iindaba

Emva kokuba umntu emdala, ukuva kwabantu kuyehla ngokuthe ngcembe. Kuyo yonke iminyaka eyi-10 ubudala, izehlo zokungeva ziphantse ziphindwe kabini, kwaye isibini kwisithathu sabantu abadala abaneminyaka ≥ 60 bafumana uhlobo oluthile lokulahleka kokuva okubalulekileyo kweklinikhi. Kukho ulungelelwaniso phakathi kokungeva kakuhle kunye nokuphazamiseka konxibelelwano, ukuncipha kwengqondo, ukudodobala kwengqondo, ukonyuka kweendleko zonyango, kunye nezinye iziphumo ezibi zempilo.

Wonke umntu uya kuba namava okungeva okunxulumene nobudala kubo bonke ubomi bakhe. Ikhono lokuva umntu lixhomekeke ekubeni indlebe yangaphakathi (cochlea) ingafaka ngokuchanekileyo isandi kwimiqondiso ye-neural (ethi emva koko icutshungulwe kwaye icaciswe kwintsingiselo yi-cerebral cortex). Naluphi na utshintsho lwe-pathological kwindlela esuka kwindlebe ukuya ebuchosheni ingaba nemiphumo emibi kwindlebe, kodwa ukulahleka kweendlebe ezinxulumene neminyaka ebandakanya i-cochlea yimbangela eqhelekileyo.

Uphawu lwelahleko yokuva enxulumene neminyaka kukulahleka ngokuthe ngcembe kweeseli zeenwele ezivalwayo ezingaphakathi kwindlebe enoxanduva lokufaka isandi kwiimpawu ze-neural. Ngokungafaniyo nezinye iiseli ezisemzimbeni, iiseli zeenwele ezivalwayo kwindlebe engaphakathi azikwazi ukuphinda zikhule. Phantsi kweziphumo ezongezelekayo zeetiologies ezahlukeneyo, ezi seli ziya kulahleka ngokuthe ngcembe kubomi bomntu. Ezona zinto zibalulekileyo zomngcipheko wokulahlekelwa kwindlebe okunxulumene nobudala ziquka ubudala, umbala wolusu olukhaphukhaphu (oluphawu lwe-cochlear pigmentation kuba i-melanin inefuthe elikhuselayo kwi-cochlea), ubudoda, kunye nokuvezwa kwengxolo. Ezinye izinto ezinobungozi zibandakanya izinto ezinobungozi besifo senhliziyo, ezifana nesifo seswekile, ukutshaya kunye noxinzelelo lwegazi, ezinokukhokelela ekonakaleni kwe-microvascular ye-cochlear blood.

Ukuva kwabantu kuyehla ngokuthe ngcembe njengoko besiya ebudaleni, ngakumbi xa kufikwa ekuveni izandi eziphuma phezulu. Isiganeko sokulahleka kweendlebe okubalulekileyo kweklinikhi sikhula ngokukhula, kwaye yonke iminyaka eyi-10 ubudala, iziganeko zokulahlekelwa kwindlebe ziphantse ziphindwe kabini. Ngoko ke, isibini kwisithathu sabantu abadala abaneminyaka yobudala ≥ 60 bahlupheke kuhlobo oluthile lokulahlekelwa kwindlebe okubalulekileyo.

Izifundo ze-Epidemiological zibonise ulungelelwaniso phakathi kokulahlekelwa kwindlebe kunye nemiqobo yonxibelelwano, ukuncipha kwengqondo, ukudandatheka, ukunyuka kweendleko zonyango, kunye nezinye iziphumo ezibi zempilo. Kule minyaka ilishumi idlulileyo, uphando lugxininise ngokukodwa kwimpembelelo yokulahlekelwa kwindlebe ekunciphiseni kwengqondo kunye nokuphazamiseka kwengqondo, ngokusekelwe kobu bungqina, iKhomishini yeLancet kwi-Dementia yagqiba ngo-2020 ukuba ukulahlekelwa kwindlebe phakathi kwabadala kunye neyona nto inkulu enokuthi iguqule umngcipheko wokuphuhliswa kwengqondo, i-8% yazo zonke iimeko ze-dementia. Kucingelwa ukuba eyona ndlela iphambili apho ukulahlekelwa kwindlebe kwandisa ukuhla kwengqondo kunye nomngcipheko we-dementia yimiphumo emibi yokulahlekelwa kwindlebe kunye ne-encoding eyaneleyo ye-auditory encoding kumthwalo wokuqonda, i-brain atrophy, kunye nokuhlukaniswa kwentlalo.

