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Pashure pokunge vakura, kunzwa kwomunhu kunoderera zvishoma nezvishoma. Kwemakore gumi ega ega, chiitiko chekunzwa kurasikirwa chinopetwa kaviri, uye zvikamu zviviri kubva muzvitatu zvevakuru vane makore ≥ 60 vanotambura neimwe nzira yekiriniki yakakosha kurasikirwa kwekunzwa. Pane kuwirirana pakati pekurasikirwa kwekunzwa uye kukanganisa kutaurirana, kuderera kwekuziva, dementia, kuwedzera kwemitengo yekurapa, uye zvimwe zvinokonzeresa hutano.

Wese munhu zvishoma nezvishoma achaona kurasikirwa kwekunzwa kunoenderana nezera muhupenyu hwavo hwose. Kugona kwekunzwa kwevanhu kunoenderana nekuti nzeve yemukati (cochlea) inogona kunyatso kupinza ruzha mumasaini emuneural (awo anozogadziridzwa uye kudhindwa kuita zvinoreva necerebral cortex). Chero kuchinja kwepathological munzira kubva munzeve kuenda kuuropi kunogona kuva nemigumisiro yakaipa pakunzwa, asi kurasikirwa kwekunzwa kwezera kunosanganisira cochlea ndiyo inonyanya kukonzera.

Hunhu hwekurasika kwekunzwa hunoenderana nezera kurasika zvishoma nezvishoma kwemaseru ebvudzi remukati nzeve ane chekuita nekukodha ruzha muzviratidzo zveneural. Kusiyana nemamwe masero ari mumuviri, masero ebvudzi anonzwikwa ari munzeve yomukati haakwanisi kuberekwa patsva. Pasi pekuwedzera kwemaitiro akasiyana etiologies, masero aya anorasika zvishoma nezvishoma muhupenyu hwemunhu. Zvikonzero zvinonyanya kukosha zvekurasikirwa nekunzwa zvine chekuita nezera zvinosanganisira kuchembera, ruvara rweganda rwakareruka (inova chiratidzo checochlear pigmentation nekuti melanin ine kudzivirira pacochlea), hurume, uye kuratidzwa kweruzha. Zvimwe zvinokonzera njodzi zvinosanganisira chirwere chemoyo chengozi, zvakadai seshuga, kusvuta uye hypertension, izvo zvinogona kutungamirira kukukuvara kwe microvascular ye cochlear blood nerve.

Kunzwa kwevanhu kunodzikira zvishoma nezvishoma pavanenge vava vanhu vakuru, kunyanya kana tasvika pakunzwa ruzha rwepamusoro-soro. Chiitiko chekurasikirwa kwekunzwa kwekliniki kunowedzera nezera, uye pazera remakore gumi rega rega, chiitiko chekunzwa kurasikirwa chinopeta kaviri. Nokudaro, zvikamu zviviri kubva muzvitatu zvevanhu vakuru vane makore ≥ 60 vanotambura kubva kune imwe nzira yekliniki yekurasikirwa kwekunzwa.

Zvidzidzo zveEpidemiological zvakaratidza kuwirirana pakati pekurasikirwa kwekunzwa uye zvipingamupinyi zvekutaurirana, kuderera kwekuziva, dementia, kuwedzera kwemitengo yekurapa, uye zvimwe zvinokanganisa hutano mhedzisiro. Mumakore gumi adarika, tsvagiridzo yakanyanya kutarisisa kukanganisa kwekunzwa kurasikirwa nekuderera kwekuziva uye dementia, zvichibva pahumbowo uhu, Lancet Commission yeDementia yakagumisa muna 2020 kuti kurasikirwa kwekunzwa pakati nekukwegura ndiyo yakakura inogona kuchinjika njodzi yekuvandudza dementia, inoverengera 8% yezvese nyaya dzedementia. Zvinofungidzirwa kuti nzira huru iyo kurasikirwa kwekunzwa kunowedzera kuderera kwekuziva uye njodzi yedementia ndiyo yakaipa mhedzisiro yekurasikirwa kwekunzwa uye kusakwana kwekunzwa encoding pane cognitive mutoro, brain atrophy, uye kugarisana.

