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ABSTRACT
Cochleovestibular disorders (CVD) are of great medical and social importance due to their significant prevalence and
the presence of a large number of negative manifestations on the part of the hearing and balance organs, as well as
other div systems. All authors agree that cochleovestibular disorders affect the most active and able-bodied
population, and this determines its social significance. Considering that the statistics of hearing and balance disorders
are kept separately, it is not always possible to characterize the real statistical picture, the epidemiology of CVN.
Approximately 17% of the total population complains of cochleovestibular disorders, but more than half of the cases
do not seek medical help. Long-term temporary incapacity for work, a high rate of disability in patients with CVN, make
the problem even more urgent to develop, require the improvement of early diagnosis methods. During mass
examinations, cochleovestibular disorders were noted in 9-12% of the population of the Russian Federation.
Approximately 10% of patients who visit an ENT doctor present complaints typical of KVN, and this figure for a general
practitioner is 5%, and for a neurologist about 10-20%. According to the World Health Organization (WHO), in 2020,
over 460 million people in the world suffered from hearing loss and by 2050 this number could exceed 900 million).
Research Article
INITIAL STATE OF COCHLEOVESTIBULAR FUNCTION IN PATIENTS
WITH HD WITH CVD
Submission Date:
January 09, 2022,
Accepted Date:
January 19, 2022,
Published Date:
January 29, 2022 |
Crossref doi:
https://doi.org/10.37547/TAJMSPR/Volume04Issue01-07
Ulugbek S. Khasanov
DSc, professor, department of Otorhinolaryngology and stomatology, Tashkent Medical Academy,
Uzbekistan
Nazim A. Akhundjanov
Senior teacher, department of Otorhinolaryngology and stomatology, Tashkent Medical Academy,
Uzbekistan,
Azizkhon Z. Shaumarov
PhD, senior teacher, department of Otorhinolaryngology and stomatology, Tashkent Medical Academy,
Uzbekistan
Jamolbek A. Djuraev
DSc, associate professor, department of Otorhinolaryngology and stomatology, Tashkent Medical
Academy, Uzbekistan
Journal
Website:
https://theamericanjou
rnals.com/index.php/ta
jmspr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
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Dizziness is one of the three most common complaints presented by patients to a general practitioner, and among
emergency consultations it occurs in 2.4-2.6% of patients.
KEYWORDS
Cochleovestibular apparatus, nerves, auditory canal, cochlea, dizziness.
INTRODUCTION
The cochleovestibular apparatus is one of the most
ancient analyzers; it is the first of all receptors to form
in embryogenesis [1]. In terms of its structure,
extensive connections within the CNS, and functional
properties, the cochleovestibular apparatus differs
sharply from all cranial nerves: when it is irritated, not
a narrow local reaction occurs, but an effect on all div
functions (somatic and vegetative) is observed.
The central parts of the vestibular and auditory
analyzer are very complex, which reflects the diversity
and complexity of the function of this peculiar nerve [2-
6]. Morphologically and functionally, the vestibular
apparatus is clearly divided into two sections: the
otolith apparatus and the system of semicircular
canals. The first responds to rectilinear accelerations
and deviations from the vertical, while the second to
angular accelerations in any of the three main planes in
which the channels are oriented.
The vestibular nerve enters the brain stem at the level
of the cerebellopontine angle, slightly above the
external (cochlear) root, between it and the spinal root
of the fifth nerve. In the internal parts of the rope div,
not reaching the bottom of the IV ventricle, the
vestibular nerve divides into ascending and descending
branches. Part of the descending fibers terminate in
the lower nucleus, part in the medial and lateral nuclei.
The ascending fibers of the vestibular nerve terminate
in the superior nucleus. Some of these fibers, passing
through the nucleus, end in the roofing nucleus of the
cerebellum.
