Державна установа «Інститут отоларингології імені професора О. С. Коломійченка Національної академії медичних наук України», м. Київ Вступ. Акутравма, вплив звуків високої інтенсивності викликає специфічне ураження слухової системи. При бойовій акутравмі страждають як периферичний, так і центральні відділи слухового аналізатора. Слід зважати також на системну дію шуму, звуків високої інтенсивності не лише на структури слухової системи, але і на увесь організм постраждалого. Тому при акутравмі поряд з ауральними (які стосуються стану різних відділів слухової системи) мають місце й виражені екстраауральні прояви (з боку органів і систем, не пов'язаних безпосередньо зі структурами слухової системи, але стан яких впливає на слухову функцію). Насамперед це стосується центральної нервової та серцево-судинної систем (мозкового кровообігу в найбільшій мірі). Тому доцільним є дослідження функціонального стану ЦНС у пацієнтів з акутравмою. Мета дослідження-визначити зміни в стані біоелектричної активності головного мозку за даними електроенцефалографії (ЕЕГ) у військовослужбовців, які отримали бойову акутравму в зоні проведення антитерористичної операції (АТО). Матеріали та методи дослідження. Ми відібрали для аналізу серед усіх обстежених нами хворих з акутравмою групу з 50 бійців з акутравмою з асиметричними сенсоневральними порушеннями та низхідним типом кривої. Методика виконання роботи передбачала проведення ЕЕГ за допомогою комп'ютерного електроенцефалографа фірми «DХ-системи». Електроди накладали таким чином, щоб рівномірно охоплювати лобні, скроневі та потиличні області обох півкуль, згідно зі схемою накладання електродів «10-20», рекомендованою Міжнародною федерацією електроенцефалографії. Результати та їх обговорення. За даними ЕЕГ у обстежених військовослужбовців з акутравмою, отриманою під час бойових дій, було виявлено іритативні зміни як при фоновому записі, так і при функціональних навантаженнях, особливо-гіпервентиляції, виражені в різному ступені. Частіше всього були виявлені: виражені дезорганізація та десинхронізація ритмів, тенденція до згладжування або відсутність зональних розбіжностей, наявність гострих піків і потенціалів, «прискорення» основних ритмів, переважання в структурі біоелектричної активності бета-ритму та значна частка повільних Δ-та θ-ритму. У частини хворих мало місце загальне зниження біоелектричної активності головного мозку, виражене в різному ступені, особливо в скроневих відведеннях. Ці зміни мали переважно загальномозковий (генералізований) характер і були більш вираженими у хворих з більш значними порушеннями у слуховому аналізаторі. У багатьох випадках спостерігалася асиметрія біотоків, переважно в задньолобних, скроневих і тім'яних відведеннях, особливо в тих випадках, коли в пацієнтів було асиметричне ураження слухової системи зі значною різницею в показниках двох сторін. Також часто в обстежених осіб з бойовою акутравмою спостерігалися спалахи гіперсинхронної активності, у тому числі з повільнохвильовими елементами, що свідчить про значне переважання процесів збудження в глиб...

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Objective: to study the state of the auditory analyser central regions in operators of automated bottling of non-alcoholic and low-alcoholic drinks working in the conditions of exposure to high-level industrial noise. Material and methods. The work gives the hygienic assessment of working conditions and related factors, and in-depth clinical examination of the auditory analyser condition in operators of automated bottling of non-alcoholic and low-alcoholic drinks. Results. It has been found that the leading harmful factor in the working environment of the bottling operators is industrial noise. The signs of the specific impact of the noise on the central regions of the auditory analyser manifested in the function infringement of its brainstem and cortical structures. Conclusion. The causal relationship between the conditions, nature of work and the changes in the central regions of auditory analyser in the bottling operators has been established, which makes it possible to improve the system of preventive medical examinations, labour examination and preventive measures.

A lot of researchers are concerned about the problem of diagnosis of functional diseases of vocal apparatus and their treatment. It is due to diagnostic difficulty of these diseases, a fairly high prevalence of the pathology among people of voice professions, untimely detection of voice disorders. Besides, young people of working age can also suffer these disorders. In case of impaired function disorders associated with changes in timbre, intensity,voice modulation, motor and vibration abilities of the vocal cords come to the fore. Moreover, almost a quarter of patients, suffering chronic functional hypotonic dysphonia, CFHD, had frequent relapses, persistent voice disorders and complicated course of the disease. Purpose of the study is to give a detailed clinical and instrumental characterization of vocal apparatus condition of patients suffering CFHD and having various degrees of voice disorders. Materials and methods: 123 patients aged 19 to 44, suffering CFHD and having various degrees of voice disorders, have been examined. In the control group there were included 15 healthy people aged 18 to 23, having not any voice disorders. In total, 138 people were examined. A detailed anamnesis and analysis of patients complaints were made. General clinical ENT and specialized phoniatric examination were performed as well. Video laryngological examination was performed with the help of a video laryngoscope ,manufactured by Karl Shtorz, Germany. Results and discussion: All the examined patients suffering CFHD were divided into 4 groups depending on the degree of vocal disorders, according to the results of specialized phoniatric examination and videolaryngostroboscopy. The patients, suffering functional hypotonic dysphonia and mild disorders in functioning of vocal apparatus, were included to group 1. Group 2 included patients having more severe laryngeal mobility disorders. Group 3 was formed of 34 patients having severe disorders of voice apparatus (like those in group 2), along with complicated course of the disease (prenodulus state, vocal cords nodules, Mediale Edge thinning). Group 4 included patients having severe disorders of voice apparatus, as well as various degrees of hypertonicity of vestibular larynx, which in some cases was transformed into pseudo-folded mechanism of voice formation. Due to the analysis of otolaryngological and specialized phoniatric examination, the data of patients suffering FHD were found to differ significantly according to clinical condition and degree of voice disorders. This allows to form groups of patients taking into account the data of clinical and instrumental studies in order to determine treatment tactics. Distribution of patients suffering CFHD into appropriate groups provides more differentiated approach to their treatment.Besides, this makes forecasting of further course of the disease and effectiveness of therapeutic measures more objective. It is important for solving issues of labor examination and professional suitability of people of voice professions. Conclusions: 1.Clinical signs and changes of laryngoscopic picture in case of functional voice disorders can be unexpressed and variable. It complicates the diagnosis, that is why, patients suffering functional hypotonic dysphonia need to be examined thoroughly including usage of additional instrumental methods. 2. In case patients suffering CFHD are not provided with specialized care on time, a number of complications can develop (Mediale Edge thinning, prenodulus state, hypertonicity of vestibular larynx, pseudo-folded mechanism of voice formation etc.) It can complicate the treatment and reduce its effectiveness. 3. In the presence of such signs, it is important to determine whether they testify of independent nosology or a complicated course of chronic functional hypotonic dysphonia. It proves to be defining to determine treatment tactics, which in such cases does not seem to be effective without correction of functional disorders of voice formation. 4. Target data analysis during otolaryngological and specialized phoniatric examination of patients suffering CFHD permits to create groups, based on the results of clinical and instrumental studies. Such distribution of patients into appropriate groups provides more differentiated approach to their treatment, and makes both forecasting of the disease and therapeutic measures more effective. It matters to solving issues of labor examination and professional suitability of people of voice profession.

