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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": "I00",
"name": "Ревматическая лихорадка без упоминания о вовлечении сердца",
"icd_name": "Ревматическая лихорадка без упоминания о вовлечении сердца",
"gender": 0,
"age_min": 1,
"age_max": 94,
"cause": [
3,
2,
4,
9
],
"periodicity": 1,
"slug": "i00_revmaticheskaya_lihoradka_bez_upominaniya_o_vovlechenii_serdca",
"lead": "Нарушение здоровья, относящееся к группе острая ревматическая лихорадка",
"description": "Согласно международной классификации болезней, острая ревматическая лихорадка (ОРЛ) — системное заболевание соединительной ткани с преимущественной локализацией процесса в сердечно-сосудистой системе, развивающееся в связи с острой А-стрептококковой инфекцией у предрасположенных к нему лиц, главным образом в возрасте 7–15 лет.",
"etiology": "<p>Ревматической атаке обычно предшествует стрептококковая инфекция, вызываемая β-гемолитическим стрептококком группы А: скарлатина, тонзиллит, родильная горячка, острый отит, фарингит, рожа. У 97% пациентов, перенесших стрептококковую инфекцию, формируется стойкий иммунный ответ. У остальных лиц стойкого иммунитета не вырабатывается, и при повторном инфицировании β-гемолитическим стрептококком развивается сложная аутоиммунная воспалительная реакция. </p>\r\n<p>Развитию ревматизма способствуют сниженный иммунитет, молодой возраст, большие коллективы (школы, интернаты, общежития), неудовлетворительные социальные условия (питание, жилье), переохлаждение, отягощенный семейный анамнез. </p>",
"pathogenesis": "<p>В патогенезе условно выделяются два периода: </p>\r\n<p>1. Непосредственное повреждающее и токсическое действие на организм, оказываемое персистирующими стрептококками и их антигенами.</p>\r\n<p>2. Развитие иммунного воспаления в соединительной ткани организма с преимущественным вовлечением в процесс сердца и сосудов в результате запуска механизма синтезааутоантител.</p>",
"diagnostics": "<p>Клинико-диагностические критерии ОРЛ Киселя-Джонса: </p>\r\n<p>Большие: </p>\r\n<p>ревмокардит (преимущественно поражения миокарда в виде миокардита и эндокардит с пороками сердца и без); </p>\r\n<p>полиартрит (преимущественно крупных суставов, мигрирующий характер, без остаточных деформаций, рентгенологически негативный); </p>\r\n<p>малая хорея; </p>\r\n<p>ревматические узелки (подкожные узловатые уплотнения); </p>\r\n<p>анулярная эритема (кольцевидные покраснения кожи туловища и проксимальных отделов конечностей). </p>\r\n<p>Малые: </p>\r\n<p>клинические: лихорадка, боли в суставах; </p>\r\n<p>лабораторно-инструментальные: </p>\r\n<p>а) лабораторные (С-реактивный белок, антистрептолизин-О, ревматоидный фактор); </p>\r\n<p>б) инструментальные (ЭКГ, электромиография, УЗИ сердца). </p>",
"treatment": "<p>Активная фаза ревматизма требует госпитализации пациента и соблюдения постельного режима. Применяются гипосенсибилизирующие и противовоспалительные препараты, кортикостероидные гормоны, нестероидные противовоспалительные препараты, иммунодепрессанты. <br class=\"SCXW246008330\" /> </p>",
"prevention": "<p>Первичная: своевременная санация стрептококковых инфекций (ангины, стрептодермии, лечение болезней полости рта, болезней ЛОР-органов, правильная гигиена и т. д.), закаливание и т. д. </p>\r\n<p>Вторичная (бициллинопрофилактика): экстенциллин 2,4 млн единиц раз в 3 недели: </p>\r\n<ul>\r\n<li>стандартно — в течение 5 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате без порока сердца — до 18 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате с пороком сердца — до 25 лет. </li>\r\n</ul>\r\n<p>Текущая: обязательное назначение при интеркуррентных заболеваниях пенициллинов и НПВС. </p>\r\n<p> </p>",
