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Diagnostik, Therapie und aktuelle Forschungsaspekte ausgewählter chronisch-entzündlicher Erkrankungen mit Beteiligung im Kopf-Hals-Bereich

Diagnosis, therapy and current research aspects of selected chronic inflammatory diseases with head and neck involvement

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Zusammenfassung

Wegener-Granulomatose, Churg-Strauss-Syndrom und das chronisch hyperplastische Sinusitis-Asthma-Analgetika-Intoleranz-Syndrom zeigen meist unspezifische Manifestationen im Kopf-Hals-Bereich. Häufig sind diese Beschwerden allerdings Erstsymptome und können so frühzeitig zu einer korrekten Diagnose und einer raschen Einleitung der notwendigen Therapie führen. Die Vieldeutigkeit der Befunde und Beschwerden mit ihren mannigfaltigen und seltenen Differenzialdiagnosen stellt eine Herausforderung für den primär behandelnden Arzt dar. Dies ist aufgrund der Lokalisation der Erstmanifestation in aller Regel der Otorhinolaryngologe. Diagnostik und Therapie erfolgen in interdisziplinärer Kooperation mit Rheumatologen, Pulmonologen, Pathologen, Radiologen, Ophthalmologen, Infektiologen und Nephrologen. Trotz erheblicher wissenschaftlicher und therapeutischer Fortschritte sind die Erkrankungen nicht heilbar. In den letzten Jahrzehnten hat der Erkenntnisgewinn zu einem Wechsel von meist tödlich verlaufender Erkrankung (Wegener-Granulomatose) hin zu einem chronisch rezidivierenden Krankheitsgeschehen geführt. Die pathophysiologischen Zusammenhänge sind allerdings weiterhin weitgehend unbekannt. Das Spektrum der unerwünschten Wirkungen derzeitiger Therapien ist Ansporn für weitere Bemühungen, die Ätiologie der Erkrankungen aufzudecken und neue Therapien zu entwickeln. Aktuelle Forschungsaspekte werden in der vorliegenden Publikation zusammengefasst.

Abstract

Wegener’s granulomatosis, Churg-Strauss syndrome and analgesics intolerance syndrome with polyps demonstrate non-specific manifestations in the head and neck region. These symptoms can often lead to early diagnosis and initiation of the correct therapy. However, symptoms are often ambiguous and many rare differential diagnoses must be borne in mind. This clinical picture presents a challenge for the otorhinolaryngologist, who is commonly the first contacted physician. Diagnostics and therapy have to be carried out in an interdisciplinary approach between rheumatologist, pulmonologist, pathologist, radiologist, ophthalmologist, infection specialist and nephrologist. Despite significant scientific and therapeutic advances, these diseases remain incurable. In recent decades they have lost their life-threatening character (Wegener’s granulomatosis) and are now chronically relapsing diseases. Their aetiology, however, is still unclear and treatment leads to a wide spectrum of undesirable effects. Research work is needed to advance diagnostics and therapy in this field. Recent research aspects are presented in this article.

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Abbreviations

AAS:

Chronisch hyperplastisches Asthma-Analgetika-Intoleranz-Syndrom

ACR:

„American College of Rheumatology“

ANCA:

Anti-neutrophiler zytoplasmatischer Autoantikörper

CSS:

Churg-Strauss-Syndrom

CT:

Computertomographie

ELISA:

„Enzyme-linked immunosorbent assay“

ENT:

„Ear-nose-throat“

Ig:

Immunglobulin

IL-5:

Interleukin-5

IO-SH:

Innenohrschwerhörigkeit, Schallempfindungsschwerhörigkeit

NAB:

Nasenatmungsbehinderung

NaCl:

Natriumchlorid

NLR:

„NOD-like-Rezeptor“

OM:

Ohrmuschel

S. aureus :

Staphylococcus aureus

SH:

Schleimhaut

Sl-SH:

Schallleitungsschwerhörigkeit

TGF:

„Transforming growth factor“

TNF:

Tumor-Nekrose-Faktor

WG:

Wegener-Granulomatose

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Danksagung

Gefördert durch: DFG Klinische Forschergruppe (KFO) 170: Frühpathogenese der Wegenerschen Granulomatose: Von der natürlichen Abwehr mit Granulombildung zur Autoimmunität.

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Authors and Affiliations

  1. Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie der Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Straße 14, 24103, Kiel, Deutschland

    M. Laudien & P. Ambrosch

  2. Institut für Klinische Molekularbiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    A. Till

  3. Institut für Infektionsmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    R. Podschun

  4. Poliklinik für Rheumatologie, Vaskulitiszentrum UKSH & Rheumaklinik Bad Bramstedt, Universität zu Lübeck, Lübeck, Deutschland

    P. Lamprecht

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  1. M. Laudien
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  2. P. Ambrosch
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Laudien, M., Ambrosch, P., Till, A. et al. Diagnostik, Therapie und aktuelle Forschungsaspekte ausgewählter chronisch-entzündlicher Erkrankungen mit Beteiligung im Kopf-Hals-Bereich. Z. Rheumatol. 67, 397–406 (2008). https://doi.org/10.1007/s00393-008-0324-3

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