Perspektiven der Gleichgewichtsdiagnostik und -therapie

Zusammenfassung

Wie viele Bereiche der klinischen Medizin unterliegen auch die Gleichgewichtsdiagnostik und -therapie den modernen technologischen, wissenschaftlichen und sozio-ökonomischen Veränderungen, die in den letzten Jahren erfreulicherweise zu einer erheblichen Diversifizierung in der Neurotologie geführt haben. Die Einführung neuartiger Diagnostikverfahren zur Charakterisierung der vestibulären Rezeptorenfunktion (z. B. VEMPs), die Fortschritte in der Bildgebung (z. B. Darstellung des Endolymphhydrops) und in der Darstellung zentral-vestibulärer Neuroplastizität sind hervorstechende Beiträge. Die Grundlagen vestibulärer Erkrankungen wurden durch neurogenetische Erkenntnisse (z. B. COCH-Genmutationen), durch die Aufdeckung neuartiger Krankheitsmechanismen (z. B. Dehiszenzsyndrome) und verwandter Störungen (z. B. migräne-assoziierter Schwindel) erweitert. In der Therapie wurden eingeführte chirurgische Verfahren durch Neubewertungen wieder in das Standardrepertoire übernommen (z. B. die Sakkusexposition), neue Operationstechniken beschrieben (z. B. Dehiszenzverschlusstechniken) und die medikamentöse Therapie deutlich erweitert (z. B. Lokaltherapie am Innenohr). Wenn auch implantierbare Neuroprothesen für das Gleichgewichtsorgan noch in der Ferne liegen, sind bereits die ersten klinisch einsetzbaren, extern getragenen Neurofeedbacksysteme zur Rehabilitation verfügbar (z. B. VertiGuard). Diese und andere Trends in der Gleichgewichtsdiagnostik und -therapie zeigen eine medizinisch-therapeutische Zukunft, die durch den Altersschwindel als Ausdruck des demografischen Wandels, durch Ressourcenverknappung und medico-legal überregulierte Rahmenbedingungen für ärztlich-klinische Tätigkeit eingeschränkt werden.

Abstract

Perspectives in Neurotology

Vestibular diagnostics and therapy is the mirror of technological, scientific and socio-economics trends as are other fields of clinical medicine. These trends have led to a substantial diversification of the field of neurotology. The improvements in diagnostics have been characterized by the introduction of new receptor testing tools (e. g., VEMPs), progress in imaging (e. g., the endolymphatic hydrops) and in the description of central-vestibular neuroplasticity. The etiopathology of vestibular disorders has been updated by geneticists (e. g., the description of the COCH gene mutations), the detection of structural abnormalities (e. g., dehiscence syndromes) and related disorders (e. g. migraine-associated vertigo). The therapeutic options were extended by re-evaluation of techniques known a long time ago (e. g., saccus exposure), the development of new approaches (e. g., dehiscence repair) and the introduction of new drug therapy concepts (e. g., local drug delivery). Implantable, neuroprosthetic solutions have not yet reached experimental safety and validity and are still far away. However, externally worn neuroprosthetic solution were introduced in the rehab of vestibular disorders (e. g., VertiGuard system). These and related trends point into a medical future which is characterized by presbyvertigo as classical sign of the demographic changes ahead, by shortage of financial resources and a medico-legally over-regulated, even hostile environment for physicians in clinical medicine.

Schlüsselwörter

Gleichgewichtsdiagnostik - Vestibularistherapie - Altersschwindel - Neurofeedbacktraining

Key words

vestibular diagnostics - vestibular therapy - presbyvertigo - neurofeedback training

