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"lead": "Нарушение здоровья, относящееся к группе отморожение",
"description": " \r\n\r\nОбморожение характеризуется повреждением кожного покрова и тканей при воздействии на них низкой температуры, возникает также при непосредственном контакте с предметом, охлажденным до сверхнизкой температуры (контактные отморожения) и длительном периодическом охлаждении в условиях высокой влажности воздуха",
"etiology": "<p>К отморожению на морозе приводят: </p>\r\n<p>тесная и влажная одежда и обувь; </p>\r\n<p>физическое переутомление; </p>\r\n<p>голод; </p>\r\n<p>вынужденное длительное неподвижное и неудобное положение; </p>\r\n<p>предшествующая холодовая травма; </p>\r\n<p>ослабление организма в результате перенесённых заболеваний; </p>\r\n<p>потливость ног; </p>\r\n<p>хронические заболевания сосудов нижних конечностей и сердечно-сосудистой системы; </p>\r\n<p>тяжёлые механические повреждения с кровопотерей. </p>\r\n<p>При употреблении алкоголя происходит расширение периферических сосудов, что характеризуется усиленной потерей тепла, в то время как в норме при действии холода происходит их сужение. Достаточно часто тяжёлые отморожения, приводящие к ампутации конечностей, происходят именно в состоянии сильного алкогольного опьянения, по причинам скорее не физиологического свойства, а в первую очередь из-за неспособности нетрезвого человека своевременно принять меры против замерзания; в случае же тяжёлого опьянения пропадает способность нормально передвигаться, осознание опасности исчезает, и человек может просто заснуть на морозе, что нередко приводит и к смертельному исходу. </p>",
"pathogenesis": "<p>Воздействие низких температур вызывает стойкий спазм сосудов. Скорость кровотока уменьшается, вязкость крови увеличивается. Форменные элементы «забивают» мелкие сосуды, образуются тромбы. Таким образом, патологические изменения при отморожении возникают не только в результате непосредственного воздействия холода, но и вследствие реакции со стороны сосудов. </p>\r\n<p>Местные расстройства кровообращения провоцируют нарушения со стороны вегетативной нервной системы, регулирующей деятельность всех внутренних органов. В результате развиваются воспалительные изменения в удаленных от места отморожения органах (дыхательных путях, костях, периферических нервах и желудочно-кишечном тракте). </p>",
"diagnostics": "<p>Пострадавший указывает на длительное пребывание в условиях низкой температуры воздуха. Дифференциальный диагноз отморожение проводится с гангреной пальцев стоп при диабетической ангиопатии или облитерирующем эндартериите. </p>",
"treatment": "<p>Первая помощь состоит в прекращении охлаждения, согревании конечности, восстановлении кровообращения в поражённых холодом тканях и предупреждении развития инфекции. Первое, что надо сделать при признаках обморожения — доставить пострадавшего в ближайшее тёплое помещение, снять промёрзшую обувь, носки, перчатки. Одновременно с проведением мероприятий первой помощи необходимо срочно вызвать врача, скорую помощь для оказания врачебной помощи. </p>\r\n<p>При поступлении в отделение пациента с отморожением согревают. В артерию поврежденной конечности вводят смесь растворов новокаина, эуфиллина и никотиновой кислоты. Назначают препараты для восстановления кровообращения и улучшения микроциркуляции, при тяжелых поражениях – кортикостероиды. Внутривенно и внутриартериально вводят подогретые до 38 градусов глюкозо-солевые растворы. Пациенту с отморожением назначают антибиотики широкого спектра действия и антикоагулянты. </p>\r\n<p>Для уменьшения стимуляции восстановительных процессов, уменьшения отечности и болевого синдрома проводят физиолечение (магнитотерапия, ультразвук, лазерное облучение, диатермия, УВЧ). Пузыри прокалывают, не удаляя. На область отморожения накладывают спирт-хлоргексидиновые и спирт-фурацилиновые влажно-высыхающие повязки, при нагноении – повязки с антибактериальными мазями. При значительном отеке травматологи выполняют фасциотомию для устранения сдавления тканей и улучшения кровоснабжения области отморожения. При сохранении выраженного отека и формировании участков некроза на 3-6 сутки проводят некрэктомию и некротомию. </p>\r\n<p>После формирования демаркационной линии определяют объем хирургического вмешательства. Как правило, под поврежденной кожей в зоне демаркации сохраняются жизнеспособные мягкие ткани, поэтому при сухом некрозе обычно выбирают выжидательную тактику лечения, позволяющую сохранить больше тканей. При влажном некрозе существует большая вероятность развития инфекционных осложнений с распространением процесса «вверх» по здоровым тканям, поэтому выжидательная тактика в таких случаях неприменима. Оперативное лечение при отморожениях IV степени заключается в удалении омертвевших участков. Выполняется ампутация некротизированных пальцев, кистей или стоп. </p>",
