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Laryngorhinootologie 2017; 96(S 01): S103-S122
DOI: 10.1055/s-0042-122385
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© Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie des Hörsturzes

Diagnostics and Therapy of Idiopathic Sudden Sensorineural Hearing Loss
Stefan K Plontke
1   Kopf- und Hals-Chirurgie, Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
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Publication History

Publication Date:
12 May 2017 (online)

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Zusammenfassung

Die Übersichtsarbeit behandelt aktuelle Aspekte der Diagnostik, der Differentialdiagnostik sowie der Evidenz im Bereich der systemischen und lokalen Therapie des Hörsturzes. Da vielfältige Erkrankungen existieren, die auch eine akute einseitige Schallempfindungsschwerhörigkeit als Symptom haben können, kommt der sinnvollen, gezielten Diagnostik bei der Abklärung dieses Symptomes eine besondere Rolle zu. Eine bisher wahrscheinlich relativ häufig übersehene Differentialdiagnose sind intralabyrinthäre Schwannome, da diese bisher wenig beachtet wurden und auf den häufig durchgeführten „Kopf-MRTs“ mit groben Schichten leicht zu übersehen sind. Daher sollte bei der Anforderung einer Schläfenbein-MRT-Untersuchung zur Abklärung eines Hörsturzes explizit auch nach Vorhandensein oder Ausschluss eines intralabyrinthären Schwannoms gefragt werden. Mit geeigneten MRT-Untersuchungen lässt sich heutzutage auch ein endolymphatischer Hydrops visualisieren.

Die Studienlage bei der Therapie des Hörsturzes ist – bezogen auf die Qualität, nicht auf die Anzahl der Studien – unbefriedigend. Der Wert von systemisch (niedrige Dosis) oder intratympanal applizierten Kortikosteroiden in der Primärtherapie des Hörsturzes ist unklar. Um die Frage der Wirksamkeit einer in der aktuell gültigen AWMF-Leitlinie empfohlenen primären, systemischen Hochdosis-Kortikosteroidtherapie beim Hörsturz zu beantworten, wird mit Unterstützung des Deutschen Studienzentrums HNO (DSZ-HNO) in Deutschland derzeit eine multizentrische, klinische Studie durchgeführt (http://hodokort-studie.hno.org/). Bei ungenügender Erholung der Hörschwelle nach systemischer Therapie des Hörsturzes scheint nach derzeitiger Datenlage die intratympanale Kortikosteroidtherapie als Sekundärtherapie mit einer signifikant höheren Wahrscheinlichkeit der Hörschwellenverbesserung einherzugehen. Die Hörverbesserung scheint dabei jedoch unabhängig zu sein vom Behandlungsbeginn. Eine Empfehlung für ein Therapieprotokoll für die intratympanale Therapie kann auf der Basis der derzeitigen Datenlage nicht abgeleitet werden.

Abstract

This article reviews recent aspects of diagnostics, differential diagnostics and evidence in systemic and local therapy of idiopathic, sudden, sensorineural hearing loss (ISSHL). Since a number of disorders can be accompanied by sudden hearing loss a meaningful and targeted diagnostic strategy is of utmost importance. An important differential diagnosis of sudden hearing loss are intralabyrinthine schwannomas (ILS). The incidence of ILS is probably significantly underestimated. This may be due to the lack of awareness or lack of explicit search for an intralabyrinthine tumor on MRI or an inappropriate MRI technique (’head-MRI’ instead of ’temporal bone-MRI’ with too high slice thickness) for the evaluation of sudden hearing loss. Therefore, the request to the radiologist should specifically include the question for (or exclusion of) an ILS. With special MRI techniques, it is today possible to visualize an endolymphatic hydrops. The evidence in the therapy of ISSHL is – with respect to quality not quantity of studies – unsatisfying. The value of systemically (low dose) or intratympanically applied corticosteroids in the primary treatment of ISSHL is still unclear. In order to investigate the efficacy and safety of high dose corticosteroids in primary treatment for ISSHL a national, multicenter, three-armed, randomized, triple-blind controlled clinical trial is currently performed in Germany (http://hodokort-studie.hno.org/). After insufficient recovery of threshold with systemic therapy of ISSHL, intratympanic corticosteroid therapy appears to be associated with a significantly higher chance of improvement of hearing threshold than no therapy or placebo. Both, hearing gain and final hearing thresholds, however, appear to be independent of the start of secondary therapy. Based on the currently available data from clinical studies, no recommendation can be made with respect to type of corticosteroid and specifics of the intratympanic application protocol.

Schlüsselwörter

Hörsturz - Differentialdiagnostik - intralabyrinthäres Schwannom - intratympanal

Key words

sudden hearing loss - differential diagnosis - intralabyrinthine schwannoma - intratympanal
 

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