Bufofo bua tshimpitshimpi (Disama dia mu matshi) ne ditshibuka dia tshitupa tshia matshi diambuluisha dia kumpala¶

Nomba ya malu a tshimpitshimpi idi mishilangane bilondeshile ditunga. Dibeji edi didi dienza mudimu ne 911, nomba wa ditunga dia États-Unis ne dia Canada. Matunga makuabu a bungi adi ne nomba wa 112, 999 anyi nomba mukuabu. Keba nomba wa ditunga dienu.

Kujuka ne ditshi "difue," dibuikila, anyi didi dikuma kakuyi kanyinganyinga ka mu ditshi, anyi dijimija dia matshi mu tshimpitshimpi kunyima kua dikuma dia ditshi, dibutuka, dibuela mu mâyi, anyi disama dia tshilamba tshia butoke, bidi bikengela kuenza dishilangana dia lukasa pankatshi pa malu abidi mashilangane a mu matshi: Dijimija dia matshi dia tshimpitshimpi (dijimija dia tshimpitshimpi, Disama dia tshiadi" anyi disama dia mijilu ya munda mua matshi) ne Dibutuka dia tshitupa tshia matshi tshia munda (ditapa dia tshiamu tshia matshi) anyi dikanga dia njila. Bantu binunu ne binunu badi ne disama dia dijimija dia matshi dia tshimpitshimpi badi bela meji ne: badi anu ne tshiamu tshia eustachien tshidi tshikanga bua mashika, disama dia sinus, anyi disama dia mu matshi, ne badi bajimija 2 anyi 4 ya mbingu mikole benza mudimu ne bintu bia kuela mu mishiku anyi mafuta a mu matshi padi selile ya nsuki idi munda mua cole yabu ifua kashidi. Kadi, bantu badi ne disama dia ditshi ditshibuka batu batamba kuela mayi, peroxyde wa hydrogène anyi manga a ku matshi adibu bapanyisha ku tshisalu mu tshina tshia matshi, adi asukula bintu bidi ne buanga ne bactérie buludiludi kupitshila ku ditshi ditshibuka mu ditshi dia pankatshi ne dia munda. Kumanya mua kuenza 5-Second Bedside "Hum Test" (Weber Test), kutangila Anterior Inferior Cerebellar Artery (AICA) brainstem stroke red flags, ne kulonda dry-ear precautions kudi kusungila diumvua dia kashidi.

Bufofo bua tshimpitshimpi ne vertigo udi wenda unyunguluka, dipanga dia bulongame anyi butekete bua mpala bidi mua kuikala disama dia tshiadi tshia buongo

Shi dijimija dia matshi dia tshimpitshimpi mu ditshi dimue didi dienda pamue ne disama dia tshimpitshimpi (vertigo), dipanga dia mushindu wa kuenda mu mulongo mululame (ataxia), dipanga dia mpala anyi dipanga dia lungenyi ku luseke lumue, dimona dia misangu ibidi, dikolela dia kumina, anyi dipanga dia kuakula, bikila nimero webe wa lupitadi lua lukasa mu ditunga dia États-Unis (1991 ne Canada, 112 mu matunga masanga a ku Mputu, 999 mu Royaume-Uni) diakamue. Mushipa wa labyrinthine (munda wa kuteleja) udi udisha ditshi dia munda udi upatuka buludiludi ku Mushipa wa kumpala wa muinshi mua buongo (AICA) mu tshitupa tshia panyima tshia buongo; bufofo bua tshimpitshimpi ne vertigo budi misangu ya bungi tshimanyishilu tshia kumpala tshia AICA cerebellar/brainstem stroke.