"prevention": "<ol>\r\n<li>Одежда должна соответствовать температуре, быть сухой и подходящего размера. </li>\r\n<li>При отсутствии теплой одежды утеплиться можно при помощи обычной бумаги или лоскутов ткани, скомканных и помещенных между слоями одежды. </li>\r\n<li>Не стойте на месте, двигайтесь. Человеческий организм в сутки способен истратить более шести тысяч калорий, большая часть которых расходуется на теплообразование. </li>\r\n<li>Не носите тесной обуви. Подошва должна быть не менее сантиметра толщиной; </li>\r\n<li>По возможности найдите внешний источник тепла, разведите огонь. </li>\r\n<li>Прием пищи должен быть своевременен. В рационе питания доля жиров и углеводов должна быть увеличена. Источниками жира могут послужить, например, сало, подсолнечное масло, мясо; источниками углеводов – мучные изделия, рис, картофель. </li>\r\n<li>Людям с нарушенным кровообращением необходима более теплая одежда. </li>\r\n<li>Не используйте алкоголь с целью согревания. Алкоголь дает лишь короткий временный эффект, после чего следует усугубление замерзания. </li>\r\n</ol>",
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},
"code": "H92.1",
"name": "Оторея",
"icd_name": "Оторея",
"gender": 0,
"age_min": 1,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "h92.1_otoreya",
"lead": "выделения из уха в виде крови, ушной серы, гноя или другой жидкости",
"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В большинстве случаев речь идет о естественном выделении ушной серы, которая покидает ушной канал. Обильные выделения серы могут быть вызваны разными причинами – например, повышенной влажностью, из-за которой в ухе образуется достаточно много пота, который покидает ушной канал, вымывая оттуда серу.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Есть несколько основных причин выделений из уха:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ушная инфекция – это одна из самых распространенных причин отореи. Ушная инфекция развивается, когда бактерии или вирусы проникают в среднее ухо, минуя защитный слой ушной серы. Некоторые вирусные инфекции сопровождаются повышенной выработкой секрета, который начинает вытекать из уха</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">травма ушного канала может стать причиной появления гнойных или кровянистых выделений из уха. Неаккуратное использование ватных палочек, резкий перепад давления в самолете, слишком громкая музыка – все это может стать причиной разрыва барабанной перепонки, который сопровождается выделением секрета</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">внешний отит или ухо пловца возникает, когда бактерии или грибок поражают ткани ушного канала. Как правило, это случается после длительного пребывания в воде, из-за чего болезнь принято называть «ухом пловца». Инфекция, закрепившаяся в ушном канале, провоцирует выделение жидкого секрета и гноя</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">перелом костей черепа – чрезвычайно редкая причина выделений из уха. Однако если у пациента, пережившего травму головы, появились необычные выделения из уха, ему следует немедленно обратиться за медицинской помощью.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Осмотр и сбор анамнеза</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Сначала врач расспрашивает пациента с выделениями из уха о его симптомах, возможных занятиях/действиях, которые могли повлиять на ушной канал или барабанную перепонку (например, плавание; введение в ухо инородных тел, в том числе ватных тампонов, а также использование ушных капель), о хронических инфекциях уха и сопутствующих заболеваниях. </span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Затем врач проводит осмотр уха и окружающих тканей.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Данные, полученные при сборе анамнеза и осмотре, часто указывают на причину выделений из уха и на обследование, которое может потребоваться.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Обследование</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Отоскопия</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Риноскопия</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Исследование функции черепно-мозговых нервов</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Если при обследовании не удается сразу установить чем вызваны те или иные симптомы, необходимо провести дополнительные исследования: \u2028</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Аудиограмма</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">КТ височных костей или МРТ с контрастом</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Биопсия (при наличии грануляционной ткани в слуховом проходе)</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При выявлении серной пробки врач удаляет ее, предварительно размягчив специальными препаратами. Удаляют пробки с помощью промывания или аспирации и кюретажа.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Ирригация возможна только при отсутствии противопоказаний, о которых врач обязательно сообщит (перфорация барабанной перепонки, наружный отит).</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение при отите может включать обезболивание, физиотерапию и этиотропную терапию в зависимости от возбудителя заболевания. Аллергическая природа выделений из уха требует использования антигистаминных препаратов. Холестеатома лечится только хирургическим путем.