"clinical_picture": "<p>Симптомы ревматизма крайне полиморфны и зависят от степени остроты и активности процесса, а также вовлеченности в процесс различных органов. Типичная клиника ревматизма имеет прямую связь с перенесенной стрептококковой инфекцией (тонзиллитом, скарлатиной, фарингитом) и развивается спустя 1-2 недели после нее. Заболевание начинается остро с субфебрильной температуры (38—39 °С), слабости, утомляемости, головных болей, потливости. Одним из ранних проявлений ревматизма служат артралгии - боли в средних или крупных суставах (голеностопных, коленных, локтевых, плечевых, лучезапястных). </p>\r\n<p>При ревматизме артралгии носят множественный, симметричный и летучий (боли исчезают в одних и появляются в других суставах) характер. Отмечается припухлость, отечность, локальное покраснение и повышение температуры, резкое ограничение движений пораженных суставов. Течение ревматического полиартрита обычно доброкачественно: через несколько дней острота явлений стихает, суставы не деформируются, хотя умеренная болезненность может сохраняться в течение длительного времени. </p>\r\n<p>При ревматизме может поражаться центральная нервная система, специфическим признаком при этом служит, так называемая, ревматическая или малая хорея: появляются гиперкинезы – непроизвольные подергивания групп мышц, эмоциональная и мышечная слабость.</p>\r\n<p>Реже встречаются кожные проявления ревматизма: кольцевидная эритема (у 7–10% пациентов) и ревматические узелки. Кольцевидная эритема(аннулярная сыпь) представляет собой кольцевидные, бледно-розовые высыпания на туловище и голенях; ревматические подкожные узелки - плотные, округлые, безболезненные, малоподвижные, единичные или множественные узелки с локализацией в области средних и крупных суставов. </p>\r\n<p> </p>",
"image": null,
"image_alt": null,
"standard_type": 3,
"danger": 82,
"published": 2,
"parent": null,
"block_rubric": 90,
"standards": []
},
{
"id": 6505,
"symptoms": [
{
"id": 2581,
"synonyms": [
{
"name": "нехватка воздуха"
},
{
"name": "диспноэ"
},
{
"name": "Ощущение тяжести"
},
{
"name": "чувство удушья"
},
{
"name": "усилия для дыхания"
}
],
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"code": "I01",
"name": "Ревматическая лихорадка с вовлечением сердца",
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3,
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"lead": "Нарушение здоровья, относящееся к группе острая ревматическая лихорадка",
"description": "Ревмокардит — это основное клиническое проявление ревматизма, относящегося к системным заболеваниям соединительной ткани, при котором патологический процесс локализуется преимущественно в сердце. Ревматизм поражает чаще детей в возрасте 7—15 лет, реже встречается в дошкольном возрасте. ",
"etiology": "<p>Ревматической атаке обычно предшествует стрептококковая инфекция, вызываемая β-гемолитическим стрептококком группы А: скарлатина, тонзиллит, родильная горячка, острый отит, фарингит, рожа. У 97% пациентов, перенесших стрептококковую инфекцию, формируется стойкий иммунный ответ. У остальных лиц стойкого иммунитета не вырабатывается, и при повторном инфицировании β-гемолитическим стрептококком развивается сложная аутоиммунная воспалительная реакция. </p>\r\n<p>Развитию ревматизма способствуют сниженный иммунитет, молодой возраст, большие коллективы (школы, интернаты, общежития), неудовлетворительные социальные условия (питание, жилье), переохлаждение, отягощенный семейный анамнез. </p>",
"pathogenesis": "<p>В патогенезе ОРЛ также можно говорить о ревматической патогенетической триаде: </p>\r\n<ol>\r\n<li>Прямое повреждение миокарда факторами патогенности стрептококка </li>\r\n<li>Аутоиммунный механизм - повреждение миокарда циркулирующими иммунными комплексами (антиген-антитело). </li>\r\n<li>Сосудистый механизм (поражение сосудов миокарда по вышеописанным механизмам ведет к нарушению циркуляции в миокарде — ишемии, ацидозу, — способствуя развитию воспаления, с одной стороны, и реактивному фиброзу, с другой). </li>\r\n</ol>",