Enza nunku mpindieu¶

Tshia kumpala, tangila ni dijimija dia matshi dia tshimpitshimpi dienzeke KU MUDIMU (kujuka anyi kumona dipueka dia tshimpitshimpi mu minite anyi mêba) anyi DIAKAMUE PANYIMA PA MUTU (tshilamba tshia butoke, dikuma, dibutuka, anyi dishintuluka dia pression).
Bikalaku bimanyinu bikunze bia mu lungenyi anyi bia tshiadi (disama dia mutshima didi muntu kayi mua kuimana kayi ne diambuluisha, mutu mupiamupia/nshingu udi usama, butekete bua mpala, dimona dia malu abidi, tshianza tshibi, anyi ngakuilu mubi): Bikila 911 / 112 / 999 diakamue bua kupeta diambuluisha dia lukasa mu nzubu wa tshipupu.
Bikalaku disama dikole ku mutu ne mâyi matoke anyi mashi adi apueka mu tshina tshia matshi: Ela meji ne: ditshibuka dia tshifu ne dipatuka dia mâyi a mu tshiadi (CSF) (tangila mputa ku mutu). Bikila ku 911 / 112 / 999, ikala ne mukolo kayi unyunguluka, ne kuela anyi kukanga tshina tshia matshi tshidi tshipatuka to.
Wenza tshikebelu tshia 5-Second Bedside "Hum Test" (Modified Weber Test) mpindieu bua kutapulula disama dia nsongo/ditshi dia munda ne ditshi dia pambelu/dia pankatshi didi dikanga:
Lomba muntu bua kukanga mukana muende ne kuela dîyi dikole dia "MMMMMM" mu tshitupa tshia masekonde 5, ne kumuebeja ne: "Ditshi kayi didi diumvua mutoyi webe bikole: ditshi DIMPALA, anyi ditshi DIFUA/DIFUKA?"
Bikala tshiona tshiumvuika bikole mu ditshi dimpe (dimpe): Bidi bileja ne: Dijimija dia diumvua dia tshimpitshimpi (SSNHL / Inner-Ear Nerve Emergency) mu ditshi dibi. Ditshi dia munda anyi muonji wa kuteleja udi mu ditshi dibi mmulekele kuenza mudimu, nunku nansha dikankamika didi difumina ku mifuba didi mua kumvuika anu kudi ditshi dimpe. Bino bilomba ENT / tshikebelu tshia lukasa tshia luondapu bua luondapu lua corticosteroid (bimpe mu mêba 24 too ne ku 72, ne kumpala kua matuku 14 kujika).
Bikala mutoyi udi umvuika bikole (udi wenda ukola) munda mua ditshi dibi (dikanga): Bidi bileja ne: Dijimija dia matshi (bu mudi: dibue dia matshi didi dikuate, mâyi a mu ditshi dia pankatshi, anyi dibue dia mu ditshi didi kadiyi ne disama dia mu ditshi dia munda).
Londa mukenji wa kumpala wa kumpala bua dijimija dia matshi dia tshimpitshimpi ne ditshibuka dia tshiamu tshia matshi: Lama tshitupa tshia matshi tshiume 100% ne KUTEKA nansha kakese matonsi, mafuta, peroxyde wa hydrogène anyi tshilamba tshia butoke munda mua matshi to.
Kuteka mayi, mafuta a olive, peroxyde d'hydrogène, maluvu a kusukula nawu, anyi mafuta a ku matshi adibu bapanyisha ku tshisalu tshidi ne tshiamu tshia matshi tshidi ne mputa kudi kutuma mâyi adi kaayi ne disama ne bintu bidi bishipa bantu buludiludi mu tshina tshia ditshi dia pankatshi ne kupitshila ku tshilamba tshia dididishi tshidi tshinyunguluke mu tshitupa tshia ditshi tshidi tshinyunguluke, bienza bua tshinyangu tshikole tshikale tshienda tshinyunguluka, disama dia matshi dia pankatshi, disama dia matshi dia kashidi anyi disama dia tshimpitshimpi dia kashidi.
Bikala tshiamu tshia ku matshi tshipanduluke bua disama (dikuma, dikuma dia manaya, dibutuka, barotrauma wa mu mâyi, anyi poker wa Q-tip), ikala ulama ditshi ne ukandike dikuma dia mu mishiku:
KUFUMI muulu webe ku bukole ne kufinyi mu mishiku yebe nansha kakese paudi utua mishiku (kupuekesha mishiku ne mukana muunzulula). Kufuimisha mu mishiku kudi kuenzeja kapepe ne bactérie ya mu mishiku bua kuya buludiludi mu tshiadi tshia eustachien ne kutshipatula mu tshitupa tshia mu matshi tshidi tshipanduluke, tshipatula miaba idi iondapa.
Shi mashi nansha mayi apatuka mu ditshi dia pambelu, kukupula anu tshibombi tshia pambelu (concha) ne tshilamba tshia gaze tshikezuke; kuena ne bua kuela mipinganyi ya butoyi munda menemene mu tshina tshia mâyi to.
Ndaku ku tshibambalu tshia malu a mpukapuka diakamue pikala disama dia mu matshi dienzeja disama dia mu nzubu, disama dia mutshima/difuisha, dipanga dia matshi, anyi diteketa dia misunya ya ku mpala (bidi bileja ne: mufuba wa stapes uvua mubuele mu ditshi dia munda, bienza bua perilymphatic fistula anyi dislocascular chain).
Bua dijimija dia matshi dia tshimpitshimpi (SSNHL): KUITABI ne: "mmushindu wa dipanga dia matshi, wangate manga adi ajikija lutetuku ne windile mbingu isatu" kuyi muenze tshikebelu tshia otoscopique ne tshikebelu tshia tuning-fork/audiogram. Bilondeshile American Academy of Otolaryngology-Head and Neck Surgery (AAO-H) ne mikenji ya CE** Buondapi bua corticosteroïde (prednisone wa mukana anyi injection wa steroïde intratympanique buludiludi mu ditshi dia munda) budi ne mushindu mutambe bunene wa kupingaja diumvua didi dijimija padibu batuadija mu mêba 72 a kumpala too ne matuku 14.

Mutshi wa mapangadika a tshimpitshimpi: Dijimija dia matshi dia tshimpitshimpi ne ditshibuka dia tshiamu tshia ku matshi¶

Ingidija tshikandakanda etshi bua kusungula dipanga dia diumvua mu minite 2.

flowchart TD
    Start["Dijimija dia matshi dia tshimpitshimpi, ditshi dibuikila,<br/>Dikuma dikole (Tinnitus), anyi disama dia matshi"] --> NeuroCheck{"Tangila ni udi ne disama dia tshiadi tshia buongo (AICA)<br/>anyi dia ditshibuka dia tshiadi."}

    NeuroCheck -->|"EYOWA (Tshimanyinu tshionso tshia mitu anyi tshia mutu)"| StrokeER["MIMMEDIETE 911 / 112 / 999 EMERGENCY:<br/>1. Udi wela meji ne AICA Labyrinthine Stroke anyi Basilar Skull Fracture<br/>2. Diya nadi ku nzubu wa tshipupu anyi wa disama dia tshiadi lelu<br/>3. Kuena ne bua kukanga anyi kubueja mu tshina tshia matshi tshidi tshipatuka CSF to"]

    NeuroCheck -->|"KAKUENA Bimanyinu bia mutshi wa buongo to"| MechCheck{"Diumvua diakapueka diakamue kunyima kua<br/>Disama dia ku matshi (Q-Tip, Slap, Blast,<br/>Water Ski, Scuba/Flight Barotrauma) anyi?"}

    MechCheck -->|"EYOWA: Disama dia buludiludi dia tshiamu / dia bukole<br/>+ Disama dikole anyi dipueka dia mashi mu tshina tshia mâyi:<br/>MUDI MUSHINDU WA KUTANTUKA (TM Perforation)"| TraumaCheck{"Mubedi wa tshipupu udiku ne<br/>Tshitupa tshia mpala tshidi tshienda tshinyunguluka, disama dia mutshima anyi disama dia mpala anyi?"}

    TraumaCheck -->|"EYOWA: Tshilumbu / Disama / Disama dia mpala"| FistulaER["IMMEDIATE ENT / EMERGENCY ROOM:<br/>Suspect Inner-Ear Perilymphatic Fistule,<br/>Stapes Subluxation, or Facial Nerve Injury"]

    TraumaCheck -->|"KAKUENA Vertigo (Disama + Dipanga dia kumvua anu)"| DryEar["DITANGA DIA DITUPA DIA MU MUTU:<br/>1. Lama ditshi diume 100% (kakuyi mayi, kakuyi matonyi a OTC, kakuyi peroxyde)<br/>2. KUFUMI mu mishiku to; kuela mbila ne mukana muunzulula<br/>3. Tshikebelu tshia lukasa tshia luondapu/ENT mu 24-48h bua audiogramme"]

