izindaba

Ngemva kokungena ebudaleni, ukuzwa komuntu kuyehla kancane kancane. Kuyo yonke iminyaka engu-10 ubudala, izehlakalo zokulahlekelwa izindlebe zicishe ziphindeke kabili, futhi izingxenye ezimbili kwezintathu zabantu abadala abaneminyaka engu-≥ 60 bahlushwa uhlobo oluthile lokulahlekelwa ukuzwa okubalulekile ngokomtholampilo. Kukhona ukuhlobana phakathi kokulahlekelwa ukuzwa kanye nokukhubazeka kokukhulumisana, ukuncipha kwengqondo, ukuwohloka komqondo, izindleko zokwelashwa ezikhuphukayo, neminye imiphumela emibi yezempilo.

Wonke umuntu kancane kancane uzolahlekelwa ukuzwa okuhlobene neminyaka kukho konke ukuphila kwakhe. Ikhono lomuntu lokuzwa lincike ekutheni indlebe engaphakathi (i-cochlea) ingakwazi yini ukufaka ikhodi ngokunembile kumasignali emizwa (okuwukuthi kamuva acutshungulwe futhi ahlukaniswe abe incazelo yi-cerebral cortex). Noma yiziphi izinguquko ze-pathological endleleni esuka endlebeni iye ebuchosheni ingaba nemiphumela emibi ekuzweni, kodwa ukulahlekelwa ukuzwa okuhlobene neminyaka okubandakanya i-cochlea kuyimbangela evamile.

Isici sokulahlekelwa ukuzwa okuhlobene neminyaka ukulahlekelwa kancane kancane kwamaseli ezinwele ezindlebeni zangaphakathi ezibophezelekile ekubhaleni umsindo kumasignali emizwa. Ngokungafani namanye amangqamuzana emzimbeni, amangqamuzana ezinwele ezizwayo endlebeni yangaphakathi awakwazi ukuvuselela. Ngaphansi kwemiphumela enqwabelene ye-etiologies ehlukahlukene, lawa maseli azolahleka kancane kancane kukho konke ukuphila komuntu. Izimbangela ezibaluleke kakhulu zengozi yokulahlekelwa ukuzwa okuhlobene neminyaka zihlanganisa ubudala, umbala wesikhumba okhanyayo (okuyinkomba ye-cochlear pigmentation ngoba i-melanin inomphumela ovikelayo ku-cochlea), ubudoda, nokuchayeka komsindo. Ezinye izici eziyingozi zihlanganisa izici eziyingozi zesifo senhliziyo, njengesifo sikashukela, ukubhema nomfutho wegazi ophakeme, okungase kuholele ekulimaleni kwemithambo yegazi ecochlear.

Izindlebe zomuntu ziyehla kancane kancane njengoba zingena ebudaleni, ikakhulukazi uma kuziwa ekuzweni imisindo yefrikhwensi ephezulu. Izehlakalo zokulahlekelwa izindlebe ezibalulekile emtholampilo zikhula ngokuya ngeminyaka, futhi kuyo yonke iminyaka engu-10 ubudala, izehlakalo zokulahlekelwa izindlebe zicishe ziphindeke kabili. Ngakho-ke, izingxenye ezimbili kwezintathu zabantu abadala abaneminyaka engu-≥ 60 bahlushwa uhlobo oluthile lokulahlekelwa ukuzwa okubalulekile emtholampilo.

Ucwaningo lwe-Epidemiological lubonise ukuhlobana phakathi kokulahlekelwa ukuzwa kanye nezithiyo zokuxhumana, ukuncipha kwengqondo, ukuwohloka komqondo, izindleko zezokwelapha ezikhuphukayo, neminye imiphumela emibi yezempilo. Kule minyaka eyishumi edlule, ucwaningo luye lwagxila ikakhulukazi emthelela wokulahlekelwa izindlebe ekunciphiseni kwengqondo kanye nokuwohloka komqondo, ngokusekelwe kulobu bufakazi, Ikhomishana ye-Lancet Yokuwohloka Komqondo yaphetha ngo-2020 ukuthi ukulahlekelwa kwezindlebe phakathi nokuguga kuyisici esikhulu esingahle siguquleke engozini yokuthuthukisa ukuwohloka komqondo, okubalelwa ku-8% wazo zonke izimo zokuwohloka komqondo. Kucatshangelwa ukuthi indlela eyinhloko lapho ukulahlekelwa kwezindlebe kukhulisa ukwehla kwengqondo kanye nengozi yokuwohloka komqondo imiphumela emibi yokulahlekelwa ukuzwa kanye nokufakwa kwekhodi okwanele kokuzwa kumthwalo wokuqonda, ukuwohloka kobuchopho, nokuhlukaniswa nomphakathi.

