Method for audiologic rehabilitation with use of ultrasonic radiation

FIELD: medicine.

SUBSTANCE: cochlea is exposed to contact ultrasonic radiation (UR) through a postaural surface of the individual's head. Ultrasound amplitude is modulated by electric signal generated by microphone sound receiver. The microphone is arranged close to an ultrasonic transmitter providing the binarual effect. The electric output signals of the microphone are filtered within the frequency range of 0.5÷5 kHz; an ultrasonic oscillation frequency is set at a value of at least 100 kHz; an ultrasound intensity is set at a value of no more than 0.1 Wt/cm2; a radiation pressure is generated in the cochlea of not less than 2·10-4 Pa.

EFFECT: method enables restoring the sound sensation and compensating the middle ear dysfunction that is ensured by ultrasound modulation by the audio signal generated by the microphone and providing the required pressure in the cochlea.

2 dwg

 

We propose a method of rehabilitation of auditory sensations person when otosclerosis, based on the effects of radiation pressure (EP) ultrasonic radiation directly to the inner ear.

Known[1, 2, 3, 4, 5, 6, 7], that otosclerosis is bilateral focal process in the bony labyrinth of the ear, accompanied by proliferation and impaired mobility of the auditory ossicles can lead to complete hearing loss.

Community ENT-specialists currently have formed a strong opinion that medical treatment of otosclerosis does not exist. All activities for the rehabilitation of hearing loss caused by otosclerosis, are surgical in the middle ear, called scapegoating or calibrated stapedia. During this operation removes pathological stone fireplace, which is replaced by a prosthetic head and the arch of the stapes.

There is an opinion [7, 8] that the occurrence of otosclerosis is associated with hereditary inferiority ear labyrinth, which is expressed in increased sensitivity to ULTRASOUND. As in patients with otosclerosis revealed a decrease in the content of many of bioactive elements in the bone substance, in particular in the stirrup, then appeared the proposal and drug support body in the treatment of otosclerosis. The authors of medication stauts the followers and surgical treatment, considering it the most effective. This position is explained by the fact that the duration of medication treatment (oral administration of bone calcium supplements, phosphorus, fluoride sodium 20 mg 2 times a day) for 1-2 years to keep up with the chronic development of otosclerosis, impairing hearing.

It should also lead the list of contraindications for surgical treatment of otosclerosis and a list of possible postoperative complications, which acquaint patients in an Israeli hospital Ichilov [6].

Contraindications for surgical treatment:

- the General condition of the patient,

one hearing ear,

- low reserve function of the cochlea of the inner ear,

- tinnitus or dizziness,

- the presence of active foci of otosclerosis.

The list of possible postoperative complications:

- paralysis of half of the face,

- vertigo in the postoperative period,

- vomiting,

- allocation of perilymph from the ear,

- damage to the sound of the labyrinth of the middle ear,

- inflammation of the structures of the inner ear.

Despite well done operation may subsequently manifest complications in the form:

- complete deafness in the operated ear,

- long vertigo,

- the constant feeling of noise or hum in the operated ear,

- paralysis of half of the face in the form of damage the Affairs of the branches of the facial nerve.

Because according to statistics, the otosclerosis affects about 1-2% of the world population [6], it becomes obvious that to provide surgical care to many patients is impossible. But those patients for whom such assistance is provided, suffer from uncertainty and fear to lose hearing due to the lack of guarantee of statistical data on the service life specified in Kostochka prosthesis, membrane input of the ear and the oval window of the cochlea.

Thus, a method of rehabilitation of hearing in otosclerosis, based on the surgical procedure for replacing stone system prosthesis, can be considered as an analogue of the proposed method.

The technical solution of the proposed method is an exception surgery in the rehabilitation process (recovery) of auditory sensation in otosclerosis.

