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Laryngorhinootologie 2005; 84: 37-53
DOI: 10.1055/s-2005-861139
Gestörtes Hören
© Georg Thieme Verlag KG Stuttgart · New York

Gestörtes Hören
Chirurgische Verfahren

T.  Zahnert1
  • 1 Universitäts-HNO-Klinik Dresden (Direktor: Priv.-Doz. Dr. med. Dr. h. c. T. Zahnert)
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Publication History

Publication Date:
22 April 2005 (online)

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Zusammenfassung

Die Wiederherstellung der Hörfunktion ist in vielen Fällen mit einer Resozialisierung der Betroffenen verbunden und nimmt deshalb in einer Gesellschaft mit immer schneller werdender Kommunikation einen wichtigen Platz ein. Nicht alle Probleme lassen sich auf chirurgischem Weg lösen. Auch 50 Jahre nach Einführung der Tympanoplastik sind die Hörergebnisse unbefriedigend und erreichen häufig nicht die Schwelle zum sozialen Gehör. Als Ursache dafür kann in den meisten Fällen eine unvollständige Wiederherstellung der Schleimhautfunktion des Mittelohres und der Tube angesehen werden, die zu Belüftungsstörungen des Ohres führt und eine regelrechte Schwingung des rekonstruierten Mittelohres nicht erlaubt. Einige Ursachen liegen jedoch auch in der Biomechanik der rekonstruierten Kette begründet. Es gibt heute Fortschritte in der rekonstruktiven Mittelohrchirurgie, die sich vor allem auf die Weiterentwicklung von Implantaten beziehen. Dabei können Implantate aus Titan als eine neue Generation betrachtet werden, die sich durch eine hervorragende Biokompatibilität, ein graziles Design und durch neue biomechanische Möglichkeiten in der Wiederherstellung der Kettenfunktion auszeichnen. Metallimplantate erlauben erstmalig einen kontrollierten Kraft- und Formschluss an den verbliebenen Rest der Kette sowie die Integration mikromechanischer Funktionen in das Implantat. Darüber hinaus gibt es auch Fortschritte in der Mikrochirurgie selbst. Diese betreffen vor allem das operative Vorgehen bei Gehörgangsatresie, bei der Wiederherstellung des Trommelfells und der Ankopplung von Implantaten. Das vorliegende Referat gibt einen Überblick über den derzeitigen Stand der rekonstruktiven Mittelohrchirurgie unter Beachtung der akusto-mechanischen Gesetzmäßigkeiten.

Schlüsselwörter

Mittelohrchirurgie - Mittelohrrekonstruktion - Tympanoplastik - Stapesplastik - Gehörgangsplastik - Mittelohrimplantat - Gehörgangsatresie

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Priv.-Doz. Dr. med. Dr. h. c. Thomas Zahnert

Universitäts-HNO-Klinik Dresden

Fetscherstraße 74 · 01307 Dresden

Email: thomas.zahnert@uniklinikum-dresden.de

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