    MechCheck -->|"KAKUENA kanyinganyinga: Dipueka dia patupu dia tshianana<br/>(Uvua mujuke ne ditshi difue anyi 'diuwule tente' + Tinnitus)"| HumTest{"Enza tshikebelu tshia ku luseke lua bulalu (tshikebelu tshia Weber):<br/>Ela 'MMMMM' ne dîyi dikole ne mukana mukanga.<br/>Ntshinyi tshidi tshiumvua tshiona tshikole?"}

    HumTest -->|"Mutoyi udi ne dîyi dikole mu ditshi dimpe (dia pa tshibidilu):<br/>(udi uya kule ne ditshi didi disama)"| SSNHL["SUDDED SENSORINEURAL HEARING LOSS<br/>(SSNHL / 'Ear Stroke' Emergency):<br/>1. Dikonkonona dia lukasa dia dituku dimue dimue / 24-72h dia luondapu ne dia ENT<br/>2. Bidi bikengela Audiogramme wa dîyi dimpe + Corticosteroïdes diakamue<br/> (High-dose Oral Prednisone anyi Intratympanic Steroids)<br/>3. Kujimiji matuku a bungi ku manga adi ajikija lutetuku anyi matonshi a wax to"]

    HumTest -->|"Mutoyi udi ne dîyi dikole mu ditshi dibi (dikanga):<br/>(udi uya ku luseke lua ditshi didi disama)"| Conductive["DIJIMIJA DIA MUSHINDU:<br/>1. Pamuapa tshintu tshia ku matshi tshidi tshikuate anyi mâyi a mu matshi a pankatshi<br/>2. Tshikebelu tshia otoscopie tshia lukasa tshia mu lupitadi bua kujadika ne: tshitupa tshia matshi tshidi katshiyi tshinyanguke<br/> kumpala kua kumbusha tshintu tshionso tshia mu matshi anyi kutshiela mâyi"]

Bualu 1: Dijimija dia matshi dia tshimpitshimpi (SSNHL / "Tshipupu tshia ku matshi")¶

Dijimija dia matshi dia tshimpitshimpi ntshinyi ne bua tshinyi batu badimona bibi misangu 70%?¶

Mu lupitadi, Dijimija dia matshi dia tshimpitshimpi (SSNHL) didi diumvuija bu dijimija dia \(30\text{ decibels (dB)}\) mu 3 consecutive sound frequencies didi dienzeka musangu umue anyi mu tshikondo tshia muinshi mua mêba 72, difumina ku disama dikole dia mu matshi anyi mu matshi tshitupa tshia mu tshiadi tshia Cranial Nerve VIII (vestibulocochlear nerve).

Bua tshinyi babedi ba bungi, ne nansha nzubu ya luondapu ya lukasa lukasa, batu bapangila SSNHL mu tshikondo tshia diondopangana dikole? 1. The "Aural Fullness" Illusion: Padi selile ya nsuki mikese idi munda mua tshiadi ilekela kutuma lumu lua nzembu mu buongo, buongo bua muntu kabuena bumvuija ditalala adi bu "disama dia mijilu", kadi, buongo budi bumona dipanga dia mutoyi dia mu tshimpitshimpi bu diumvua dia bukole, anyi "dikuata dia mayi mu mubidi" ditshi" (buwule bua ditshi). 2. Kakuyi disama dia mu matshi ne tshintu tshia ku matshi tshidi tshimueneka tshimpe menemene: Padi munganga utangila mu tshitupa tshia matshi tshia mubedi udi ne SSNHL ku diambuluisha dia tshiamu tshia otoscope, tshitupa tshia matshi tshidi tshikezuke ne tshiamu tshia matshi tshidi tshimueneka 100 pa lukama tshikunze ne tshimpe (bualu dinyanguka didi panyima pa mufuba udi munda mua cochlee muwule tente ne mâyi). 3. The Congestant Trap: Bu mudi mubedi wela mbila ne: ditshi diende "didi dibuikila ne kadiena mua kupatuka," ne tshitupa tshia matshi katshiena ne pus panyima patshi to, baminganga badi kabayi benza tuning-fork / Weber Hum Test batu misangu ya bungi bamba ne: "Udi mua kuikala ne disama dia eustachian tube dysfunction bua allergies; wangate steroïdes anyi sprays antiminées mu mbingu 3." Dîba didi mubedi uya kumona mumanyi wa malu a matshi ngondo umua pashishe, selile ya nsuki ya mu matshi idi mimane kuikala ne mputa ne dijimija dia matshi kadiena mua kupingana to.

Pathophysiology: Ntshinyi tshidi tshienzeka munda mua tshiadi mu tshikondo tshia SSNHL?¶

Cochlea i tshitupa tshia mubidi tshidi tshienza bu tshisuku tshidi munda mua mufuba mutambe bukole mu mubidi wa muntu (mufuba wa petrous temporal). Nsuki yende ya munda idi kayiyi ne bukole ne stria vascularis idi ne dijinga dia bungi dia oxygène, kadi ditshi dijima dia munda didi dipeta kudi mushipa umuepele wa ku ndekelu udi kayi ne tshintu tshidi tshimuambuluisha: mushipa wa labyrinthine (mushipa wa munda wa matshi), udi anu \(0.15\text\{t}t {t}to. milimetre}\) mu butshiama.

Mishindu inayi ya kumpala idi ifila SSNHL wa tshimpitshimpi: 1. Microvascular Ischemia ("Cochlear Stroke"): Micro-thrombus, vasospasm, anyi viscosity wa mashi mu matamba a ndekelu a mushipa wa labyrinthine udi upangisha selile ya nsuki ya mu tshiadi ne neurons ya ganglion spiral ya oxygène mu minite mikese. 2. Viral Cochleitis / Neuritis: Dijadikulula dia bipupu bia mu mikolo (bu mudi Herpes simplex, Varicella-zoster, anyi bipupu bia mu mikolo) didi dijula disama dikole dia munda mua tshitupa tshia mifuba tshia mu tshiadi anyi tshitupa tshia Corti. 3. Ditapuluka dia tshitupa tshia munda mua matshi / Endolymphatic Hydrops: Ditapuluka dia tshitupa tshia Reissner anyi tshitupa tshia dididishi dia tshijengu/tshia tshijengu didi disangisha endolymph udi ne potassium ne perilymph udi ne sodium, bienza bua mijilu ya ku matshi ikale kayiyi ne bukole. 4. Disama dia mu matshi dia munda dia auto-immune anyi Retrocochlear Schwannoma: Bantu batue ku 3 too ne ku 5 pa lukama badi ne disama dia SSNHL dia tshimpitshimpi badi ne tshitupa tshia mubidi tshidi katshiyi tshimpe tshidi tshimueneka ku muonji wa bulongame (schwannoma wa vestibulaire / neuroma wa dîyi) udibu bapete ku MRI wa buongo.