Ukulahleka kokuva okunxulumene nobudala kuya kubonakala ngokuthe ngcembe kwaye ngokufihlakeleyo kuzo zombini iindlebe ngokuhamba kwexesha, ngaphandle kweziganeko ezicacileyo ezibangela. Kuya kuchaphazela ukuva kunye nokucaca kwesandi, kunye namava onxibelelwano lwemihla ngemihla yabantu. Abantu abanengxaki yokungeva kakuhle kaninzi abaqondi ukuba ukuva kwabo kuyancipha kwaye endaweni yoko bakholelwa ukuba ubunzima babo bokuva bubangelwa yimiba yangaphandle efana nentetho engacacanga kunye nengxolo yangasemva. Abantu abaneendlebe ezingevayo kakhulu baya kuqaphela ngokuthe ngcembe imiba yokucaca kwentetho nakwindawo ezolileyo, ngelixa ukuthetha kwindawo enengxolo baya kuziva bediniwe ngenxa yokuba umzamo othe kratya wokuqonda uyafuneka ukuze kusetyenzwe imiqondiso yentetho ethotyiweyo. Ngokuqhelekileyo, amalungu entsapho ayiqonda kakuhle ingxaki yokuva komguli.

Xa uvavanya iingxaki zokuva kwesigulana, kubalulekile ukuqonda ukuba imbono yomntu yokuva ixhomekeke kwizinto ezine: umgangatho wesandi esingenayo (njengokuthotywa kwemiqondiso yentetho kumagumbi anengxolo yangasemva okanye i-echoes), inkqubo yomatshini wokuhanjiswa kwesandi phakathi kwendlebe ephakathi ukuya kwi-cochlea (okt ukuva nge-conductive), i-cochlea eguqulela izibonakaliso zesandi kwi-brain sensor kunye ne-translation yombane I-cerebral cortex decoding imiqondiso ye-neural kwintsingiselo (okt ukusetyenzwa kwe-auditory esembindini). Xa isigulane sifumanisa iingxaki zokuva, unobangela unokuba ngomnye wamacandelo amane akhankanywe ngasentla, kwaye kwiimeko ezininzi, ngaphezu kwenxalenye enye sele ichaphazeleka ngaphambi kokuba ingxaki yokuva ibonakale.

Injongo yovavanyo lokuqala lweklinikhi kukuvavanya ukuba ngaba isigulane sinokulahlwa lula kokulahlekelwa kwindlebe okanye ezinye iindlela zokulahlekelwa kwindlebe ezinokufuna ukuvavanywa ngakumbi yi-otolaryngologist. Ukulahlekelwa kwindlebe okuqhubekileyo okunokuphathwa ngoogqirha beentsapho kubandakanya i-otitis media kunye ne-cerumen embolism, enokuthi imiselwe ngokusekelwe kwimbali yonyango (njengokuqala ngokukhawuleza okukhatshwa yintlungu yendlebe, kunye nokugcwala kweendlebe ezihamba kunye nosulelo oluphezulu lokuphefumla) okanye ukuhlolwa kwe-otoscopy (njenge-cerumen embolism epheleleyo kwi-canal yendlebe). Iimpawu ezihamba kunye neempawu zokulahlekelwa kwindlebe ezifuna ukuvavanywa ngakumbi okanye ukubonisana ne-otolaryngologist ziquka ukukhutshwa kwendlebe, i-otoscopy engaqhelekanga, i-tinnitus eqhubekayo, isiyezi, ukuguquguquka kweendlebe okanye i-asymmetry, okanye ukulahlekelwa kwindlebe ngokukhawuleza ngaphandle kwezizathu eziqhubayo (ezifana nokukhupha indlebe ephakathi).