Topicality: Objective research methods of the auditory analyzer are of great importance in diagnosis sensorineural disorders of auditory function, treatment of such diseases and solving a number of expert questions. While diagnosis the damage of auditory system, especially the receptor part of the auditory analyzer the method of the caused OAE on the frequency distortion product (DPOAE) plays a significant role. Quite often at sensorineural hearing loss of different genesis is observed an affection of cochlea structures of the inner ear. Diabetes mellitus (DM) is one of the most acute medical and social problems. According to the latest data, there are 463 million adults with diabetes mellitus in the world; accounting for 9.3% of the world's total population, meaning that 1 among 11 people suffers from diabetes (IDF Diabetes Atlas 9th edition, 2019). Among patients with diabetes, according to various authors, there are disorders in the auditory analyzer. Purpose: to determine changes in the condition of the receptor part of auditory analyzer according to the OAE registration of the frequency of distortion products among patients with diabetes mellitus type II with impaired auditory function. Materials and methods: 17 patients with diabetes mellitus type II were examined, who, according to subjective audiometry, revealed impairments of auditory function of the I-II degree. The control group consisted of 15 healthy normal-hearing persons who did not report hearing impairment, had no elevated blood sugar levels. 32 persons were examined in total. The registration of the caused OAE at frequency of distortion product (DPOAE) was conducted on the analyzing system "Eclipse" "Interacoustics" (Denmark) at frequencies 1-6 kHz. Statistical processing of the obtained results was carried out according to the conventional methods of mathematical variation statistics using the STATISTICA software package. The average value of indicators was calculated - magnitude (M) and its error (+- m). The probability of changes and differences between the comparative values was estimated by the criterion for the reliability of the difference (t) according to the Student's table. Results and discussion: We have selected for the analysis patients with diabetes mellitus type II, who according to subjective audiometry revealed impaired auditory function. Patients also reported otologic complaints of hearing loss, periodic or persistent subjective ear noise. As a result of the OAE researches at frequency distortion products, the following data were obtained. A full adequate response of the otoacoustic emission across all frequency spectrums was reported in only 3 patients (9.4% of cases) on the one hand. The majority of the observed patients in whom the OAE was registered received a partially positive test (68.7%). In 7 patients (21.8%) the OAE response was not registered. The absence of OAE response or a partially positive registration in 90.6% of the observed patients indicated violation function of the cochlea in such patients. The DPOAE (response intensity) emission amplitude at all tested frequencies (1-6 kHz) in patients with diabetes mellitus type II was significantly (P<0.01) lower than the norm at all frequencies. Particularly pronounced such a decrease is in the area of 4 kHz, where the amplitude of the OAE response was 5.9±0.2 dB at a norm of 9.4±0.5 dB. Therefore, in patients with diabetes mellitus type II with hearing impairment, there are changes in the receptor part of the auditory analyzer, which is confirmed by the data of objective examination methods. The changes we have identified in the OAE indicators may express the affection of the receptor structures of the auditory analyzer among patients with diabetes mellitus type II with impaired auditory function. The information obtained on the OAE indicators provides the detection of early violations and the objective ascertainment of changes in the receptor part of the hearing analyzer in diabetes mellitus type II. Conclusions: 1. OAE data on the frequency of distortion products in patients with diabetes mellitus type II objectively confirm the presence of violations in the auditory receptor. 2. In patients with diabetes mellitus type II, the OAE amplitude at the frequency of distortion products is significantly lower than normal at all tested frequencies (1-6 kHz). Particularly pronounced such a decrease is in the area of 4 kHz, where the amplitude of the OAE response was 5.9±0.2 dB at a norm of 9.4±0.5 dB. 3. The conducted researches prove the expediency of examination by the method of registration of OAE of patients with diabetes mellitus type II, since it promotes the early detection of violation in the receptor structures of the auditory analyzer in such patients. 4. The use of the method of recording otoacoustic emissions in the examination of patients with type II diabetes is important for the objectification of early signs of sensorineural hearing impairment in this contingent.