A. Brodal, F. Wahlberg, O. Pompeano revealed the
specific nature of the commissural, as well as the
somatotopic organization of vestibular connections
with the cerebellum and spinal cord. The vestibular
nuclear complex is located at the level of the upper
part of the medulla oblongata and stretches in the
retrocaudal direction by 9.5-12 mm. The works of the
above authors have shown that the nuclei of the
vestibular complex are very complex in structure. The
cytoarchitectonics of each of them has features, as
well as extensive afferent-efferent connections with
various formations of the central nervous system, and
from the latter to the vestibular nuclei. A distinctive
feature of the nuclear vestibular complex is an
unusually large number of pathways emerging from it
in a wide variety of directions and connecting the
nuclei with various anatomical structures of the brain.
These connections provide a diffuse effect of the
vestibular apparatus on all functions without
exception. The most important clinically are the
following connections of the vestibular nuclei:
connections with the spinal cord; with eye muscles;
vestibulo-vegetative connections; vestibulocerebellar
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connections; connections with the reticular formation
of the brain stem; with the cerebral cortex [7-12].
In addition to the vestibular analyzer, the pyramid of
the temporal bone contains peripheral sections of the
auditory analyzer. The peripheral receptor of the
auditory analyzer is a spiral organ located in the
cochlea.
The cochlear part perceives sound vibrations. It
originates outside the brain from a special gang node.
spiralis located at the base of the spiral plate. One of
the processes of the ganglion cells of the cochlear
nerve goes to the periphery. The cochlear part
branches between the epithelial cells in the spiral
organ, while the central process passes into the nerve
fibers. The receptor elements of the cochlea are
represented by external hair cells (13500) and internal
(3400).
According to modern concepts, the mechanism of
physiological processes occurring in the cochlea under
the influence of sound is carried out as follows: a
mechanical wave that occurs in the liquid media of the
inner ear under the influence of sound leads to a
displacement of the tenctorial membrane relative to
the hair cells, which causes the tilt of the hairs. The
latter, acting like microlevers, cause certain physical
and chemical changes in the microstructures of
receptor cells, bringing them into a state of excitation.
The transmission of excitation from the hair cells to the
fibers of the auditory nerve is carried out chemically
through synapses or electrically by irritating the fibers
of the auditory nerve with an electric current of the
microphone effect. The endocochlear potential of the
cochlea provides a high sensitivity of the receptor
apparatus. There is a frequency-temporal-spatial
representation of the stimulus along the structure of
the cochlea.
Unlike vestibular hearing disorders are subjective
sensations, they are difficult and sometimes impossible
to investigate in severely ill patients, young children.
The information content of auditory disorders is much
lower than that of vestibular ones. In most cases,
despite the use of the full range of modern audiometric
tests, it is often difficult to establish the level of
damage to the central auditory pathways. It is
determined by comparison with more topically reliable
vestibular disorders, as well as taste and other
otoneurological and neurological symptoms.
MATERIAL AND METHODS
Under our supervision were 110 patients with HD of a
stable course treated in the clinical bases of the
Research Institute of Cardiology of the Ministry of
Health of the Republic of Uzbekistan. HD was
diagnosed according to the WHO criteria. The control
group consisted of 30 persons not suffering from HD.
All examined were males, whose age was distributed
as follows. 25-44 years old - 12 people (10.9%), 45 - 59
years old - 76 patients (69.1%) and over 60 years old - 22
examined (20%).
As can be seen from the above data, among the
patients with HD examined by us, persons aged 45-59
years predominate, i.e. mature and older persons.
The duration of HD varied from 1 year to 20 years,
including; 1 year suffered from hypertension 1 person, 1
- 5 years - 30 patients, 5-10 years - 36 examined, 10-15
years - 30 people and more than 15 years were 13
people.
Regarding the research methods, it should be noted
that all patients underwent a general clinical
examination, which included: examination of the
somatic
(cardiological),
neurological
and
otoneurological status, rheoencephalography (REG),
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echoencephaloscopy
(EchoES),
electroencephalography (EEG), audiometry (AM) and
electronystagmography (ENG) according to generally
accepted methods.
In addition, all patients underwent a general analysis of
urine, blood, the level of total cholesterol, lipid
fractions in the blood, and a coagulogram were
determined. Since the obtained results of biochemical
studies did not differ from the literature data, we did
not describe them.
