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},
"code": "H74.0",
"name": "Тимпаносклероз",
"icd_name": "Тимпаносклероз",
"gender": 0,
"age_min": 20,
"age_max": 100,
"cause": [
"0"
],
"periodicity": 1,
"slug": "h74.0_timpanoskleroz",
"lead": "фиброзирующая форма среднего отита, которая является исходом катарального воспаления слизистой оболочки среднего уха",
"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;\">Определяющими факторами развития тимпаносклероза являются острые или хронические катаральные или гнойные воспаления среднего уха.</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;\">Способствующими факторами являются:</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;\">периодические или постоянные обструкции слуховой трубы;</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;\">наличие хронической перитубарной инфекции в области лимфоаденоидной ткани;</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;\">индивидуальная склонность к преобразованию соединительной ткани в рубцово-склеротическую;</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;\">нарушения обмена веществ, ведущие к пансклерозу, увеличению содержания холестерина и мочевины в крови;</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;\">аллергические реакции;</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;\">частые воспалительные заболевания верхних дыхательных путей.</span></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;\">Возникновение тугоухости обусловлено комбинацией нескольких причин: наличие перфорации барабанной перепонки, ограничение подвижности изменённой барабанной перепонки, дефекты оссикулярной цепи и, что наиболее характерно для данного заболевания, ограничение подвижности или полная фиксация слуховых косточек очагами ТС.</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;\">Основным субстратом патологии является образование тимпаносклеротического комплекса или бляшки. Они состоят из гиалиновых масс, кальцинатов, оссифицированной ткани. Большая часть бляшек располагается на внутренней оболочке среднего уха или поражает барабанную перепонку. Слизистая теряет эластичность, становится более плотной. Постепенно нарушается способность барабанной перепонки к совершению колебательных движений, уплотняется кольцевидная связка стремечка.</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 барабанной полости формируются соединительнотканные спайки, нарушающие подвижность слуховых косточек. Патологический процесс в слизистой развивается неоднородно: очаги склерозирования сочетаются с очагами вялотекущего катарального воспаления. Фиброзирование может протекать двумя способами: по типу замещения дефекта в слизистой грануляционной тканью с последующим рубцовым перерождением или же путем формирования на его месте соединительной ткани.</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;\">Диагностика тимпаносклероза осуществляется на основании данных анамнеза, жалоб пациента, осмотра врача-отоларинголога, комплекса лабораторных и инструментальных исследований. При опросе больного особое внимание уделяется наличию в анамнезе перенесенного ранее отита различной давности или травм барабанной перепонки, а также уточняется время возникновения первых симптомов. Для диагностики заболевания используются:</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;\">Физикальное обследование. При осмотре выявляется истончение кожи в области слухового прохода, реже обнаруживаются серозные выделения. Отоскопическая картина характеризуется наличием дефекта в барабанной мембране или ее утолщением. В редких случаях обнаруживаются атрофические рубцы или наслоения гиалина.</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;\">Микроотоскопия. Тимпаносклеротические изменения среднего уха сопровождаются образованием бляшек на слизистой оболочке и в области барабанной перепонки. Они отграничены от окружающих тканей и плотно спаяны с ними, имеют белесоватый оттенок и различные размеры. Сама слизистая оболочка среднего уха истончена, на ней имеются единичные участки гиперемии. Визуализируется полный или частичный разрыв барабанной перепонки.</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;\">Инструментальные исследования. Магнитно-резонансная томография или КТ височной кости позволяют обнаружить разрушение слуховых косточек, повреждение барабанной полости. С помощью рентгенографии черепа можно определить положение отдельных кальцинатов в составе тимпаносклеротических комплексов.</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 функций органов слуха. С целью подтверждения тугоухости и определения ее степени применяют камертональные пробы. Для склеротита характерны кондуктивная тугоухость или смешанная форма с преобладанием кондуктивного компонента. Это связано с повреждением барабанной перепонки и нарушением проведения звуковой волны. Аудиометрия назначается с целью измерения остроты слуха, значительно снижающейся при заболевании.</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> </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;\">Если заболевание имеет ограниченную форму, то возможно консервативное лечение, которое включает:</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;\">продувание слуховой трубы по Политцеру;</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;\">пневмомассаж барабанной перепонки;</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;\">парентеральное (внутримышечное) введение таких биостимуляторов как алоэ и стекловидное тело;</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;\">транстубарное введение эмульсии гидрокортизона, химотрипсина (катетеризация слуховой трубы);</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;\">физиотерапевтические процедуры – УВЧ, электрофорез, сеансы лазеротерапии, массаж тубарных валиков с помощью ультразвука, сеансы виброакустической терапии, энауральный фонофорез рассасывающего препарата лидазы;</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;\">витамины группы В и кокарбоксилазы (витаминоподобный препарат).</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;\">Большинство авторов сходится во мнении, что хирургическое лечение является наиболее эффективным способом реабилитации больных, страдающих ТС, хотя отдалённые результаты не всегда являются удовлетворительными. Цель хирургического вмешательства - улучшение слуха и санация среднего уха. Успех операции и стабильность результатов во многом определяется выраженностью ТС процесса, локализацией и характером очагов, сохранностью и подвижностью элементов цепи слуховых косточек, а также состоянием слуховой трубы. Лечение может быть одноэтапным и многоэтапным. Хирургическое вмешательство включает удаление патологических образований из полости среднего уха, мобилизацию сохранных элементов звукопроводящей цепи, реконструкцию оссикулярной цепи и восстановление барабанной перепонки.</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;\">Основными вмешательствами при ТС являются следующие:</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;\">тимпанопластика (мирингопластика) – при очагах ТС не фиксирующих цепь слуховых косточек;</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;\">тимпанопластика (мирингопластика) с мобилизацией цепи слуховых косточек посредством удаления ТС комплексов;</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;\">тимпанопластика (мирингопластика) с оссикулопластикой дефектов слуховой цепи после удаления ТС комплексов;</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;\">стапедотомия и реконструкция звукопроводящей цепи при фиксации стремени.</span></li>\r\n</ul>\r\n<p> </p>",
"prevention": "<p><span id=\"docs-internal-guid-58803b3c-7fff-14f9-5545-fe44fc3f01fb\"><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;\">Профилактикой тимпаносклероза является своевременное и рациональное лечение отита среднего уха. </span></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 заболевания характерно медленное течение и постепенное нарастание симптомов. Большинство пациентов через несколько лет после перенесенного среднего отита отмечают периодическое появление шума в ушах, который усиливается во время физических нагрузок или психоэмоционального напряжения. Позже больные замечают постепенное снижение остроты слуха вплоть до полной его потери.</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;\">Около 46% людей отмечают наличие слизистых выделений из наружного слухового прохода, не связанных с каким-либо заболеванием. При длительном течении процесса пациенты предъявляют жалобы на диффузную головную боль без четкой локализации. Если на фоне тимпаносклероза происходит обострение хронического отита, могут возникать характерные клинические проявления в виде болевого синдрома или гнойных выделений из уха.</span></p>",
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