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Pathophysiologie des Hörverlusts

Klassifikation und Therapieoptionen

Pathophysiology of hearing loss

Classification and treatment options

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Zusammenfassung

Aus dem Blickwinkel der Therapien von Hörstörungen können die Ursachen und die pathophysiologischen Folgen von Hörschäden nach der Ausprägung der primären Ursachen klassifiziert werden. Hörstörungen können unterschiedliche Folgen für den Zellerhalt im Corti-Organ und im Spiralganglion haben. Diese haben aus Sicht der Autoren nicht nur wesentliche Konsequenzen für den Erfolg von prothetischer Therapie, sondern beinhalten auch sehr unterschiedliches Potenzial für neue kausale molekulare Therapie. Ursachen, die auf ein einzelnes oder wenige Moleküle ohne nachgeschaltete zelluläre Schäden beschränkt sind, haben das beste Potenzial für eine kausale Therapie. Erste Erfolge von molekularer Therapie im Tierversuch sind seit wenigen Jahren bekannt. Leider sind diese Ursachen sehr selten, und die Therapie wird auch in der Zukunft unterschiedliche Methoden nutzen müssen. Zusätzlich zu peripheren Veränderungen haben Hörschäden auch Konsequenzen für die Funktion des Gehirns, die individuell unterschiedlich sein können. Wir plädieren deshalb für eine Individualisierung der Therapie, die nicht nur das Symptom des Hörschadens behandelt, sondern den Fokus auf die individuellen, zentralen Folgen und Adaptationen lenkt. Nur mit einer individualisierten Therapie kann der Erfolg der Therapie von Hörstörungen wesentlich gesteigert werden.

Abstract

From the therapeutic perspective, the etiology and pathophysiology of hearing loss can be classified based on the extent of the primary cause. Hearing loss can have very different consequences for cell preservation in the organ of Corti and the spiral ganglion. These not only have implications for prosthetic therapy outcome, but may also influence the potential for future causal molecular therapies. Etiologies leading to deficits that are limited to one or a few molecules without having an effect on cell survival have the greatest potential for future causal therapy using molecular and cellular approaches. Preliminary success for molecular therapy was recently reported in animal experiments. Unfortunately, the incidence of these types of hearing loss is very low and in the future the therapy of hearing loss will therefore also require several different approaches. In addition to peripheral pathophysiology, hearing loss has consequences on the functioning of the brain, which can vary greatly due to individual adaptation to the situation without hearing. The authors therefore argue for individualization of the diagnostics and therapy that focus not only the symptom of hearing loss, but also the individual pathophysiology and consequences. Only with individualized therapy can the success of treating hearing disorders be significantly improved.

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Danksagung

Unterstützt von der Deutschen Forschungsgemeinschaft (Exzellenzcluster Hearing4all).

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  1. Institut für AudioNeuroTechnologie & Abteilung für Experimentelle Otologie der HNO-Klinik, Medizinische Hochschule Hannover, Stadtfelddamm 34, 30625, Hannover, Deutschland

    A. Kral

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A. Kral gibt an, dass kein Interessenkonflikt besteht. A. Kral führt Forschungsprojekte in Kooperation mit MedEl GmbH, Cochlear Ltd und Sonova (Advanced Bionics) durch.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Kral, A. Pathophysiologie des Hörverlusts. HNO 65, 290–297 (2017). https://doi.org/10.1007/s00106-016-0183-1

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