Differenzialdiagnostik der Schallleitungsschwerhörigkeit

Eine Schallleitungsschwerhörigkeit (SLSH) kann durch eine Vielzahl von Ursachen hervorgerufen werden, die von banalen Mittelohrentzündungen bis hin zu komplexen strukturellen Anomalien reichen. Durch gezielte Anamnese und Untersuchung, ergänzt durch audiometrische und ggf. apparative Diagnostik, sowie ggf. eine explorative Tympanotomie kann die richtige Ursache herausgefunden und damit die optimale Behandlung gewählt werden.

Abstract

Conductive hearing loss (CHL) is a complex symptom that can have many different underlying etiologies. Identifying the causative pathology and its clinical presentation is a significant challenge in otology. CHL encompasses a broad spectrum of possible causes, from acute middle ear infections to structural abnormalities and tumors. A precise differential diagnosis is essential to enable targeted and effective treatment. This article highlights the main etiologies, diagnostic approaches and differentiation of CHL, including history taking, clinical examination, audiometric testing and radiologic imaging. Particular attention is be paid to the importance of ear microscopy, pure-tone audiometry, tympanometry and imaging techniques such as high-resolution CT and MRI for the differential diagnosis of CHL. In addition, rare but relevant causes such as tumors and syndromic diseases are explained. The aim is to provide ENT physicians and specialists with a comprehensive understanding of the diagnosis and treatment options for CHL in order to sustainably improve the prognosis and quality of life of patients.

Kernaussagen

• Die Schallleitungsschwerhörigkeit (SLSH) umfasst Ursachen von akuten Mittelohrinfektionen bis hin zu komplexen strukturellen Anomalien und Tumoren.

• Präzise Diagnosen sind entscheidend, um gezielte Behandlungen zu ermöglichen. Eine sorgfältige Anamnese, klinische Untersuchung und Diagnostik (z.B. Audiometrie, Bildgebung) sind essenziell.

• Ohrmikroskopie, Tonaudiometrie, Tympanometrie und Bildgebung (z.B. CT, MRT) liefern wichtige Informationen zur Differenzierung von Pathologien wie Otosklerose, Cholesteatom oder Tympanosklerose.

• Fehlfunktionen der Eustachischen Röhre können indirekt zu SLSH führen, indem sie pathologische Prozesse wie Paukenergüsse oder Retraktionstaschen begünstigen.

• Tumoren wie Paragangliome oder Syndrom-assoziierte Fehlbildungen sollten differenzialdiagnostisch berücksichtigt werden, insbesondere bei ungewöhnlichen Befunden.

• Die Differenzierung von Erkrankungen mit ähnlichen Symptomen, z.B. Otosklerose vs. Hammerkopffixation, erfordert häufig die Kombination aus Funktionsdiagnostik und chirurgischer Exploration.

Schlüsselwörter

Schallleitungsschwerhörigkeit - Tubenventilationsstörung - chronische Otitis media - Cholesteatom - Mukotympanon - Paragangliom

Keywords

conductive heraring loss - Eustachian tube dysfunction - chronic otitis media - cholesteatoma - mucotympanum - paraganglioma

Publikationsverlauf

Artikel online veröffentlicht:
01. Juli 2025

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