years). All study participants were divided into two age groups: Group I 17-59 years old), and Group II (over 60 years old). Patients were required to undergo two hearing assessment tests: using the Interacoustics AC-40 clinical audiometer and using our web application ‘Automated System for Initial Hearing Assessment’ (patent No. 2019664671). Results. The maximum difference in average hearing thresholds between pure-tone threshold audiometry and the web application in Group I was 3.3 dB at a frequency of 2 kHz on the right and 3.2 dB at frequencies of 2 and 4 kHz on the left; in Group II, it constituted 4.7 and 3.5 dB at 1 and 2 kHz, on the right, correspondingly, and 7.2 dB at 4 kHz on the left. The presented data were evaluated using the Cohen’s kappa coefficient, which confirmed high level of agreement between the results obtained using the clinical audiometer vs. our original web application. Conclusion. Based on the obtained results, a conclusion was made about the possibility of using the original web application for the initial hearing express assessment in general practice in conditions of limited availability of audiological care.

The increase in life expectancy of the population is reflected both in statistics on chronic sensorineural hearing loss and on issues related to hearing rehabilitation methods. Evaluation of the effectiveness of the use of auditory training using the virtual reality program developed by us in patients of older age groups as an additional method of rehabilitation was carried out. 68 patients took part in the study (average age was 81,3±2,1 years), according to the results of the training, the parameters of speech and spatial hearing were evaluated.

PURPOSE OF THE STUDY:To evaluate the effectiveness of the application of the web application "Automated system of primary hearing assessment" created by us for the diagnosis of hearing impairment in different age groups.MATERIAL AND METHODS:With the help of this web application, 712 patients were examined in 3 age groups: group 1 - patients aged 18 to 44 years, 196 people (average age 25.6±2.7 years), group 2 - patients aged 45 to 59 years, 265 people (mean age 46.3±3.6 years), 3rd group - patients 60 years old and older, 251 people (mean age 75.4±1.1 years).RESULTS:It was revealed that 61.8% of patients had risk factors for the development of hearing loss. In the 1st age group, one risk factor for hearing loss prevailed, in the 2nd and 3rd groups, up to 5-9 factors were simultaneously combined. Clinically significant hearing loss was found in 24.3% of patients. Hearing studies at frequencies of 10 and 12 kHz revealed latent hearing loss in 31.3% of patients, 57% of them had risk factors for the development of hearing loss. Comparative analysis in the groups showed that hearing impairment at high frequencies was found in 47.4% of patients in older age groups and in 15.8% of young people. The possibility of performing otoscopy images made it possible to identify changes in the tympanic membrane in 17.1% of patients, to give a correct conclusion about the state of their hearing and to propose an algorithm for further examination. It was found that the sensitivity of the study in the web application was 98%, the specificity - 99.9%.FINDINGS:The use of the web application allows assessing the risk factors for the development of hearing loss, identifying patients with latent hearing loss, objectifying the study with otoscopy images, and remotely obtaining a conclusion about the state of hearing from a specialist doctor.

OBJECTIVE:To establish the features of tinnitus in older age patients with autonomic dysfunction.MATERIAL AND METHODS:We examined 94 patients aged 60 to 93 years (average age is 75.4±3.2 years). Patients with an imbalance of the autonomic nervous system were identified according to the questionnaire of A.M. Wayne and Kerdo's autonomic index. The questionnaires assessing the strength of subjective ear noise, the psychoemotional state of patients, the impact of tinnitus on various spheres of life were used in this study.RESULTS:It was revealed that more than 50% of patients of older age groups with tinnitus had a dysfunction of the autonomic nervous system. Patients with parasympathicotonia more often noted bilateral persistent subjective ear noise than patients with sympathicotonia.CONCLUSIONS:Autonomic dysfunction could be the cause of sleep disturbances, psychoemotional disorders and a decrease in the quality of life.

To date, an otorhinolaryngologist has no single Russian language screening questionnaire for patients with complaints of tinnitus in the practice. At the same time, it is important to describe its qualitative characteristics in the diagnosis of tinnitus, including monitoring the effectiveness of treatment, which is impossible when using existing score questionnaires. The aim of the work was the translation, adaptation, and validation of the Russian language version of the questionnaire of The European School for Interdisciplinary Tinnitus Research Screening Questionnaire (ESIT-SQ) for the diagnosis of hearing loss in patients of different age groups. After cultural and linguistic adaptation, the ESIT-S was validated by the test-retest method among patients of two groups: Group I – persons with tinnitus and normal hearing (77 people), group II – persons with tinnitus and hearing loss from mild to profound (79 people). The results of the study demonstrated the reliability of the questionnaire, as well as clinical validity in the study groups. The assessment of the qualitative characteristics of hearing using the Russian version of the ESIT-SQ before and after complex treatment of tinnitus confirmed the sensitivity of the questionnaire. Thus, the Russian language version of the ESIT-SQ can be used in the practice of an otorhinolaryngologist as an additional diagnostic tool for subjective ear noise.