Ukulahleka kokuva ngokukhawuleza kwe-sensorineural enye yeelahleko ezimbalwa zokuva ezifuna ukuvavanywa ngokukhawuleza yi-otolaryngologist (ngokukhethekileyo kwiintsuku ze-3 zokuqala), njengoko ukuxilongwa kwangaphambili kunye nokusetyenziswa kokungenelela kwe-glucocorticoid kunokuphucula amathuba okubuyisela ukuva. Ukulahlekelwa kwindlebe ngokukhawuleza kwe-sensorineural kunqabile, kunye nesiganeko sonyaka se-1 / 10000, ngokuqhelekileyo kubantu abadala abaneminyaka engama-40 okanye ngaphezulu. Xa kuthelekiswa nokulahlekelwa kwindlebe ehlangeneyo ebangelwa zizizathu eziqhubayo, izigulane ezine-sensorineural loss loss ngesiquphe zidla ngokuxela ukulahleka kokuva okubuhlungu, okungenabuhlungu kwindlebe enye, okukhokelela ekungakwazini ngokupheleleyo ukuva okanye ukuqonda abanye abathethayo.

Ngoku kukho iindlela ezininzi ezisecaleni kwebhedi zokuhlola ukungeva, kubandakanya novavanyo lokusebeza kunye novavanyo lokujija iminwe. Nangona kunjalo, ubuntununtunu kunye nokuchaneka kwezi ndlela zovavanyo zahluka kakhulu, kwaye ukusebenza kwazo kunokuncitshiswa ngokusekelwe kumathuba okuphulukana nokuma okunxulumene nobudala kwizigulana. Kubaluleke kakhulu ukuqaphela ukuba njengoko ukuva kuncipha ngokuthe ngcembe ebomini bomntu (Umfanekiso 1), kungakhathaliseki ukuba zithini iziphumo zokuhlola, kunokucingelwa ukuba isigulane sinomlinganiselo othile wokulahlekelwa kwindlebe ehambelana nobudala ngokusekelwe kwiminyaka yabo, iimpawu ezibonisa ukulahlekelwa kwindlebe, kwaye akukho ezinye izizathu zeklinikhi.

Qinisekisa kwaye uvavanye ilahleko yokuva kwaye ubhekisele kwi-audiologist. Ngethuba lenkqubo yokuvavanya ukuva, ugqirha usebenzisa i-audiometer elinganisiweyo kwigumbi elingenasandi ukuvavanya ukuva kwesigulane. Vavanya ubuncinci bobunzulu besandi (oko kukuthi i-threshold yokuva) apho isigulane sinokuyifumana ngokuthembekileyo kwii-decibels ngaphakathi koluhlu lwe-125-8000 Hz. Ukuva okuphantsi kubonisa ukuva kakuhle. Kubantwana kunye nabantu abadala abancinci, umda wokuva kuzo zonke iifrikhwensi usondele kwi-0 dB, kodwa njengoko iminyaka ikhula, ukuva kuncipha ngokuthe ngcembe kwaye umda wokuva ukhula ngokuthe ngcembe, ngakumbi kwizandi eziphezulu. Umbutho wezeMpilo weHlabathi uhlela ukuva ngokusekwe kumyinge womyinge wokuva komntu kwezona ziza zibalulekileyo zezandi zentetho (500, 1000, 2000, kunye ne-4000 Hz), eyaziwa ngokuba yi-4 frequency yethowuni esulungekileyo avareji [PTA4]. Iikliniki okanye izigulane zinokuqonda impembelelo yenqanaba lokuva isigulane kumsebenzi kunye nezicwangciso zokulawula ezifanelekileyo ezisekelwe kwi-PTA4. Ezinye iimvavanyo eziqhutywe ngexesha lovavanyo lokuva, ezifana novavanyo lokuva ithambo kunye nokuqonda ulwimi, lunokunceda kwakhona ukwahlula ukuba unobangela wokulahlekelwa kwindlebe unokuba yi-conductive hearing loss or central auditory processing hearing loss, kunye nokubonelela ngesikhokelo kwizicwangciso ezifanelekileyo zokuvuselela ukuva.