</span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Чтобы снизить риск ушных выделений, рекомендуется защищать уши от воды и переохлаждений, вовремя лечить ЛОР-болезни и регулярно наблюдаться у отоларинголога. </span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Количество, цвет, прозрачность, запах, консистенция выделений из уха, а также сопутствующие симптомы, – широко варьируют. Так,</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">истечение гноя присуще, в основном, инфекционно-воспалительным процессам бактериальной или грибковой этиологии;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">примесь крови в той или иной концентрации характерна для отореи при травмах или онкопатологии;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">прозрачные текучие выделения типичны для аллергических наружных отитов, экссудативных средних отитов, травматической ликвореи (см. выше).</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">В большинстве случаев оторея сопровождается следующими симптомами (единичными или в различных сочетаниях):</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">снижение остроты слуха, чувство заложенности или инородного тела, восприятие внешнего звука словно сквозь вату или из-под воды;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">оталгия (болевой синдром с локализацией во внешних или внутренних структурах уха);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">головная боль;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">вестибулярные нарушения (головокружение, дискоординация, утрата равновесия и пр.);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">разного рода шумы в ухе;</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">ринит (насморк), нередко с симптомами синусита (воспаления придаточных пазух носа);</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">субфебрилитет, реже высокая температура тела.</span></li>\r\n</ul>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
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},
"code": "H80",
"name": "Отосклероз",
"icd_name": "Отосклероз",
"gender": 0,
"age_min": 20,
"age_max": 60,
"cause": [
"0"
],
"periodicity": 1,
"slug": "h80_otoskleroz",
"lead": "патология развития органа слуха, вызванная разрастанием костной ткани во внутреннем и среднем ухе",
"description": "<p><span id=\"docs-internal-guid-72d080ba-7fff-c86e-10a3-38ba57fe1bb8\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Отосклероз – это очаговое поражение костной капсулы лабиринта внутреннего уха, сопровождающееся дистрофическими изменениями во всем слуховом анализаторе и развитием тугоухости. </span></span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Наиболее вероятным причинам отосклероза относят следующие факторы:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Наследственная предрасположенность. По различным оценкам, от 27 до 40% всех больных, диагностированных отосклерозом, имеют в семейной истории случаи этого заболевания у родственников предыдущего поколения. Кроме того, у многих пациентов выявляются генетические дефекты различного характера.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Эндокринные и метаболические нарушения. В пользу этой гипотезы говорит то, что у женщин, страдающих отосклерозом, ухудшение наблюдается во время беременности.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">К факторам риска, повышающим вероятность развития отосклероза, относят инфекционные заболевания (в частности, корь), постоянные акустические травмы (работа в условиях производственного шума без использования защитных наушников и пр.), а также сосудистые заболевания, при которых нарушается кровоснабжение тканей внутреннего уха.</span></p>\r\n</li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Общее состояние здоровья, как полагают многие исследователи, имеет косвенное отношение к развитию отосклероза. Не являясь прямой причиной этого заболевания, любое нарушения состояния здоровья (перенесенная простуда, сильный стресс, хроническое заболевания ЖКТ и пр.) может активировать механизмы, непосредственно отвечающие за развитие болезни.</span></p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Особенностью костной капсулы лабиринта является то, что она представляет собой первичную, образовавшуюся в процессе эмбриогенеза, кость без вторичной оссификации. При отосклерозе в различных ограниченных участках костного лабиринта активируется процесс образования зрелой кости. В начале происходит образование незрелой спонгиозной костной ткани, содержащей множество сосудов. Такой очаг отосклероза носит название активного. Затем незрелая костная ткань очага трансформируется в склерозированную зрелую кость.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Очаги отосклероза могут иметь множественный характер. В 50% случаев отосклероза их обнаруживают в области окна преддверия, в 35% — в капсуле улитки, в 15% — в полукружных канальцах. Расположение очага отосклероза в области окна преддверия приводит к вовлечению в склеротический процесс основания стремени с развитием его анкилоза. В результате возникающей обездвиженности стремени нарушается звукопроводящая функция уха и развивается кондуктивная тугоухость. Если очаги отосклероза находятся в лестнице лабиринта, то нарушается работа звуковоспринимающего аппарата уха, что ведет к появлению нейросенсорного типа тугоухости.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">С признаками отосклероза следует обращаться к отоларингологу. Обследование начинается с опроса пациента, сбора жалоб и анамнеза. Далее врач приступает к инструментальному обследованию, которое включает следующие методы:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #232323; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Отоскопия или микротоскопия. Обнаруживают отсутствие ушного секрета, сухость и атрофию кожи в слуховом проходе, снижение ее чувствительности, а также характерные изменения барабанной перепонки.