Data on the frequency and nature of hearing impairment in newborns and children during the first months of life after acute otitis media are contradictory. Otoacoustic emission is one of the methods for assessing the hearing function in infants. The main advantages of this method are objectivity, non-invasiveness, speed and accuracy. Objectives. To evaluate the features of otoacoustic emission registration at the frequency of the product distortion in children of the first 3 months of life after an acute inflammation of the middle ear. Material and methods. Distortion-product otoacoustic emission was performed in 36 children after complete recovery from acute otitis media (main group) and in 32 children without otitis media (comparison group). The estimation of the amplitude and spectrum of the response received was performed. The analysis of the otoacoustic response at frequencies of 1 kHz, 1.5 kHz, 2 kHz, 3 kHz, 4 kHz, 5 kHz, 6 kHz, 8 kHz was carried out. Results. Otoacoustic emission was registered in 74.2% of investigations in the comparison group, in 56.0% of observations in otoscopically healthy ears in case of unilateral inflammation, in 35.1% of cases after a non-suppurative form of the disease, and only in 15.4% of cases after a purulent form of acute otitis media. Statistically significant differences were revealed in the frequency of registration of otoacoustic emission in children of the examined groups. The greatest amplitude of the signal/noise relationship was recorded at frequencies of 5 and 6 kHz, and the smallest one at the frequency of 1 kHz in all studied groups. Conclusions. A decrease in auditory function is observed in children of the first 3 months of life after past acute otitis media. This is confirmed by significantly higher rate of absence of otoacoustic emission in this group of patients. Distortion-product otoacoustic emission in children of the first 3 months of life is recommended to be carried out at frequencies of 1.5 kHz and higher.

П роблема острых средних отитов (ОСО) у детей сохраняет свою актуальность и активно изуча-ется во всех странах мира ввиду стабильно высокой распространенности и отсутствия тенденции к ее снижению. По данным различных авторов, на первом году жизни частота развития ОСО варьирует в широком диапазоне от 21 до 62% [1].Диагностика заболевания в этом возрасте представ-ляет трудную задачу. В значительной степени это связано с малосимптомностью, стертостью клинических проявле-ний болезни, высокой частотой сопутствующей патологии, маскирующей картину воспаления среднего уха. Особую опасность представляют собой ОСО у новорожденных и детей первых месяцев жизни, поскольку в этот возраст-ной период закладываются основы для формирования здорового организма, а младенцы в силу незрелости защитных механизмов наиболее уязвимы перед действи-ем патогенов. В силу указанных причин формирование групп риска развития воспаления среднего уха у детей первых месяцев жизни на основе выявления и стратифи-кации факторов, способствующих заболеванию, пред-ставляет собой важное направление современной педи-атрии. Знание факторов риска имеет смысл использовать как в диагностике, так и в профилактике заболевания.В литературе достаточно много внимания уделяется анатомо-физиологическим особенностям, предрасполага-ющим к развитию ОСО в данной возрастной группе: кра-нио-фациальному дисморфизму, возрастным особенно- Results. In the pregravid health status of the mother the most significant in terms of the risk of developing of otitis media in children in the first months of life are the presence of respiratory allergy (OR = 7,74; P = 0,014) and chronic infections of ENT organs (OR = 1,15; P = 0,022). In the prenatal period the risk of early manifestations of the first episode of otitis media in a child increases obesity during pregnancy (OR = 11,78, p<0,000), waterless period of more than 8 hours (OR = 8,60, p<0,000), TORCH and urogenital infections in the mother (OR = 7,29, P = 0,028). Formula (OR = 4,20, p = 0,004) and mixed (P = 0,008) feeding in the postnatal period and the male sex (58,6%) of the child are also associated with an increased risk of developing otitis media. For this age group otitis media was characterized by a high association with ARI (99,1%). Conclusion. We have identified risk factors of otitis media in infants and children during the first months of life allow us to form a high-risk group for development of this disease.

