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„Hidden hearing loss“ – Schäden der Hörverarbeitung auch bei niederschwelliger Lärmbelastung?

Hidden hearing loss—damage to hearing processing even with low-threshold noise exposure?

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Zusammenfassung

Hintergrund

Neue Forschungen – im Tierversuch – belegen, dass durch geringere Lärmbelastungen und -pegel bereits Defekte der Synapsen der Hörbahn auftreten können. Zu direkten mechanischen Schädigungen der Haarzellen und damit zu messbaren (Audiogramm; Distorsionsprodukte otoakustischer Emissionen, DPOAE) Schäden des Innenohrs kommt es nur bei sehr hohen Lärmpegeln. Diese Arbeit bietet eine Kasuistik und Literaturübersicht.

Kasuistik

Ein 41-jähriger Patient erlitt bei einem Autounfall mit Auslösen der Airbags ein Lärmtrauma. Es resultierte ein rechtsbetonter Hörverlust mit Tinnitus. Der Hörverlust besserte sich teilweise, Tinnitus und v. a. Schwierigkeiten im Sprachverstehen persistierten. In der Audiometrie bestand initial ein typischer Hochtonhörverlust von 40 dB mit einem tonalen Tinnitus bei 8 kHz. Zwar waren 6 Monate nach dem Unfall DPOAE und BERA-Potenziale („brainstem evoked response audiometry“, Welle III und V) komplett normal, in der Elektrocochleographie ließ sich jedoch kein cochleäres Aktionspotenzial (CAP) nachweisen.

Diskussion

Trotz Erholung des initial bestehenden Hörverlusts mit Haarzellschaden blieb die synaptische Übertragung beeinträchtigt – mit geringem Hörverlust und schlechtem Sprachverstehen in komplexeren Schallsituationen. In der neuen Literatur wird dies als verdeckter Hörverlust („hidden hearing loss“) beschrieben. Während derartige retrocochleäre Schädigungen der Hörbahn im Tierversuch nachgewiesen wurden, fehlen bislang valide Aussagen dazu beim Menschen, auch weil bislang keine adäquate Diagnostik verfügbar ist.

Schlussfolgerung

Ein Lärmtrauma führt initial zu einem Haarzellschaden, nach Erholung können Beschwerden persistieren, die aus Schäden an den Synapsen des 1. Neurons resultieren können. Eine entsprechende Testbatterie muss entwickelt werden.

Abstract

Background

New research in animal models indicates that even at lower intensities, noise exposure can induce defects in the synapses of the auditory pathway. However, only very high levels of noise exposure lead to mechanical hair cell damage with lesions of the inner ear and measurable hearing loss (audiogram; distortion product otoacoustic emissions, DPOAE). This paper revises the literature, starting with a case study.

Case history

A 41-year-old patient suffered from hearing loss and tinnitus in the right ear following a car accident with airbag deployment. Hearing loss recovered partially, tinnitus and difficulties in speech discrimination persisted. Audiometry showed typical high-frequency hearing loss (40 dB) and tonal tinnitus (8 kHz). Although DPOAE and ABR potentials (auditory brainstem response, wave III and V) were completely normal 6 months after the accident, there was no detectable cochlear action potential (CAP) in electrocochleography (ECochG).

Discussion

These findings indicate recovery of initial hair cell damage, whereas synaptic transformation remains reduced and slight hearing loss and poor speech perception in complex listening situations persist. This phenomenon has been described as “hidden hearing loss” in newer literature. Although similar retrocochlear lesions in the auditory pathway could be detected in animal models, valid data in humans are currently lacking because no adequate diagnostic methods are available.

Conclusion

Noise trauma initially results in hair cell damage. After recovery, hearing loss may persist, which can be due to synaptic lesions in the first neuron. An adequate testbattery has to be developped.

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Authors and Affiliations

  1. Tinnitus-Klinik und Ohr- und Hörinstitut, Große Allee 50, 34454, Bad Arolsen, Deutschland

    G. Hesse & G. Kastellis

  2. Universität Witten-Herdecke, Witten, Deutschland

    G. Hesse

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  1. G. Hesse
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  2. G. Kastellis
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Correspondence to G. Hesse.

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Interessenkonflikt

G. Hesse und G. Kastellis geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

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Hesse, G., Kastellis, G. „Hidden hearing loss“ – Schäden der Hörverarbeitung auch bei niederschwelliger Lärmbelastung?. HNO 67, 417–424 (2019). https://doi.org/10.1007/s00106-019-0640-8

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  • DOI: https://doi.org/10.1007/s00106-019-0640-8

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