In accordance with the proposed method of rehabilitation of hearing in otosclerosis with the use of ULTRASONIC radiation to the cochlea of the inner ear is exposed to contact, through the ear the surface of a human head, the amplitude of the ULTRASONIC radiation modulate an electric microphone signal receiver of sound, and the microphone feature near the ULTRASONIC emitter, providing binaurality hearing, while the electrical output signals of the microphone is filtered to form the modulation signals in the frequency range of 0.5÷5.0 kHz, the frequency At which oscillations are set not less than 100 kHz, and the value of the intensity of the ULTRASONIC emitter is not higher than 0.1 W/cm2ensuring the formation of KMG in the cochlea of the inner ear not less than 2·10-4PA.

The essence of the proposed method is illustrated by the following drawings.

Fig.1 - family of curves of equal loudness depending on the frequency of the sound;

Fig.2 is A functional diagram of the device that implements the proposed method, where 1 is the power source device 2 to the ultrasonic oscillator with emitter and focusing system of knots, 3 - microphone, 4 - frequency filter and shaper of the modulation signal; the direction of the arrows indicates the functional dependence of the blocks; "B" - illustration affecting ULTRASONIC radiation modulated acoustic electric signal indicating the maximum power of the emitter.

As follows from the description, the proposed method is based on the phenomenon that is called RD and which occurs on the obstacles to the propagation of ULTRASONIC radiation. The mechanism of occurrence of RD are examined in detail in the works [9, 10, 11, 12] and refers to the sound effects of the 2nd order. The authors found no known literature publications on the practical application of this effect.

Sound vibrations, e.g. ULTRASONIC as a phenomenon of the 1st order are alternating compressions and razrjazhenie in the distribution environment. While the adoption is about to consider, the amount of compression and rarefaction, creating BONDS, equal and form two points of the medium located two from each other at a distance of λSV/2 (λSV- wavelength ULTRASONIC), the maximum voltage. It is this tension and use when exposed to ULTRASOUND on tissues and organs in medical diagnostic and therapeutic practice.

However, the ULTRASONIC oscillation as a phenomenon of the 1st order on the surface of the obstacle does not create constantly directed force (in the direction of propagation of the ULTRASONIC).

KMG is reflected in the fact that the surface of the obstacles ULTRASONIC experiencing constant pressure in magnitude and direction, which is directly proportional to the intensity of ULTRASONIC radiation and, like a light pressure, open Lebedev b.p. in 1903

The power of this constant RD 103 times smaller than the power of the ULTRASONIC radiation.

The physical interpretation of the occurrence of RD is given in [10, 11] and is associated with the phenomena, in which the resistance to movement of the particles of the medium in the region of suction from the region of compression will be less than in the case when particles move from a region of suction in the region of compression. It is this difference in the resistance of the medium and is the cause of constant pressure in the direction of propagation of the sound wave.

The authors agree with the physical interpretation of the above causes of RD.

Thus, the proposed with the persons is based on two physical assumptions associated with the use of ULTRASONIC radiation:

the dependence of RD on the intensity of ULTRASONIC radiation;

- the use of ULTRASOUND as a carrier for delivery to the desired internal body pressure, changing the amplitude and frequency according to a certain law, the alarm.

The presence of bone bone conduction in the auditory system of a person practically used in the diagnosis of hearing loss of a person. Bone conduction of sound waves in air exposed to significantly less bone conduction of the same sound at the contact effect on the bones of the skull. This is due to a significant difference of acoustic impedance of air and the bones of the skull (it is clear that the equality of the acoustic impedance of the sound transmission is carried out freely).

In [13] it is shown that the reflection of sound waves at the boundary of two media with different values of acoustic impedance is determined by dependence

αabouttp=|Zpandd-ZabouttpZpandd+Zabouttp|2=|ΔP panddΔPabouttp|2(1),

where Zpadand ZRefaccordingly acoustic impedance of the medium with the incident and the reflected wave, and ΔPpadand ΔRefaccordingly, the pressure p is the giver and reflected waves.

For example, the passage of ULTRASONIC radiation from air to water and from water in the air to show the role of the values of acoustic impedance (ZAKcf·SVwhere ρcfthe density of the propagation medium, withSV- the speed of propagation of sound in the medium). So ρd=1.29 kg/m3withSV.the hcpa.=340 m/s, ρwater=103kg/m3withSV.water=1500 m/s and αRef=0,999.

Indeed experience shows that out of the water in the air from the air into the water, the sound almost all is due to total reflection at the boundary of these environments.