RESULTS AND DISCUSSION
The functional study of the organ of hearing and the
vestibular apparatus was preceded by an examination
of the upper respiratory tract and ear, the results of
which are shown in Table 1.
Таблица 1
The state of the upper respiratory tract in patients with HD with DBCD.
Changes
Number of
patients
% of the total
Deviation of the nasal septum
Vasomotor rhinitis
Nasal bleeding
The development of the vascular pattern
а) nasal septum
б) oropharynx
атрофия слизистой:
а) nose
б) pharynx
chronic tonsillitis
chronic pharyngitis
26
3
15
25
14
6
9
13
11
23,6
2,7
13,6
22,7
12,7
5,4
8,1
11,8
10
The table shows that in hypertension with DBCD, the
most common deviation of the nasal septum and the
development of the vascular pattern on the mucous
membrane of the nose and pharynx. These changes
were usually localized in symmetrical areas of the nasal
septum and soft palate, and were not accompanied by
any unpleasant subjective sensations..
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Changes in the function of the auditory analyzer in
patients with HD with DBCD.
Subjective symptoms.
Of the 110 patients with DBCD examined by us, 76
people (69.1%) complained of noise (Table 2): 15
patients (13.6%) of them localized noise in the ears, 12
people (10.9%) in the head , in the head and ears of 49
patients (44.6%).
Table 2
Noise frequency and localization by DVR forms
TsVR form
in the ears
in head
in the head
and ears
Total
% to total
Quantity
NPNMK
GE-I Art.
GE-II Art.
HPP PNMK
2
4
5
4
2
4
3
3
8
16
14
11
12
24
22
18
10,9
21,8
20
16,4
Total
15
12
49
76
69,1
Of the above 76 patients with HD with DBCD, 25 people
noted constant noises, 51 - periodic. Most patients
noted a relationship between the occurrence and
intensity of noise with a deterioration in general well-
being, increased blood pressure and increased
headaches. These noises were usually subjective in
nature and were expressed in a very diverse way:
patients noted whistling, ringing, buzzing, murmuring
water, slight wind noise, etc. The nature of the
subjective noise was different: low and high pitch,
constant, periodic, one-sided and two-sided.
According to the data in Table. 2, out of 28 people
suffering from NPLMC, 12 (42.8%) complained of noise
in the head, ears; hypertensive encephalopathy (HE)-I
stage out of 37 people 24 (64.8%) complained of noise
in the head, ears: hypertensive encephalopathy stage
II - 22 (84.6%) of 26 patients and out of 19 patients with
HE and PNMK - 18 (94.7%). Therefore, the frequency of
noise complaints increases as the disease worsens. We
also conducted an analysis of the ratio of complaints
about noise and hearing loss. (Table 3)
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Table 3.
The ratio of complaints of patients with HD with DBCD for noise and hearing loss
Complaints
Illness complicated by:
NPNMK
GE – I
GE – II
GE with
PNMK
Total
Noises
12
24
22
18
76
Hearing loss
4
13
17
16
50
Thus, as can be seen from Table 3.3, in 50 examined
tinnitus and head noise coincided with complaints of
hearing loss.
In order to clarify the nature of tinnitus and head noise,
we compared these data with those of the control
group. In the control group, noise was detected in 2
people out of 30 examined, which is 6.6%. Thus, in
patients with hypertension, noise was more common
by 62.5% than in the control group, and, therefore, is a
sign of damage to the organ of hearing in HCVR on the
basis of HD.
Of the 110 examined, 50 (45.5%) complained of hearing
loss, and of these, only 6 people complained of
unilateral hearing loss, the rest - bilateral. Most of
those who complained of hearing loss noted that they
hear the words, but they do not always understand
their meaning.
Audiometric study of hearing.
1. Results of tone threshold audiometry.
For the purpose of a more detailed study of auditory
reliefs over a wider frequency range, we conducted,
along with tuning fork studies, a study of hearing with
an audiometer.
Of the 110 examined, in 82 (74.5%) on the audiogram,
damage to sound perception of varying degrees was
detected, in 28 (25.5%) patients, tonal hearing was
within the normal range. If we consider the state of
tonal hearing according to the stages of HE, then
normal hearing was detected in 11 out of 28 patients
with NLUMC, with HE - Ist. in 13 out of 37, with GE - II
st. in 3 out of 26 patients and in HE with PNMK - in 1
out of 7 patients.