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #232323; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Аудиометрия. Врач выявляет снижение слышимости шепотной речи, а также ухудшение проводимости звуков в воздушной среде при нормальном проведении через ткани.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #232323; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Исследование вестибулярных функций (вестибулометрия, стабилография). Проводится при наличии головокружений.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #232323; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Компьютерная томография черепа. Позволяет визуализировать изменения в костной ткани и определить активность отосклероза.</span></p>\r\n</li>\r\n</ul>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">После полного обследования врач определяет форму и стадию развития заболевания. При необходимости пациенту назначают дополнительные диагностические процедуры для установления окончательного диагноза. При подозрении на эндокринологическую природу заболевания отоларинголог ведет пациента совместно с эндокринологом.</span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лечение отосклероза проводят с учетом формы заболевания и степени снижения слуха. Оно направлено на нормализацию передачи колебаний со слуховых косточек на перилимфу лабиринта, улучшение слуха и повышение качества жизни пациента.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Достигнуть этих целей можно с помощью хирургической операции, однако вмешательство нельзя проводить в активной стадии заболевания, чтобы не стимулировать чрезмерную оссификацию. На этапе предоперационной подготовки рекомендовано применение консервативных методов.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Консервативное лечение</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Терапия направлена на снижение активности склеротических изменений, уменьшение размеров очагов резорбции. За счет этого замедляется прогрессирование сенсоневральной тугоухости, увеличивается плотность костной капсулы и предупреждается повторная оссификация после хирургического лечения.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Медикаментозное лечение включает препараты из группы бисфосфонатов, средства на основе фосфора и кальция, а также витамина D3. Лечение курсовое, длительность 3 месяца. Перед операцией проводится 1-2 курса с интервалом в 3 месяца. Эффективность лечения контролируют по результатам компьютерной томографии.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Хирургическое лечение</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">«Золотым стандартом» хирургического лечение отосклероза признана стапедопластика. Это микрохирургическая операция, которая подразумевает удаление стремени (слуховой косточки) с заменой на протез. Показанием для проведения вмешательства являются стойкие нарушения слуха или постоянный шум в ушах. Операция не останавливает развитие отосклероза, однако позволяет восстановить способность пациента слышать.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Операцию проводят под общей или местной анестезией. Вмешательство продолжается 1-1,5 часа. В процессе операции врач отводит перепонку, с помощью микроскопа находит причину нарушений подвижности слуховых косточек, удаляет стремя и устанавливает протез, затем возвращает перепонку на место. Сразу после вмешательства слух пациента улучшается.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Методика не применяется при кохлеарной форме отосклероза, когда звуковосприятие значительно ухудшается, а порог костного проведения превышает 40 дБ. У таких пациентов стапедопластика не эффективна, поскольку не восстанавливает слух до необходимого для общения уровня.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Комбинированное лечение</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Если интраоперационно обнаруживают активный склеротический процесс, применяют комбинированную методику – проводят хирургическое вмешательство, а затем назначают инактивирующую терапию.</span></p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Так как развитие отосклероза в большей степени связано с генетической предрасположенностью, специальных профилактических мер не разработано. Следует как можно меньше находиться в обстановке с повышенным уровнем шума, избегать стрессовых ситуаций и перегрузок, а также своевременно лечить воспалительные процессы органов слуха.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Основную опасность представляет собой длительный бессимптомный период отосклероза. Незаметные и постепенные изменения в костной капсуле могут происходить в течение 2-3 лет, проявляя себя лишь незначительным шумом в пораженном ухе. </span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">По мере развития болезни и отсутствия лечения симптомы отосклероза проявляются следующим образом:</span></p>\r\n<p> </p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нарушение восприятия низкого диапазона частот с сохранением восприятия высоких. В ряде случаев восприимчивость звуковоспринимающего аппарата к высоким частотам даже усиливается. На этом этапе характерны жалобы больных на проблемы с пониманием мужской речи, хотя речь детей и женщин сохраняет для них свою четкость и ясность.