Mushindu kayi wa kuenza "Hum Test" (Modified Weber Test) ya ku luseke lua bulalu bimpa¶

Nansha wewe kuyi ne tshiamu tshia kuondopa natshi tshia \(512\text{ Hz}\) kumbelu, mionji yebe ya dîyi idi yenza mudimu ne mifuba ya mutu webe idi yenza mudimu bilondeshile tshilele tshimue tshimue (tshikebelu tshia Weber Bone-Conduction):

Kuenda	Kuenza	Diumvuija dia tshipeta tshia luondapu
Tshitupa 1: Umbusha matshi onso abidi	Ikala mu nzubu mutoke. Kufuki anyi kufina pa ditshi nansha dimue (kufina pa ditshi didi dikuata mutoyi ne dinyanga diteta).	Udi ulongolola matshi onso abidi bua kufuanyikija dienda dia luya ne mifuba mu mushindu wa pa buawu.
Tshitupa 2: Kuimba dîyi dikese ("MMMMM")	Lama mishiku yebe mikange bitekete bitekete ne wela mutoyi wa "MMMMM" (anyi "NNNNN") mu tusunsa 5. (Wewe uteta muntu mukuabu udi ne tshiamu tshia dikokangana anyi tshianza tshia brosse à dents wa ku nzembu, fina tshintu tshidi tshinyunguluka bikole ku tshitupa tshia mpala mufue anyi ku tshibuelelu tshia muulu wende.)	Dikankamika didi dienda mu mushindu wa muomumue mu mifuba ya mutu too ne ku matshi a munda a ku dia bakaji ne a ku dia balume (cochleas).
Tshipeta A: Mutoyi udi ne dîyi dikole mu matshi mimpe	Udi umvua mutoyi webe bimpe ku luseke lua makanda a mubidi, eku ditshi dibi diumvuika dipuwe anyi difua.	DIJIMA DIA KUUMVUA (Emergency): Ditshi dia munda / muonji udi ku luseke lubi mmunyanguke ne kena mua kumona dikankamika dia tshifu to. Keba luondapu lua dituku dimue / mêba 24-72 bua corticosteroïdes.
Tshipeta B: Mutoyi udi ne dîyi dikole mu ditshi dibi (dikanga)	Mutoyi webe udi umvuika mukole, wenda ukola, ne wenda unyunguluka munda mua ditshi didi dikanga (anu bu paudi wela munu mu ditshi dimue ne udila).	Dijimija dia diumvua: Muonji wa munda mua ditshi udi ku luseke lubi udi muimpe menemene. Dikanga dia ditshi dia pambelu anyi dia pankatshi (dibuikila dia matshi, mâyi a mu ditshi dia pankatshi, anyi tshiamu tshia ku matshi tshidi ne mputa) didi anu dikanga mutoyi wa mu nzubu wa panyima, dienza bua dikankamika dia tshifu diumvuike bikole ku luseke alu (tshipeta tshia dikanga).

Tshilumbu tshia mushinga mukole: Mushindu kayi wa kusunguluja SSNHL wa mu ditshi dia munda ne tshipupu tshia AICA tshikole¶

Nansha mudi SSNHL (dijimija dia matshi + dikuma dia matshi, kakuyi disama dia mutu) didi anu mu tshiadi, 30 pa lukama ya babedi ba SSNHL badi kabidi ne disama dia mutu dia tshimpitshimpi anyi disama dia tshiadi. Bua tshinyi bualu ebu budi mua kuikala ne muoyo ne lufu?

Bishilangane na tshitupa tshikuabu tshia ditshi dia munda (tshidi misangu ya bungi tshinyanguka kudi masama bu mudi vestibulaire neuritis anyi BPPV adi kayi mua kujimija diumvua nansha kakese), Anterior Inferior Cerebellar Artery (AICA) udi ufila bionso bibidi ditshi dia munda (ku diambuluisha dia mushipa wa labyrinthine) **ne ponlum ** ne ponlum wa ku luseke lua kumpala kua buongo. - Nunku, tshipupu tshia tshimpitshimpi + dijimija dia diumvua dia tshimpitshimpi mu ditshi dimue ("tshilejilu tshia labyrinthitis") tshidi mua kuikala tshijadiki tshijalame tshia disama dia AICA dia panyima dia mashi, didi dienzeka mêba 12 too ne ku 48 kumpala kua disama dia mutshi wa buongo difikisha ku koma anyi ku diimanyika dia mupuya. - Tangila HINTS-Plus ne Brainstem Red Flags diakamue: Bikila 911 / 112 / 999 bua tshilongelu tshia Stroke Center pikala dijimija dia matshi dia tshimpitshimpi + vertigo dipetangana ne tshimue tshia ku bintu bidi bilonda ebi: - Truncal ataxia mikole: Muntu kena mua kusomba anyi kuimana/kuenda kayi ne diambuluisha kayi upona to. - Nystagmus udi ushintulula njila anyi dishintuluka dia mêsu dia muulu/dishindame. - Mushipa wa mutu anyi bimanyinu bia lungenyi: Dipanga dia lungenyi anyi dijimija dia kanyinganyinga/kumvua luya ku mpala anyi ku mubidi, butekete bua mpala, disama dia horner (tshilamba tshia mêsu tshidi tshipueka + mulongi mukese), dîyi dikole, lutatu lua kumina, tshianza/diboko didi dinyanguka (dysmetria), anyi disama dia mutu dipiadipia/disama dia mu nshingu. - Malu adi mua kufikisha ku njiwu ya mishipa: Bidimu bipite pa 50, disama dia mutshima, disama dia mashi a bungi, disama dia diabete, dinua dia makanya, anyi disama dia mu nshingu dia matuku mashale aa.

