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Zentral-auditorische Implantate

Central auditory prosthesis

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Zusammenfassung

Taube Patienten mit einer cochleären Schwerhörigkeit können heute durch ein Kochleaimplantat, das die Hörnervenfasern stimuliert, rehabilitiert werden. Doch Patienten mit einer Schädigung des Hörnervs können von einem Kochleaimplantat nicht profitieren. Nur etwa 1% aller tauben Patienten weisen eine neurale Schwerhörigkeit auf, die meisten leiden an einer Neurofibromatose Typ 2 (NF2). Aufgrund bilateraler Akustikusneurinome und der erforderlichen chirurgischen Entfernung kommt es zu einer neuralen Taubheit beidseits. Für die Rehabilitation bietet sich das auditorische Hirnstammimplantat an, das mit einer Oberflächenelektrode den Nucleus cochlearis am Hirnstamm stimuliert. Obwohl das Hirnstammimplantat (ABI) die Wahrnehmung von Umweltgeräuschen ermöglicht und das Lippenlesen verbessert, können nur wenige Patienten ein offenes Sprachverstehen erreichen. Auf der Suche nach alternativen Verfahren wurde in Zusammenarbeit mit Cochlear Ltd. (Australien) ein auditorisches Mittelhirnimplantat („auditory midbrain implant“, AMI) entwickelt, das mit einer penetrierenden Elektrode den Colliculus inferior im Mittelhirn stimuliert. Der Colliculus inferior bietet den Zugang zur neuronalen Projektion, wie sie für die Sprachwahrnehmung und die dafür erforderliche spektrale Information notwendig ist. Der Beitrag stellt den Stand zentraler auditorischer Prothesen im Hinblick auf Technologie, chirurgische Technik und Hörergebnisse dar. Zusätzlich wird auf den konzeptionellen Hintergrund des ABI und des AMI eingegangen.

Abstract

Deaf patients with severe sensory hearing loss can benefit from a cochlear implant (CI), which stimulates the auditory nerve fibers. However, patients who do not have an intact auditory nerve cannot benefit from a CI. The majority of these patients are neurofibromatosis type 2 (NF2) patients who developed neural deafness due to growth or surgical removal of a bilateral acoustic neuroma. The only current solution is the auditory brainstem implant (ABI), which stimulates the surface of the cochlear nucleus in the brainstem. Although the ABI provides improvement in environmental awareness and lip-reading capabilities, only a few NF2 patients have achieved some limited open set speech perception. In the search for alternative procedures our research group in collaboration with Cochlear Ltd. (Australia) developed a human prototype auditory midbrain implant (AMI), which is designed to electrically stimulate the inferior colliculus (IC). The IC has the potential as a new target for an auditory prosthesis as it provides access to neural projections necessary for speech perception as well as a systematic map of spectral information. In this paper the present status of research and development in the field of central auditory prostheses is presented with respect to technology, surgical technique and hearing results as well as the background concepts of ABI and AMI.

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  1. Hals-Nasen-Ohrenklinik, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    T. Lenarz, H. Lim, G. Joseph, G. Reuter & M. Lenarz

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  1. T. Lenarz
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  2. H. Lim
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  3. G. Joseph
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  4. G. Reuter
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  5. M. Lenarz
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Correspondence to T. Lenarz.

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Lenarz, T., Lim, H., Joseph, G. et al. Zentral-auditorische Implantate. HNO 57, 551–562 (2009). https://doi.org/10.1007/s00106-009-1944-x

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