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Повышение остроты слуха в шумной среде. Этот симптом — субъективное ощущение больного, который принимает за улучшение слуха естественное повышение громкости речи собеседника, который пытается говорить громче в шумной обстановке.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нарушения функций звуковоспринимающего аппарата приводит к тому, что одновременное поступление в улитку звуков из внешней среды и акустических волн, передаваемых по мягким тканям тела, ухудшает восприятие первых. Так, человек может жаловаться на то, что когда он передвигается, пережевывает пищу и пр., у него существенно ухудшается понимание речи собеседника.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">По мере прогрессирования заболевания вышеописанные симптомы «сглаживаются» — наступает ухудшение восприятия как низких, так и высоких частот, а понимание собеседника, говорящего шепотом или в полный голос становится примерно равнозначным.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Одной из характерных особенностей отосклероза является постоянное регрессирование слуха. В отличие от ряда других заболеваний, при которых наблюдается периодическое снижение или повышение остроты слуха, при отосклерозе этого не происходит.</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Шум в пораженном ухе. Этот симптом присутствует у подавляющего числа больных отосклерозом и описывается ими как «шелест», «белый шум».</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 8pt; font-family: Verdana; color: #666666; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Кроме слуховых нарушений у больных отосклерозом могут развиваться нарушения невротического характера. Ограничение в общении, накладываемое тугоухостью, приводит к снижению социальной активности человека, что может стать причиной его замкнутости, вызвать перепады настроения. Нередко у больных развиваются нарушения сна, вызванные постоянным шумом в ушах.</span></p>\r\n</li>\r\n</ul>",
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},
"code": "H80.9",
"name": "Отосклероз неуточненный",
"icd_name": "Отосклероз неуточненный",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "h80.9_otoskleroz_neutochnennyy",
"lead": "поражение костной капсулы лабиринта внутреннего уха, в ходе которого ткани претерпевают дистрофические изменения",
"description": "",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Причины, которые приводят к развитию отосклероза уха:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Наследственная предрасположенность. Нарушения в росте и функционировании тканей внутреннего уха возникают у близких кровных родственников в 40% случаев. Большая часть таких пациентов страдают не только от поражения среднего и внутреннего уха, но и от болезней суставов, нарушений в работе щитовидной железы и пр. Поэтому ученые предполагают, что неполноценность развития соединительной ткани – это следствие генетических нарушений, которые передаются по наследству.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Перенесенные инфекционные заболевания. Особенно опасны они для людей, которые склонны к глухоте на уровне генетики. Чаще всего отосклероз у таких больных развивается после перенесенной кори .</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Принадлежность женскому полу. Экспериментальным путем было доказано, что избыточный рост костных тканей в ухе наблюдается у женщин в период гормональной нестабильности. Патология может манифестировать во время полового созревания, после первой менструации, во время беременности, после родов, во время климакса. Около 80% всех заболевших – это женщины. Спровоцировать отосклероз уха могут опухоли желез внутренней секреции.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Травма уха. В плане развития отосклероза особенно опасны именно акустические травмы. Причем продолжительность звукового влияния на структуры уха значения не имеет.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нарушение кровообращения. Если внутренние структуры уха не получают нормального питания, то это приводит к развитию патологического процесса.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Воспаление внутренних структур уха. Особенно опасны в плане развития заболевания хронические вялотекущие процессы. Структуры уха постоянно травмируются, что приводит к замещению нормальной ткани на рубцовую.</span></li>\r\n</ul>\r\n<p> </p>",
"pathogenesis": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Особенностью костной капсулы лабиринта является то, что она представляет собой первичную, образовавшуюся в процессе эмбриогенеза, кость без вторичной оссификации. При отосклерозе в различных ограниченных участках костного лабиринта активируется процесс образования зрелой кости. В начале происходит образование незрелой спонгиозной костной ткани, содержащей множество сосудов. Такой очаг отосклероза носит название активного. Затем незрелая костная ткань очага трансформируется в склерозированную зрелую кость.