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"lead": "поражение костной капсулы лабиринта внутреннего уха, в ходе которого ткани претерпевают дистрофические изменения",
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"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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"lead": "поражение вестибулярного нерва, предположительно имеющее воспалительный генез и проявляющееся единичным острым пароксизмом интенсивного головокружения с расстройством равновесия и полной сохранностью слуха",
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"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;\">Этиофакторы вестибулярного нейронита не совсем ясны. Субстратом заболевания принято считать воспалительный процесс, избирательно поражающий вестибулярный нерв. Вероятнее всего, воспаление имеет вирусную этиологию. Это подтверждается манифестацией нейронита после перенесенных ОРВИ. Известны случаи, когда на фоне вестибулярного нейронита развивался герпетический энцефалит, в связи с чем предполагается, что одним из этиофакторов выступает вирус простого герпеса. В пользу инфекционной этиологии свидетельствуют описанные случаи заболевания сразу нескольких членов семьи.</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;\">Ряд авторов высказывается в пользу инфекционно-аллергического механизма развития вестибулярного нейронита, при котором вирусы являются сенсибилизаторами и провоцируют локальный аутоиммунный воспалительный процесс. Воспаление, как правило, затрагивает верхнюю ветвь вестибулярного нерва. Патология нижней ветви отмечается гораздо реже. Слуховой нерв остается полностью интактным. Кроме того, описаны случаи вестибулярного нейронита токсического генеза, обусловленного применением антибиотиков аминогликозидного ряда, в частности гентамицина.</span></p>",
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"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;\">В подавляющем большинстве случаев диагностика основывается на типичной клинической картине. Диагноз можно подтвердить с помощью видеонистагмографии (регистрация движения глазных яблок при выполнении ряда тестов), теста импульсного движения головой (тест, оценивающий функциональность сразу 6 полукружных каналов — составляющей внутреннего уха, отвечающего за координацию) и пробы Фудуко (маршевая проба, в ходе теста оценивается отклонение пациента от первоначального положения). Кроме этого, у пациентов с ВН выявляется спонтанный горизонтально-ротаторный нистагм, усиливающийся при взгляде в сторону здорового уха.</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;\">Другие тесты и исследования, в том числе аудиометрия (исследование слуха) и МРТ головного мозга, выполняются по показаниям, для исключения других причин головокружения.</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;\">Основные направления терапии пациентов с ВН — уменьшение головокружения, тошноты и рвоты (симптоматическое лечение) и ускорение вестибулярной компенсации.</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;\">Симптоматическое лечение включает использование лекарств, подавляющих вестибулярную функцию: антигистаминных средств (дименгидринат); бензодиазепиновых транквилизаторов (диазепам); противорвотных средств (метоклопрамида гидрохлорид, тиэтилперазин).</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;\">Симптоматическое лечение рекомендуют использовать не более 3 дней, поскольку оно замедляет вестибулярную компенсацию, что ведет к длительно сохраняющемуся головокружению.</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;\">Эффективность глюкокортикостероидов, которые ранее активно использовались у пациентов с ВН, в настоящее время ставится под сомнение.</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;\">Несмотря на предположительную вирусную этиологию ВН, связанную, в частности, с вирусом простого герпеса 1 типа, применение противогерпетических препаратов также не ускоряет процесса выздоровления, и они не должны использоваться в лечении ВН.</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 лечения ВН не рекомендованы пирацетам, трентал, мексидол, актовегин, кавинтон, глицин и прочие лекарства с недоказанной эффективностью.</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;\">Примерно с третьего дня заболевания пациентам с ВН рекомендуется вестибулярная гимнастика — упражнения, ускоряющие компенсаторные процессы, от более простых к более сложным. Это упражнения на фиксацию взора, тренировку глазодвигательных реакций, на удержание равновесия в различных позах стоя и в движении.</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;\">Причин развития вестибулопатии учеными не установлено. Именно поэтому специальных профилактических мер для исключения возникновения нарушения не существует. Пациентам рекомендовано своевременно лечить инфекционные заболевания и соблюдать дозировку лекарственных препаратов, которую установил лечащий врач.