The inner ear of humans, which is located in the temporal region of the head, combines the organ of equilibrium and the organ of hearing is the cochlea. The bony canal of the cochlea is a tapering tube, rolled into 2.5 turns of a coil in the shape of a snail.

The proposed method is based on the reflection of ULTRASONIC radiation from the border of the bone of the cochlea, the fluid inside the cochlea, which generates RD.

The acoustic impedance of the external bone basics snails can be taken equal to 160·105kg/m2·and the acoustic impedance of perilymph snails equal to 15·105kg/m2·C. In this case, the reflection coefficient at the boundary of the bone of the cochlea, its liquid, calculated by (1), will be ~0,7.

The effect of excitation of the fluid of the cochlea RD similar to her excitement when bone is the conduction of sound. This excitation provides the occurrence of resonance phenomena on the surface of the primary membrane, located along the cochlea in the form of "relief". This "relief" stimulates the nerve hair cells located at the base membrane in multiple layers, forming the organ of Corti. The result of the interaction of "relief" primary membrane with elements of the organ of Corti is the conversion of acoustic signals into electrical. Electrical signals in the auditory nerves are transmitted to the auditory areas of the brain, causing the sense of hearing.

It should again be noted that the proportion of sound energy entering the cochlea through bone conduction at the contact impact is much more energy entering the cochlea through the air.

Estimate the value of the intensity of ULTRASONIC radiation aimed at a snail that provides the perilymph of the cochlea RD, is equal to 2·10-4PA. As shown in Fig.1, this pressure exceeds the minimum threshold of human audibility, equal to 2·10-5PA, in the frequency range of 0.5÷5.0 kHz. These values are typical for normal functioning of the entire auditory system of a person.

The auditory ossicles in the ear canal and middle ear are a kind of transformer sound pressure. The leverage effect increases pressure force when transferring it from moloto the ka to the stapes in ~1.3 times. In addition, the effective area of the input surface of the eardrum lot more surface of the stirrup, which also leads to the increase of pressure, providing the total value of the transformation ratio of the pressure (according to the békésy) equal to(15÷20):1 [14].

Thus, the strengthening of the middle ear sound pressure 20 times must be taken into account when calculating the power of the ULTRASONIC radiation, and by the pressure of 2·10-4PA should be increased to 4·10-3PA. Since RD is three orders of magnitude less than the pressure of the ULTRASONIC radiation, the magnitude of the pressure source should be taken equal to 4 PA, which corresponds to the intensity of ~0.1 W/m2or 10-5W/cm2. The resulting intensity value should be increased according to the authors of two orders of magnitude due to:

the small values of the coefficient of the useful area of the cochlea 0,25÷0,35, which determines the proportion of the total flow of ULTRASONIC radiation interacting with the perilymph of the cochlea;

- possible loss of ULTRASONIC radiation in the bones on the way to the cochlea.

The working is the power of the Ultrasonic radiation should be not less than 10-3W/cm2.

In numerous outdoor publications requests "Biological effects of ULTRASOUND", "Treatment of otosclerosis, Hearing loss and other level of ULTRASONIC emitters not to exceed 0.5 W/cm2referred to small intensity values, to the which are widely used in medical practice [15, 16, 17, 18, 19, 20].

This allows the authors to argue that the working intensity of the ULTRASONIC emitters for the implementation of the proposed method are safe for humans.

The choice of frequency of the ULTRASONIC emitter in the proposed method is determined by the need to meet the following requirements:

- frequency ULTRASONIC radiation as a "carrier" shall not be less than 20 times greater than the upper frequency of the modulation signal (the authors proposed a frequency fcentury fashion.=5 kHz);

the frequency must provide a minimum absorption of the bones of the skull when the contact method effects;

- to have the possibility of small linear dimensions, taking into account the physiological characteristics of head sizes.

According to the authors, the lower bound of the frequency range of the ULTRASONIC radiator must be equal to 100 kHz, and the upper value can be set in the process of experimental studies of the dependence of the losses of the ULTRASONIC waves from the ULTRASONIC frequency in the bones. During these studies, the frequency range may have an upper limit of ~1 GHz.