Objectives to evaluate the realism and usefulness of the model developed by us "The ear simulator for practicing emergency care skills in otorhinolaryngology". Material and methods.49 otorhinolaryngologists participated in the study. They performed the initial surgical debridement of the external ear, removal of earlobe atheroma, otoscopy, removal of foreign bodies of the external auditory canal, and paracentesis of the tympanic membrane using the developed simulator. The results were evaluated using a questionnaire on practicing emergency care skills in otorhinolaryngology. Results.The majority of the specialists (94%) defined the developed ear simulator as an adequate model for training, while 83% considered it possible to use it as a training tool for practicing doctors. Conclusion.The developed model of the simulator is intended for practical training of students and residents in otiatrics in the scope of performing emergency and urgent manipulations.

Objectives - to analyse the complex solutions for rehabilitation of sensorineural hearing loss in adults and elderly people. Material and methods. We reviewed 27 articles on the problem, published in the recent 5 years, presented in the international databases PubMed, Scopus and E-library. Conclusion. The rehabilitation procedure for chronic SNHL is quite clearly regulated and defined at the state level only for the person with hearing disabilities. While determining the needs of the disabled person in rehabilitation, the recommended rehabilitation approaches are described. However, in the normative documents, there is no clearly defined rehabilitation algorithm, taking into account the patient's individual characteristics. A high index of multimorbidity in adults with SNHL, including anxiety-depressive disorders and cognitive deficit, determines the need for inclusion of the auditory training in the rehabilitation process. The use of various options for auditory training along with electro-acoustic correction of hearing or cochlear implantation is an essential component of an individual rehabilitation program.

Цель - провести анализ комплексных решений по реабилитации слуха для взрослых пациентов с хронической сенсоневральной тугоухостью и лиц старшей возрастной группы. Материал и методы. Проведен обзор 27 статей по данной тематике, представленных в международных базах данных PubMed, Scopus и E-library, за последние 5 лет. Заключение. Процедура реабилитации при ХСНТ регламентирована и определена на государственном уровне только для инвалидов по слуху. В определении потребности инвалида в мероприятиях по реабилитации прописаны возможные реабилитационные подходы, носящие рекомендательный характер. Четко обозначенного алгоритма реабилитации с учетом индивидуальных особенностей пациента в документах нет. Высокий индекс мультиморбидности у взрослых лиц с ХСНТ, включая тревожно-депрессивные расстройства и когнитивный дефицит, определяет необходимость включения в реабилитацию слухового тренинга. Использование различных вариантов слухового тренинга наряду с электроакустической коррекцией слуха или проведением кохлеарной имплантации является обязательным компонентом индивидуальной программы реабилитации.

Цель – оценить реалистичность и полезность модели разработанного нами «симулятора-тренажера уха по отработке навыков экстренной и неотложной помощи в оториноларингологии». Материал и методы. В исследовании приняли участие 49 оториноларингологов. На разработанном нами симуляторе-тренажере они выполняли первичную хирургическую обработку ушной раковины, удаление атеромы мочки уха, отоскопию, удаление инородных тел наружного слухового прохода, парацентез барабанной перепонки. Результаты участники исследования оценивали, используя опросник по отработке навыков экстренной и неотложной помощи в оториноларингологии. Результаты. Большинство (94%) специалистов отметили, что разработанный симулятор-тренажер уха является адекватной моделью для обучения, при этом 83% сочли его использование возможным в качестве учебного пособия для практикующих врачей. Выводы. Разработанная модель симулятора-тренажера предназначена для практической подготовки студентов и ординаторов по отиатрии в объеме выполнения экстренных и неотложных манипуляций.

Цель – проанализировать возрастные особенности течения и ведения пациентов старших возрастных групп с хронической сенсоневральной тугоухостью. Материал и методы. Нами проведен обзор статей по данной тематике, представленных в международных базах данных PubMed, Scopus и E-library, за последние 5 лет. Результаты. Учитывая сложности принятия решения врачом по диагностике и реабилитации пациентов с ХСНТ, актуальными являются разработки автоматизированных компьютерных программ, объединяющих актуальную информацию по вопросам персонификации диагностических и лечебных алгоритмов. Согласно научным данным, процедура реабилитации при ХСНТ должна учитывать коморбидные состояния пациента, прием им фармакологических препаратов с возможным ототоксическим действием.

Objectives to analyse the age-related features of chronic sensorineural hearing loss (SNHL) in elderly patients in regards to the course of the disease and treatment. Material and methods.We reviewed the articles on the problem, published in the recent 5 years, presented in the international databases PubMed, Scopus and E-library. Results.Considering the difficulty of decision-making on the diagnosis and rehabilitation of patients with chronic SNHL, the development of automated computer programs combining the relevant information on the personification of diagnostic and treatment algorithms is relevant. According to scientific data, the rehabilitation procedure for chronic SNHL should take into account the patient's comorbid conditions, the use of pharmacological preparations with a possible ototoxic effect.