Dididishi dia dipandisha dia corticosteroid bua SSNHL¶

Bilondeshile AAO-HNS Clinical Practice Guideline on Sudden Hearing Loss: - Golden Window (Matuku 1 too ne ku 14, bimpe menemene mu mêba 24 too ne ku 72): Corticosteroïdes ya bungi (pa tshibidilu prednisone wa ku mishiku \(1\text{ mg/kg/dituku}\), bungi bupite pa \(60\text{ mg}\) dituku dionso munkatshi mua matuku 7 too ne ku 10) idi ilonda kudi dibidija anyi dibidija mubidi Tuishi tua dexamethasone/methylprednisolone** (tudi tuela kudi mumanyi wa malu a ENT ku diambuluisha dia tshiamu tshia ku matshi tshidi katshiyi tshienza mudimu buludiludi pa dididishi dia tshijengu dia tshiadi, nangananga bua babedi badi ne disama dia diabete anyi glaucome badi kabayi mua kuangata manga a steroïdes) bidi bikepesha disama dia munda mua ditshi ne dipingaja mashi mu ditshi. - Salvage Window (Weeks 2 to 6): Shi steroïdes ya ku mishiku kayiyi mua kupingaja diumvua bimpe anyi mubedi udi umueneka pankatshi pa mbingu 2 ne 6 kunyima kua dibanga dia disama, injections ya steroïdes intratympanique (ne mu bilumbu kampanda bikole mu matuku 14 too ne ku 28, hyperbaric oxygen therapy [HTBO**) idi mua kusungila diteleja dia mushinga.

Bualu 2: Dibutuka dia tshitupa tshia mu matshi (dibutuka dia matshi)¶

Bulongolodi bua tshitupa tshia matshi ne tshia pankatshi: Ntshinyi tshidi anu panyima pa tshilamba tshia ku matshi?¶

Tympanic membrane (eardrum) i tshintu tshikole, tshitoke, tshienza bu tshikokedi tshia bitupa bisatu tshidi anu ne bunene bua \(0.1\text{ millimeters}\) (\(0.004\text{ inches}\)) tshidi tshitapulula tshitupa tshia pambelu tshia matshi ne tshitupa tshia **tshitupa tshia matshi tshidi tshiuwule tente ne kapepe. Bidi bilamakaja buludiludi anyi bienda bipitshila ku luseke lua panyima lua tshibombi tshia matshi munda mua ditshi dia pankatshi bidi: 1. Mifuba isatu ya kuteleja (Malleus, Incus, ne Stapes): Mifuba mikese menemene mu mubidi wa muntu, idi ikolesha dikankamika dia tshitupa tshia matshi too ne ku dididishi dia tshijengu dia ditshi dia munda diuwule tente ne mâyi. 2. Nerve wa Chorda Tympani: Ditamba ditekete dia nerve wa mpala udi wenda buludiludi ku mutu kua tshitupa tshia ku matshi tshidi tshifila diumvua dia mupuya wa kumpala kua bitupa bibidi bia bisatu bia ludimi. 3. Nerf wa mpala (Cranial Nerve VII): Udi wenda mu tshitupa tshikese tshia mifuba tshidi tshilonda tshimanu tshia panyima/tshia munda tshia ditshi dia pankatshi. 4. Dididishi dia tshijengu ne Dididishi dia tshijengu: Bintu bibidi bitekete bidi bitapulula ditshi dia pankatshi ne ditshi dia munda ne bitupa bia mubidi bidi bienza buobumue.

Malu adi atamba kufikisha ku ditshibuka dia mu matshi¶

Disama dia tshintu tshia ku babende (Disama dia Q-Tip / Hairpin): Kuela tshilamba tshia butoyi (Q-tip), tshiamu tshia bobby, tshifungu tshia mashinyi, tshilamba tshia kufunda natshi, anyi muendu wa ku matshi mu tshitupa tshia matshi, nangananga bikala muntu muele tshianza tshia muntu anyi muana mushintulule mutu wende mu tshimpitshimpi, udi ukuma buludiludi mu tshitupa tshia matshi. (Njiwu: Bintu bidi bibuela munda menemene mu tshitupa tshia panyima-tshia ku mutu tshia tshitupa tshia matshi tshidi mua kunyangakaja mifuba ya incus/stapes ne kufikisha tshiamu tshia stapes buludiludi mu ditshi dia munda.)
Dikuma dia tshianza anyi disama dia mayi ("Piston Effect"): Dikuma dia tshianza tshiunzulula dikuata ku ditshi, dikuma dia mvita ya mvita, mupimbu wa ndundu udi ukuma ku luseke lua mutu, anyi ukuma mu mayi ku ditshi dia kumpala padibu baditua mu mâyi, mu dinaya dia pa mâyi, anyi mu dinaya dia surf didi mua kukuata tshilongo tshia kapepe munda mua matshi, tshidi mua kupuekesha mu matshi.
Acoustic Blast Overpressure: Bintu bia kapia, bingoma bidi kabiyi ne tshiamu tshia kukuba natshi matshi, tshiamu tshia luya tshidi pabuipi ne ditshi mu njiwu ya mashinyi, anyi dibutuka dia mu midimu anyi dia basalayi didi dipatula mutoyi wa bukole udi utshibula pars tensa wa tshiamu tshia matshi.
Barotrauma mukole (dibuela mu mayi anyi dipueka dia lukasa dia ndeke): Kupueka mu mayi anyi mu ndeke ne tshiamu tshia eustachien tshikanga (ku mashika a ku mutu) kakuyi dikuma dia bukole didi dikosa tshitupa tshia matshi munda too ne paditshi tshipatuka; tshibi menemene, diteta dia bukole dia Valsalva mu tshikondo tshia dibuela mu mayi didi mua kutshibula tshilamba tshia dididishi dia munda mua ditshi (barotrauma wa ditshi dia munda / fistula perilymphatique).
Disama dia kapia anyi dia tshiamu tshia mitaku: Tshiamu tshia tshiamu tshia kapia tshidi tshibuela mu tshina tshia matshi padibu benza mudimu wa disuika dia pa mutu tshidi tshiosha buludiludi mu tshitupa tshia matshi (tshidi tshikebesha dibutuka dia kashidi ne bungi bua bungi budi kabuyi buondopa budi bulomba dilama dia ENT).