It should be noted that the frequency of 100 kHz is used in the ULTRASONIC stimulation of the human brain [21, 22]. In particular in [21] was used, the intensity of the ULTRASONIC radiation of about 1÷2 W/cm2that is 100 times greater than the calculated intensity recommended in the proposed CSP is both.

Currently, the achieved level of ULTRASONIC instrumentation as the variety of application and parameters (intensity, frequency, focus, mode and others) allows authors hope that when creating a device that implements the proposed method can be used parts, elements and circuits from the existing ULTRASONIC devices. Therefore, the authors believe that it is enough to cause functional diagram of a device in simplified form, is shown in Fig.2. In Fig.2 "A" power supply 1 provides power to the ULTRASONIC emitter 2, the microphone 3 and the shaper of the modulation signal 4. The direction of the arrows connecting the blocks, indicates their functional dependence. Fig.2 "B" illustrates a view of influencing the ULTRASONIC radiation, modulated acoustic electric signal indicating the operating values of the radiation intensity.

As already noted, the ULTRASONIC emitter is placed in the ear of the head, and the irradiation of the cochlea provide a contact way. The microphone should be placed near the ULTRASONIC emitter for providing binaural properties of sound perception, allowing us to determine the direction to the sound source. Such an arrangement of the ULTRASONIC transducer and the microphone should be observed in the case of disease otosclerosis in both ears of the patient.

According to the authors, the device may be provided for the network disabling the ULTRASONIC emitter in the absence of the output of the microphone output signal (absence of an acoustic signal).

Thus, the proposed method of rehabilitation of hearing in otosclerosis eliminates the conventional surgical method of treatment of this disease.

Bibliography

1. Transfiguration B., J. Temkin, A. Likhachev, "diseases of the ear, throat, nose. - M.: Medicine, 1968

2. http://www.krasotaimedicina.ru (SEE clinic) "Hearing loss".

3. http://www.diagnos.ru "Otosclerosis", 2012

4. http://www.gutaclinic.ru "Otosclerosis. Treatment of otosclerosis", 2012

5. http://www.lechim-uxo.ru "Treat the ear. Signs, treatment, surgery of otosclerosis", 2013

6. http://www.ichilov./net/ENT disease/otosclerosis (Ichilov hospital, Israel) "Otosclerosis", 2012

7. http://www.XServer.ru "Otosclerosis".

8. Soldatov, I. B. "Lectures on otolaryngology", textbook. - M.: Medicine, 1994

9. Rosenberg, L. D., "Application of ultrasound." - M.: Union RAS, 1957

10. Krasilnikov C. A., Krylov, C. C., "Introduction to physical acoustics". - M.: Nauka, 1984

11. Prokhorov, A. M. (editor) "the encyclopedia of physics". - M.: Nauka, 1983

12. Kolesnikov A. I. "ULTRASONIC measurement". - M.: Nauka, 1970

13. Edited Sapozhkova A. M. "Acoustics" directory. - M.: Radio communication, 1989

14. Vahitov W. J., Kavalhin Y. A. Fadeev A. A., the administration renin Nikolay Dmitrievich Y. P. "Acoustics" e-mail for technical Colleges. - M.: The Mountains. line - Telecom, 2009

15. GOST 12.1.003-86 SBT "Noise, General safety requirements", section "the Influence of ULTRASONIC radiation."

16. http://www.avicena.narod.ru/techno/ultrasound.htm "ultrasound Treatment", 2008,

18. GOST 12.2.051-80 SSBT "System of occupational safety standards. ULTRASONIC technological equipment. Safety requirements".

19. Hygienic norms Saint Pin 2.2.4/2.1.8.582-96 "Hygienic requirements for work with sources of air and contact ULTRASONIC industrial, medical and domestic use".

20. http://www.readitall.ru/medezine/0038/htm "Biological effects of ULTRASOUND".

