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Zentrale und periphere Aspekte der Lärmschwerhörigkeit

Central and peripheral aspects of noise-induced hearing loss

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Zusammenfassung

Lärm stellt in den entwickelten Industrieländern ein großes sozioökonomisches Problem dar. Für die Behandlung der durch die Lärmschwerhörigkeit auftretenden audiologischen Phänomene ist ein vertieftes Verständnis der zugrunde liegenden Schädigungsmechanismen peripherer und zentraler Anteile der Hörbahn notwendig. Die mechanische Schädigung, die Ischämie, die Exzitotoxizität sowie die auditorische Synaptopathie stellen die wesentlichen lärminduzierten Schädigungsprozesse in der Cochlea dar. Neben cochleären pathologischen Veränderungen treten jedoch auch zentralnervöse Schädigungen infolge der Lärmexposition auf. Aufgrund der Überstimulation kommt es sehr frühzeitig zum Zellverlust im Versorgungsgebiet des N. cochlearis. Der spätere Zellverlust in höheren auditorischen Kerngebieten ist im Gegensatz dazu auf die sensorische Deprivation zurückzuführen. Insgesamt wird dem strukturellen Verlust durch eine Modulation der Spontanaktivität im Sinne der Netzwerkhomöostase entgegenreguliert. Dennoch nimmt sehr wahrscheinlich die Verarbeitungsgüte durch die lärminduzierten neuroplastischen Veränderungen ab. Die Lärmschwerhörigkeit ist somit durch eine Reihe von peripheren und zentralen Veränderungen gekennzeichnet, die bisher nur teilweise einer Therapie zugänglich sind. Besonders im Hinblick auf die auditorische Synaptopathie und die zentralen Verarbeitungsdefizite werden neue therapeutische Ansätze benötigt, um audiologische Phänomene wie Tinnitus, Hyperakusis oder schlechtes Diskriminationsvermögen effektiv behandeln zu können.

Abstract

Noise is an important socioeconomic problem in industrialized countries. Development of efficient treatment options for the audiological phenomena resulting from noise-induced hearing loss requires in-depth understanding of the underlying damage mechanisms causing peripheral and central nervous changes. Mechanical damage, ischemia and excitotoxicity are mainly responsible for noise-induced cell death and biophysical changes in the cochlea. Auditory synaptopathy is an additional consequence. Besides these cochlear pathologies, noise exposure leads to extensive changes within the central auditory pathway. Overstimulation causes early cell loss in the ventral cochlear nucleus just after noise exposure, which is in accordance with enhancement of apoptotic mechanisms within the corresponding timeframe. In contrast to the cell loss in lower auditory structures due to overstimulation, the later significant reduction of cell density in higher auditory structures is due to sensory deprivation. Changes in network homeostasis seem to partially compensate structural losses by modulation of spontaneous activity. However, central nervous processing of auditory information is permanently impaired by the neuroplastic changes. Unfortunately, the various noise-induced peripheral and central pathologies are difficult to treat. New therapeutic approaches are required, particularly for treatment of central nervous processing disorders and auditory synaptopathy, which contribute to audiological phenomena such as tinnitus, hyperacusis and poor speech perception in noise.

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Authors and Affiliations

  1. Klinik für Hals‑, Nasen- und Ohrenheilkunde, Unfallkrankenhaus Berlin, Warener Str. 7, 12683, Berlin, Deutschland

    D. Basta, M. Gröschel Dr. & A. Ernst Prof. Dr.

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  1. D. Basta
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  2. M. Gröschel Dr.
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  3. A. Ernst Prof. Dr.
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Correspondence to D. Basta.

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D. Basta, M. Gröschel und A. Ernst geben an, dass kein Interessenkonflikt besteht.

Der Beitrag enthält von den Autoren durchgeführte tierexperimentelle Untersuchungen. Diese wurden vorab behördlich genehmigt.

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Basta, D., Gröschel, M. & Ernst, A. Zentrale und periphere Aspekte der Lärmschwerhörigkeit. HNO 66, 342–349 (2018). https://doi.org/10.1007/s00106-017-0442-9

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