Ukulahlekelwa kwezindlebe okuhlobene nobudala kuzobonakala kancane kancane futhi ngokucashile kuzo zombili izindlebe ngokuhamba kwesikhathi, ngaphandle kwemicimbi ecacile eyimbangela. Kuzothinta ukuzwakala nokucaca komsindo, kanye nolwazi lwansuku zonke lwabantu lokuxhumana. Abanenkinga yokuzwa kancane ngokuvamile abaqapheli ukuthi ukuzwa kwabo kuyehla futhi kunalokho bakholelwa ukuthi izinkinga zabo zokuzwa zibangelwa izici zangaphandle ezifana nenkulumo engacacile nomsindo wangemuva. Abantu abangezwa kakhulu bazoqaphela izinkinga zokucaca kwenkulumo ngisho nasezindaweni ezithule, kuyilapho ukukhuluma endaweni enomsindo bazozizwa bekhathele ngoba kudingeka umzamo wokuqonda okwengeziwe ukuze kucutshungulwe izimpawu zenkulumo ezincishisiwe. Ngokuvamile, amalungu omkhaya anokuqonda okungcono kakhulu kwezinkinga zokuzwa zesiguli.

Lapho uhlola izinkinga zokuzwa zesiguli, kubalulekile ukuqonda ukuthi indlela umuntu abona ngayo ukuzwa incike ezicini ezine: izinga lomsindo ongenayo (njengokuncishiswa kwezimpawu zenkulumo emakamelweni anomsindo wangemuva noma enanela), inqubo yomshini yokudluliswa komsindo phakathi kwendlebe ephakathi ukuya ku-cochlea (okungukuthi, i-conductive hearing), i-cochlea eguqula amasignali omsindo abe yinzwa yokuzwa kagesi ebuchosheni kanye nenzwa kagesi. I-cerebral cortex ihlukanisa amasignali emizwa abe yincazelo (okungukuthi, ukucutshungulwa kokuzwa okuphakathi). Lapho isiguli sithola izinkinga zokuzwa, imbangela ingase ibe noma yiziphi izingxenye ezine ezishiwo ngenhla, futhi ezimweni eziningi, ingxenye engaphezu kweyodwa isivele ithintekile ngaphambi kokuba inkinga yokuzwa ibonakale.

Inhloso yokuhlolwa kokuqala komtholampilo ukuhlola ukuthi isiguli sinakho yini ukungezwa okuphathekayo okulapheka kalula noma ezinye izinhlobo zokungezwa ezingase zidinge ukuhlolwa okwengeziwe yi-otolaryngologist. Ukulahlekelwa kokuzwa okuqhutshwayo okungaphathwa odokotela bomndeni kuhlanganisa i-otitis media kanye ne-cerumen embolism, enganqunywa ngokusekelwe emlandweni wezokwelapha (njengokuqala okunamandla okuhambisana nobuhlungu bezindlebe, nokugcwala kwezindlebe okuhambisana nokutheleleka kwepheshana eliphezulu lokuphefumula) noma ukuhlolwa kwe-otoscopy (njenge-cerumen embolism ephelele emgodini wendlebe). Izimpawu ezihambisanayo nezimpawu zokungezwa ezidinga ukuhlolwa okwengeziwe noma ukubonisana ne-otolaryngologist zihlanganisa ukuphuma kwendlebe, i-otoscopy engavamile, i-tinnitus eqhubekayo, isiyezi, ukushintshashintsha kwezindlebe noma i-asymmetry, noma ukulahlekelwa ukuzwa kungazelelwe ngaphandle kwezimbangela zokuziphatha (njengokuphuma kwendlebe emaphakathi).