21. Karkishchenko N. N., Ivanov D. B., A. Vartanov P. "About the effectiveness and safety of ULTRASOUND-th transcranial stimulation of the human brain". - M.: Biomechanica, No. 2, 2011

22. http://bt-test.ru/advices/ultrazvukom_lechat_ne_tolko_delfiny/ "Ultrasound treated not only dolphins, Almazov Y., 2012

The method of rehabilitation of hearing in otosclerosis using ultrasonic radiation, characterized in that through the ear the surface of a human head contact, carry out the irradiation of the cochlea of the inner ear focused ultrasonic radiation, the amplitude of which modulate an electric microphone signal receiver of sound, and the microphone feature near the ultrasonic transducer, providing binaurality hearing, while the electrical output signals of the microphone is filtered in the frequency range 0,5÷5 kHz, the frequency of ultrasonic vibrations set not less than 100 kHz, and the values of the intensity of the ultrasonic radiation is set not higher than 0.1 W/cm 2and ensure the formation of radiation pressure in the cochlea of the inner ear not less than 2·10-4PA.



 

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EFFECT: device provides more effective surgical management in patients with an acoustic tube dysfunction by reliable fixation of the tympanic shunt in the tympanic cavity; it arranges the efflux of liquid from the tympanic cavity in a combination with preventing its penetration into the tympanic cavity from the outside.

4 cl, 2 dwg

FIELD: medicine.

SUBSTANCE: retention element comprises a wall and an interior space, wherein at least two thin plates directed into the interior space are placed on the wall. The above at least two thin plates face oppositely in the interior space, and the above at least two thin plates are configured so that to overlap each other axially.

EFFECT: creating the auricular suppository with the retention element that prevents the further migration of condensation water and potential bleeding of wax, and that provides an air permeability of the retention element even in case of greater amounts of condensation water and wax.

14 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology, and can find application in radical middle ear surgery. The method consists in separating an epidermal lining of a tympanic region of the trephine cavity which extends from an intersection, a facial canal, labyrinth windows, while exposing a stapes footplate and a cochlear window. An autograft is placed on a prepared bed whereon an implant bobbin is placed and fixed. Then, the implant bed is prepared. The implant is placed and fixed. The separating procedure covers an additional region from a medial wall to an auditory tube, and also within an anterior bone ring. The epidermis surrounding a tympanic opening of the auditory tube is removed circumferentially by 3-5 mm. The implant ribbon is fixed on a promontory with delimitation of the tympanic opening of the auditory tube from the trephine cavity.

EFFECT: using the given invention enables improving the clinical-morphological effect of the reparative middle ear surgery due to the closure of the tympanic opening of the auditory tube.

1 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to otolaryngology and neurology and can be applied in treatment of patients with benign paroxysmal positional dizziness with injury of front semicircular duct. Method includes carrying out the following positional manoeuvre: from sitting position patient is laid on back with fast movement, throwing their head 30 degrees back, and holding patient in this position until manifesting vertical rotary nystagmus and dizziness stop. After that, patient's head is bent 60 degrees frontward and, not less than after a minute after appearance of rotary nystagmus, patient is sat back into the initial position.

EFFECT: method makes it possible to increase treatment efficiency, reduce risk of recurrence and reduce treatment terms.

1 cl, 2 ex

FIELD: medicine, otolaryngology.

SUBSTANCE: the present innovation deals with introducing neomycin sulfate antibiotic in granules prepared by the following technique. Tablet of neomycin sulfate 1.0g should be put into a vial with 100 ml distilled water till tablet's decomposition. Then vial's content should be shaken and kept till suspension sedimentation. In a day one should take 1 ml of supernatant liquid to be put into another vial and diluted with distilled water at 1:100 ratio. This procedure should be repeated 4 times more, moreover, during the last procedure one should apply alcohol for dilution. Then one should transfer the drop of alcoholic solution into a vial with granules out of milk sugar to then shaken and kept open for 1 d till granules" drying up. The suggested preparation should be applied per 1 granule under the tongue, moreover, multiplicity and duration of the above-suggested intake should be matched individually by patient's sensitivity and obtaining the clinic effect. The method enables to improve the value of tonic threshold audiometry by about 30-50 dB, decrease perception threshold of vocal range frequencies and widen the range towards high frequencies.

EFFECT: higher efficiency of therapy.

1 dwg

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