"diagnostics": "<p>Клинико-диагностические критерии ОРЛ Киселя-Джонса: </p>\r\n<p>Большие: </p>\r\n<ul>\r\n<li>ревмокардит (преимущественно поражения миокарда в виде миокардита и эндокардит с пороками сердца и без); </li>\r\n<li>полиартрит (преимущественно крупных суставов, мигрирующий характер, без остаточных деформаций, рентгенологически негативный); </li>\r\n<li>малая хорея; </li>\r\n<li>ревматические узелки (подкожные узловатые уплотнения); </li>\r\n<li>анулярная эритема (кольцевидные покраснения кожи туловища и проксимальных отделов конечностей). </li>\r\n</ul>\r\n<p>Малые: </p>\r\n<ul>\r\n<li>клинические: лихорадка, боли в суставах; </li>\r\n<li>лабораторно-инструментальные: </li>\r\n</ul>\r\n<p>а) лабораторные (С-реактивный белок, антистрептолизин-О, ревматоидный фактор); </p>\r\n<p>б) инструментальные (ЭКГ, электромиография, УЗИ сердца) </p>",
"treatment": "<p>Активная фаза ревматизма требует госпитализации пациента и соблюдения постельного режима. Лечение проводится ревматологом и кардиологом. Применяются гипосенсибилизирующие и противовоспалительные препараты, кортикостероидные гормоны, нестероидные противовоспалительные препараты, иммунодепрессанты. <br class=\"SCXW182360504\" /> </p>",
"prevention": "<p>Первичная: своевременная санация стрептококковых инфекций (ангины, стрептодермии, лечение болезней полости рта, болезней ЛОР-органов, правильная гигиена и т. д.), закаливание и т. д. </p>\r\n<p>Вторичная (бициллинопрофилактика): экстенциллин 2,4 млн единиц раз в 3 недели: </p>\r\n<ul>\r\n<li>стандартно — в течение 5 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате без порока сердца — до 18 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате с пороком сердца — до 25 лет. </li>\r\n</ul>\r\n<p>Текущая: обязательное назначение при интеркуррентных заболеваниях пенициллинов и НПВС. </p>",
"clinical_picture": "<p>Поражение сердца при ревматизме отмечается у 70-85% пациентов. При ревмокардите воспаляются все или отдельные оболочки сердца. Чаще происходит одновременное поражение эндокарда и миокарда (эндомиокардит), иногда с вовлеченностью перикарда (панкардит), возможно развитие изолированного поражения миокарда (миокардит). Во всех случаях при ревматизме в патологический процесс вовлекается миокард. </p>\r\n<p>При диффузном миокардите появляются одышка, сердцебиения, перебои и боли в сердце, кашель при физической нагрузке, в тяжелых случаях – недостаточность кровообращения, сердечная астма или отек легких. Пульс малый, тахиаритмичный. Благоприятным исходом диффузного миокардита считается миокардитический кардиосклероз. </p>\r\n<p>При эндокардите и эндомиокардите в ревматический процесс чаще вовлекается митральный (левый предсердно-желудочковый) клапан, реже аортальный и трикуспидальный (правый предсердно-желудочковый) клапаны. Клиника ревматического перикардита аналогична перикардитам иной этиологии.</p>",
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"code": "I09",
"name": "Другие ревматические болезни сердца",
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"lead": "Нарушение здоровья, относящееся к группе хронические ревматические болезни сердца",
"description": "Ревмокардит — это основное клиническое проявление ревматизма, относящегося к системным заболеваниям соединительной ткани, при котором патологический процесс локализуется преимущественно в сердце. Ревматизм поражает чаще детей в возрасте 7—15 лет, реже встречается в дошкольном возрасте. ",