</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;\">Для ВН характерно монофазное течение — острое или подострое начало с последующим стиханием симптомов. Продолжительность клинических проявлений составляет в среднем от 1 недели до 3 месяцев (максимальные проявления — от нескольких дней до нескольких недель), после чего болезнь бесследно исчезает. Вероятность рецидива ВН составляет 2-5%.</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;\">Заболевание начинается с сильного головокружения, сопровождающегося нистагмом определенного вида. Головокружение усиливается при движениях головы и уменьшается при фиксации взора. В 78% случаев оно появляется внезапно, у 22% больных за 1-2 дня до дебюта заболевания отмечаются явления в виде неустойчивости и легкого нарушения координации движений. Часто наблюдается осциллопсия — нечеткое зрительное восприятие окружающих предметов при выполнении пассивных или активных движений головой вследствие нестабильности изображения на сетчатке. Резко нарушаются координация движений и равновесие. Почти у всех пациентов отмечается тошнота, у 65% — рвота.</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;\">В течение первых суток пациент лежит в постели — малейшие движения головой провоцируют тошноту, рвоту. На 2-5-е сутки больной способен перемещаться в пределах комнаты (палаты), однако сохраняется шаткость походки, а резкие движения головой или ходьба на большие расстояния провоцируют возникновение тошноты. На 10-14-е сутки пациент жалуется на «тяжесть» в голове, утомляемость, но в целом чувствует себя здоровым и может вернуться к привычному образу жизни.</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;\">В первые дни развития заболевания головной мозг «понимает», что вестибулярный аппарат транслирует неверный сенсорный сигнал: здоровый лабиринт всегда находится в активном состоянии, другой (пораженный) — угнетен, что интерпретируется мозгом как постоянное вращение в здоровую сторону. Поскольку восстановить проведение по пораженному вестибулярному нерву в короткие сроки невозможно, головной мозг блокирует активность здорового лабиринта, выравнивая потоки сенсорных сигналов от обоих вестибулярных аппаратов. По мере восстановления вестибулярного нерва система контроля возвращается в исходное, здоровое состояние.</span></p>",
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"description": "<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;\">Лабиринтит – это воспаление перепончатых образований и нервных структур внутреннего уха, вызванное различными вирусами, бактериями и их токсинами, а также травмой. </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;\">Нередко причина заболевания остается невыясненной. Считается, что его могут вызвать патогенные вирусы, например, гриппа, или возбудители ОРВИ. Симптомы лабиринтита могут быть связаны с инфекцией микобактериями, стрептококками, менингококками.</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;\">Другие возможные причины, вызывающие асептическое (безмикробное) воспаление внутреннего 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;\">ушиб, травма головы, сотрясение мозга;</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;\">аллергическая реакция, например, при поллинозе;</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;\">злоупотребление алкоголем;</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;\">доброкачественное новообразование среднего уха (холестеатома);</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;\">прием некоторых лекарств, таких как аспирин или фуросемид, в больших дозах.</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;\">Вследствие внутреннего расположения лабиринта его инфицирование с развитием лабиринтита возможно только при распространении микроорганизмов или их токсинов из других инфекционных очагов. Наиболее часто причиной лабиринтита бывает средний отит. В костных структурах улитки и преддверия имеются окна, которые закрыты соединительнотканными мембранами. Таким образом внутреннее ухо отделено от барабанной полости среднего уха. При воспалении среднего уха происходит набухание и инфильтрация мембран, в результате чего они становятся проницаемы для микробных токсинов, проникающих из барабанной полости и обуславливающих серозное воспаление внутреннего уха. Развивающийся серозный лабиринтит приводит к повышению давления внутри лабиринта, что может сопровождаться прорывом соединительнотканных мембран окон в барабанную полость. Через возникшие отверстия во внутреннее ухо попадают патогенные микроорганизмы, вызывающие развитие гнойного лабиринтита.