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Laryngorhinootologie 2017; 96(S 01): S209-S229
DOI: 10.1055/s-0042-120050
Referat
© Georg Thieme Verlag KG Stuttgart · New York

Aktuelle operative Therapie des vestibulären Schwindels

Recent surgical options for vestibular vertigo
Stefan Volkenstein
1   Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie der Ruhr-Universität Bochum am St. Elisabeth-Hospital Bochum
,
Stefan Dazert
1   Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie der Ruhr-Universität Bochum am St. Elisabeth-Hospital Bochum
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Publication History



Publication Date:
12 May 2017 (online)

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Zusammenfassung

Das Leitsymptom „Schwindel“ ist keine klar abgrenzbare Krankheitsentität, sondern stellt ein sehr heterogenes Krankheitsbild dar, das hauptsächlich von HNO-Ärzten, Neurologen, Internisten sowie Allgemeinmedizinern diagnostiziert und therapiert wird. Die meisten Schwindelsyndrome haben eine gute Prognose und können meist konservativ (medikamentös, physikalisch und psychotherapeutisch) erfolgreich behandelt werden. Operative Therapieverfahren des peripher vestibulären Schwindels spielen in absoluten Zahlen nur eine untergeordnete Rolle, sie stellen aber für die betroffenen Patienten nach Ausschöpfen alternativer Therapieverfahren oft die einzig verbleibende Option dar. In dem vorgelegten Referat wird die Entwicklung der operativen Therapieverfahren für hydropische Innenohrerkrankungen, hierbei insbesondere des M. Menière, für Dehiszenzsyndrome, Perilymphfisteln und für den benignen paroxysmalen Lagerungsschwindel vorgestellt und diskutiert. Abschließend erfolgt mit der Diskussion der vestibulären Implantate ein Ausblick auf mögliche zukünftige Therapieoptionen. Die Anwendung der vorgestellten operativen Therapieverfahren für die einzelnen Krankheitsbilder ist nach Ausschöpfen von funktionserhaltenden, konservativen Alternativen bei Fortbestehen einer belastenden Symptomatik indiziert. Der Erfolg hängt hierbei vor allem von der richtigen Diagnose- und Indikationsstellung und damit von einer geeigneten Patientenselektion ab. Da es sich z. T. um irreversible, intrakranielle Eingriffe mit entsprechenden Risiken für den Patienten handelt, ist eine ausführliche individuelle Beratung des Patienten über die Chancen und Risiken des Eingriffs unabdingbar. Mit der oft erfolgreichen Schwindelkontrolle durch die destruierenden Verfahren steigen auch die operativen Risiken, insbesondere für eine Hörverschlechterung oder Ertaubung, weswegen das vorhandene Restgehör meist in den Entscheidungsprozess miteinfließt.

ABSTRACT

Vertigo is not a well defined symptom but a heterogenous entity diagnosed and treated mainly by otolaryngologists, neurologists, internal medicine and primary care physicians. Most vertigo syndroms have a good prognosis and management is predominantly conservative, whereas the need for surgical therapy is rare, but for a subset of patients often the only remaining option. In this paper, we describe the development of surgical therapy for hydropic inner ear diseases, Menière disease, dehiscence syndroms, perilymphatic fistulas, and benign paroxysmal vertigo. At the end, we shortly introduce the most recent development of vestibular implants. Surgical vestibular therapy is still indicated for selected patients nowadays when conservative options did not reduce symptoms and patients are still suffering. Success depends on the correct diagnosis and indication for the different procedures going along with an adequate patient selection. In regard to the invasiveness and the possible risks due to the surgery, in depth individual counselling is necessary. Ablative and destructive surgical procedures usually achieve a successful vertigo control, but go along with a high risk for hearing loss. Therefore, residual hearing has to be included in the decission making process for a surgical therapy.

Schlüsselwörter

peripher vestibulärer Schwindel - operative Therapie - Morbus Menière - Dehiszenzsyndrom - Saccus-Chirurgie - vestibuläre Implantate

Key words

peripheral vestibular vertigo - surgical treatment - M. Menière - dehiscence syndrome - endolymphatic sac surgery - vestibular implants
 

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