Снижение слуха у пациентов старших возрастных групп представляет собой распространенную проблему. По результатам многочисленных исследований, на долю населения в возрасте от 60 лет приходится более 69 % пациентов с тугоухостью. Цель работы - анализ показателей комплексной оценки слуха у пациентов старших возрастных групп. В исследовании принимали участие 300 пациентов в возрасте от 60 до 95 лет (средний возраст - 78,9 ± 12,9), у которых, помимо исследования слуха (тональная пороговая и речевая аудиометрия), было проведено анкетирование при помощи опросника для пожилых людей с нарушением слуха (HHIE). Представленные результаты свидетельствуют о том, что изменение слуха у лиц старших возрастных групп нельзя рассматривать как закономерность. Опросник HHIE представляется удобным скрининговым методом в работе врача первичного звена. Для понимания уровня восприятия речи пациентам старше 60 лет важно проводить им речевую аудиометрию в комплексной оценке слуха.

Objectives - to study the influence of the individual characteristics of a patient with chronic sensorineural hearing loss on the perception of VR technique. Material and methods. The perception of VR was studied in 77 people in relation to their gender, age, auditory function, psychological and cognitive status. Results. All the patients positively evaluated the use of the virtual reality method. The level of perception of VR in adults is determined by the degree of auditory impairment. A negative correlation was revealed between the indicators of cognitive and psychological status of the examined persons and the level of perception of VR. Conclusion. The VR technique can improve the existing aural rehabilitation methods, especially in the group of people with socially significant hearing impairments.

Цель – изучить пороги слуха на высоких частотах у пациентов пожилого и старческого возраста с учетом возрастной нормы и наличия коморбидных заболеваний. Материал и методы исследования. В процессе проведения скрининга было обследовано 111 пациентов в возрасте от 50 до 97 лет (средний возраст составил 70,5±2,1 года) с учетом их возраста, слуховой функции, сопутствующих заболеваний. Результаты. Сравнение средних порогов слуха на высоких частотах с возрастными нормами слуховой чувствительности выявило, что у 12,6% пациентов имеются недооцененные потери слуха. Наличие сопутствующих заболеваний оказывает существенное влияние на процесс развития хронической сенсоневральной тугоухости в каждой возрастной группе. Заключение. Аудиометрия в расширенном диапазоне частот у пациентов старшей возрастной группы с сопутствующими заболеваниями может дополнить алгоритм обследования пациента в плане оценки состояния слуха.

Hearing loss in patients of older age groups is a common problem. Numerous studies show that more than 69% of patients with hearing loss are at the age of 60 and older. The aim of the work was to analyze the indicators of complex assessment of hearing in patients of older age groups. The study involved 300 patients aged 60 to 95 (mean age - 78.9 ± 12.9), who in addition to the study of hearing (tonal threshold and speech audiometry) were surveyed by using a questionnaire for elderly people with hearing impairment (HHIE). The presented results indicate that the change in hearing in this group is not regular. The HHIE questionnaire is a convenient screening method in the work of a primary care physician. To understand the level of speech perception in those aged 60 or over, it is important to conduct speech audiometry in a comprehensive assessment of hearing.

Objectives - to study hearing thresholds at high frequencies in elderly and senile patients, taking into account the age norm and the presence of comorbid diseases. Material and methods. 111 patients aged from 50 to 97 years (mean age 70.5 ± 2.1) were examined, their age, auditory function, and concomitant diseases were also registered. Results. The measured average auditory thresholds at high frequencies, if compared to the age-related standards for auditory sensitivity, have revealed an underestimated hearing loss in 12.6% of patients. The presence of concomitant diseases has a significant impact on the development of chronic sensorineural hearing loss in each age group. Conclusion. Audiometry in an extended frequency range in elderly patients with concurrent diseases can improve the hearing examination algorithm.

Aim - to examine the results of a comprehensive geriatric assessment depending on the degree of hearing loss. Material and methods. We examined 110 patients aged from 60 to 90 years with bilateral symmetrical impairment of the hearing function. The research design included examination of the otolaryngologist, auditory function test, and geriatric assessment of neuropsychological status. Two groups were allocated based upon the study of the hearing function: the main group, which included 58 people with moderate hearing loss, and the control group, which included 52 people with significant hearing loss. Results. It was revealed that hearing loss has a negative influence on the cognitive abilities of geriatric patients. With increasing degrees of hearing loss, the progression of dementia is observed. There is a direct correlation between the progression of hearing loss and development of depression in geriatric patients. Conclusion. Our study revealed a relationship between the degree of hearing loss and neuropsychological changes in geriatric patients. Hearing function test as a part of comprehensive geriatric assessment would facilitate the understanding of the causes of neuropsychological disorders in geriatric patients.