Literatur

• 1 Andreas M, Debong B, Bruns W. Handbuch Arztrecht, Nomos, Baden-Baden. 
• 2 Allum JHJ, Carpenter MG. A speedy solution for balance and gait analysis: angular velocity measured at the centre of body mass.  Current opinion in Neurology. 2005;  18 15-21
• 3 Helling K. Funktionsstörungen der Otolithenorgane: Klinische Aspekte und Therapieoptionen.  HNO. 2008;  56 996-1002
• 4 Halmagyi GM, Weber KP, Curthoys IS. Vestibular function after acute vestibular neuritis.  Restor Neurol Neurosci. 2010;  28 37-46
• 5 Halmagyi GM, Curthoys IS. A clinical sign of canal paresis.  Arch Neurol. 1998;  45 737-739
• 6 Viciana D, Ferrer J, Palma MJ, Zapata C, Lopez-Escamez JA. Dynamic visual acuity during head-thrust test in canal planes in healthy subjects and patients with vestibular neuritis.  Acta Otolaryngol. 2010;  7 Epub ahead of print
• 7 Lehnen N, Aw ST, Todd MJ, Halmagyi GM. Head impulse test reveals residual semicircular canal function after vestibular neurectomy.  Neurology. 2004;  62 2294-2296
• 8 MacDougall HG, Weber KP, McGarvie LA, Halmagyi GM, Curthoys IS. The video head impulse test: diagnostic accuracy in peripheral vestibulopathy.  Neurology. 2009;  73 1134-1141
• 9 Jorns-Häderli M, Straumann D, Palla A. Accuracy of the bedside head impulse test in detecting vestibular hypofunction.  J Neurol Neurosurg Psychiatry. 2007;  78 1113-1118
• 10 Strupp M, Brandt T. Vestibular neuritis.  Semin Neurol. 2009;  29 509-519
• 11 Brandt T, Huppert T, Hüfner K, Zingler VC, Dieterich M, Strupp M. Long-term course and relapses of vestibular balance disorders.  Restor Neurol Neurosci. 2010;  28 69-82
• 12 Basta D, Clarke A, Ernst A, Todt I. Stance performance under different sensorimotor conditions in patients with post-traumatic otolith disorders.  J Vest Res. 2007;  17 25-32
• 13 Basta D, Singbartl F, Todt I, Clarke A, Ernst A. Vestibular rehabilitation by auditory feedback in otolith disorders.  Gait & Posture DOI 2008; 10.1016/j.gaitpost.2008.01.006
• 14 Basta D, Todt I, Ernst A. Postural control in otolith disorders.  Human Movement Sciences. 2005;  24 268-279
• 15 Jacot E, Van Den Abbeele T, Debre HR, Wiener-Vacher SR. Vestibular impairments pre- and post-cochlear implant in children.  Int J Pediatr Otorhinolaryngol. 2009;  73 209-217
• 16 Ernst A, Basta D, Seidl RO, Todt I, Scherer H, Clarke A. Management of posttraumatic vertigo.  Otolaryngol Head & Neck Surg. 2005;  132 554-558
• 17 Ernst A, Seidl RO, Nölle C, Pudszuhn A, Ganslmeier A, Ekkernkamp A, Mutze A. Hör- und Gleichgewichtsstörungen nach Kopfanpralltraumen.  Trauma Berufskrankheit. 2001;  3 27-31
• 18 Helling K, Schönfeld U, Scherer H, Clarke AH. Testing utricular function by means of on-axis rotation.  Acta oto-laryngol (Stockh). 2006;  126 587-593
• 19 Basta D, Todt I, Ernst A. Normative data for P1/N1 latencies of VEMP induced by air- or bone conducted tone burst.  Clin Neurophysiol. 2005;  116 2216-2219
• 20 Basta D, Todt I, Ernst A. Characterization of age-related changes in VEMPs.  J Vest Res. 2007;  17 93-98
• 21 Ernst A, Todt I, Basta D. The application of VEMP in otoneurosurgery.  Otolaryngol Head & Neck Surg. 2006;  135 286-290
• 22 Ernst, A. Chirurgische Behandlung von Gleichgewichtserkrankungen.  HNO Praxis heute. 2007;  27 79-85
• 23 Todt I, Basta D, Ernst A. Does the surgical approach in cochlear implantation influence the occurrence of postoperative vertigo?.  Otolaryngol Head & Neck Surg. 2008;  138 8-12
• 24 Allum JHJ, Zamani F, Aitkin AL, Ernst A. Differences between trunk sway characteristics foam support surface and on the Equitest ankle-sway-referenced support surface.  Gait & Posture. 2002;  16 264-270