Difuanyikija dia malu onso: Dijimija dia matshi dia tshimpitshimpi ne ditshibuka dia tshitupa tshia matshi ne disama dia mu matshi/Otitis¶

Tshimanyinu tshia luondapu	Dijimija dia matshi dia tshimpitshimpi (SSNHL / "Tshipupu tshia ku matshi")	Tshiamu tshia matshi tshidi tshinyanguka (TM Perforation)	Perilymphatic Fistula / Inner-Ear Trauma	Disama dia mu matshi (Cerumen) anyi Otitis Externa
Trigger & Onset	Spontaneous (misangu ya bungi udi umueneka paudi ujuka, anyi ne "pop" wa tshimpitshimpi ne dikuma dikole mu dituku dia pa tshibidilu).	Diakamue kunyima kua bualu bua tshiamu/bukole: Dikuluka dia Q-tip, dikuma ku ditshi, dibutuka, dibuela mu mâyi, dipueka dia ndeke, anyi dibutuka dia disama dikole dia matshi (otitis media).	Diakamue kunyima kua dikuma dia Q-tip, dikuma/dikuma, dibandisha/dikolesha, anyi barotrauma wa mu mâyi.	Divulangana dia ku kakese ku kakese, anyi dijika dia tshimpitshimpi diakamue panyima pa mayi abuela mu ditshi padibu bowa mâyi anyi padibu bowa mâyi (bienza bua tshintu tshiume tshia wax tshikale tshikanga).
Disama dia ku matshi ne dipatuka dia mashi	Kakuyi kanyinganyinga nansha kakese; kakuyi mashi anyi mayi adi apatuka.	Disama dikole, dia tshitupa tshîpi mu tshikondo tshia ditshibuka (anyi dipuekesha dia tshimpitshimpi dia disama dia tshimpitshimpi pikala ditshi dia pankatshi didi ne disama dipatuka), misangu ya bungi ne matonsi makese a mashi makunze anyi a mayi a rose mu tshina.	Disama dikole + disama dia tshimpitshimpi dia tshimpitshimpi ne disama dia mutshima/difuka.	Earwax: Buwule kabuyi ne kanyinganyinga. Otitis Externa (Ditshi dia muena mayi): Disama dikole padibu bakoka tshitupa tshia pambelu tshia ditshi anyi bafina tragus.
Mushindu wa dijimija dia matshi ne Weber "Hum Test"	Sensorineural: Mutoyi udi umvuika BIKOLE mu ditshi dimpe (dimpe).	Dilombola (pa tshibidilu 15 too ne ku 40 dB dijimija): Mutoyi udi umvuika BIKOLE munda mua ditshi didi ditapike.	Mixed or Profound Sensorineural: Hum utu misangu ya bungi ufika ku Ditshi dimpe; tshiona tshikole tshia mu matshi.	Conductive: Hum udi umvuika LOUDED munda mua ditshi dikanga.
Tshimanyinu tshia lupepele ne autophony	Kumbuka.	Mubedi udi mua kumvua anyi kumvua lupepele luela mbila anyi lupatuka mu tshitupa tshia matshi yeye mufume mu mishiku yende ku mpukapuka (KUTEKI bualu ebu ku budisuile to.).	Kufina pa tshilamba tshia ku matshi (tragus) anyi kutshioka kudi kuenza bua kunyunguluka kua mêsu (nystagmus) ne kunyunguluka kua nzubu (tshimanyinu tshia Tullio / Fistula).	Dîyi dia muntu nkayende didi diumvuika munda mua ditshi (autophony); kakuyi tshiona tshia luya.
Diondapangana dia pa buloba ne luondapu	KAKUKOKA ne "kuindila ne budimu" nkayaku misangu ya bungi to: Bidi bikengela malu a corticosteroïdes a lukasa mu matuku 24h-14.	80% too ne ku 90% badi buondopa nkayabu mu mbingu 3 too ne ku 6 BIkalabu balame 100% biume ne bakubibue ku masama/difuisha dia mishiku.	Urgent ENT Surgical Emergency: Bidi bikengela kulala pa bulalu ne mutu mubandishibue, kakuyi lutatu, ne bidi mua kuenzeka bua kupanda dididishi dia tshijengu anyi dia tshijengu.	Diumusha dia matshi dia mu matshi didi kadiyi ne njiwu anyi diela dia manga a antibiotique (ANYI panyima pa bamane kujadika ne: tshitupa tshia matshi tshidi tshimpe).

Diambuluisha dia kumpala dia ku kakese ku kakese bua disama dia mu matshi didi ditshibuka¶

Shi muana nansha muntu mukulumpe udi ne disama dia tshiadi tshia mu matshi didi difumina ku disama dia Q-tip, dikuma, dikuma dia manaya, dibutuka, anyi barotrauma:

1. Tangila diakamue bimanyinu 4 bia "Inner-Ear & Facial Nerve Red Flags" (Nzubu wa lupitadi mpindieu)¶

Ndaku buludiludi ku tshibambalu tshia malu a mpukapuka tshia mu lupitadi (anyi tshibambalu tshia ENT tshia lukasa) lelu pikala ditshibuka dia mu matshi dienda pamue ne tshimue tshia ku bintu bidi bilonda ebi: - Mushindu wa kunyunguluka mulelela, dijimija dia nkatshinkatshi, anyi disama dia mutshima/difuisha: Bidi bileja ne: dikuma anyi tshintu tshidi tshibuele munda tshidi tshitute mufuba wa stapes mu tshibuelelu tshia ditshi dia munda anyi tshitshibule dididishi dia tshijengu/dia tshijengu (fistula perilymphatique). - Dipanga dia matshi dikole mu ditshi didi ditapa (anyi tshikebelu tshia Weber Hum tshidi tshitangile ku ditshi dimpe): Ditapa dia matshi dia patupu didi difikisha anu ku dipuekesha dia matshi (\(15\text{ too ne ku }40\text{ dB}\)). Bufofo bujima budi bumvuija ne: nshinga wa mifuba mmupatuke anyi cochlea mmunyanguke. - Diteketa dia mpala, dipanga dia bulongame padi muntu useka anyi ukanga dîsu, anyi dipembu dia tshiamu tshia mitaku ku luseke lumue lua ludimi: Bidi bileja disama dia Nerve wa mpala (Cranial Nerve VII) anyi nerve wa chorda tympani udi wenda panyima pa tshingoma tshia ku matshi. - Mayi matoke, a mayi adi atungunuka ne kupatuka mu ditshi kunyima kua dikuma ku mutu: Bidi bileja mayi a mu tshiadi (CSF) a otorrhea adi afumina ku ditshibuka dia mufuba wa tshitupa tshîpi.

