COMBAT BLAST-INDUCED OTOLOGIC INJURY AND POSSIBILITIES OF SUPPORT WITH THE COMPOSITE AGENT COCHLEATON®
DOI:
https://doi.org/10.37219/g0aspx14Keywords:
blast injury, acoustic barotrauma, acute sensorineural hearing loss, tympanoplasty, tinnitus, Cochleaton®, melatonin, magnesium, cochlear blood flowAbstract
Background. Continuous hostile bombardments across Ukraine result in widespread blast injuries, with blast-induced acoustic barotrauma (ABT) serving as a frequent and critical component. The pathogenesis of inner ear damage in ABT involves interconnected mechanical, vascular (vasoconstriction and ischemia), and metabolic pathways, including oxidative stress, ionic imbalance, and glutamatergic excitotoxicity. Because emergency triage and evacuation protocols prioritize life-threatening somatic wounds, specialized otological care is routinely delayed. This delay facilitates the chronicity of sensorineural disorders, highlighting the urgent need to evaluate multi-component therapeutic agents capable of targeting these distinct pathogenic pathways.
Objective. To evaluate the clinical efficacy of the composite agent Cochleaton® (comprising French maritime pine bark extract, the active form of folic acid, melatonin, and magnesium) in patients presenting with acute sensorineural hearing loss (ASNHL) and acute post-traumatic otitis media (APTOM) secondary to blast-induced acoustic barotrauma.
Materials and Methods. The study involved 69 male patients (mean age 36–38 years) with ABT sustained during combat operations. Concomitant somatic injuries and cerebral concussion were present in 89.7% of cases. The patients were divided into two groups: Group 1 included 32 patients with ABT without tympanic membrane perforation; Group 2 consisted of 37 patients with tympanic membrane perforation who underwent type I tympanoplasty (the graft take rate was 94.6%). Cochleaton® was prescribed as a monotherapy for 30 days, starting on average 38–41 days after the injury. Efficacy was evaluated by the dynamics of bone conduction (BC) and air conduction (AC) hearing thresholds at frequencies of 500–4000 Hz, as well as by subjective symptoms (tinnitus, vertigo).
Results. In Group 1 (without perforation), the use of Cochleaton® resulted in a reduction of BC hearing thresholds by more than 10 dB in 71.9% of patients (including 21.9% with an improvement exceeding 20 dB). The mean threshold improvement was 11.7±4.6 dB for BC and 10.8±5.8 dB for AC. In Group 2 (post-tympanoplasty), a BC threshold reduction of more than 10 dB was recorded in 56.8% of casualties (and more than 20 dB in 10.8%). An AC hearing improvement of more than 10 dB was reported by 91.9% of individuals (the mean AC gain was 19.7±5.6 dB due to the closure of the tympanic defect). Positive dynamics of subjective tinnitus (reduction in intensity, duration, and change in pitch) was noted by 100% of patients in both groups, with complete resolution of tinnitus achieved in 4 cases. Regression of vestibular disorders (dizziness, ataxia) was reported by the patients as early as the 10th day of administration.
Conclusions.
1. The composite agent Cochleaton® demonstrates high therapeutic efficacy in restoring cochlear function in patients following blast-induced acoustic barotrauma, even when the initiation of therapy is delayed.
2. Integrating Cochleaton® into the postoperative regimen after tympanoplasty stimulates neuroprotective mechanisms and enhances cochlear perfusion, thereby mitigating additional surgical trauma to the inner ear.
3. The 100% response rate regarding tinnitus regression, combined with the rapid elimination of vestibular symptoms, supports the recommendation of Cochleaton® as an effective pathogenic intervention for blast-induced hearing damage in both military personnel and civilians.
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