"etiology": "<p>Ревматической атаке обычно предшествует стрептококковая инфекция, вызываемая β-гемолитическим стрептококком группы А: скарлатина, тонзиллит, родильная горячка, острый отит, фарингит, рожа. У 97% пациентов, перенесших стрептококковую инфекцию, формируется стойкий иммунный ответ. У остальных лиц стойкого иммунитета не вырабатывается, и при повторном инфицировании β-гемолитическим стрептококком развивается сложная аутоиммунная воспалительная реакция. </p>\r\n<p>Развитию ревматизма способствуют сниженный иммунитет, молодой возраст, большие коллективы (школы, интернаты, общежития), неудовлетворительные социальные условия (питание, жилье), переохлаждение, отягощенный семейный анамнез.</p>",
"pathogenesis": "<p> В патогенезе ОРЛ также можно говорить о ревматической патогенетической триаде: </p>\r\n<ol>\r\n<li>Прямое повреждение миокарда факторами патогенности стрептококка </li>\r\n<li>Аутоиммунный механизм - повреждение миокарда циркулирующими иммунными комплексами (антиген-антитело). </li>\r\n<li>Сосудистый механизм (поражение сосудов миокарда по вышеописанным механизмам ведет к нарушению циркуляции в миокарде — ишемии, ацидозу, — способствуя развитию воспаления, с одной стороны, и реактивному фиброзу, с другой). </li>\r\n</ol>",
"diagnostics": "<p>Клинико-диагностические критерии ОРЛ Киселя-Джонса: </p>\r\n<p>Большие: </p>\r\n<ul>\r\n<li>ревмокардит (преимущественно поражения миокарда в виде миокардита и эндокардит с пороками сердца и без); </li>\r\n<li>полиартрит (преимущественно крупных суставов, мигрирующий характер, без остаточных деформаций, рентгенологически негативный); </li>\r\n<li>малая хорея; </li>\r\n<li>ревматические узелки (подкожные узловатые уплотнения); </li>\r\n<li>анулярная эритема (кольцевидные покраснения кожи туловища и проксимальных отделов конечностей). </li>\r\n</ul>\r\n<p>Малые: </p>\r\n<ul>\r\n<li>клинические: лихорадка, боли в суставах; </li>\r\n<li>лабораторно-инструментальные: </li>\r\n</ul>\r\n<p>а) лабораторные (С-реактивный белок, антистрептолизин-О, ревматоидный фактор); </p>\r\n<p>б) инструментальные (ЭКГ, электромиография, УЗИ сердца). </p>",
"treatment": "<p> Активная фаза ревматизма требует госпитализации пациента и соблюдения постельного режима. Лечение проводится ревматологом и кардиологом. Применяются гипосенсибилизирующие и противовоспалительные препараты, кортикостероидные гормоны, нестероидные противовоспалительные препараты, иммунодепрессанты.</p>",
"prevention": "<p>Первичная: своевременная санация стрептококковых инфекций (ангины, стрептодермии, лечение болезней полости рта, болезней ЛОР-органов, правильная гигиена и т. д.), закаливание и т. д. </p>\r\n<p>Вторичная (бициллинопрофилактика): экстенциллин 2,4 млн единиц раз в 3 недели: </p>\r\n<ul>\r\n<li>стандартно — в течение 5 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате без порока сердца — до 18 лет; </li>\r\n<li>при манифестации ОРЛ в препубертате/пубертате с пороком сердца — до 25 лет. </li>\r\n</ul>\r\n<p>Текущая: обязательное назначение при интеркуррентных заболеваниях пенициллинов и НПВС. </p>",
"clinical_picture": "<p>Поражение сердца при ревматизме отмечается у 70-85% пациентов. При ревмокардите воспаляются все или отдельные оболочки сердца. Чаще происходит одновременное поражение эндокарда и миокарда (эндомиокардит), иногда с вовлеченностью перикарда (панкардит), возможно развитие изолированного поражения миокарда (миокардит). Во всех случаях при ревматизме в патологический процесс вовлекается миокард. </p>\r\n<p>При диффузном миокардите появляются одышка, сердцебиения, перебои и боли в сердце, кашель при физической нагрузке, в тяжелых случаях – недостаточность кровообращения, сердечная астма или отек легких. Пульс малый, тахиаритмичный. Благоприятным исходом диффузного миокардита считается миокардитический кардиосклероз. </p>\r\n<p>При эндокардите и эндомиокардите в ревматический процесс чаще вовлекается митральный (левый предсердно-желудочковый) клапан, реже аортальный и трикуспидальный (правый предсердно-желудочковый) клапаны. Клиника ревматического перикардита аналогична перикардитам иной этиологии. </p>",
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