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Die Entstehung und Behandlung der Presbyakusis

Heutiger Stand und Perspektiven für die Zukunft

Pathogenesis and treatment of presbyacusis

Current status and future perspectives

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Zusammenfassung

Neben endogenen und exogenen Ursachen können „physiologische Alterungsprozesse“ zur Abnahme des Hörvermögens führen. Zu den wichtigsten exogenen Faktoren werden in Industrieländern Lärm und Überernährung gezählt. Als Auslöser der Presbyakusis werden Hypoxie/Ischämie, Radikalbildung und oxidativer Stress, apoptotischer und nekrotischer Zelltod von Haarzellen und Spiralganglien sowie vererbte bzw. erworbene Mutationen der mitochondrialen DNA diskutiert.

Therapeutisch steht zzt. eine möglichst frühzeitige und beidseitige Versorgung mit Hörgeräten an erster Stelle, um die Kommunikation zu verbessern und die Hörbahn mit akustischen Signalen zu versorgen. Hierdurch kann auch die Detektionsschwelle eines bestehenden Tinnitussignals angehoben werden. Verschiedene pharmakologisch orientierte Behandlungsstrategien werden zzt. diskutiert. Um Schaden durch oxidativen Stress zu vermeiden oder zu mindern, kommen die Gabe von Antioxidanzien oder eine Kalorienreduzierung in der Nahrung in Betracht. Ein weiterer Ansatz wäre die Überexpression oder die Modulation der Superoxiddismutase 2 (SOD2) in der Kochlea, da tierexperimentell eine starke Abnahme der SOD2 im Alter nachgewiesen wurde. Technisch könnte dieser therapeutische Ansatz durch einen adenoviral vermittelten Gentransfer realisiert werden. Schließlich bietet die Haarzellregeneration eine Möglichkeit zur Behandlung der Presbyakusis in der Zukunft.

Abstract

Factors responsible for presbyacusis include physiological ageing processes as well as endogenous or exogenous causes. In the industrial countries, two main exogenous causes are exposure to loud noise and obesity. Pathomechanisms contributing to presbyacusis are hypoxia/ischemia, reactive species formation and oxidative stress, apoptotic and necrotic death of hair cells and spiral ganglion cells as well as inherited and acquired mutations in the mitochondrial DNA.

Important for the successful treatment of presbyacusis is a timely fitting of hearing aids on both ears to improve communication and provide the auditory system with acoustic information. Using the hearing aids will also elevate the detection threshold of an existing tinnitus signal. At present, several therapeutic strategies based on pharmacological intervention are under discussion. The application of antioxidants or caloric restriction are considered to prevent or reduce oxidative stress-induced damage. Animal experiments evidenced that superoxide dismutase 2 (SOD2) strongly decreases in age; thus, a further approach may be the overexpression or modulation of the SOD2 within the cochlea. Adenoviral-mediated gene transfer technology would be a tempting approach to address this type of therapy. Finally, hair cell regeneration could be a possible treatment of presbyacusis in the future.

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  1. HNO-Klinik und Poliklinik, Tinnituszentrum und Molekularbiologisches Forschungslabor, Charité – Universitätsmedizin Berlin, Campus Charité-Mitte, Charitéplatz 1, 10117, Berlin, Deutschland

    B. Mazurek, H. Haupt, J. Gross & A. Szczepek

  2. HNO-Klinik und Poliklinik, Medizinische Hochschule Hannover, Hannover, Deutschland

    T. Stöver

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  1. B. Mazurek
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Correspondence to B. Mazurek.

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Mazurek, B., Stöver, T., Haupt, H. et al. Die Entstehung und Behandlung der Presbyakusis. HNO 56, 429–435 (2008). https://doi.org/10.1007/s00106-008-1676-3

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