• 25 Basta D, Ernst A. Moderne Rehabilitation von Gleichgewichtsstörungen mithilfe von Neurofeedback-Trainingsverfahren.  HNO. 2008;  56 990-995
• 26 Basta D, Ernst A. Neurofeedback-based vestibular rehab in vestibular disorders.  J Vest Res. 2010;  (submitted)
• 27 Yamamoto M, Teranishi M, Naganama S, Otake H, Sugiura M, Iwata T, Yoshida T, Katayama N, Nakata S, Sone M, Nakashima T. Relationship between the degree of endolymphatic hydrops and electrocochleography.  Audiol Neurootol. 2010;  15 254-260
• 28 Perez-Fernandez N, Montes-Jovellar L, Cervera-Paz J, Domenech-Vadillo E. Auditory and Vestibular Assessment of Patients with Ménière's Disease Who Suffer Tumarkin Attacks.  Audiol Neurootol. 2010;  15 399-406
• 29 Brandt T, Dieterich M. The vestibular cortex. Its locations, functions, and disorders.  Ann N Y Acad Sci. 1999;  871 293-312
• 30 Dieterich M. Functional brain imaging. A window into the visio-vestibular systems.  Curr Opin Neurol. 2007;  20 12-18
• 31 Dieterich M, Brandt T. Funtional imaging of peripheral and central vestibular disorders.  Brain. 2008;  131 2538-2552
• 32 Kim HA, Lee H. Isolated vestibular nucleus infarction mimicking acute peripheral vestibulopathy.  Stroke. 2010;  41 1558-1560
• 33 Zu Eulenburg P, Stoeter P, Dieterich M. Voxel-based morphometry depicts central compensation after vestibular neuritis.  Ann Neurol. 2010;  68 241-249
• 34 Wang JR, Parmes LS. Superior semicircular canal dehiscence associated with external, middle, and inner ear abnormalities.  Lryngoscope. 2010;  120 390-393
• 35 Minor LB, Solomon D, Zinreich JS, Zee DS. Sound- and/or pressure-induced vertigo due to bone dehiscence of the superior semicircular canal.  Arch Otolaryngol Head neck Surch. 1998;  124 249-258
• 36 Chi FL, Ren DD, Dai CF. Variety of audiologic manifestations in patients with superior semicircular canal dehiscence.  Otol Neurotol. 2010;  31 2-10
• 37 Hildebrand MS, Tack D, Deluca A, Hur IA, Van Rybroek JM, McMordie SJ, Muilenburg A, Hoskinson DP, Van Camp G, Pensak ML, Stoper IS, Huygen PL, Casavant TL, Smith RJ. Mutation in the COCH gene is associated with superior semicircular canal dehiscence.  Am J Med Genet. 2009;  149A 280-285
• 38 Koo JW, Hong SK, Kim DK, Kim JS. Superior semicircular canal dehiscence syndrome by the superior petrosal sinus.  J Neurol Neurosurg Psychiatry. 2010;  81 465-467
• 39 Kurzweg T, Dalchow CV, Bremke M, Majdani O, Kureck I, Knecht R, Werner JA, Teymoortash A. The value of digital volume tomography in assessing the position of cochlear implant arrays in temporal bone specimens.  Ear Hear. 2010;  1 413-419
• 40 Petrovic BD, Futterer SF, Hijaz T, Russell EJ, Karagianis AG. Frequency and diagnostic utility of intralabyrinthine FLAIR hyperintensitiy in the evaluation of internal auditory canal and inner ear pathology.  Acad Radiol. 2010;  17 992-1000
• 41 Kim HC, An YS, Ahn JH. Petrous apex cholesterol granuloma presenting as endolymphatic hydrops: a case report.  Clin Exp Otorhinolaryngol. 2009;  2 151-154
• 42 Kasai S, Teranishi M, Katayama N, Sugiura M, Nakata S, Sone M, Naganawa S, Nakashima T. Endolymphatic space imaging in patients with delayed endolymphatic hydrops.  Acta Otolaryngol. 2009;  129 1169-1174
• 43 Naganawa S, Ishihara S, Iwano A, Sone M, Nakashima T. Three-dimensional (3D) visualization of endolymphatic hydrops after intratympanic injection of Gd-DTPA: optimization of a 3D-real inversion-recovery turbo spin-echo (TSE) sequence and application of a 32-channel head coil at 3 T.  J Magn Reson Imaging. 2010;  31 210-214
• 44 Diaz RC, Amjad EH, Sargent EW, Larouere MJ, Shaia WT. Tumors and pseudotumors of the endolymphatic sac.  Skull Base. 2007;  17 379-393
• 45 Ge X, Shea JJ. Transtympanic electrocochleography: a 10-year experience.  Otol Neurotol. 2001;  22 465-470