</span></p>\r\n<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Очаги отосклероза могут иметь множественный характер. В 50% случаев отосклероза их обнаруживают в области окна преддверия, в 35% — в капсуле улитки, в 15% — в полукружных канальцах. Расположение очага отосклероза в области окна преддверия приводит к вовлечению в склеротический процесс основания стремени с развитием его анкилоза. В результате возникающей обездвиженности стремени нарушается звукопроводящая функция уха и развивается кондуктивная тугоухость. Если очаги отосклероза находятся в лестнице лабиринта, то нарушается работа звуковоспринимающего аппарата уха, что ведет к появлению нейросенсорного типа тугоухости.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выявлением заболевания занимается оториноларинголог. Диагностика в обязательном порядке включает следующие процедуры:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Компьютерная томография. Используется для определения степени изменений в костных тканях в слуховом проходе и улитке уха. С этой же целью может использоваться МРТ.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для определения воздушной проводимости используется камертональное исследование.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Вестибулярные пробы отображают нарушение реакций и наличие нистагма.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Тональная аудиометрия назначается для определения степени тугоухости.</span></li>\r\n</ul>\r\n<p> </p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выбор тактики лечения определяется только после полного обследования пациента в клинике. При выборе значение имеет стадия заболевания и активность очагов, а также их количество. Для устранения патологии костной ткани используются как лекарственные препараты, так и операции.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Консервативное лечение</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Направлено на нормализацию работы внутреннего уха при смешанных формах. Положительный эффект отмечается от препаратов на основе фосфора, фтора, кальция. Все это нормализует обменные процессы. Дополнительно используются витамины В, Е и А.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Пациенту рекомендуется пройти физиолечение в медицинском учреждении. Устранить шум в ушах помогает электрофорез. Также положительный результат дает дарсонвализация. Принимать препараты и продолжать терапию нужно до устранения всех симптомов. В случае, если улучшений нет, прибегают к хирургии.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Хирургическое лечение</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Для нормализации слуха используется стапедэктомия и стапедопластика. Вмешательство подразумевает замену пораженного участка трансплантатом из синтетического материала. Как правило, такая операция используется у пациентов с тимпанальной формой или со смешанной.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Также популярна поршневая стапедопластика, в ходе которой используются биосовместимые материалы. Такая операция более щадящая за счет продуманного способа фиксации протеза на стремени. Соответственно, и восстановление займет меньше времени.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Комбинированное лечение</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Отдельным группам пациентов показано первоначально медикаментозное лечение с применением препаратов и физиотерапии, и только после достижения определенного результата назначается хирургическое вмешательство по восстановлению слуха.</span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Специфической профилактики отосклероза не разработано. Однако врачи рекомендуют вести здоровый образ жизни, правильно питаться, чаще гулять на свежем воздухе, регулярно проходить осмотр у оториноларинголога. Важно также оградить себя от стрессов.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">К основным проявлениям патологии относят:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Фоновый шум в ушах.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Головокружение, которое возникает при резком повороте головы.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Тошнота и рвота.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Боль за ухом. Она давящая, сосредоточена в области сосцевидного отростка.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Заложенность уха, ухудшение слуха.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Обостренное восприятие звуков высокой частоты. Звуки низкой частоты человек, напротив, слышит хуже.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Паракузис Виллиса. Человеку с отосклерозом кажется, что слух у него улучшается, когда вокруг шумно.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Паракузис Вебера. Ухудшение слуха происходит при жевании или во время ходьбы, в любых ситуациях, когда происходит движение мягких тканей. Это обусловлено раздражением улитки внутреннего уха.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">По мере прогрессирования патологии человек перестает воспринимать не только низкие, но и высокие звуки.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Проявления неврастенического симптома. У больного возникают головные боли, он становится апатичным, его мучает бессонница. Днем человек выглядит уставшим, память и внимание снижается.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Симптом Тойнби. Он проявляется неясным восприятием речи при одновременном разговоре сразу нескольких людей.</span></li>\r\n</ul>\r\n<p> </p>",
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