Ukulahlekelwa kokuzwa okungazelelwe kwenzwa kungenye yezinkinga ezimbalwa zokuzwa ezidinga ukuhlolwa okuphuthumayo yi-otolaryngologist (mhlawumbe phakathi nezinsuku ezingu-3 zokuqala), njengoba ukuxilongwa kusenesikhathi kanye nokusetshenziswa kokungenelela kwe-glucocorticoid kungathuthukisa amathuba okuthola ukuzwa. Ukulahlekelwa kwezinzwa kungazelelwe kuyivelakancane uma kuqhathaniswa, nesigameko sonyaka esingu-1/10000, ngokuvamile kubantu abadala abaneminyaka engu-40 noma ngaphezulu. Uma kuqhathaniswa nokulahlekelwa ukuzwa okuhlangene okubangelwa izizathu zokuqhuba, iziguli ezilahlekelwa ukuzwa ngokuzumayo ngokuvamile zibika ukulahlekelwa ukuzwa okubuhlungu, okungenabuhlungu endlebeni eyodwa, okuholela ekungakwazini ngokuphelele ukuzwa noma ukuqonda abanye abakhuluma.

Njengamanje kunezindlela eziningi eziseceleni kombhede zokuhlolelwa ukungezwa, okuhlanganisa ukuhlolwa kokuhleba nokuhlolwa kokusonta iminwe. Kodwa-ke, ukuzwela nokucaciswa kwalezi zindlela zokuhlola kuyahluka kakhulu, futhi ukusebenza kwazo kungase kulinganiselwe ngokusekelwe emathubeni okulahlekelwa ukuzwa okuhlobene neminyaka ezigulini. Kubaluleke kakhulu ukuqaphela ukuthi njengoba ukuzwa kuncipha kancane kancane kukho konke ukuphila komuntu (Umfanekiso 1), kungakhathaliseki ukuthi imiphi imiphumela yokuhlolwa, kungase kuthiwe isiguli sinezinga elithile lokulahlekelwa kwezindlebe okuhlobene neminyaka ngokusekelwe eminyakeni yaso, izimpawu ezibonisa ukungezwa, futhi azikho ezinye izizathu zomtholampilo.

Qinisekisa futhi uhlole ukulahlekelwa kwezindlebe bese ubhekisa kudokotela ohlola izindlebe. Phakathi nenqubo yokuhlola ukuzwa, udokotela usebenzisa i-audiometer elinganisiwe ekamelweni elingazwakali ukuze ahlole ukuzwa kwesiguli. Hlola ubukhulu obuncane bomsindo (okungukuthi umkhawulo wokuzwa) isiguli esingawuthola ngokuthembekile kuma-decibel ngaphakathi kwebanga lika-125-8000 Hz. Umkhawulo wokuzwa ophansi ukhombisa ukuzwa kahle. Ezinganeni nakubantu abadala abasebasha, umkhawulo wokuzwa wawo wonke ama-frequency useduze no-0 dB, kodwa njengoba iminyaka ikhula, ukuzwa kuncipha kancane kancane futhi umkhawulo wokuzwa ukhula kancane kancane, ikakhulukazi imisindo ephezulu. I-World Health Organization ihlukanisa ukuzwa ngokusekelwe kumkhawulo omaphakathi wokuzwa komuntu kumaza omsindo abaluleke kakhulu enkulumo (500, 1000, 2000, kanye no-4000 Hz), okwaziwa njengesilinganiso sethoni emsulwa emine [PTA4]. Odokotela noma iziguli zingaqonda umthelela wezinga lokuzwa kwesiguli emsebenzini kanye namasu okuphatha afanelekile asekelwe ku-PTA4. Okunye ukuhlola okwenziwa phakathi nokuhlolwa kokuzwa, okufana nokuhlolwa kokuzwa kwethambo nokuqonda ulimi, kungasiza futhi ukuhlukanisa ukuthi imbangela yokulahlekelwa ukuzwa ingaba ukulahlekelwa ukuzwa okuqhutshwayo noma ukulahlekelwa kokuzwa kokucubungula okuphakathi, futhi inikeze isiqondiso sezinhlelo ezifanele zokuvuselela izindlebe.

