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Endolymph-Homöostase und M. Menière

Grundlagen, pathologische Veränderungen, Aminoglykoside

Endolymph homeostasis and Menière’s disease

Fundamentals, pathological changes, aminoglycosides

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Zusammenfassung

Die Wirkmechanismen der empirisch so erfolgreich angewandten – und hier in ihrer individuellen Titration vorgestellten – minimal dosierten Gentamicin-Therapie bei M. Menière sind noch nicht hinreichend bekannt. Die meisten tierexperimentellen Studien zur Wirkung von Aminoglykosiden in der Kochlea haben mit hohen, für die Haarzellen und viele andere Zelltypen toxischen Dosen gearbeitet. Bisher fehlen Studien zur Aufklärung der Mechanismen der therapeutischen Wirkung niedrig dosierten Gentamicins auf den Schwindel. Dargelegt wird, wie eine Störung der Endolymph-Homöostase zum endolymphatischen Hydrops und schließlich zum Entweichen von K+ aus der Endolymphe in den Perilymphraum führt. Dadurch kann es zu einer unphysiologischen Aktivierung vestibulärer Nervenfasern und damit zum Schwindel kommen.

Abstract

Although low dose intratympanal gentamicin has empirically been very effective in treating Menière’s disease, the mechanisms of elimination or amelioration of vertigo are still insufficiently understood. Most animal studies investigating the effect of aminoglycosides used high doses that damage or kill hair cells and many other cell types of the inner ear. Additional studies are needed to investigate the effects of low dose gentamicin to elucidate the mechanisms affecting vertigo. In this article it will be explained how disturbances of endolymph homeostasis lead to endolymphatic hydrops and finally to leakage of K+ from the endolymph into the perilymphatic space. This can lead to a non-physiological activation of vestibular nerve fibres thus causing vertigo.

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Abbreviations

K+ :

Kaliumionen

Na+ :

Natriumionen

Cl- :

Chloridionen

mM:

Millimol

mV:

Millivolt

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  1. HNO-Klinik, Universität Regensburg, Franz-Josef-Strauß-Allee 11, 93042, Regensburg, Deutschland

    O. Gleich, J. Strutz & K. Schmid

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  1. O. Gleich
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  2. J. Strutz
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  3. K. Schmid
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Correspondence to O. Gleich.

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Gleich, O., Strutz, J. & Schmid, K. Endolymph-Homöostase und M. Menière. HNO 56, 1243–1252 (2008). https://doi.org/10.1007/s00106-008-1841-8

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