Zusammenfassung
Hintergrund: Temporäre und persistierende Hörverluste sind nach einer Ohroperation zu unterscheiden. In der Literatur wurden bisher nur wenige Untersuchungen zu temporären Innenohrhörverlusten nach Ohroperationen berichtet. Patienten und Methoden: Für die retrospektive Analyse wurden die Knochenleitungsschwellen bei 500 Hz, 1000 Hz, 2000 Hz und 4000 Hz vor einer Ohroperation, an den ersten vier postoperativen Tagen und nach drei Wochen bei 393 Patienten (125 × Otitis media mesotympanalis, 164 × Cholesteatom, 44 × Tympanosklerose, 60 × Otosklerose) bestimmt. Ergebnisse: Es zeigten sich geringe temporäre Hörverluste bei 2000 Hz an den ersten drei und bei 4000 Hz an den ersten beiden postoperativen Tagen von bis zu 7 dB. Die Anwendung des Bohrers führte ausschließlich am ersten postoperativen Tag bei 2000 Hz zu einem geringen temporären Abfall der Innenohrkurve (4,2 dB). Bei Kettenpräparationen war postoperativ eine nur geringe, aber persistierende Differenz in der Hörleistung bei 500 Hz zuungunsten der Kettenpräparation „Cholesteatom” im Vergleich zu den Präparationen „Entfernen/Lösen von Narben und Granulationen” sowie „Kette mobil und reizlos” zu beobachten. Schlussfolgerungen: Temporäre kochleäre Hörverluste von geringem Ausmaß können bei 2000 Hz und 4000 Hz nach Ohroperationen beobachtet werden. Die Anwendung des Bohrers und Kettenpräparationen im Rahmen der Mittelohrchirurgie sind in aller Regel mit keiner bedeutenden Innenohrschädigung assoziiert.
Abstract
Background: Temporary and persistent threshold shifts can occur after ear surgery. So far, only few studies deal with temporary sensory hearing deficits after ear surgery. Patients and methods: In a retrospective study, thresholds at 500 Hz, 1000 Hz, 2000 Hz and 4000 Hz were analysed in 393 patients (125 × mesotympanal chronic otitis media, 164 × cholesteatoma, 44 × tympanosclerosis, 60 × otosclerosis) before, the first 4 days and 3 weeks after ear surgery to evaluate possible temporary threshold shifts. Results: Analysis of all patients in total proved statistically significant slight temporary threshold shifts of up to 7 dB at 2000 Hz (postoperative day 1 to 3) and at 4000 Hz (postoperative day 1 and 2). Use of a drill caused a statistically slight temporary threshold shift only at 2000 Hz at the first postoperative day (4.2 dB). In cholesteatoma surgery with preparations at the ossicular chain a statistically significant slightly higher threshold level was found in all postsurgical evaluations at 500 Hz. Removal of scars or granulation tissue attached to the ossicular chain was not associated with an elevation of threshold levels. Conclusion: Slight temporary threshold shifts can be observed at 2000 Hz and 4000 Hz after ear surgery. Use of the drill and preparation at the ossicular chain usually results in no significant sensory hearing deficit.
Schlüsselwörter
temporärer Hörverlust - Ohrchirurgie - Bohrer - Tinnitus
Key words
temporary hearing deficit - ear surgery - drill - tinnitus
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PD Dr. med. Bernhard Schick
Hals-Nasen-Ohrenklinik,
Kopf- und Halschirurgie
Friedrich-Alexander-Universität Erlangen-Nürnberg
Waldstraße 1
91054 Erlangen
Email: bernhard.schick@hno.imed.uni-erlangen.de