According to the degree of hearing loss in air and
bone conduction, all audiograms were divided into 4
groups. Information on the number of patients in
each group is presented in Table 4.
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Table 4
Degree of hearing loss by air conduction
Used -
A loss
Forms
DTSVR
Total
Frequencies
hearing in
%
NPNM
K
I
II
With
PNMK
Qty
% to total
Quantity
125-2000 Hz
5 -10
11 - 20
21 - 30
>30
13
3
1
-
15
5
3
1
9
7
5
2
5
8
3
2
42
23
12
5
38,2
20,9
10,9
4,5
3000 -
8000 Hz
5 -10
11 - 20
21 - 30
>30
7
8
2
-
7
10
3
4
3
5
4
11
2
2
1
13
19
25
10
28
17,3
22,7
9,1
25,5
As can be seen from the table, for damage to the organ
of hearing in DBCD, a predominant decrease in the
perception of high tones is characteristic. So, if during
the perception of tones of the speech zone, hearing
loss of more than 30% was detected in 5 (4.5%) patients,
then with the perception of tones of 3000-8000 Hz in
28, which is more than 5 times more often.
In patients with NPLMC, a decrease in hearing acuity by
more than 30% was not detected in any of them, in
patients with HE-I stage. in 4 out of 37, with GE-II st. in
11 out of 26, and in those suffering from HE with PNMK
- in 13 out of 19 examined. Consequently, with the
aggravation of the disease, the volume of hearing for
high tones decreases.
For a more complete reflection of the nature of the
damage to the organ of hearing, we analyzed the
degree of hearing loss for bone conduction sounds.
Information about this is presented in Table 5.
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Table 5
The degree of hearing loss for bone conduction sounds.
Used
A loss
hearing in %
Forms of DTSVR
Total
Frequencies
NPNMK
I
II
With PNMK
Qty
% to
total
Quantit
y
125-2000 Hz
5 -10
11 - 20
21 - 30
>30
11
4
2
-
11
7
4
2
7
7
5
4
2
4
6
6
31
22
17
12
28,2
20
15,5
10,9
3000 -
8000 Hz
5 -10
11 - 20
21 - 30
>30
3
4
6
4
1
4
8
11
-
4
4
15
-
-
3
15
4
12
21
45
3,6
10,9
19,1
40,9
As can be seen from the table, the drop in hearing
acuity for bone-conducted sounds is also more
pronounced for high tones. Thus, a decrease in
auditory volume by more than 30% was detected in 12
(10.9%) patients with tones of the speech zone, and in
45 (40.9%) patients with tones of 3000-8000 Hz.
We have analyzed and systematized tone audiograms
and obtained the following types: 1. Curves with almost
normal hearing up to 2000 Hz followed by a sharp
decline (“dip”) at 2000 Hz, 4000 Hz or 6000 Hz. This
type of audiogram was obtained in 20 (18.1%), and 3 of
them had it in only one ear. 2. Curves of a descending
type - with a gentle or steep drop in hearing to high
tones or concave were present in 56 (50.9%) of the
examined, 3 of them had only one ear. 3. The horizontal
type of the curve was found in 6 (5.4%) examined
patients with a loss of hearing acuity in air and bone
conduction by an average of 20 dB.
Most of the surveyed met mainly the first and second
types of audiometric curves. Thus, 28 examined
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patients had normal hearing, 20 had an isolated fall on
tones of 2000 Hz, 4000 Hz or 6000 Hz, and 62 had
impaired sound perception.
In the first type of curves, there was a slight decrease
in hearing acuity or there was none at all up to 2000 Hz,
and then a drop by 4000 Hz in 11 patients, by 6000 Hz
in 8, and in one examined person - 2000 Hz.
Here are typical audiograms of this type (Figure 1).
Figure 3.1. Audiogram: The first type of audiometric curves.
According to the degree of hearing loss during air and
bone conduction of sounds, the curves were divided
into 4 groups. Information on the number of patients
in each group is presented in Table 6.