Aim: to evaluate the efficacy of non-pharmacological sedation method with concentrate glucose solution during the hearing test in infants of the first 3 months of life. Patients and Methods: a non-randomized clinical study on the efficacy of non-pharmacological sedation method with 25% glucose solution was performed during the hearing tests (tympanometry and otoacoustic emission) in infants from birth to 3 months of life versus breastfeeding in three parallel groups. The first group included infants examined with the proposed sedation method with 25% glucose solution. The second group consisted of patients who underwent the hearing test within an hour after feeding (n=30). The third group included infants examined an hour or more after feeding who didn’t underwent the sedation (n=24). To evaluate the efficacy of the proposed method, we used the Newborn Acute Pain (DAN) scale. Results: in the infant group receiving 25% glucose solution during the test, the DAN score was 1 (Q25; Q75 (0; 2)) point; in infants examined after feeding — 2 (2; 4) points, and in the third infant group — 4 (4; 5) points. The Kruskal-Wallis test showed statistically significant differences between patient groups (p<0.0001). Subsequent post hoc analysis established the significance of differences in infant behavior between groups where sedation with glucose was and wasn’t performed (p<0.0001), as well as between infants examined after feeding and after sedation with glucose (p<0.0001). Conclusions: the use of 25% glucose solution reduces the discomfort reaction in infants of the first 3 months of life when conducting the hearing test and is more effective than breastfeeding. The hearing test of infants in this age group should be performed within the first hour after feeding. KEYWORDS: hearing test, hearing loss, infants, glucose, non-pharmacological sedation, endogenous opiates. FOR CITATION: Merkulova E.P., Ustinovich K.N. Hearing tests of infants using the non-pharmacological sedation method. Russian Medical Inquiry. 2020;4(4):233–237. DOI: 10.32364/2587-6821-2020-4-4-233-237.

No abstract

Введение. Сведения о частоте и характере нарушений слуха у новорожденных и детей первых месяцев жизни после перенесенного острого среднего отита (ОСО) разноречивы, кроме того, тимпанограммы у детей данной возрастной группы имеют ряд особенностей, порой затрудняющих интерпретацию результатов. Цель. Оценить возможности метода тимпанометрии на частоте 226 Гц в диагностике функционального состояния среднего уха у детей первых трех месяцев жизни после перенесенного острого среднего отита, а также охарактеризовать особенности тимпанограмм в данной возрастной группе. Материалы и методы. Проанализированы результаты акустической импедансометрии 74 детей первых трех месяцев жизни после перенесенного ОСО (основная группа) и 34 здоровых младенцев аналогичного возраста, не болевших отитами (группа сравнения). Результаты. Установлено, что в каждом четвертом случае после перенесенного острого гнойного среднего отита у новорожденных и детей первых трех месяцев жизни выявлялись патологические типы тимпанограмм (тип В и С). При выявлении тимпанограммы типа В дисфункция слуховых труб носила достаточно стойкий характер, поскольку сохранялась через 6 месяцев после выздоровления. Характерной особенностью данного возрастного контингента пациентов явилась регистрация двупиковых тимпанограмм, которые наблюдались во всех исследованных группах, без статистически значимых различий. Выводы. Детям первых трех месяцев жизни после перенесенного острого среднего отита необходимо проводить акустическую импедансометрию. При регистрации патологических типов тимпанограмм (в частности типа В) пациентов следует включать в группу риска нарушений слуховой функции. Регистрацию двупиковых тимпанограмм следует отнести к возрастным особенностям нормы АИ у новорожденных и детей первых месяцев жизни. Introduction. The frequency and nature of hearing impairment in newborns and children of the first months of life after acute otitis media is unclear. Tympanograms in children of this age group have a number of features that sometimes make it difficult to interpret the results. Purpose. Assessment of the capabilities of the tympanometry method at the frequency of 226 Hz in diagnostics of the functional state of the middle ear in children during the first three months of life after acute otitis media and evaluation of the features of tympanograms in this age group. Materials and methods. The results of acoustic impedance measurement were analyzed in 74 children during the first three months of life after acute otitis media (main group) and 34 healthy infants of the same age, who did not suffer from otitis media (comparison group). Results. Pathological types of tympanograms (type B and C) were revealed in every fourth case after acute purulent otitis media in newborns and children of the first 3 months of life. The dysfunction of the auditory tubes was quite persistent, since it persisted in many cases 6 months after recovery, if the type B tympanogram was detected initially. Double-peaked tympanograms were observed in all studied groups without statistically significant differences. Conclusions. Children of the first three months of life after suffering acute otitis media need to undergo acoustic impedance measurement. If pathological types of tympanograms (in particular, type B) is registered, the patients should be included in the risk group for hearing impairment. Registration of double-peaked tympanograms should be attributed to the age characteristics of newborns and children in the first months of life.