Kurasikirwa kwekunzwa kwakabatana nezera kunozoratidza zvishoma nezvishoma munzeve mbiri nekufamba kwenguva, pasina zviitiko zvinokonzeresa. Ichakanganisa kunzwika uye kujeka kwenzwi, pamwe neruzivo rwemazuva ese rwekutaurirana kwevanhu. Varwere vakapfava vanorasikirwa nekunzwa kazhinji havazivi kuti kunzwa kwavo kuri kuderera uye panzvimbo pezvo vanotenda kuti kusanzwa kwavo kunokonzerwa nezvinhu zvekunze zvakaita sekutaura kusina kujeka uye ruzha rwekumashure. Vanhu vane kurasikirwa kwekunzwa zvakanyanya vanozoona zvishoma nezvishoma nyaya dzakajeka dzekutaura kunyangwe munzvimbo dzakanyarara, nepo kutaura munzvimbo dzine ruzha vanonzwa kuneta nekuti hunyanzvi hwekuziva hunodiwa kugadzirisa zviratidzo zvekutaura zvakadzikira. Kazhinji, nhengo dzemhuri dzinonzwisisa zvakanyanya matambudziko ekunzwa kwemurwere.

Paunenge uchiongorora matambudziko ekunzwa kwemurwere, zvakakosha kuti unzwisise kuti maonerwo emunhu ekunzwa anoenderana nezvinhu zvina: kunaka kweinzwi rinopinda (sekudzikamisa masaini ekutaura mumakamuri ane ruzha rwekumashure kana maungira), iyo mechanical process yekufambisa inzwi kuburikidza nepakati nzeve kuenda kucochlea (kureva conductive kunzwa), iyo cochlea inoshandura masaini ezwi kune iyo uropi uye transort sensors muuropi cerebral cortex decoding neural signatures kuita zvinoreva (kureva nechepakati maodhiyo ekugadzirisa). Kana murwere akawana matambudziko ekunzwa, chikonzero chinogona kunge chiri chero chezvikamu zvina zvataurwa pamusoro apa, uye kakawanda, chikamu chinopfuura chimwe chinenge chatokanganiswa dambudziko rekunzwa risati rava pachena.

Chinangwa chekutanga kuongororwa kwekiriniki ndechekuongorora kana murwere ane nyore kurapika conductive kurasikirwa kwekunzwa kana mamwe maitiro ekurasikirwa kwekunzwa angangoda kuongororwazve neotolaryngologist. Kurasikirwa kwekunzwa kunogona kurapwa navanachiremba vemhuri kunosanganisira otitis media uye cerumen embolism, iyo inogona kutsanangurwa maererano nenhoroondo yezvokurapa (zvakadai sekukurumidza kutanga kunoperekedzwa nemarwadzo enzeve, uye kuzara kwenzeve kunoperekedzwa nepamusoro pekufema kwechirwere chetachiona) kana kuongorora otoscopy (zvakadai sekuzara kwecerumen embolism mugero renzeve). Zviratidzo uye zviratidzo zvekunzwa kurasikirwa zvinoda kumwe kuongororwa kana kubvunzurudzwa neotolaryngologist zvinosanganisira kubuda panzeve, otoscopy isina kujairika, tinnitus inoenderera, dzungu, kushanduka kwekunzwa kana asymmetry, kana kurasikirwa kwekunzwa kamwe kamwe pasina zvikonzero zvinokonzeresa (senge pakati nzeve effusion).