Table 6
The degree of reduction in the perception of sounds during air conduction in patients with the first type of
audiometric curve.
downgrade
hearing in %
Researched frequencies
125 -2000 Hz
3000 – 8000 Hz
Abs
%
Abs
%
5 -10
11 - 20
19
1
17,2
0,9
3
15
2,7
13,6
-10
0
10
20
30
40
50
60
70
80
90
100
110
0.125
0.25
0.5
1
2
3
4
6
8
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21 - 30
>30
-
-
-
-
2
-
1,8
-
Thus, both with air and bone conduction of sounds
with the second type of curve, hearing acuity
decreases most often by 11-30% in the speech zone, and
by more than 30% in high tones. With bone conduction
of sounds, perception is disturbed more than with air
conduction. For high tones, the sensitivity of the organ
of hearing falls more, both with air and bone
conduction of sounds.
In addition, in those examined with the second type of
audiometric curve, a “break” in bone perception to
high tones was revealed: at 3000-8000 Hz. - in one
patient, at 4000-8000 Hz. - in 3 patients; at 6000-8000
Hz - in 4 patients; at 8000 Hz. - in 6 patients. Thus, 12.7%
of the examined patients had a bone break for high
tones (Figure 2). Of all the persons who had a bone
“breakage”, 1 suffered from the first stage, 6 - from the
second stage of HE, 7 - from HE with PNMK.
Figure 2. Audiogram: The second type of audiometric curves.
The third type of curve was found in 6 patients. As an
illustration, we present an audiogram of the third type
of curve. In 5 patients of this group, during air
conduction of sounds to the speech zone, the acuity of
tonal hearing was reduced by 20%, in one examined - by
30%. With bone conduction of sounds, the acuity of
tonal hearing is reduced by tones of 125 - 3000 Hz. in 4
patients by 30%, in 2 by more than 30%, by high
frequencies in 2 by 20%, in 4 examined patients by more
than 30%. Consequently, in those examined with a
horizontal type of curve, the decrease in tonal hearing
both with bone and air conduction of sounds is almost
the same (Figure 3).
-10
0
10
20
30
40
50
60
70
80
90
100
110
0.125
0.25
0.5
1
2
3
4
6
8
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Figure 3. Audiogram: The third type of audiometric curves.
In order to find out whether the found changes in
hearing acuity depend on the suffering of DBCD, we
compared the average curves of patients and persons
in the control group (Figure 4).
Figure 4. Audiogram of persons in the control group.
As can be seen on the audiograms, the average curves
in patients with NPNMK are located below the curves
of the faces of the control group by 3-10 dB. - by 5 - 20
dB., GE with PNMK - by 6 - 23 dB. Moreover, this
difference is more pronounced for high tones in all
stages of the DBCD. As can be seen on these
audiograms, the loss of tonal hearing increases with
the severity of the disease.
Comparison of complaints about hearing loss and the
results of tone audiometry revealed that hearing loss is
observed 1.5 times more often than the subjects
themselves noticed.
-10
0
10
20
30
40
50
60
70
80
90
100
110
0.125
0.25
0.5
1
2
3
4
6
8
-10
0
10
20
30
40
50
60
70
80
90
100
110
0.125
0.25
0.5
1
2
3
4
6
8
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Therefore, to accurately determine the acuity of
hearing in patients with DBCD, it is necessary to
conduct pure-tone audiometry. With the latter, the
majority of those examined revealed a bilateral
decrease in perception both during air and bone
conduction of sounds. The curves are located almost at
the same level, but the volume of hearing acuity in the
vast majority of sounds examined during bone
conduction decreases to a much greater extent,
especially for high tones. Normal tonal hearing is quite
rare. In the majority of the examined patients, there is
a lesion of sound perception of varying degrees.
The decrease in the acuity of tonal hearing increases
depending on the stage of the disease, and not on age.
At DTSVR three types of audiometric curves are
characteristic; isolated drop on tones 4000 or 6000
Hz., descending and horizontal type of curve. For
NPNMK and the first stage of HE, the first type is
characteristic with an isolated drop into individual
tones, with GE-II stage and GE with PNMK, a gently
descending type of audiogram is most often observed.