• 46 Katayama N, Yamamoto M, Teranishi M, Naganawa S, Nakata S, Sone M, Nakashima T. Relationship between endolymphatic hydrops and vestibular-evoked myogenic potential.  Acta Otolaryngol. 2010;  130 917-923
• 47 Neuhauser H, Leopold M, von Brevern M, Arnold G, Lempert T. The interrelations of migraine, vertigo, and migrainous vertigo.  Neurology. 2001;  56 436-441
• 48 Cha YH. Migraine-associated vertigo: diagnosis and treatment.  Semin Neurol. 2010;  30 167-174
• 49 Cha YH, Kane MJ, Baloh RW. Familial clustering of migraine, episodic vertigo, and Ménière's disease.  Otol Neurotol. 2008;  29 93-96
• 50 Baier B, Winkenwerder E, Dietrich M. “Vestibular migraine”: effects of prophylactic therapy with various drugs. A retrospective study.  J Neurol. 2009;  256 436-442
• 51 Brandt T, Zwergal A, Strupp M. Medical treatment of vestibular disorders.  Expert Opin Pharmacother. 2009;  10 1537-1548
• 52 Todt I, Hennies HC, Basta D, Ernst A. Vestibular dysfunction in patients with mutations of connexin 26.  Neuroreport. 2005;  16 1179-1181
• 53 Todt I, Hennies HC, Küster W, Smolle J, Rademacher G, Mutze S, Basta D, Seidl RO, Ernst E. Neurotological and neuroanatomical changes in the Connexin-26 related HID/KID syndrome.  Audiol Neuotol. 2006;  11 242-248
• 54 Selvanathan SK, Shenton A, Ferner R, Wallace AJ, Huson SM, Ramsden RT, Evans DG. Further genotype-phenotype correlations in neurofibromatosis 2.  Clin Genet. 2010;  77 163-170
• 55 Jen JC. Recent advances in the genetics of recurrent vertigo and vestibulopathy.  Curr Opin Neurol. 2008;  21 3-7
• 56 Furman JM, Raz Y, Whitney SL. Geriatric vestibulopathy assessment and management.  Curr Opin Otolaryngol Head Neck Surg. 2010;  July: Epub ahead of Print
• 57 Walther LE, Westhofen M. Presbyvertigo-aging of otoconia and vestibular sensory cells.  J Vestib Res. 2007;  17 89-92
• 58 Katsarkas A. Dizziness in aging: the clinical experience.  Geriatrics. 2008;  63 18-20
• 59 Basta D, Todt I, Göpel F, Ernst A. Loss of saccular function after cochlear implantation.  Audiology & Neurotology. 2008;  13 187-192
• 60 Agrawal SK, Parnes LS. Human experience with canal plugging.  Ann N Y Acad Sci. 2001;  942 300-305
• 61 Crane BT, Lin FR, Minor LB, Carey JP. Improvement in autophony symptoms after superior canal dehiscence repair.  Otol Neurotol. 2010;  31 140-146
• 62 Seo T, Hashimoto M, Saka N, Sakagami M. Hearing and vestibular functions after plugging surgery for the posterior semicircular canal.  Acta Otolaryngol. 2009;  129 1148-1152
• 63 Fiorino F, Barbieri F, Pizzini FB, Beltramello A. A dehiscent superior semicircular canal may be plugged and resurfaced via the transmastoid route.  Otol Neurotol. 2010;  31 136-139
• 64 Westhofen M. Surgical treatment of vestibular vertigo: methods and indications.  HNO. 2008;  56 1003-1010
• 65 Charpiot A, Rohmer D, Gentine A. Lateral semicircular canal plugging in servere Ménière's disease: a clinical prospective study about 28 patients.  Otol Neurotol. 2010;  31 237-240
• 66 Westhofen M. Menière's didease: evidence and controversies.  HNO. 2009;  57 446-454
• 67 Pullens B, Giard JL, Verschuur HP, van Benthem PP. Surgery for Ménière's disease.  Cochrane Database Syst Rev. 2010;  20 CD005395
• 68 Park JJ, Chen YS, Westhofen M. Impact of endolymphatic mastoid shunt surgery on saccule and lateral semicircular canal function.  Eur Arch Otorhinolaryngol. 2009;  9 (Epub ahead of print)
• 69 Hu A, Parnes LS. 10-year review of endolymphatic sac surgery for intractable meniere disease.  J Otolaryngol Head Neck Surg. 2010;  39 415-421
• 70 Durland Jr WF, Pyle GM, Connor NP. Endolymphatic sac decompression as a treatment for Meniere's disease.  Laryngoscope. 2005;  115 1454-1457