Kamwe-kamwe sensorineural kunzwa kurasikirwa ndeimwe yevashoma kurasikirwa kwekunzwa kunoda kuongororwa nekukurumidza neotolaryngologist (zvichida mukati memazuva matatu ekutanga), sezvo kuongororwa kwekutanga uye kushandiswa kweglucocorticoid kupindira kunogona kuvandudza mikana yekunzwa kupora. Kamwe-kamwe kunzwa kurasikirwa kwekunzwa kunenge kushoma, ine chiitiko chegore negore che1/10000, kazhinji muvakuru vane makore makumi mana kana kupfuura. Kuenzaniswa nekurasikirwa kwekunzwa kweunilateral kunokonzerwa nezvikonzero zvinotungamirira, varwere vane kamwe-kamwe kunzwa kurasikirwa kwekunzwa vanowanzorondedzera kurasikirwa kwekunzwa kwakanyanya, kusingarwadzi mune imwe nzeve, zvichikonzera kupotsa kutadza kunzwa kana kunzwisisa vamwe vachitaura.

Parizvino kune nzira dzakawanda dzepadivi pemubhedha dzekutarisa kurasikirwa nekunzwa, kusanganisira bvunzo dzekuzevezera uye bvunzo dzekumonyorora zvigunwe. Nekudaro, kunzwisiswa uye kujeka kweidzi nzira dzekuyedza dzinosiyana zvakanyanya, uye kushanda kwavo kunogona kushomeka zvichienderana nemukana wekurasikirwa kwekunzwa kwezera muvarwere. Zvinonyanya kukosha kuziva kuti sezvo kunzwa kunoderera zvishoma nezvishoma muupenyu hwose hwemunhu (Mufananidzo 1), pasinei nemigumisiro yekuongorora, inogona kufungidzirwa kuti murwere ane imwe nhanho yekurasikirwa kwekunzwa kwezera zvichienderana nezera ravo, zviratidzo zvinoratidza kurasikirwa kwekunzwa, uye hapana zvimwe zvikonzero zvekliniki.

Simbisa uye ongorora kurasikirwa kwekunzwa uye taura kune audiologist. Munguva yekunzwa yekuongorora maitiro, chiremba anoshandisa calibrated audiometer mukamuri inonzwika kuti aedze kunzwa kwemurwere. Ongorora huwandu hushoma hwekunzwika (kureva kuti kunzwa chikumbaridzo) icho murwere anogona kuona nekuvimbika mumadecibel mukati mehuwandu hwe125-8000 Hz. Kunzwa kwakaderera kunoratidza kunzwa kwakanaka. Muvana nevakuru vechidiki, chikumbaridzo chekunzwa kwese mafrequencies chiri pedyo ne0 dB, asi sezvo zera rinowedzera, kunzwa kunoderera zvishoma nezvishoma uye chikamu chekunzwa chinowedzera zvishoma nezvishoma, kunyanya kune-high-frequency inzwi. Sangano reWorld Health Organisation rinoronga kunzwa zvichibva paavhareji yekunzwa kwemunhu paavhareji eruzha rwekutaura (500, 1000, 2000, uye 4000 Hz), inozivikanwa sechina frequency pure toni avhareji [PTA4]. Vanakiriniki kana varwere vanogona kunzwisisa kukanganisa kwekunzwa kwemurwere pane basa uye nzira dzakakodzera dzekutungamira dzinobva paPTA4. Mimwe miedzo inoitwa panguva yekunzwa bvunzo, senge bone conduction kunzwa bvunzo uye nzwisiso yemutauro, inogonawo kubatsira kusiyanisa kana chikonzero chekunzwa kurasikirwa chingave conductive kunzwa kurasikirwa kana nechepakati auditory processing kunzwa kurasikirwa, uye kupa nhungamiro yezvirongwa zvakakodzera zvekugadzirisa kunzwa.