In patients with DBCD, regardless of the type of curves,
a decrease in perception is especially pronounced,
mainly during bone conduction of high-pitched sounds.
The greatest hearing loss is found in those examined
with the second type of curves.
The vast majority of hearing loss exceeds that of the
control group. Consequently, with DTsVR there is a
decrease in tonal hearing, and in the presence of age-
related changes, the sensitivity of the sound analyzer
decreases even more.
In order to find out whether the detected speech
hearing impairments depend on dyscirculatory
disorders or on age-related changes in the hearing
organ, we compared the average indicators of those
suffering from CVD with the data of the control group.
In the latter, the first type of speech intelligibility curve
was found in 2 examined patients (6.67%), the second
type of curve in 27 patients (90%), and the third type of
curve in 1 (3.33%). Speech hearing disorder was found
in 3 patients (10%).
Thus, in persons of the control group, speech hearing
is changed to a much lesser extent than in patients
with DBCD. They are less likely to have the first type of
speech intelligibility curve than hypertensive patients.
We also performed speech audiometry with bass and
treble words. In persons suffering from NPNMK and
GE-Ist., the speech intelligibility curve for the bass
group of words is shifted to the right along the abscissa
axis (i.e., loss of speech acuity) by 5 dB, and for the
treble group of words - by 10 dB; in II Art. GE the speech
intelligibility curve for the bass group is shifted by 10
dB, and for the treble by 15-20 dB. Approximately the
same hearing loss is present for HE with MIH.
Therefore, when using the treble group of words,
there is a slightly greater loss of speech hearing than
when using the bass group of words, which is typical
for the defeat of sound perception.
Summarizing the above, we note that in patients with
DBCD, changes in speech hearing were detected in the
vast majority. Violation of speech hearing, as well as
tonal hearing, increases with the severity of the
disease. Age-related changes only burden it
somewhat. The change in speech hearing is bilateral.
According to the type of speech intelligibility curves,
the examined can be divided into 3 groups, which differ
from each other in the range: increased, normal,
shortened. Most patients with DBCD are characterized
by speech intelligibility curves of the first type
(increased range).
72
Volume 04 Issue 01-2022
The American Journal of Medical Sciences and Pharmaceutical Research
(ISSN
–
2689-1026)
VOLUME
04
I
SSUE
01
Pages:
60-73
SJIF
I
MPACT
FACTOR
(2020:
5.
286
)
(2021:
5.
64
)
OCLC
–
1121105510
METADATA
IF
–
7.569
Publisher:
The USA Journals
Among those with a second type of speech
intelligibility curve (with a normal range), the majority
of speech hearing is altered. Moreover, a significant
number of their speech intelligibility curves are shifted
along the abscissa to the right more than the average
loss of tonal hearing in the speech frequency zone,
which indicates the presence of tone-speech
dissociation.
In the majority of patients with NPNMK and GE-I st. the
second type of speech intelligibility curve is observed.
For the majority of those surveyed with GE-II Art. and
GE with PNMK-1 type of speech intelligibility curve is
typical. In persons with NPLMC, the quantitative loss of
speech hearing is small, in persons with HE-I st. - it is
increased by 2 - 3 times, with HE-II st. - 3-4 times, and in
HE with LIMC - by 6-7 times, compared with loss of
speech hearing in those suffering from CNMC.
Consequently, the acuity of speech hearing worsens
with the severity of the disease. Tono-speech
dissociation also increases with the progression of the
disease. Its presence is characteristic of the defeat of
the sound-perceiving department of the cochlea and
the cortical department of the sound analyzer.
When perceiving the words of the treble group, speech
hearing is impaired more than the words of the bass
group, which confirms our observations about the
predominant lesion of the sound-perceiving section of
the sound analyzer in those suffering from DBCD.
Speech hearing impairment is associated with the
severity of the disease and, in addition, it increases
with age.
The study of speech hearing allows to reveal subtle
disorders in the functional state of the central parts of
the sound analyzer, which cannot be detected with
tone audiometry.
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