INDICATORS OF CEREBRAL HEMODYNAMICS IN MILITARY PERSONNEL WITH REPEATED ACUTRAUMATIC LESIONS IN REAL COMBAT CONDITIONS DEPENDING ON HEARING IMPAIRMENT

Shydlovska TА, Shydlovska TV, Kozak MS, Ovsyanik KV

State Institution “O.S. Kolomiychenko Institute of Otolaryngology of National Academy of Medical Sciences of Ukraine”;
Email: lorprof3@ukr.net

Abstract

Relevance: Objective assessment of cerebral hemodynamics in patients with acute trauma received in combat conditions is a necessary condition for effective comprehensive treatment of sensorineural hearing disorders in such patients.

Purpose: to study the quantitative and qualitative indicators of cerebral blood circulation in servicemen who received repeated acute trauma in real combat conditions, taking into account the state of auditory function.

Materials and methods: Rheoencephalography indicators were analyzed in 75 patients with repeated acute trauma, who were divided into three groups of 25 people each depending on the severity of sensorineural deafness: mild, moderate and severe hearing impairment according to the international classification – 1^st, 2^nd and 3^rd groups, respectively. Fifteen healthy individuals with normal hearing served as controls. We analyzed a total of 90 rheoencephalograms. The examination was carried out with the help of a computer rheograph of the company “DX – systems” (Ukraine).

Results and discussion: According to the data of subjective audiometry, the subjects had sensorineural deafness with a descending, often abrupt, type of audiometric curve.

Normal indicators of the state of cerebral blood circulation according to REG were not registered in any patient with repeated combat acute trauma. The examined patients had changes in the tone of cerebral vessels and obstruction of venous outflow, as well as a decrease in pulse blood filling, both in the carotid and in the vertebral-basilar systems. Thus, venous outflow obstruction occurred in the 1^st group in 58,42 %, in the 2^nd group – 86,91 %, in the 3^rd group – 89,93 %. Cases of decreased tone: in the 1^st group in 27,18 %, in the 2^nd group – 18,12 %, in the 3^rd group – 18,72 %. Unstable vascular tone was registered in 39,85 % of patients in the 1^st group, 46,35 % in the 2^nd group, and 49,85 % in the 3^rd group. Reduction of pulse blood filling in the 1^st group was recorded in 69,12 % of cases, in patients of the 2^nd group – in 89,76 %, in patients of the 3^rd group – in 94,36 %.

Cerebral blood circulation disorders in the examined patients with repeated acute trauma, especially in the vertebral-basilar system, were evidenced by changes in the quantitative indicators α, dicrotic (DKI), diastolic (DSI) and rheographic (Pi) indexes of the REG curve in both systems of cerebral blood supply. Thus, in the carotid system in subgroups B, the DKI was in the 1^st group – 48,26±0,85 %, in the 2^nd group – 48,29±1,02 %, in the 3^rd group – 58,34±0,50 %; DSI was 49,39±0,85 % in the 1^st group, 49,40±1,04 % in the 2^nd group, and 59,73±1,01 % in the 3^rd group.

Note that we observed a decrease in Ri in all studied groups and subgroups of patients with repeated combat acute trauma, regardless of the degree of auditory function impairment or decrease or increase in the tone of cerebral vessels. So, in the vertebral-basilar system, the Ri in subgroups B in the 1^st group was 0,75±0,04, in the 2^nd group – 0,53±0,05, in the 3^rd group – 0,58±0,05.

Thus, in patients with sensorineural hearing disorders after repeated combat acute trauma, there are significant deviations from the norm in the state of cerebral blood circulation according to REG, especially in the vertebral-basilar system, more pronounced in deeper lesions of the auditory analyzer.

Conclusions

1. In patients with sensorineural hearing disorders after repeated combat acute trauma, there are substantial deviations from the norm in the state of cerebral blood circulation according to REG data, more pronounced in deeper lesions of the auditory analyzer.
2. Decreases in Ri occur in all studied patients with repeated combat trauma, regardless of the degree of impaired auditory function or decrease or increase in the tone of cerebral vessels.
3. According to REG data, servicemen with repeated combat acute trauma have impaired cerebral blood circulation, with the predominant complications being venous outflow, decreased pulse blood flow, and a tendency to decrease tone, or unstable tone of cerebral vessels. Significant (р<0,05) deviations from the norm in DKI and Ri indicators indicate pronounced cerebral blood circulation disorders in repeated combat acute trauma, especially in severe auditory disorders.

Keywords: sensorineural disorders, cerebral hemodynamic, acute trauma, cardiovascular system.