Isiseko seklinikhi esiphambili sokujongana nokulahlekelwa kwindlebe enxulumene neminyaka kukuphucula ukufikeleleka kwentetho kunye nezinye izandi kwindawo yokuva (njengomculo kunye ne-alamu yesandi) ukukhuthaza unxibelelwano olusebenzayo, ukuthatha inxaxheba kwimisebenzi yemihla ngemihla, kunye nokhuseleko. Okwangoku, akukho nyango lokubuyisela kwilahleko yokuva enxulumene nobudala. Ulawulo lwesi sifo ikakhulu lujolise ekukhuseleni ukuva, ukwamkela izicwangciso zonxibelelwano ukuze kuphuculwe umgangatho wemiqondiso yokuva engenayo (ngaphaya kwengxolo ekhuphisanayo yangasemva), kunye nokusebenzisa izixhobo zokuva kunye nokufakelwa kwe-cochlear kunye nezinye iteknoloji yokuva. Izinga lokusetyenziswa kwezinto ezincedisa ukuva okanye ukufakwa kwe-cochlear kubantu abaxhamlayo (kunqunywe ngokuva) kusephantsi kakhulu.
Ingqwalasela yezicwangciso zokukhusela iindlebe kukunciphisa ukubonakaliswa kwengxolo ngokuhlala kude nomthombo wesandi okanye ukunciphisa umthamo womthombo wesandi, kunye nokusebenzisa izixhobo zokukhusela iindlebe (ezifana nee-earplugs) ukuba kuyimfuneko. Amaqhinga onxibelelwano aquka ukukhuthaza abantu ukuba bancokole ubuso ngobuso, ukubagcina beqelelene ngexesha lencoko, nokunciphisa ingxolo engasemva. Xa benxibelelana ubuso ngobuso, umphulaphuli unokufumana imiqondiso ecacileyo yokuva kwakunye nokubona inkangeleko yobuso yesithethi kunye nokushukuma kwemilebe, nto leyo enceda inkqubo yemithambo-luvo esembindini ikwazi ukwahlula imiqondiso yentetho.
Izixhobo zokuva zihlala ziyiyona ndlela yongenelelo yokunyanga ukulahleka kokuva okunxulumene neminyaka. Izixhobo zokuva zinokukhulisa isandi, kwaye izixhobo zokuva ezihambele phambili ngakumbi zinokuphucula umlinganiso wesandi ukuya kwingxolo yesandi esifunwayo kusetyenziswa imibhobho ekhomba indlela kunye nokusetyenzwa komqondiso wedijithali, okubalulekileyo ekuphuculeni unxibelelwano kwiindawo ezinengxolo.
Izixhobo zokuncedisa ukuva ezingezizo zifanelekile kubantu abadala abanokulahlekelwa kwindlebe kancinci ukuya phakathi, ixabiso le-PTA4 lingaphantsi kwe-60 dB, kwaye eli nani libalelwa kwi-90% ukuya kwi-95% yazo zonke izigulane ezingevayo. Xa kuthelekiswa noku, izixhobo zokuncedisa ukuva okuchazwe ngugqirha zinezinga eliphezulu lokuphuma kwesandi kwaye zifanelekile kubantu abadala abaneendlebe ezibuhlungu kakhulu, kodwa zinokufumaneka kuphela kwiingcali zokuva. Nje ukuba imarike ivuthwe, ixabiso lezixhobo zokuva ezithengiswayo kulindeleke ukuba lithelekiswe neeplugs ezikumgangatho ophezulu ezingenazingcingo. Njengoko ukusebenza koncedo lokuva kuba yinto yesiqhelo yee-earbuds ezingenazingcingo, izixhobo zokuva ezingaphaya kwekhawuntara zinokungahlukanga kwii-earbuds ezingenazingcingo.
Ukuba ukulahlekelwa kwindlebe kunzima (ixabiso le-PTA4 ngokubanzi ≥ 60 dB) kwaye kusenzima ukuqonda abanye emva kokusebenzisa izixhobo zokuva, utyando lokufakelwa kwe-cochlear lunokwamkelwa. Ukufakelwa kwe-Cochlear zixhobo ze-neural prosthetic ezifaka isandi kwaye zivuselela ngokuthe ngqo i-cochlear nerves. Ifakwe kwi-otolaryngologist ngexesha lotyando lwangaphandle, oluthatha malunga neeyure ezingama-2. Emva kokufakelwa, izigulane zidinga iinyanga ze-6-12 ukulungelelanisa ukuva okuphunyeziweyo ngokusebenzisa i-cochlear implants kunye nokubona ukuvuselela kombane we-neural njengolwimi olunentsingiselo kunye nesandi.