• 71 Ghossaini SN, Wazen JJ. An update on the surgical treatment of Meniere's disease.  J Am Acad Audiol. 2006;  17 38-44
• 72 Derebery MJ, Fisher LM, Berliner K, Chung J, Green K. Outcomes of endolymphatic shunt surgery for Meniere's disease: comparison with intratympanic gentamicin on vertigo control and hearing loss.  Otol & Neurotol. 2010;  31 640-655
• 73 Cohen JE, Spektor S, Valarezo J, Felling Y, Umansky F. Endolymphatic sac tumor: staged endovascular-neurosurgical approach.  Neurol Res. 2003;  25 237-240
• 74 Bassim MK, Berliner KI, Fisher LM, Brackmann DE, Friedman RA. Radiation therapy for the treatment of vestibular schwannoma: a critical evaluation of the state of the literature.  Otol Neurotol. 2010;  31 567-573
• 75 Cheung SW, Aranda D, Driscoll CL, Parsa AT. Mapping clinical outsomes expectations to treatment decisions: an application to vestibular schwannoma management.  Otol Neurotol. 2010;  31 284-293
• 76 Bruns W. Der Patient muss über das Risiko der Nichtbehandlung ausreichend aufgeklärt werden.  ArztRecht. 2010;  45 183-187
• 77 Wall C, Weinberg MS. Balance prosthesis for postural control.  IEEE BME. 2001;  22 84-90
• 78 Merfeld DM, Priesol A, Lee D, Lewis RF. Potential solution to several vestibular changes facing clinicians.  J Vestib Res. 2010;  20 71-77
• 79 Salt AN, Plontke SK. Principles of local drug delivery to the inner ear.  Audiol Neurootol. 2009;  14 350-360
• 80 Gouveris H, Lange G, Mann WJ. Intratympanic gentamicin treatment after endolymphatic sac surgery.  Acta Otolaryngol. 2005;  125 1180-1183
• 81 Nabi S, Parnes LS. Bilateral Ménière's disease.  Curr Opin Otolaryngol Head Neck Surg. 2009;  17 356-362
• 82 Nguyen KD, Minor LB, Della Santina CC, Carey JP. Vestibular function and vertigo control after intratympanic gentamicin for Ménière's disease.  Audiol Neurootol. 2009;  14 361-372
• 83 Hassler T, Homann G, Duong Dinh TA, Jüngling E, Westhofen M, Lückhoff A. Pharmacological modulation of transmitter release by inhibition of pressure-dependent potassium currents in vestibular hair cells.  Naunyn Schmiedebergs Arch Pharmacol. 2000;  380 531-538
• 84 Bronstein AM, Lempert T. Management of the patient with chronic dizziness.  Restor Neurol Neurosci. 2010;  28 83-90
• 85 Szturm T, Ireland DJ, Lessing-Turner M. Comparison of different exercise programs in the rehabilitation of patients with chronic peripheral vestibular dysfunction.  J Vest Res. 1994;  4 (6) 461-479
• 86 Horak FB. Postural compensation for vestibular loss and implications for rehabilitation.  Restor Neurol Neurosci. 2010;  28 57-68
• 87 Kamide N, Shiba Y, Shibata H. Effects on balance, falls, and bone mineral density of a home-based exercise program without home visits in community-dwelling elderly women: a randomized controlled trial.  J Physiol Anthropol. 2009;  28 115-122
• 88 Hegemann J, Honegger F, Kupper M, Allum JHJ. The balance control of bilateral peripheral vestibular loss subjects and its improvement with auditory prosthetic feedback.  J Vest Res. 2005;  15 1-8
• 89 Ernst A, Singbartl F, Basta D, Seidl RO, Todt I, Eisenschenk A. Postural stabilization through auditory feedback training in patients with posttraumatic otolith disorders: a pilot study.  J Vest Res. 2008;  17 137-147
• 90 Danilov YP, Tyler ME, Skinner KL, Hogle RA, Bach-Y-Rita P. Efficacy of electrotactile vestibular substitution in patients with peripheral and central vestibular loss.  J Vest Res. 2007;  17 119-130
• 91 Basta D, Steinhagen-Thiessen E, Gövercin M, Ernst A. Ageing effects in human postural control: Normative data to predict falls.  Gait &Posture. 2010;  (in press)

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