Isisekelo somtholampilo esiyinhloko sokubhekana nokulahlekelwa kwezindlebe okuhlobene neminyaka siwukuthuthukisa ukufinyeleleka kwenkulumo neminye imisindo endaweni yokuzwa (njengomculo nama-alamu omsindo) ukuze kuthuthukiswe ukuxhumana okuphumelelayo, ukubamba iqhaza emisebenzini yansuku zonke, nokuphepha. Okwamanje, alukho ukwelapha okubuyisela esimweni sokulahlekelwa ukuzwa okuhlobene neminyaka. Ukuphathwa kwalesi sifo kugxile kakhulu ekuvikelweni kwezindlebe, ukusebenzisa amasu okuxhumana ukuze kuthuthukiswe ikhwalithi yezimpawu zokuzwa ezingenayo (ngaphezu komsindo wangemuva oqhudelanayo), kanye nokusebenzisa izinsiza-kuzwa kanye nokufakwa kwe-cochlear nobunye ubuchwepheshe bokuzwa. Izinga lokusetshenziswa kwezinsiza zokuzwa noma izifakelo ze-cochlear kubantu abazuzayo (okunqunywa ukuzwa) lisephansi kakhulu.
Ukugxila kwamasu okuvikela ukuzwa ukunciphisa ukuvezwa komsindo ngokuhlala kude nomthombo womsindo noma ukunciphisa ivolumu yomthombo womsindo, kanye nokusebenzisa izinto zokuvikela ukuzwa (njengama-earplugs) uma kudingeka. Amasu okuxhumana ahlanganisa ukukhuthaza abantu ukuthi babe nezingxoxo zobuso nobuso, ukubagcina behlukene phakathi ngesikhathi sezingxoxo, nokunciphisa umsindo ongemuva. Lapho ukhuluma ubuso nobuso, isilaleli singathola izimpawu zokuzwa ezicacile kanye nokubona isimo sobuso sesikhulumi nokunyakaza kwezindebe, okusiza isimiso sezinzwa esimaphakathi sinqume izimpawu zenkulumo.
Izinsiza-kuzwa zihlala ziyindlela yokungenelela eyinhloko yokwelapha ukulahlekelwa ukuzwa okuhlobene neminyaka. Izinsiza-kuzwa zingakhulisa umsindo, futhi izinsiza-kuzwa ezithuthuke kakhulu zingase futhi zithuthukise isilinganiso sesignali-kuya-nomsindo somsindo oqondiwe owuqondisayo ngemibhobho eqondisayo nokucutshungulwa kwesignali yedijithali, okubalulekile ekuthuthukiseni ukuxhumana ezindaweni ezinomsindo.
Izinsiza zokuzwa ezinganikezwa ngudokotela zifanele abantu abadala abanenkinga yokuzwa okumaphakathi kuya kokuphakathi, Inani le-PTA4 livamise ukuba ngaphansi kuka-60 dB, futhi lesi sibalo sibalelwa ku-90% kuya ku-95% wazo zonke iziguli ezingezwa. Uma kuqhathaniswa nalokhu, izinsiza zokuzwa ezinikezwa ngudokotela zinezinga eliphezulu lokukhipha umsindo futhi zifanele abantu abadala abanenkinga yokungezwa kakhulu, kodwa zingatholwa kuphela kochwepheshe bezindlebe. Uma imakethe isivuthiwe, izindleko zezinsiza zokuzwa ezitholakala ngaphandle kwekhawunta kulindeleke ukuthi ziqhathaniswe nama-earplugs angenantambo ekhwalithi ephezulu. Njengoba ukusebenza kwensiza yokuzwa kuba isici esivamile sama-earbud angenantambo, izinsiza zokuzwa ezitholakala ngaphandle kwekhawunta ekugcineni zingahluka kuma-earbud angenantambo.
Uma ukulahlekelwa kwezindlebe kubi kakhulu (inani le-PTA4 ngokuvamile ≥ 60 dB) futhi kusenzima ukuqonda abanye ngemva kokusebenzisa izinsiza-kuzwa, ukuhlinzwa kokufakelwa kwe-cochlear kungase kwamukelwe. Izimila ze-cochlear zingamathuluzi okufakelwa kwe-neural afaka umsindo futhi ashukumise ngokuqondile imizwa ye-cochlear. Ifakwe i-otolaryngologist ngesikhathi sokuhlinzwa kwesiguli, okuthatha cishe amahora amabili. Ngemva kokufakelwa, iziguli zidinga izinyanga ezingu-6-12 ukuze zivumelane nokuzwa okutholakala ngokufakwa kwe-cochlear futhi zithole ukukhuthazwa kagesi we-neural njengolimi oluzwakalayo nomsindo.