Nheyo huru yekiriniki yekutarisa kurasikirwa kwekunzwa kwezera ndeyekuvandudza kuwanikwa kwekutaura uye mamwe manzwi munzvimbo yekunzwa (semimhanzi uye ma alarm alarm) kukurudzira kutaurirana kunoshanda, kutora chikamu mumabasa ezuva nezuva, nekuchengeteka. Parizvino, hapana kurapa kwekudzorera kwekurasikirwa kwekunzwa kwezera. Kutarisira kwechirwere ichi kunonyanya kutarisisa kudzivirira kunzwa, kutora nzira dzekutaurirana kuti dzikwidzise kunaka kwezviratidzo zvinopinda zvekunzwa (kupfuura ruzha rwekukwikwidzana), uye kushandisa zvinoyamura kunzwa uye cochlear implants nehumwe tekinoroji yekunzwa. Chiyero chekushandiswa kwezviyamuro zvekunzwa kana kudyara kwecochlear muvanhu vanobatsirwa (kunotemerwa nekunzwa) kuchiri kuderera.
Tarisiro yemaitiro ekudzivirira kwekunzwa ndeyekudzikisa kuratidzwa kweruzha nekugara kure nekwainobva ruzha kana kudzikisa huwandu hweinonzwika sosi, pamwe nekushandisa midziyo yekudzivirira yekunzwa (senge earplugs) kana zvichidikanwa. Nzira dzekukurukurirana dzinosanganisira kukurudzira vanhu kuti vataure vakatarisana, kuvachengeta kureba kwemaoko panguva yekukurukurirana, uye kuderedza ruzha. Pakutaurirana chiso nechiso, muteereri anogona kugamuchira masaini akajeka ekunzwa pamwe nekuona chiso chemutauri uye kufamba kwemiromo, izvo zvinobatsira mutsinga wepakati wetsinga kusarudza masaini ekutaura.
Kubatsira kwekunzwa kunoramba kuri nzira huru yekupindira yekurapa kurasikirwa kwekunzwa kwezera. Zviyamuro zvekunzwa zvinogona kukwidziridza ruzha, uye zvinoyamura zvekunzwa zvemberi zvinogona zvakare kuvandudza chiyero-kune-ruzha reshiyo yeinodiwa inonzwika kuburikidza nemakrofoni anotungamira uye madhijitari masaini kugadzirisa, izvo zvakakosha mukuvandudza kutaurirana munzvimbo dzine ruzha.
Zvishandiso zvekunzwa zvisina kunyorerwa zvakakodzerwa nevanhu vakuru vane nyoro kusvika pakati pekurasikirwa kwekunzwa, Iyo PTA4 kukosha kazhinji iri pasi pe60 dB, uye huwandu uhu hunotora 90% kusvika 95% yevose vanorasikirwa nekunzwa. Zvichienzaniswa neizvi, mishonga yekubatsira kunzwa ine mwero wepamusoro wekubuda kwenzwi uye inokodzera vanhu vakuru vane kurasikirwa kwakanyanya kwekunzwa, asi inogona kuwanikwa chete kubva kune nyanzvi dzekunzwa. Kana musika wakura, mutengo we-over-the-counter kunzwa zvekushandisa unotarisirwa kufananidzwa neyemhando yepamusoro-wireless earplugs. Sezvo kuita kwekubatsira kunzwa kunova chinhu chenguva dzose chemaearbuds asina waya, pamusoro-the-counter zvekunzwa zvinokwanisa kupedzisira zvave zvisina kusiyana newireless earbuds.
Kana kurasikirwa kwekunzwa kwakanyanya (PTA4 kukosha kazhinji ≥ 60 dB) uye zvichiri kuoma kunzwisisa vamwe mushure mekushandisa rubatsiro rwekunzwa, kuvhiyiwa kwecochlear implant kunogona kugamuchirwa. Cochlear implants ndeye neural prosthetic madivayiri anokodha ruzha uye anokurudzira zvakananga tsinga dzecochlear. Inoiswa neotolaryngologist panguva yekuvhiyiwa kwekunze, iyo inotora maawa maviri. Mushure mekudyarwa, varwere vanoda mwedzi 6-12 kuti vajairane nekunzwa kunowanikwa kuburikidza necochlear implants uye kuona neural magetsi kukurudzira semutauro unoreva uye ruzha.