2. Londa mikenji mikole ya "Dry-Ear Precautions" (Mushindu wa kuowa mâyi kuyi usama ditshi dia pankatshi)¶

Bualu bua 80 too ne ku 90 pa lukama ya bipupu bia mu matshi bidi kabiyi bikole bidi bijika nkayabi mu mbingu 3 too ne ku 6 padi selile ya dikoba ipita mu tshitupa atshi, mudimu webe wa kumpala ngua kupangisha mâyi ne bactérie bua kubuela mu ditshi dia pankatshi didi diunzulula: - Kuela nansha kakese mayi mu ditshi to, anu padi munganga mumanye ne: tshitupa tshia matshi tshidi ne mputa: Kuena ne bua kuenza mudimu ne bintu bidi bilengeja matshi (carbamide peroxide), maluvu/vinegre a mu matshi a muena matshi, peroxyde wa hydrogène, manyi a olive/ail, anyi aminoglycoside antibiotic (bu mudi, gentamicine, anyi tobramycin), idi mishipa ya munda mua matshi ne idi inyanga selile ya nsuki ya munda mua ditshi padiyi ipita mu tshitupa tshia matshi tshiunzulula. (Bikala munganga wa ENT anyi munganga mufundile matonsi bua dipanda didi ne disama, badi benza mudimu anu ne matonsi a mu matshi adi kaayi ne toxique fluoroquinolone bu mudi ofloxacin anyi ciprofloxacin.) - Mushindu wa kulama mayi mu tshikondo tshia kuowa mâyi anyi tshia kusukula nsuki: Angata tshilamba tshia butoke tshiume tshikezuke, ela tshilamba tshia pambelu tshia tshilamba etshi bimpe menemene ne vaseline (Vaseline) bua kutshienza bua katshiyi tshibuela mâyi, ne utshiteke bitekete bitekete mu tshibombi tshia pambelu (concha) tshia ditshi bua kukanga tshibuelelu, katshiyi mua kutshibueja mu matshi to. Umbusha ne wela tshilamba tshia butoyi diakamue panyima pa tshimane kuuma. - Kuena mua kuowa mâyi, kuela mu mayi, anyi kuela mutu muinshi mua mayi too ne padi munganga utangila ditshi ne tshiamu tshia otoscope ne ujadika ne: tshitupa tshia ditshi ntshimane kujika.

3. Lama tshitupa tshia matshi tshidi tshiondapa ku bipupu bia kapepe¶

Kuena mua kupuekesha mishiku yebe ku bukole to munkatshi mua mbingu 3 anyi 4. Ela bitekete bitekete anyi ukupula muulu udi upatuka ne tshilamba.
Biwikala ne bua kukoka anyi kukokola, kangula mukana muebe bikole: Kukokola ne mushiku mukanga anyi mukana mukanga kudi kupatula bukole bua mu mishiku budi bupita pa \(100\text{ mmHg}\) budi buenda buenda bululame mu tshiadi tshia eustachien ne bumbusha tshilonda tshidi tshiondapa tshidi pa matshi.
Epuka dienza dia mudimu mukole (Valsalva), kuimba biombelu bia mijiki bia tshiamu tshia mitaku anyi bia mabaya, anyi kuendela mu ndeke udi kayi ne bukole too ne padi munganga ukuanyishila.

Mukanda wa dimanyishangana udi mujalame bua 911 / 112 / 999, luondapu lua lukasa, ne nzubu ya luondapu ya ENT¶

Bualu bena mudimu ba mu lupitadi batu misangu ya bungi bateta bua kufunda babedi badi ne "ditshi dikanga" mu mbingu 3 anyi 4 mu matuku atshilualua, enza mudimu ne meyi aa menemene bua kuepuka dipanga dia dîba dia kuenza mudimu:

Paudi ubikila nzubu wa lupitadi lua ENT, wa lupitadi lua lukasa, anyi wa lupitadi lua lukasa lukasa bua dijimija dia matshi dia tshimpitshimpi (SSNHL):

*"Ndi dijinga ne tshikebelu tshia lukasa tshia dituku dimue bua dijimija dia diumvua dia tshimpitshimpi ('Disama dia mu matshi'). Mubedi udi ne bidimu [Bidimu] ne mmujimije diumvua mu tshimpitshimpi mu ditshi dia [tshia bakaji/dia balume] mêba a bungi adi mapite kayi ne disama dia mu matshi. Pa tshikebelu tshia Weber Hum tshia ku luseke lua bulalu, mutoyi udi wenda uya ku luseke lukole, GOOD udi ne tshiji tshia munda tshia matshi tshilumbu tshia tshimpitshimpi tshia mu matshi ne ki mbua mayi a mu matshi anyi a mu tshiadi to.
Paudi ubikila 911 / 112 / 999 bua bufofo bua tshimpitshimpi + Vertigo (udibu bela meji ne: udi ne disama dia AICA Brainstem):

"Ndi dijinga ne ambulanse wa lukasa lukasa ku [Adrese mulelela]. Mubedi udi ne bidimu [Age] uvua mupete disama dia tshimpitshimpi mu ditshi dia [dia bakaji/dia balume] musangu umue ne vertigo mukole wa spinning ne dipanga dia kuimana [kusangisha ne dipanga dia mpala / diakula dibi / diboko dinyanguke]. Bualu disama dia tshimpitshimpi didi ne disama dia anvertigo dia tshimpitshimpi. Disama dia tshiadi tshia muinshi mua buongo (AICA), tudi dijinga ne kuya diakamue ku nzubu wa tshiadi tshisungula."
Paudi ufika ku tshibambalu tshia malu a mpukapuka bua disama dia mu matshi didi ditshibuka ne bimanyinu bikunze:

"Mubedi uvua mupeta [tshipupu tshia [Q-tip penetrating / slap / blast / diving barotrauma] ku [left/right] ditshi mu [Time] ne mpindieu udi ne dijimija dia matshi dikole, mashi adi apatuka mu tshina, ne [vertigo wa tshimpitshimpi / nausea / metallic taste / facial weakness]. Tudi balame ditshi dia 1000 pa lukama ne katuena dijinga ne dipueka dia lukasa ne katuyi dijinga ne dipueka dia lukasa ne katuena dijinga ne dikonkonona dia lukasa to. bua disama dia nshinga ya mifuba anyi dia fistule perilymphatique."