</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;\">Инфекционные агенты и их токсины через внутренний слуховой проход могут проникнуть во внутреннее ухо из полости черепа. Причиной лабиринтита в таких случаях является менингит, который в свою очередь может быть обусловлен менингококковой и пневмококковой инфекцией, гриппом, корью, туберкулезом, скарлатиной, сыпным тифом. </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;\">В основе диагностики лежит тщательно собранный анамнез. На приеме врач проводит отоскопию (осмотр наружного уха и барабанной перепонки), оценку вестибулярной функции, аудиометрию (исследование слуха). Пациентам с подозрением на лабиринтит рекомендуется компьютерная томография височных костей или магнитно-резонансная томография головного мозга для выявления очага инфекции.</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;\">При исследовании слуха выявляется тугоухость смешанного типа, чаще с преобладанием сенсоневрального компонента.</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;\">В общеклиническом и биохимическом анализах крови выявляются характерные признаки воспаления (лейко- и лимфоцитоз, ускорение СОЭ, повышение концентрации С-реактивного белка).</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;\">Медикаментозная терапия лабиринтита требует комплексного подхода. Она включает назначение антибактериальных и противовоспалительных препаратов, медикаментов, улучшающих кровообращение внутреннего уха, нейропротекторов, гипосенсибилизирующих средств. Купирование приступов головокружения при лабиринтите производится вестибулолитиками.</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;\">Тимпаногенный гнойный лабиринтит подлежит хирургическому лечению, которое заключается в проведении санирующей операции на среднем ухе, лабиринтотомии или пластики фистулы лабиринта. Если лабиринтит сопровождается мастоидитом или петрозитом, соответственно производится мастоидотомия или вскрытие пирамиды височной кости. При наличие внутричерепных осложнений лабиринтита показана лабиринтэктомия (удаление лабиринта) с дренированием полости черепа.</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;\">Стойкие нарушения слуха в результате перенесенного лабиринтита нуждаются в коррекции с помощью слухопротезирования или путем проведения слуховосстанавливающей операции (кохлеарной имплантации). С целью выбора оптимальной для пациента методики слуховой реабилитации необходима консультация сурдолога и слухопротезиста.</span></p>",
"prevention": "<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;\">Профилактика лабиринтита сводится к своевременному и правильному выявлению воспаления среднего уха (средний 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;\">Также необходимо дезинфицировать нос, оральную и носовую часть глотки. Санация —лечебно-профилактические меры по оздоровлению организма. Во время санации лор-органов (носовой полости, носовых пазух, глотки, гортани, ушей) разрушаются микроорганизмы, которые живут там и могут привести к различным заболеваниям при ослабленном иммунитете.</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;\">Наиболее частые симптомы лабиринтита:</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;\">головокружение, тошнота и рвота, не приносящие облегчения;</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;\">потеря равновесия, неожиданные падения;</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;\">умеренная головная боль, звон или шелест в ухе, потеря 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;\">нистагм – движения глазных яблок в сторону поражения при серозной форме или в здоровую сторону – при гнойном варианте течения.</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;\">Эти признаки усиливаются при движении головой, поворотах и взгляде вверх. Они могут сохраняться в течение нескольких дней или даже недель в зависимости от степени тяжести болезни. Даже после начатого лечения лабиринтита его симптомы могут рецидивировать, поэтому больному следует быть осторожным при вождении автомобиля и работе на высоте в течение как минимум недели после выздоровления.</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;\">Случаи, требующие срочной консультации специалиста и лечения лабиринтита:</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;\">рвота, затрудняющая прием пищи, воды или лекарств;</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;\">лихорадка, боль в ухе, прогрессирующая потеря 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;\">сильная головная боль или головокружение, сохраняющееся в течение нескольких часов или более;</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;\">двоение в глазах, нарушение речи, слабость лицевых или скелетных мышц;</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;\">недавно перенесенная травма уха или головы.</span></li>\r\n</ul>\r\n<p> </p>",
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