Enza kalasa

Kulonga tulasa tua diambuluisha dia kumpala kudi Croix-Rouge, St John Ambulance, anyi kudi mufidi wa tulasa tua lukasa lua muaba unudi kudi kukulongesha mua kumanya bimanyinu bia disama dia tshiadi ne dia mutu, mua kukokesha disama dia tshimpitshimpi ne dia mputa, ne kukuba bitupa bia mubidi bidi biumvua kumpala kua kufika ku lupitadi.

Nkonko itubu bela misangu ya bungi¶

Bua tshinyi dijimija dia matshi dia tshimpitshimpi ("Tshipupu tshia ku matshi") didi diumvuika anu bu ditshi dikanga diuwule tente ne mayi anyi tshiamu tshia nzembu?¶

Buongo buebe budi bueyemena pa tshimanyishilu tshia nzembu tshidi tshifumina ku selile ya nsuki ya munda mua ditshi bua kumanya ne: ditshi ndiunzulula ne didi dienza mudimu. Padi ischémie anyi disama dia virus dijika mu tshimpitshimpi selile ya nsuki idi munda mua cochléa, buongo budi bumvua bibi ditalala dia tshimpitshimpi ne dijimija dia butoke bua bungi bu dikanga dia mubidi mu tshina tshia matshi, bikusaka bua kuteta bua kuela ditshi diebe anyi kuenza mudimu ne matonyi a wax paudi bushuwa ne disama dia mu ditshi dia munda didi dijinga ne steroïde wa lukasa.

Mmunyi mudi kuimba "MMMMM" (tshikebelu tshia Weber Hum) mua kuleja disama dia tshimpitshimpi dia mu mikolo pa kumbusha dibuikila dia wax mu masekonde 5?¶

Paudi wimba ne mukana mukanga, mionji yebe ya dîyi idi inyunguluka mifuba ya tshifu tshiebe, ituma dikankamika dia muomumue buludiludi ku matshi onso abidi a munda (kupita mu tshitupa tshia pambelu tshia matshi). Shi ditshi diebe dibi didi ne tshintu tshipepele tshia wax anyi tshintu tshidi tshikanga mâyi, tshintu atshi tshidi tshikuata dikankamika dia munda ne tshikanga mutoyi wa pambelu pa nzubu, tshienza bua mutoyi webe ikale mukole ne wenda ukola munda mua ditshi dibi; shi ditshi diebe dibi didi ne dijimija dia diumvua dia tshimpitshimpi, muonji wa munda mua ditshi udi munyanguke ne kena mua kumvua dikankamika dia mifuba to, nunku udi umvua mutoyi anu mu ditshi diebe dimpe.

Bua tshinyi bidi ne njiwu bua kuela mafuta a mu matshi, peroxyde d'hydrogène anyi mafuta a olive mu ditshi panyima pa disama dia Q-tip anyi dikuma?¶

Tshiamu tshia ku matshi tshidi katshiyi tshinyanguke tshidi tshienza mudimu bu tshintu tshidi katshiyi tshibuela mâyi tshidi tshikuba mifuba ya ditshi dia pankatshi ne tshilamba tshitekete tshia ku matshi tshia munda. Shi Q-tip, slap, nansha infection ya ku matshi mitapulula tshina mu tshitupa tshia matshi, kuela peroxyde wa hydrogène, kuela maluvu, wax softeners, anyi amue matonshi a antibiotique mu tshina tshia mâyi kudi kuenza bua mâyi au apita buludiludi mu ditshi dia pankatshi ne kupitshila mu dididishi dia tshijengu mu tshitupa tshia matshi, ne adi afila vertigo wa tshikisu, disama dia kapia dikole, ne dinyanga dia kashidi dia selile ya mubidi webe.

Tshiamu tshia ku matshi tshidi tshitapuluke tshidi mua kuondopibua nkayatshi kakuyi dipanda anyi?¶

Eyowa, pankatshi pa 80 ne 90 pa lukama ya bipupu bia mu matshi bidi kabiyi bikole bidi biondapa nkayabi mu mbingu 3 anyi 6 bualu tshitupa tshia pambelu tshia mu matshi tshidi tshikola nkayatshi mu tshina bu mudi tshilamba tshidi tshidilongolola nkayatshi. Malu a mushinga mukole audi ne bua kuenza bua kuondopibua nkulama tshitupa tshia matshi tshiume 100 pa lukama paudi wowa mâyi (kuenza mudimu ne tshiamu tshia butoke tshidibu balengeje ne mafuta a petrole ku tshibuelelu tshia pambelu), kubenga kuela mafuta adibu kabayi bakufundile munda, ne kubenga kupuekesha mishiku yebe ku bukole to.

Miaba mifumina¶

Tshilongelu tshia bena Amerike tshia Otolaryngology-Head and Neck Surgery (AAO-HNS, United States): Clinical Practice Guideline: Sudden Hearing Loss (Update) (Chandrasekhar et al., Otolaryngology-Head and Neck Surgery; defining the \(30\text d{\)3B-quency /3B-quency for tukning criteria for Dishilangana dia Weber/Rinne ne dijimija dia bintu, tshikebelu tshia mitu tshia AICA, ne madidishi a dipandisha dia corticosteroïde wa munda mua mubidi).
National Institute for Health and Care Excellence (NICE, United Kingdom): Hearing Loss in Adults: Assessment and Management (NG98) (immediate same-day/24-hour emergency ENT referral for sudden-onset sensorineural hearing loss developing over \(\le 3\text{\)}days}).
American Heart Association (AHA) and Neuro-Otology Consensus (HINTS-Plus Protocol): Dishilangana dia Acute Anterior Inferior Cerebellar Artery (AICA) Infarction ne Benign Labyrinthitis mu Acute Vestibular Syndrome with Hearing Loss (Newman-Toker & Leke et al.).
National Health Service (NHS, United Kingdom) ne Mayo Clinic / Cleveland Clinic Otolaryngology Protocols: Perforated Eardrum (Traumatic Tympanic Membrane Perforation) Dry-Ear Precautions, Ototoxic Drop Avoidance, and Surgical Tympanoplasty / Perilymphatic Fistula Criteria.